Fever Pitch

Weather - Average temperature 26 degrees Celsius

- Rainfall zero

Highlight of the week

An overnight stay in one of South Luangwa’s luxury camps

Lowlight of the week

Our four-wheel drive is still off the road, instead of being off-road. The blue pickup limps on.

News travels fast in modern day Africa. We no longer need the cleft stick to relay messages into the deepest darkest recesses of our adopted continent. The news cycle reaches South Luangwa without so much as a by-your-leave. The ether carries instant messages and the planet lives and breathes together. COVID-19 restrictions were very much in force as we left the UK 4 weeks ago. More recently, we read with interest about Freedom Day. Freedom day has now come and gone. Some say that COVID has also come and gone. There are reports of COVID rates steadily falling in the UK. However, the data from the ZOE COVID project belies this. COVID rates in Hambleton and Richmond, our stomping ground, are currently higher than ever, and rates seem to be increasing exponentially. How do we square this particular circle? Is COVID still coming, or is it going? Do the powers that be in England know? I put it to you: that the powers that be, in both England and Zambia, don’t really have a clue!

Whilst COVID-19 ran rampant in the rest of the world, Zambia seemed initially to escape relatively unscathed. In 2020 the Kakumbi rural health clinic appeared no busier and the local mortuaries barely noticed a hit. COVID disease seemed to be sparing South Luangwa. But the pandemic has had an insidious impact world-wide. South Luangwa is no exception. As the world shut down, economies ground to a halt. Business fat cats grew thin and time marched on. A year or so passed. Cats and mice of all sizes, further down the food-chain in the UK, and elsewhere, started to feel the pinch. Belts were tightened. Those with no reserves to fall back on fared poorly. Tourism is so key to South Luangwa. Without tourists, the South Luangwa valley also ground to a halt. The safari industry has been on ice for a whole year. Imagine the refrigeration bill! ....... Please forgive my levity. The poor peoples of the Luangwa valley have felt the impact of this catastrophic plague more than most.

The UK and the Western world had quaked in their boots as this pandemic took hold. COVID-19 hits hardest at the elderly and at those with chronic disease. Boris and Chris Whitty shut the UK down to save our NHS from inundation. They succeeded in my humble opinion. Many hoped that Zambia might be relatively protected from COVID illness, but nobody knew how the Zambian health service might cope. Zambia’s growth pyramid has a massive base. The average age here is 17. Not many people here live into old age. And chronic diseases whittle the adult population down much more than they might in the UK. Economic shutdown in Zambia was an effect of global insecurity rather than a masterplan. Nevertheless COVID-19 is now sending aftershocks into the South Luangwa valley. Whilst businesses are still on their knees, the terrible disease of COVID-19 is now hitting Zambia in earnest.

Last year, the pandemic was a theoretical concept here. The general population of South Luangwa were busy coping with the realities of life in Africa. HIV and malaria are rife and most people are doing well to put 3 meals on the table in any given day. Life is hard. Infectious disease is common. Warnings of an impending pandemic were heeded but then largely forgotten. The guidance to keep socially distant, to wear face masks and to wash hands fell on willing hearts. But the initial absence of COVID disease may have eroded initial enthusiasm. It was not until the 3rd wave was hitting the UK that South Luangwa realised that COVID-19 was a heavy hitter.

The illness started to be seen in the valley late last year. Now the virus is widespread. Social distancing in the Kakumbi villages is reasonable. Mask wearing is universal in Kakumbi clinic. Well, I say wearing. What I really mean is that most people use a mask as a fashion accessory to keep their chin warm. People come into the clinic with a mask around their chin. We ask them to pull it up. They comply. But when they speak, they pull it down again. Over and over again. It takes dedicated staff to reinforce good practices. Most people here now know someone who has either been really ill, or who has died. It’s heart-breaking. Not an unfamiliar tale for many of us now, unfortunately.

Our consultations here are probably safe in terms of cross contamination. We trust being double vaccinated. We wear our masks properly 😉 and wash our hands often. We suspect many of our patients have COVID. They complain of headache, fever, cough and runny nose with sneezing. Some say their food is tasteless, but I have tried nsima, and even without COVID I think it is tasteless. We test most of these patients for malaria, and occasionally malaria is the cause. But the vast majority don’t have malaria. Doubtless there is plenty of COVID doing the rounds. Do you want the good news, or the bad news? The good news is: we have access to lateral flow COVID tests. The bad news is that these lateral flow tests have a high false negative rate - 30% overall (86% on days 2-8, 6% on days 8-18). Last week we only had 1 box of tests and had been instructed to only use them on really sick patients. Arguably, these are the patients who do not need testing. The diagnosis in sick patients is pretty obvious. So forgive us if we are sceptical about the daily figures that we receive from the local health watchdog. The figures tell us that infection rates are going down and that rates of death are falling. Don’t test, don’t find. Hmmm.

Every morning we see a line of people queueing up for COVID vaccination. The Astra Zeneca vaccine has been available since March. Many people are already double vaccinated. The Johnson and Johnson vaccine has just arrived and the Moderna vaccine is rumoured to be close behind. Pfizer’s contributions will be limited to Lusaka due to storage and transportation issues. After early hesitancy, interest in vaccination is picking up rapidly. The valley depends on tourism, and staff who work in tourist facilities have been quick to join the queue. The camps are paragons of good practice in keeping their guests safe.

The daily queue for vaccines

Two weeks ago, we had a 61 year old man come to the clinic. He walked in with his wife complaining of a sore throat. He had lost his senses of taste and smell 2 days earlier and many of his work colleagues had had COVID-19 confirmed with tests. He looked dreadful. He was not especially breathless. His respiratory rate was 18 and his pulse rate was 88. Keith was surprised that his oxygen saturation read 60%. He called me to borrow my oxygen saturation probe. Ditto. His oxygen saturation really was 60%. Listening to his chest, we found fine crepitations in the lower half of both lungs. A sure-fire case of COVID pneumonitis. We have no oxygen in Kakumbi. We gave him some steroids and antibiotics and sent him to the nearest hospital, an hour away, expecting the worst. Sadly, he died later that day. We were later criticised for not doing a COVID test. This might mean that his death will not be labelled as COVID related. No test, no statistic!

The following day we saw a 40 year old man looking very unwell with classic COVID-19 symptoms. We started treatment and did his COVID test. It was negative! We sent him to the same hospital. We gave our opinion that this was a false negative test, a common finding. The receiving team told him that he did not have COVID. Test, no statistic!

We are stuck between a rock and a hard place.

Now, most clouds have a silver lining if you are patient enough. The great big cloud that is COVID-19 is showing us a chink of light today. COVID procedures find us in the game reserve. I write this on a Sunday. It's the middle of a holiday weekend. Four guests need COVID PCR swabs done to allow them to fly home. Needs must, and we are obliged to drive deep into the park and to cross the South Luangwa river to reach their accommodation. A luxury tented lodge. The lodge has offered us a very attractive rate to stay overnight, so we have decided to rough it for once. Compensation for us sacrificing our time on a weekend. For today, we live a life of luxury. Tomorrow we click our heels together and return to our home from home. A home within a stone’s throw of our day job: as recipients of a barrage of coughs and sneezes that might transmit various diseases.

The "commute" across the river

Slumming it for a night