Crossing my legs in Kakumbi

Weather - average temperature 27 degrees

- rainfall none

Highlight of the week

A game drive jam packed with leopards, hyenas and a bonus lion

Lowlight of the week

Our admin assistant fails to show up to an outreach clinic

Some jobs don’t set the world alight. Community paediatrics has never really been my bag. I like the cut and thrust of sick children and being able to fix very ill kids, or at least to make young lives better. I like a good intellectual challenge. Complex endocrinology and challenging eating disorders have been my bread and butter for many years. Our predecessors had warned us that the main reason that we get invited to outreach child health clinics is to provide a glorified taxi service. Hence, we had low expectations. But nonetheless we have been excited to get out into the midst of village life in Kakumbi. The culture of rural Zambia is rich. Poverty is rife, but there are major differences in the way that people lead their lives compared to rural Zanzibar. We have not felt like taxi drivers so far.

We collect our small team at, or near, the health clinic at 9 o’clock in the morning. Then weave past mud, straw and breeze block huts on dirt tracks. The tracks seem to go nowhere, and can wind on for up to a mile, before we see a small gathering under a shady tree. As we park in the shade of the tree, simple equipment arrives. A set of scales is suspended from the tree. Two tables and four chairs arrive. And the small gathering steadily becomes a multitude. An orderly queue forms in front of the scales. The hubbub is so much more than one might expect at a National Childbirth Trust (NCT) meeting in the UK. The noise of chattering women, with occasional males thrown in for good measure, builds to a crescendo and stays at almost fever pitch for practically 3 hours. Laughter is frequently heard. Children run around mischievously. A single child is always dangling from the tree, sat in the scales. Half of the children smile happily, the other half scream inconsolably.

Each child under the age of 5 is weighed once a month. Their weights are plotted on their growth cards. The growth cards are only one part of the child health record. Other areas of the record help us to know which vaccinations have been given, what medication or supplements have been used, and whether the mother had HIV during the pregnancy. Quickly a large pile of record cards gravitates to the tables in front of us. Doctors like medical records. We like to read rune stones or sift through information to find patterns. Some of the clinics have 200 or so children to weigh, jab and process. The honest truth is that we can’t realistically talk to all of the mothers or examine all of the children. Instead, we watch their growth on their charts. We also highlight when vaccinations are due to be given. And if the growth chart is at all worrying, or a child looks not quite right, we pounce. Often a quick check of the lower eyelid for anaemia, or a feel of the child’s tummy to look for a big spleen, suggesting repeated bouts of malaria, will reassure both doctor and mum.

Much of the work is quite routine. But we must be on our toes. At our second outreach clinic, Keith used his sixth sense to good effect. As he held the record of a 22-month-old boy his nose twitched. The growth chart was not quite right. Mwanza’s weight was meandering near to the bottom growth line. He had not really gained weight for over 6 months. Keith called Mum. Mum came forwards carrying Mwanza like a baby on her back. He looked a little floppy, and was not taking any interest in faces, nor in his surroundings. It was clear that this boy’s development was delayed. Mum was happy that we were showing concern, since she had been worried about Mwanza for some time. At the clinic on the following day, I spoke in detail to mum and examined Mwanza. He sadly has cerebral palsy. There is no suggestion of birth injury, or infection during pregnancy. He has a small head and global developmental delay. Fortunately, there is a community service that can offer some support to his mum. I will be exploring what they can offer shortly.

Most of the time doing the clinic is fun. Lots of cheeky children running around, giggling, staring at us and giggling some more. Wearing masks is a bit of a nuisance though. It is hard to make good facial contact with children wearing a mask. I love the very diddy babies and the sets of twins. Most of the kids are in good health. They gain weight well and almost all of the immunisations are up to date. All good.

We are happy to continue offering a taxi service to the outreach child health clinics. As much as anything else, our trips out into the villages are allowing us to understand a little about village life. The downside of working in the community is a lack of certain amenities. For example, I admonished Keith on Tuesday for peeing in what looked like a community shower enclosure. He declined to be sheepish. He had been guided there by the clinic staff. There was no hole in the ground, nor a long drop. Just flat stones surrounded by straw walls. A basic urinal. Needs must, but I still prefer to cross my legs and hold on for a more comfortable seat back at the health centre. Oh, the joys of working in the community.