Highlight of the week: Our gardeners are back. Keith drew back our curtains on Wednesday morning, but the sunlight failed. Hulking greyness blotted out the orange dawn-glow.
Lowlight of the week: My exam looms. Next Thursday is E-day.
Maximum temperature: 30 degrees Celsius
Rainfall: Nothing at all
The chief of police scratches his head. We have too many deaths. Some on the road. Some in the bush. My men want to help, but they don’t even have a car. The taxis are the first to pick up the pieces. But they struggle. Our de facto paramedics will need training. The unspoken understanding. Keith leans forward and offers to help.
Four taxi drivers and four police officers. The prospect of first aid training in Kakumbi creates a gravitational pull. Even Mambwe’s only traffic officer graces us with his presence. We all covet a traffic officer for Mfuwe. Our chief of police would give his right arm for one. Local crime is cancelled for an hour and a half as the police shut up shop. Four taxi drivers sacrifice fares for 90 minutes. Kakumbi Rural Health Centre’s state of the art education unit is hosting this prestigious training event. There is an air of high expectation. The docs will fix all of our challenges. Keith and I don’t want to burst that bubble too quickly.
Keith puts together a backup plan. Our learners are canvased to figure out how to pitch the class. We plan a practical, hands-on, session. I’ve been running resuscitation training for decades. And whilst I like to have a structure to fall back on, I love to bend like a reed in the wind. To meet trainee’s immediate needs. To adapt and tailor the session. To wing it.
We sit behind the clinic. On wooden benches. Feet parked on parched hard-packed soil. A folded sheet, a piece of bamboo and 2 pieces of cloth our only props. Friendly faces, despite the preponderance of uniforms. The police are so young these days. We reflect internally. The taxi drivers a little older. What do each of you know about saving lives?
Let me back up a little: Keith met with the Kakumbi’s chief of police shortly after our arrival in the Valley in April. Keith was keen to know what people die from in the village. Social chatter, and an active jungle telegraph, would have you believe that Mfuwe is rather like the Wild West. Death and misadventure around every corner. Keith wants cold hard numbers and official statistics. However, our clinic is rather woolly when it comes to causes of death. Most of the drama in Kakumbi heads south to Kamoto hospital and beyond. Feedback from our referral hospitals is rather unreliable. The chief of police has a thick book, filled with detail. He is only too happy to share the grim contents. Young, and unjaded, the chief wants help to tackle the disasters and deaths on the road, and in the bush.
Without a traffic officer the chief feels powerless to prevent death on the road. Eight deaths on our single road last year may be a surprise to many. There is no traffic to speak of. There is no such thing as rush hour. Unless you count sitting behind another car as it waits patiently for a troop of baboons to cross. Bicycles and motorbikes outnumber cars tenfold. Helmets are the exception rather than the rule. Bike lights are unusual. Blend darkness, alcohol, potholes, and stealth vehicles. Carnage is too frequently the result. Carnage minus any emergency vehicles means that life ebbs away. If your mashed up body happens to be found on the dark roadside, you might just be scooped up. Bundled into the nearest vehicle. The taxi drivers are the closest thing to a 999 service that we have. Currently untrained.
The Chief of police strokes his chin. If only our people would use lights, bells or whistles in the bush. The elephants would steer clear. But there is no law about this, and the Chief is merely wistful. Yes. Of course, we are happy for you to train our taxi drivers and police. I’m sure that if at least they know how to react, we will be able to save some of our bush-side casualties too.
Back in the present. We sit to greet our trainees. Four fresh-faced officers. We omit to note their ranks and service numbers. In addition, four wannabe paramedics leave their taxi meters running. We are conscious that we should offset their time with value. Our offering might include the accident and emergency recommendations that we published in Diagnosis and Treatment. If time permits, I could just top that up with a career’s worth of nuggets. Nuggets garnered from years organising resuscitation training courses in the UK. I naively think that I will let Keith run the show. I sit silent for ten seconds.
A moment’s uncertainty as Keith asks our pupils to share their angst. Their worst fears. Their experiences, or stories of trauma, in the bush. A couple of nervous looks at untied shoelaces.
Perhaps there is too much to unpack here? But the silence is comfortably broken with a hippo tale. Not a spinning yarn. There is no fiction here. And we’re not talking about a male hippo’s habit of spinning their tail as they make their mark in the world either. Emmanuel relives his frustration and paints his story. A young fisherman charged and savaged by a hippo is carried home. Left to recover, or die. After three hours the family see the writing on the wall. They call a taxi. Perhaps the clinic can patch him up? But the dye is cast. Emmanuel finds the fisherman gasping his last breath. His historical impotence wracks his face with guilt. Why did the family wait?
Me too. Asserts Gilbert. I was asked to pick up a woman who had been seeing a traditional healer. She died in my taxi. I think she had severe malaria. If only the villagers would call for help sooner. The brakes come off our taxi drivers. Our police force waives their right to remain silent. More tales of woe come wagging.
We only have two-wheel drive, Mike laments. Perhaps we should have 4-wheel drive in the wet season he dreams. Or we could tarmac all the roads. His pipedream afterthought. He is not the first to dream big when attempting to fix Africa’s major issues. I recall, in a previous life, suggesting helicopters as a possible means of tackling poor access to care in the African bush. I was 28, and a little green. I was playing a healthcare game at a Voluntary Services Overseas induction course in Birmingham. My naivety was revealed in the first round of the game. Our helicopter was grounded within a week. Maintenance such an un-African concept that the word does not exist in Chinyanja or Kiswahili. Keith’s team chose to invest in bicycle ambulances. Not ideal for the moribund, but simple enough to patch up when Murphy’s law strikes.
