An outstanding day

Highlight of the week: A morning drive delivers baby cats

Lowlight of the week: Rob drops in to clinic to discuss the cricket score. He’s an Aussie.

Maximum temperature 32 degrees

Rainfall: How many ways can we say nothing?

I would like to describe a typical day in the life of a Valley doctor. But, I’m still waiting for one. I suspect, like buses, that they will come in a cluster. As soon as I stop waiting. Fellow clinicians may snort, or guffaw, if you ask them to describe a typical day at work. Medicine has a tendency to throw up googlies. Days in South Luangwa start. And days finish. The sun rises. And the sun sets. At predictable times. But what comes in between, is far from predictable. Game-drive Wednesday came from the left of field this week.

I may have mentioned previously that Wednesday is game-drive day. The alarm is set for 0500. We don’t quite jump out of bed. But we don’t hang around either. Our aim is to get to the park gate at opening time. 0600. By hook or by crook, this plan bears fruit. Keith asks the ZAWA park guards if there are any clues. We heard lions roaring from Luangwa Wafwa. A guard rejoins. Hobson’s choice dictates our next move. Wouldn’t it be great to see the new lion cubs? Keith’s mind is made up. My opinion in the passenger seat is academic.

The morning is crisp. Our windows are closed against the cold and the tsetses. Keith’s attention-seeking, Raynaud’s syndrome, fingers force us to wear fleeces too. We will struggle to hear the bush telegraph this morning we fear. We pause momentarily with the window open to listen. Daudi, our friend from Luangwa River Camp happens by. Travelling in the opposite direction. He is following lion tracks. They have gone this way. He points away from Wafwa. Our focus shifts.

Norman Carr Drive seems a reasonable bet. Named after our mate Adrian’s dad. Inaccessible on last inspection. The route looks freshly graded. Keith at the wheel smiles and turns right. My silence, consent. Norman Carr Drive is a favourite of mine. Despite the tsetses.

The Blue Beast tempers my excitement. A frisson of fear. Two wheels might leave us stranded, far from help. We weave through dense vegetation. Ideal leopard habitat. The trail stays fair. The bends and lagoons familiar. But dense bush keeps feline secrets. No doubt leopards and lions see us. Occasional safari vehicles share tips. But our quarry stays obscure. Plenty of prey, but we pray for predators.

A lagoon-side coffee break allows us to mark our territory. Empty bladders. Clear minds. We plan our day. We are due at clinic at 0830. It is time to make tracks. There are no crows to fly straight to the clinic. Instead, we wend our way via Mushroom loop, towards the park gate. We wend. Ahead lies a dip. But the dip goes too deep. Water soaks the dip’s recesses. Deep ruts. After the swampy ruts is a steep daunting ascent. The Blue Beast declines the obstacle. We opt to be late to clinic, but we need to get to clinic. The whole of Norman Carr Drive must be retraced. At pace.

Keith puts his foot down. As much as is possible on sandy bumpy roads. We backtrack. Pass more friends. Driving the opposite way. More rumours of lions. But still nothing concrete. No one has seen them. I consider putting my camera away. And then, suddenly, the temper of the bush changes. Plains animals are looking nervous. Alarm calls. Puku pronking. Lions are prowling. Antelope breakfast is interrupted. Antelope for breakfast anyone? A lioness, and 3 cubs, are walking serenely. Straight towards us. Two diddy babies. One larger cousin. The quartet are all ours. Our vehicle in splendid isolation. Work is relegated. Cats our only priority. They take short cuts, but stay close to the crude road. We follow. Then lead. They keep up a steady pace. But we manage to pass them a couple of times. Before they head off into the bush. Away from the road. We are elated. Its only 0820 but it’s already an outstanding day.

Keith takes us out of the park. We speed to work. Only 20 minutes late. Timely for Africa. They say time waits for no man. But somehow time waits for Keith. And twenty-four health workers wait too. This week is Child Health week. It’s also polio vaccination mop-up week. We have a huge team of staff, ready to foray into the community. They need a drop off. Vitamin A drops. Anti-worming tablets. Every child, under the age of 5, will get the double whammy. And polio vaccine is delivered door to door. Keith loads the staff into the Blue Beast. The Beast whinnies as a 13th body attempts to squeeze in. He manages to load twelve souls in the first wave.

Meanwhile, the clinic boss, Kaseba, catches me. We have 2 very sick patients. Would you please see them Dr Ginny? The first, Michael, is 44 years old. He was fit and well, until 3 weeks ago. But a heavy smoker. A respiratory problem. I am told. He went to Kamoto hospital. For a chest X-ray. There was something on it. The family tell me. He did not receive any treatment. No antibiotics. No medication for TB. I suspect lung cancer. But everything is hazy, hearsay. Rather like his X-ray, I suspect. Today, he has become confused. And ill. There has been blood in his stool for 2 weeks. The story otherwise shrouded. Hidden behind language barriers and cultural barriers. I take a look. Michael looks poorly. He is breathless. But his heart rate is normal. His oxygen saturation is 60%. In 4 litres of oxygen. Better than 35%. Oxygen clearly helping. His chest sounds clear. His abdomen feels guarded. He is very pale. I suspect a big bleed into his gut. He needs more tests. A blood transfusion. More oxygen. Our oxygen concentrator is doing the best it can. I suggest antibiotics and fluids for now. Antibiotics we have. But no fluids. He needs to be in hospital. The ambulance has already been called. I speak to Dr George. Dr George is the District Medical Officer. Our boss. The ambulance is hamstrung. There is no portable oxygen. George relates. We discuss our options. Left in Kakumbi, Michael will die. No doubt. But a journey of 60 minutes, without oxygen, may also kill him. One rock. One hard place. We agree the transfer will give him a chance. I share the issue with his family. They agree on the transfer, from one rock, via a hard place.

