Faith and hope and charity

Updated: Oct 22, 2023

Highlight of the week: Lions! One male, 3 females (including stumpy) and 9 cubs feasting on zebra for breakfast

Lowlight of the week: A traumatic stillbirth in the community

Maximum temperature 30 degrees Celsius

Weekly rainfall: zero

Your husband falls to the ground. Unable to move his arm and leg. He speaks, but only nonsense. His face somehow altered. Numbed with dread, you reach for the phone and within minutes a blue light penetrates the darkness that surrounds you. Hope.

You clutch your chest. The unseen elephant crushes you. Time your enemy. Speed and science your friends.

Imagine a place devoid of blue lights. Neglected by progress. Perhaps devoid of hope?

Let me take you back to 1990. I’m a house officer at Newcastle General Hospital. Gerald, a 68-year-old man, is brought in by ambulance. Not an emergency. But his fate pivotal to the lives of many. Gerald is a father. A grandfather. A husband. I diagnose a stroke. A life-threatening stroke, based on the story and the look of him. We have no scans, back in the dark ages. The left of his brain hit by a clot I surmise. His face drooping on the right. Eyes not open. Barely conscious. Right arm and leg floppy. What shall I do? We watch him for 24 hours. Awaiting his body’s own response. Will he wake? Will he fail? No active treatment is offered. It’s out of my hands. The chaplain calls. Faith fails as Gerald fails.

Fast forward 32 years. The same man. The same scenario. Gerald’s wife has seen the adverts on TV. She knows she needs to act FAST. Gerald’s Face is drooping. His right Arm hangs limp. He is unable to Speak. She knows it’s an emergency. She dials 999. Tells her story. A category 2 amber call is put out. An ambulance arrives within 15 minutes. Gerald gets to hospital 30 minutes after his stroke hit. Within an hour he is in the CT scanner. The scan shows a clot. Clot busting drugs save his life. He makes a full recovery.

We fly seven and a half thousand miles. Not in a time machine, but back to the dark-ages nonetheless. It’s Monday morning in clinic. Ellie’s first day. Ellie is a final year medical elective student from Nottingham. A student in name only. Finals passed. Formal sign-off awaited. We call her Doc Ellie. A title well earned. I proudly show her our clinic. Fresh eyes. Peeling walls. Dark consulting rooms. A grimy treatment room. So normal to me. But to Ellie’s fresh, young eyes, it looks primitive. Daunting. A “what the …” moment. I reassure her. Its quite quiet today. We’ll just work our way through a few minor cases. Nothing to get excited about. But there is a kerfuffle in front of the clinic. A car has pulled up. Four burly men lift a large chap, Sam, out of the car and hurry him into the ward. They deposit him on a bed. The man does not complain. Or moan. Or utter any noise at all. His wife Theresa, follows him in. Fear on her face. She already knows this looks bad. Keith takes control.

How old is Sam? What’s happened? Theresa tells the story. He fell down at 08:30 this morning. He groaned. Then nothing more. Not know to be hypertensive. Nor diabetic. But overweight. At 51, Sam is fit, but not active. A bus driver. Keith asks Ellie to do a neuro exam. Comprehensive. Ellie is fresh from exams. Everything points to a nasty stroke. There are no clues as to a cause.

What happens next? Theresa has certainly acted FAST. Sam is with us within an hour of his apoplectic event. Half of African strokes are bleeds and half are clots. Sam needs a scan. Perhaps we can get one within 3 hours? The new hospital at the airport has a scanner, but it hasn’t been plugged in just yet. Chipata is our only option. Chipata is 2 hours away on a good day, but convention dictates a pit stop at Kamoto hospital to rubber stamp our referral.

An ambulance arrives to scoop Sam up at 11:30. Sans blue lights. Efficient by African standards. He’s at Kamoto by 12:45. But he never leaves. His stroke extends and his brain logs off. Sam is dead by 14:00.

