Back to the bush

Weather

6 Celsius. Sunny spells and showers with an icy wind

Bambi sprawled hapless. Her spinal cord severed. Her rectum detached. Keith held her briefly before swiftly rotating her head and snapping her neck. Bambi now lay at rest, but her mother jumped toward Keith in a gesture of distress. A macho display by competing baboons had mortally wounded the newest addition to our community outpost. The new-born bushbuck had been barely an hour old. Bambi’s mum bereft. Keith distraught. Fifteen months have now passed. Only now can Keith share his grief. My blog permits us to process our experiences. To move on.

We move on but we are ever aware of the gravitational pull of Zambia. It has been over 12 months since we left our alternate Eden. The South Luangwa valley. I hesitate to admit that our conversations are still revolving around our Zambian experiences. Neighbours, friends and family coax out our barely hidden treasure trove with minimal provocation. If they tire of the polarity in our chat, they hide it well. And the monopoly continues. Perhaps we owe our family and friends a break? Perhaps they want more? Either way: their needs are soon to be addressed. The second diet of Into Africa is impending. On the 5th of April we venture back into the arena. Our hulking grey gardeners await us. The torture of un-English weather. Even the miniscule parasites and arthropods of South Luangwa have gained our admiration. But we are no longer naïve. We steel ourselves for battle ahead of another tour of duty. We bear new weapons and guile.

Does the term combat suitably describe our African experience? Any life form found in the African bush seems to be on borrowed time. Olimba, a leopard whose facial features we can pick out of a rogues’ gallery line-up, is featured in the Times today. She stole the life of a mother baboon and gave the life of the baboon’s baby to her cub. Our friends Leanne and Will watched the cub’s rite of passage through their 8K camera lens. Not exactly dog eat dog.

In anticipation of our re-entry to the combat zone I spiral toward a diploma in tropical medicine and hygiene. There is method in my madness. I have a new-found obsession with pestilence and sorrow. The Latin names of our enemies pervade my sleep. The secrets of disease life cycles are within my grasp. Achilles heels of legless foes become tangible. The malaria season will soon be upon us. COVID may rear its evil head again too. Ever present HIV and TB lurk behind every figure to darken the clinic door. Even our furry, leather-winged, attic dwelling guests harbour rabies in their saliva. My magical book of parasitical remedies offers hope. My mentors give clarity to the quest. Learning distantly means that Kwetu in Yorkshire and Kapani in South Luangwa are my universities rather than Glasgow. The goal gauged either by remote assessment on an uncertain wi-fi link, or measured with a body count. Let’s hope I find the elixir of life soon.

Our mosquito nets offer us some kind of defence against the dark artists. But cunning bats seek out a chink. They land and move, space invader-style, to breech the over-lapping panels of our net. But we have more protection. Andrew Wakefield holds no sway in our house, nor in the Valley. We have the benefit of Pasteur’s scientific endeavours. A full arsenal of vaccinations in our arms. The bats mission is doomed.

The uncertainties of Valley life came back into focus today. Doc Leopold, the incumbent Valley doctor, spoke to us briefly on WhatsApp. Through the staccato snippets of a poor internet connection, we got a sense of how African our Kakumbi clinic still is in 2023: …… short of everything…. things go missing…. no medicines.… no emergency equipment….

The ether held together momentarily. We heard that at least our vegetable delivery system is intact. Ziyalesa and Thomas can boast better stocks and supply chains than Aldi and Tescos can. Despite running the gauntlet of our elephantine neighbours. Two steps back for Rishi. Two steps forward for HH*. Bring everything you can continued Leopold. Don’t expect to achieve anything…. Doc Leopold didn’t need to say. Zambia’s health service still lags way behind our much-maligned, but ever-cherished, NHS. Let’s hope that Stephen Barclay doesn’t try to level things up too quickly.

This episode of the blog is grounded in the UK but still Zambia-centric. I ought to update you with a precis of our toings and froings in the last 12 months. Then I can take you back into Africa for the rematch.

Fourteen months away from Zambia, between tours of duty, was a chasm. Pundits oft allege that retirement can lack focus and direction. Would we struggle to fill the void?

We have both kept our hand in the game. Royal college requirements compel Keith to offer 20 days to British primary care per year, to avoid the thorny assessments that guard the gates to UK general practice. At first a local Yorkshire country practice became Keith’s playground. A new computer system. A far cry from Africa. Latterly, he has been welcomed back into the fold at Herrington. Affirming.