Kaseba takes me to the next patient. A 16-year-old girl. Jenny. I have met Jenny before. She has severe epilepsy. And significant learning and physical disabilities. She has been unwell for a week. Not eating much. No fever. No cough. She deteriorated sharply overnight. I take a look. She is barely responsive. Her core temperature is 32 degrees. Her pulse rate 35. She is short of breath. Her oxygen levels are 88%. I can’t hear any air entry to her left lung. Perhaps severe pneumonia? Perhaps she aspirated a foreign body, or vomit? The lung might be full of pus or fluid. Whatever is going on, she is close to dying. We look at our options. We only have the one oxygen concentrator. Who should get it? A question with no right answer. There is no point in rigging up a system to share the oxygen. Michael is barely getting enough. We give intravenous antibiotics to Jenny. We put blankets on her. Warm her up. I share my concerns with Jenny’s mother. I promise we will do everything possible. But I warn mum that it may not be enough. Jenny also needs to go to Kamoto. She will share the ambulance with Michael.

Less haste more speed. Two beasts full of burden carry 24 staff safely into the community. We wonder vaguely about how many elephants that we could squeeze into the Blue Beast. As I deal with the dying, Keith completes his taxi run. Emotions are parked, for later processing. Keith collects me and we hasten away to our next appointment. Again, timely for Africa. We arrive only 10 minutes late. Our tourist has travellers’ diarrhoea. His family have been struck down. But they have rallied enough to head out of our bush and head towards another. Their flight out of Mfuwe leaves in 2 hours. But we are not talking about African time here. We need to get with the programme. They are hot footing it to the Lower Zambezi. A dose of ciprofloxacin may be needed, in advance of their next date with elephants.

We re-enter the fray. And return to the organised chaos of our Kakumbi clinic. Our 1030 patient arrives. A guide from one of the lodges. Daniel has a great catchphrase. The more you eat, the more you see. He tells his guests in the park. Daniel sustained a nasty burn 2 days ago. A hot water tank exploded on him. We had seen him within 30 minutes of the explosion. He had superficial burns to his left arm. And groin. Very painful. Daniel is a hard man. He braced himself as we cleaned and covered his wounds at ground zero. His pain killers hadn’t quite kicked in by then. When we arranged follow up, Keith had suggested that he take 2 tramadol an hour before the dressing change. I teased him about the tramadol: The more pills you take, the more you sing.

Many of you will already know that I have 3 failings in medicine. I can’t deal with eyes, nails or burns. I probably gravitated into paediatrics so that I might avoid all 3 of these Achilles heels. Somehow, with a GP by my side, I coped with managing Daniel’s first aid. Second sight of Daniel’s wounds today is easier than expected. Perhaps I only have 2 dodgy heels left. Daniel sings softly as we swap his dressings.

Its 1100. Our next patient. A valley resident with a wrist injury. Was it broken? Or badly sprained? Keith lays on hands. A nasty sprain in all probability. Even if the distal radius is broken, no heroics are needed. An X-ray in Kamoto not appealing. We provide pain killers. A bandage. No down dog for 3 weeks.

We slope off from the clinic at 1215. It’s been a busy morning. We head home for lunch, in advance of our next appointment. A protracted consultation with a Valley resident, over coffee. We collect our community outreach teams at 1530. We finally get home at 1600. I sigh with relief. I need time to process.

I sit down and consider writing the blog. I know the storyline today. It’s been an emotional day. DOGS! In the garden. Shouts Keith. I’m snapped out of my reverie. We leap up and run outside. Four wild dogs are in our garden. We stand right next to them. Unprotected. But we are not on their menu. So close that we can almost stroke them. We are tempted to follow them on foot. But sense prevails. They are master hunters. We jump in the car. Kapani is erupting. Baboons alarming. Domestic dogs barking. But the wild ones have vanished. Here one minute. Gone the next.

And so, we come to the end of another day in the valley. Not a typical day. An outstanding day, on 2 fronts. Lion cubs. And wild dogs. Not to mention our close encounters with elephants in the park. And did I mention the giraffe we found on the way home? But the thrill of our brushes with wildlife are tempered by the cruel experiences of some of our patients.

We have 5 weeks left in this amazing, fulfilling but challenging place. A place we get to call home. My blog will eventually allow me to share with you more of my processed emotions. But for now, I am living in the present. When we do leave the Valley, we will be counting the days until we can return.

For now, we will savour the sights. The smells. The essence of this place.

Photo of the week

Diddy baby lions

Rob rubs it in

The beast of burden

Painting the little finger nail after a polio drop

Daniel sings for his dressing change

DOGS!