Time and place seem to jerk randomly back and forth. Now we find ourselves deep in the South Luangwa bush. It’s 2021. Prepare yourself. A delayed storyline usually has painful emotional impact.

Opposite Shawa camp the Manzi pack of wild dogs break fast at dawn. A baby waterbuck drawn, quartered and bolted by 21 impatient canines. The dogs show their glee with celebratory chatter and then settle down in the shade, to digest. We watch the show. Rapt. Then we move on, as another vehicle arrives. Craving a unique experience, we head for new pastures. The bush telegraph beats. I suspect that we drifted into mobile phone coverage. Three missed calls flash on the doc phone. Keith calls the number.

The manager of a camp, deep inside the park is composed but distraught. We have an emergency. One of our staff has collapsed. He is 54. He is not breathing. His heart has stopped. We are doing CPR. Can you come? Keith gulps. We are an hour away from the camp.

Life and death have already flickered in front of us this morning. A battle lost and won. Would our guide and our fellow safari addict mind if we mix up pleasure and business? Is it a question of life and death? Our guide asks. Undoubtedly! We reply. Without hesitation, we head to a rendezvous halfway ‘twixt the camp and our nameless spot. The CPR goes on. A makeshift ambulance races towards us. Shadeless. The sun shows no mercy. Our thermometer hits forty.

Our road is crude and pitted. Hazardous to drive at pace. Our guide a pro. We focus. No thoughts of animal tracks and calls. We swap from game drive to game faces. We run through our options and our game plan. The single road bifurcates for both converging vehicles. Two possibilities. Bypass or meet. We gamble on the shortcut. We unite with the crude ambulance.

A handkerchief protects the resuscitator’s scalp. Immaculate technique prolongs the pronouncement. A mattress in the back of an open truck. Three men maintain a chain of potential survival.

We jump out of one frying vehicle into a more fiery one. A rapid ABCDE assessment. The story and the situation are clarified. Martin has been without a cardiac output, or respiratory effort, for over an hour. His pupils are fixed and dilated. Persistence is futile. Perfect resuscitation without prospect of success. We give permission for the heroics to stop.

Faces drop. Our arrival usually allows shoulders to drop with relief. This time the emotion flows not ebbs. Grown men wipe sweat from their eyes. Spent. Our job now to debrief and allow closure.

The story emerges. Martin had diabetes. And hypertension. He had been breathless for 2 weeks. He was getting chest pain on exertion. He thought he had asthma. His sudden death cardiac and preventable. A heart-breaking end to his life.

Two deaths. Eighteen months apart. Men in their prime. The main breadwinners for their families. Husbands. Fathers. Grandfathers. These stories familiar to too many. Our clinic fights fires. But the fires burn strongly in the African bush, and we have nothing to drench these infernos after the fact. We seek to move the battlefield and turn back the clock. Prevent not treat.

Our own African experience from 30 years ago allows us to think big. Back then one in five children did not reach their 5th birthday. We lost several children every week in Kivunge hospital, Zanzibar. They died from malaria, diarrhoea, pneumonia, measles and malnutrition. Now, vaccines, clean water, and infectious disease know-how, save lives across the whole continent. We only lost 2 children in six months in Zambia in 2021. Prevention works.

Know-how works. When the HIV epidemic hit in the 80’s and 90’s there was despair. Young people threw their dice and some lost. Not quite randomly, we now understand. But still they died. Know-how evolved. Prevention and treatments were made affordable to fight HIV. Condoms, circumcision, ART. Not ART for art’s sake. Antiretroviral therapy. Not a cure, but nonetheless a lifesaver.

An epidemic of non-communicable disease is now cutting down adults in their prime in low- and middle-income countries. Africa is no exception. Obesity. Hypertension. Type 2 diabetes. Alcohol. High cholesterol. A raft of imported habits and traits nudge people towards a catastrophic event. We might list the 7 deadly sins. Point a finger at individuals to blame their gluttony and sloth for their downfall. But this would not be woke. Let’s wake up and share the options.