I have opted to fill gaps at the Friarage. My colleagues have been delighted to find an opportunity to seek guidance from an old hand. Not that I am admitting to that particular adjective just yet. But the NHS has few pillars of wisdom these days and I am happy to oblige. On my own terms. Again affirmation.

Money in the bank. Our skills refreshed.

Some will be somewhat surprised that I’m making my way steadily to becoming a diplomat. The diploma course in tropical medicine and hygiene is hosted by Glasgow University. Two to three hours a day. My grey matter is expected to link Latin parasites and obscure diseases. Keith is already a diplomat. He did the DTM&H twenty-five years ago. Annoyingly he seems to remember everything. He has been sneaking into my virtual lectures. Keith loves a buy one get one free deal. Always a Scot at heart, despite always living in England or Africa. He is free of exam pressures and can enjoy the ride. We supplement our lectures with a diet of unsavoury podcasts. Car journeys the perfect venue. This Week in Parasitism (TWIP) and This Podcast Will Kill You (TPWKY) take us on journeys through body, stool and time.

Keith has kept busy. He receives regular screentime reports that a teenager would be proud of. He has been updating our teaching manual for healthcare workers in the developing world. We first published Diagnosis and Treatment 23 years ago. Now www.diagnosisandtreatment.org has a second edition available free online. A fringe benefit of his up-to-date tropical medical knowledge. Our Zambian nursing and medical colleagues are already using the manual for reference and learning, even in advance of its official publication. Ian Cross is our co-author. Ian has the distinction of having served 5 tours of duty in South Luangwa. Ian also has had an illustrious career working for Medicins Sans Frontiere and in British General Practice. We’ll let you decide which war zone he preferred to work in. Ian brings a wealth of experience and prestige to our publication.

My indefatigable husband has also developed an online toolkit for preventing heart attack and strokes. The toolkit will facilitate shared decision-making for the hot topic that has kept English primary care fully occupied for decades. English primary care, under the cosh, but not beyond redemption. Reduce my chance of heart attack and stroke offers patients and clinicians a leg up. It is currently being piloted in Sunderland. Momentum is building for serious investment and development in the UK. Meanwhile, Keith has even put in a research bid to take this toolkit to the Valley. https://alpha.patientcentre.org/calc/ is the portal to this toolkit. The toolkit that promises to enable patients and clinicians to make personalised informed decisions even if their health service is under the cosh. Africa has few doctors but plenty of heart attacks and strokes.

Distractions and obsessions to one side. Biking and a ration of sociability fills our post-retirement lives. Our bikes are hardly Boris bikes. But Boris gave us instructions to go out biking some time ago and we have been obeying him ever since. Mostly in Yorkshire.

We have a pair of barn owls nesting within spitting distance. The joy of a close fly-by is hard to explain to those who have never stayed at Kwetu. We do our best to attract family and friends to Kwetu. Not hard. Kwetu keeps us home with her mystical allure, even if my Facebook postings from France, Scotland, Mexico and Canada belie this delusion of mine.

We return to Zambia in April. We have signed up to be Valley docs for 3 months this time. The same house, the same job. But we travel forward in time. A different season. The emerald season. Cool evenings in their mid-winter. Single figures at night. Pyjamas, or a duvet, de rigueur. The rains will be almost over. Lush green vistas and brown muddy roads. Many of our friends’ houses have been flooded of late. But the mud and crocs should be history in April. Flood insurance? In the Valley? Pa! Just move your belongings to higher ground. Move out for a few weeks. Then clean up and move back in. Another life-cycle. If you can dodge the crocs during the floods, you get another go. Another cycle.

Our first Zambian cycle now seems like a dream. Six months. Never a dull moment. But the elephants ensured that there was no cycling to be done. We have dodged the crocs for two flood seasons during our UK sabbatical. Our second Zambian cycle is impending. We aspire to be less involved in veterinary tales of misfortune. Euthanasia isn’t normally part of our repertoire. Come what may: more blog posts are coming.

* Hakainde Hichilema – President of Zambia

Swimming with whalesharks. Thats us beside it.

Plenty of owl action

Biking in Scotland. Just below Ben Lawers