A survivor

Highlight of the week: Puppies galore. We have a tip off and spend 2 hours at a wild dog den. Watching 6 puppies pester adults for regurgitated meat.

Lowlight of the week: Our official time as Valley doctors ends. We hand over to Dr Dan. I won’t miss the doctor phone though.

Maximum temperature: 28 degrees Celsius

Rainfall: A few drops

Tick.Tick. Tick. Three ticks, three stories. The third story now completes the set. Sensitised and tick aware, both Keith and I are determined to not let tick typhus stay in the long grass. Typhus is oft obscured by reticence or ignorance. Rashes on dark skin can be tricky. But surely a fever and joint pains might point the way? Particularly, when typhus is the talk of camp. So our new bag of tricks does not rely solely on patient’s own ideas, but leans heavily on our own knowledge of local bugs. Have you had any unusual insect bites? What about ticks? We ask. Bingo. The magic words open the secret answer. Oh, yes. Two of my colleagues have typhus, and I did wonder about that tick that I took off last week.

We close another chapter of our Zambian adventures. All that is left to scribe is the cliffhanger.

We take off our Valley doctor scrubs. Celebrate and pass on the baton to Doc Dan. Kalawani Pans sees a mass gathering of assorted characters as we bid farewell and Dan says hello. The doc phone chooses to stay quiet for an evening. Possibly as a mark of respect. We bring our own booze and grub. The elephants also respect the gravity of the occasion and stay away. We reflect. Loose ends dangle. Waiting to be tied up.

Some loose ends surface from our past life. I shed a tear as I write again of Precious, and her mother Harmony. Their tale seemed ill fated and heartbreaking. Let me take you back to October 2021

https://keithandginnybirre.wixsite.com/intoafrica/post/getting-to-the-heart-of-the-matter

I find Precious to have serious heart failure. I scan her heart and send pictures back to my mate Jonathan. We wrestle to understand what is wrong with her heart. My scans are poor. No diagnosis is made. Snow storm pictures hide the structural ills of Precious’ heart. I treat her empirically with heart failure drugs. Diuretics. ACE inhibitors. In truth, second choice medicines a little beyond their sell by date. I watch her fail. She is constantly breathless. She struggles to feed. The writing seems on the wall.

As we leave South Luangwa in January 2022, Precious hangs from a thread. I hand her care over to Doc Ellie. An expert in end of life care. Just the right clinician to support and palliate. Ellie sees her monthly. Offers her extra nutrition. Watches her fade. And then the trail goes cold. We lose touch. Doc Nina does not meet her in August. We assume the worst. But hope the end is peaceful.

Roll on June 2023. Keith and I are in the Lupande clinic. Weights and jabs. The under-5 clinic at Lupande lacks a tree. Instead, concrete walls surround us and reflect a cacophony. Social catch-ups and upset babies. We scan the faces looking for patterns of illness. But the sea of faces overwhelms me. To stop myself from drowning in sensory overload, I focus on the growth charts and vaccine schedules. But Keith lets his gaze wander a little longer. You may remember that Harmony has a distinctive appearance. She has neurofibromatosis. Her face disfigured by facial fibromas. Relatively easy to pick out. Keith nudges me. Look. That’s Harmony. Precious’ mum. Harmony is holding a wee babe.

Maybe Harmony had another baby. I remark. Hopefully, this one is healthy. We look closer. But the babe in arms looks older. She is sucking on an ice pop. Precious has been reincarnated. Precious! Now just over 2 years old. And she looks quite well. Thin and malnourished still. But not breathless. Pink. Alert. Active. I approach mum. Harmony immediately recognises me. The doctor who told her monthly that she was doing a great job. The doctor who gave her medicines to help Precious to breathe. The doctor who admitted that a fix for Precious’ heart was out of reach.

And yet. And yet, here is Precious. Fixed. Normal pulses. Normal heart. No murmur. Normal breathing. Normal liver. I reach for answers and share my wonder with Harmony. Mum knows the reason and the cure. God’s will.

Precious needs nutrition. So I refer her to the valley nutrition programme. The Time and Tide foundation give hope and support to complex social and health woes. Good hands to hold the vulnerable and the disadvantaged. Hands to nurture and to nourish. Charity is offered from a Valley success story. Time and Tide were borne from Norman Carr’s successful safari legacy. Norman Carr who kicked off photographic safaris in Zambia half a century ago. Norman also nurtured talent and graft in Mfuwe. Norman’s legacy lives on in our Valley. A valley that believes in social support and education. Thanks to Norman Carr, Precious is likely now to thrive. Likely to survive. But for now, you and I are left with uncertainty. A cliffhanger.

Our 3 month stint as Valley docs has flown by. Surely we only arrived yesterday? Yet our bags are again packed. We vacate the doc house and move to a better place. A stones throw away. Pam Guhrs-Carr welcomes us and nurtures us. Just like her father did for those in need of support in Mfuwe five decades ago. Under her wing we fly. Her spare car, the Red Peril, propels us. The Red Peril keeps us in business. Our stroke prevention crusade changes gear. The automatic gearbox ratchets rapidly up the way. Before long one hundred and forty two people jump on our bandwagon.

Pam’s house is a haven. Over looking the dambo (grassy floodplain). Pams’ chitenge (a thatched gazebo) is a prime safari location. Our vital force is further restored by the absence of the doc phone. Our Chi is topped up. Or perhaps our Ying is now in flow to counter the Yang of our work, that has been so consuming for so long. 24/7 for the last 3 months.