Cardiovascular disease is the biggest neglected tropical disease of our time. We neglect to prioritise. We neglect to educate. We neglect to protect. We’ve turned things around elsewhere. We have plenty of know-how. Lifestyle nudges and medications work. Cardiovascular disease is ripe for prevention in Africa.

Here in South Luangwa few smoke thankfully. But many drink with a little too much enthusiasm. Nsima, practically glucose, is a national passion. Fine for hard labourers. But essentially diabetes on a plate. And then there is salt.

Salt. Where should I start? My grandfather used to sprinkle a little seasoning on his dinner without pausing to taste. Salt is a cultural habit. Zambian’s love to over-salt their food. Blithely unaware of its effect on blood pressure. Forgive them. They know not what they do. Many are yet to learn how else to bring out flavour from otherwise bland repast. Just don’t get me started on salt.

Evidence, know-how, science. Call it what you will. We know what works. We know what doesn’t work. A concept called shared decision-making has been making quite a stir. Like Marmite, some love it, some are not so keen. That’s your job doc. A common riposte.

With a lot of time on his hands of late, Keith has been reinventing the wheel. He has given birth to a new website that will help patients and doctors to make evidence-based personal decisions. The website is called patientcentre.org

Now more than ever, getting quality time with your doc is an issue. Patients and clinicians have always struggled to prioritise and choose. Often creating heat but not light. Keith’s new wheel means that patients are pretty much ready to make a choice by the time they see the doc. Ideal for Sunderland where GPs and nurses are still under the cosh after the pandemic. Ideal for Zambia where clinicians are even more in demand. Personal choices made where access to care is limited.

Keith’s first new toolkit is called Reduce my chance of heart attack and stroke. https://alpha.patientcentre.org/calc/ It does exactly what it says on the tin. Sunderland patients and clinicians love it. Based on UK evidence, Zambian data is lacking so far. So, the new bee in Keith’s bonnet is to set up a program to prevent heart attacks and strokes in South Luangwa. We will start small. Collect data and experience. Our journey starts now.

We have support from key players in our Valley. Project Luangwa and Chipembele Wildlife Education Trust. Lodge owners and managers. The District Medical Office and the Health Professionals Council of Zambia. The people and clinicians of Mfuwe. It’s time to explore what might work in rural Zambia. We have an African population with smart phones, internet and access to our toolkit. Many speak excellent English. They are happy to be guinea pigs as we aim to set up a low resource solution to the problem of rampant cardiovascular disease. They are ready to learn and ready to change.

Project Luangwa and Chipembele are supporting our project with community meetings. We will explore what local people might need to improve lifestyles and their cardiovascular health. Project Luangwa will also be a conduit for donated funds to our “Reduce Stroke” project. Your support might allow a local healthcare worker to learn the ropes. It might help local people to learn about new healthy diet options. Or guarantee medication supplies when times are hard.

Sustainability and self-reliance are at the heart of how Project Luangwa and Chipembele operate. They are charities worth their salt. We hope that your charity can now spice up local foods, rather than putting salt on their wounds.

Donating to “Reduce Stroke”

Dear supporter,

Thank you very much for considering donating to reducing the chance of heart attacks and strokes in South Luangwa. Project Luangwa has agreed to receive donations for this program and this can be done by bank transfer to UK bank (details below). If you are making a donation to this project, please add the notation Reduce Stroke to the payment, in order to help us track it. If you would also like to send an email to ian.macallan@projectluangwa.org then this will also be very helpful.

Thanks again for your kind support.

Metro UK Bank Account Details

Metro Bank PLC Account number: 21201928 Account Name: Project Luangwa Sort code: 23-05-80 Swift code: MYMBGB2L

IBAN: GB88MYMB23058021201928

Bank Address:

Metro Bank Plc,

One Southampton Row,

London

WC1B 5HA

Recipient Address in UK:

Project Luangwa George Fentham Meeting Room Marsh Lane Solihull United Kingdom B92 0AH