Learner and tutor agendas are, at first glance, poles apart.A thought bubble appears over my head. We aren’t going to address world poverty today. A reality check stops me from buying another helicopter. Perhaps we could just start by finding an unconscious person at the roadside. I suggest conservatively.
A lesson structure materialises. Let’s get our learners to do the doable. And we can leave the big issues for another day. I ask Keith to lie on the sheet, under the tree. The scene is set. You are asked to help with this man who can’t be woken. What will you do? I introduce them to the SAFE mnemonic. We get as far as A for Assess the scene and approach with care. But they object: We don’t even have gloves. What about the HIV risk? Without pausing for breath, we notch up our first marginal gain. Ten smiles in exchange for a promise of gloves. Keith and I always have a pair in our back pockets. Eight more souls can now feel confident to intervene when the blood starts flowing. More importantly we have 8 rapt trainees. Focused and ready to learn.
I demonstrate assessment. And then I put Keith in the recovery position. Everyone takes a turn. At being unconscious. And at being a first responder. The session is bearing fruit. We find a rich seam of marginal gains. A little chat. A demo. Some role-play. Repeat. Their agenda, our agenda. Their uncertainties nudge towards certainties. Procedures, process and practice fill the gap. Things that will at least do no harm. Where and how to press if someone is bleeding. Gloves offer safety and confidence. They play at splinting and slinging. Now they know how to call for help. And they also know how to scoop and run. No staying and playing here.
I doubt that we have changed the world in those 90 minutes. We prioritise some of the doables. And ironically whilst we were turning our police force and taxi force into makeshift paramedics, the road to our Kapani home is patched up with gravel. I almost expect the taxi rank to be upgraded to be four-wheel drives when we pause to pass a box of blue nitrile gloves to 4 smiling faces the following morning. But Mfuwe remains only partly developed. Our own 2 wheel-drive Blue Beast zigs and zags through deep ruts and potholes to our under 5 tree clinic the following day.
The reality of how it feels to be a first responder to an accident, or a traumatic event in the bush, remains vague. We get a hint of that. Brave, resourceful friends, relatives and drivers deliver mangled victims to our clinic. Their faces are strained. It seems imperative to get casualties to our clinic in a timely fashion. But our options to help someone who is badly injured are limited. We patch up and send off. Intravenous fluids are often a challenge unless a resourceful person stops at the pharmacy en- route. Kamoto hospital the next pit stop. More commonly we bring dead drunks back from the brink. When available main-lining dextrose can be a lifesaver. Otherwise, a smidgeon of moist sugar under the tongue is called for.
The next port of call with our new first aid kit is Thornicroft Lodge. They know of our presence in the Valley from our addiction to curry. Their manager, Elina, is keen to refresh rudimentary first aid skills, both in camp and out and about. Elina caught Keith in a good mood when sated. We commit to a pre-lunchtime training slot with a vague plan to avail ourselves of their culinary skills afterwards.
Before the Thornicroft session we brush up. Triangular bandages had proved a weakness for us after our masterful relocation of a dislocated and fractured humeral head several weeks earlier. YouTube puts us right. We try to cover more bases in advance of the Sunday morning spot. We suspect that Thornicroft staff needs differ from taxi drivers. But we request the same props as before. At the last minute we add 2 triangular bandages.
Matching with our last-minute theme, 2 of our prospective learners pull out to do a last-minute airport run. Two guides lose their chance to be guided. We are left with kitchen staff, a waiter, housekeepers and a pool attendant. A straw poll guides the next hour and a half. Allergies. Choking. Burns. Cuts. Broken bones. Some needs predictable with our camp team. Some a little left of centre.
Our venue is a significant upgrade on the rough ground behind our clinic. We are provided with soft comfortable rugs for our casualties to lie on. The ambience chic. The clientele upmarket. Some lodge and dinner guests mill around. Relaxing and chatting.
We rehearse some new worst-case scenarios. We aim to address fears and calm spine-tingling nightmares. A bit of chat. A demo. A role-play. But the demos were a little too vivid. Keith at first called for help. Alarming several guests in the process. And then he choked on an onion bhaji. Near pandemonium. Our learners appropriately failed to throw their hearts and souls into these roles. But at least their rolls and onion bhajis all came out, after a series of back-slaps and Heimlichs.
We save a number of lives this morning. A severe allergic reaction to a peanut, a nasty burn. We splint a broken leg and sling a dislocated shoulder. We even have the chance to do a show and tell session for a larger group of staff to advertise our stroke and heart attack prevention program. But the most important lifesaving treatment is saved for the end of our labours. We are resuscitated with butter chicken, fresh naan breads and cool refreshing water. Amazingly Elina declines to take payment for our food. Let’s call it payment in kind. Certainly, it is kind payment, and more kindness than any volunteer could want.
I must have missed something - what was the significance of the 'triangular badge'? Another sobering episode!
Another great tale- and a reminder that basic life support saves more lives than those that require heroic helicopter dashes. Even in my clinic in Aberdeen we need refresher courses to keep our skills up dated . Sounds like you have your crew ready to roll 🥰