Keith and Ginny stop being Doc Keith and Doc Ginny briefly during a trip to Chamilandu bush camp. A remote paradise. A perfect opportunity to escape work entirely. But Keith insists on recruiting another 12 staff at Chamilandu into our programme. The ants in his pants keep him moving. Chamilandu offers us new friends, lions, leopards and pizza in the bush. But Keith has now found his nirvana. An office overlooking an elephant wallow. He appears to have found the antidote to the GP recruitment crisis. There is no malcontent here.

We hit the ground running as we return to the Mfuwe area. Stroke prevention is spreading like wildfire. Why aren’t you coming to see us doc? A familiar grumble from safari staff. We appear to have created a monster. Demand. Expectation. There seems no way to meet demand as the grains of sand fall through. Time won’t wait. For no man. Our departure inevitable.

Our model of care blazes a trail. We explore ways to facilitate stroke prevention for the population in Mfuwe. Starting with the thick end of the wedge. Safari camp staff are prime cannon fodder. Prone to stroke, through a perfect storm of inactivity and rich food. This group are smitten by an astounding prevalence of high blood pressure and diabetes. Big bellies, historically prized as a mark of prosperity, now mark their owners out for potential reaping. We offer personalised support, framed around Keith’s online toolkit. alpha.patientcentre/calc/ allows patient and clinician to work together to choose their priorities. We lay out the possibilities and nudge a little. Big bellies are going out of fashion. Waistlines are fading fast.

Fwilane from Project Luangwa is a driving force for social change. We worked with Fwilane during our last stint as Valley docs. Helping girls clubs and boys clubs wrestle with their teenage angst. Now she mobilises the Project Luangwa staff to tackle lifestyle issues. We are flattered to be involved. They resolve to create a blog, or a podcast, or a vlog. Perhaps all 3. Owned by the people of Mfuwe. We hope to be regular guests. The girls and boys clubs morph to become a peoples club. A forum to promote good lifestyle practice and health awareness. Owned by the people. For the people.

Partnerships are easily forged in South Luangwa. Often with a gin and tonic in hand. Anna Tolan doesn’t need much persuasion to join our crusade. Anna and Steve Tolan are the founders of Chipembele. They inspire our community to value their environment and themselves. Anna and Steve also rehabilitate orphaned wildlife. Great care is needed to protect your lemon from Zuwa, the baboon or from Kupila, the vervet monkey. The educators at Chipembele have a long reach. They talk with 400 inhabitants of Mfuwe each week. Trusted for inspiring local children to value their environment and supporting them through education. Their long arms share messages of hope with the community. Those long arms are working with us to propagate healthy lifestyles and know-how related to stroke prevention. Cookery demonstrations are in the offing. It will be good to check that the know-how is palatable.

We reflect as the grains of sand fall through. We plan for our next turn of the hour glass.

You are the very best doctor in the Valley Doctor Keith. Proclaims Sara. Ignoring the only other doctor in the Valley, as I take notes for Keith. You may remember Sara from 2 years ago. She made quite an impression when she marched into our clinic in Kakumbi. We catch up with Sara’s antics now. But first you may choose to refresh your memory: https://keithandginnybirre.wixsite.com/intoafrica/post/mad-bad-or-sad

Sara has bipolar disorder. Keith forms a good working relationship with her during our last stint. She materialises to us in florid mania. Over a period of days, Keith manages to win her trust. And uses drugs to slowly bring her back to reality. By the time we leave, Sara is functioning normally. Mood stabilised. A low dose of medication was all that is needed. Although Keith does consider upping the dose when Sara suggests that he take another wife.

Sara reappears at clinic in early June 2023. She is brought in by her mother. Mad as a box of frogs. As high as a kite. Even so she immediately recognises Keith and myself. She talks nineteen to the dozen. Tell this nasty women to go away. She says, indicating her mother. Her mother has the patience of a saint and urges Keith to give medication to mum for safe keeping.

The negotiations start. We try to understand why Sara’s medication had been stopped. There is talk of an admission to Kamoto hospital. Her medication changed. Sara is busy telling us she is engaged to be married. To an mzungu. A white man with lots of money. A figment. She has lost perspective between reality and fantasy. Keith patiently listens. He interjects with suggestions about medications. Sara shares happily with the plan. We give the medicines to Sara’s mum.

Clear instructions. A plan. Reviews. Sara settles week by week. Her mania regresses. Sara’s mum now safe from tongue lashes. Sara comes to clinic alone. Full of insight. Not liking the highs and obviously wanting to avoid the lows, Sara and Keith work together with a plan to keep her mood stable and to return to see Doc Dan when mum starts to get dog’s abuse again. We promise to check in with Sara next July.

I promised to leave you with a cliffhanger. A reason to come back to our blog next year. We lack closure on one of our most dramatic storylines: https://keithandginnybirre.wixsite.com/intoafrica/post/the-most-fearsome-creature-in-the-valley

In summary: Joseph falls prey to a crocodile. Collateral damage as a croc tries to steal Joseph’s catch. Joseph’s arm is broken. Open wounds that can not be closed. We fight a rearguard action to salvage the arm and to stem infection. Joseph when we last see him in May is in limbo. Or should that read that his limb is in state of suspense? Supported by a back slab and a sling. Smiling because we have had him on donated antibiotics for a month. But we have not seen Joseph since May. We too, remain in suspense. Uncertain whether bone infection has taken his limb, or even his life.

Rather like Schrödinger's cat who might be in the box. Or not. Joseph’s story has played out. Written but not read. We wait on tenterhooks to read the story, but we can no longer influence the outcome. Joseph exists or does not exist. Joseph has two arms or one. Either way Joseph is likely to avoid fishing nets for quite some time to come.

Photo of the week

Precious

Keith solves the GP recruitment crisis

Making a bush pizza

A proper pizza oven. In the middle of nowhere

Working with the team at Project Luangwa

Pam's chitenge