First world problems

Weather: Sunny 13 degrees Celsius

Highlight of the week: Our pair of barn owls wave us goodbye

Lowlight of the week: The taste of Ivermectin horse paste

There is always a downside. There is always a silver-lining. Glass half-empty. Glass half-full. We sit at the cusp. Both of our homes draw us. Yorkshire and South Luangwa. From home to home. The time has come to trade one for the other. Eve proffers temptation. Adam reaches out for the apple. There is no going back.

April has crept up on us. The weather has teased the garden into action. Sun smiles on us as we offer own lawn a haircut. The daffodils of Farndale shout out spring. Mysteriously 128 kg of baggage has packed itself.

It’s been a thought-provoking build up to this trip overseas. Less of a fanfare from friends and family. A perception rather than a reality. Kwetu has been fully booked and our social calendar has, on reflection, been rather hectic.

Three months of labour feels so different from our previous 6 months stint. And yet for me personally, reapproaching the grindstone has felt more stressful this time. Despite knowing what we are going back to. We know the ropes. The house, the food, the drink. The appeal of a simple rural clinic. The drawbacks of no tests, no medicines, no support. But the Valley will hold changes and surprises. Post-pandemic the behemoths and minions of South Luangwa strain at the bit. Change is guaranteed. Daunted or not, our blog will again write itself.

Friends and foes await us in the Valley. Foes at least offer more entertainment to the blog reader. They also offer me more education in the run up to my first exam in 29 years. Friends will make our home from home, home.

Might our lives back in the Valley now be a modicum more challenging than ever? We arrive in a new season. Rains free the crocodiles and mire the roads. Insects burrow, crawl and soar. Bites and stings add to our woes. Snakes, scorpions and malaria threaten us. Pestilence might lurk anywhere. A newfound knowledge of tropical medicine and hygiene has removed my bliss of ignorance. Can we really drink the water? What food really is safe to eat? Parasites and infectious disease again dictate our behaviour. But even with apparent fastidious hygiene, osmosis seems to be in charge. Perils permeate. Keith’s insider knowledge did not allow him to escape the clutches of an, as yet, unknown parasite. What creature might he be hosting?

Barely 2 weeks ago Keith’s gut started to misbehave. An urge was impossible to resist. Late night visits to the bathroom might have suggested that his ulcerative colitis was back. Yorkshire seemed an unlikely epicentre for a cholera outbreak. Time was not on our side. The NHS had ground to a halt. A planned scope to where the sun don’t shine had failed to materialise after 15 months of waiting. Now, all Keith had to do was to click his heels together 3 times. There’s no place like home. When the chips are down the good old NHS delivered. John was on the ski slopes when Keith phoned him. It seemed reasonable to allow John a chance to break a leg before ramming his investigative tool home. John in passing asked for a blood count and some basic stool investigations. Perhaps to temporise.

Collecting stool samples is no mean feat. All of our kitchen jugs are now in quarantine after a comprehensive cleaning protocol. Stool examination for ova, cysts and parasites is an exacting science. The last few months have taught me that. And without a special concentrating technique, negative results will be unreliable. Keith’s hidden guests remain obscure.

The number eight was written in bold. Ridiculously high. Surely a mistake? Neither Keith nor I had ever seen a result so far out of the normal range. Eosinophils are not measured on a logarithmic scale. But this one should have been. There was clearly a rabbit away. This result means that Keith is likely to be a host to an alien being. A parasite. Perhaps a schistosome or another exotic worm. I started to take more of an interest in Keith’s midnight forays. This week in parasitism had suddenly become more personal. I decided to go up to Sunderland with Keith to see if John would be able to show me some photos of Keith’s covert parasite.

Regular readers of this blog will remember that my favourite investigation is time. Time, unfortunately, was not on our side on Monday. So, Keith did his homework to prepare for his exam. Not the sort of exam that happens every 29 years for him, fortunately. His homework consisted of Moviprep. An aggressive bowel prep solution, that at least was no worse than the symptoms that had disturbed his sleep the previous week. On Monday Keith eschewed the offer of diazepam and the gas and air. These drugs could have threatened to obviate his memory of any bowel invader seen on screen. John is the most accomplished scoper in the whole of the Northeast. But still Keith’s alien presence evaded him. Keith’s colitis remains at bay. There was no smoking gun on Monday.

The saga continues. John arranged for more than half an arm-full of blood to be let off. Perhaps a Medieval attempt at cure? Keith at least failed to faint. In Zambia we have a total of four tests available to us. Five if you count time. John’s tests exceeded the magic number of 5 but they at least give you a reason to read the blog again next week. Please lay your bets.

A flair of colitis now seems unlikely to blame. Might Keith have merely picked up a banal North Yorkshire bug? With his history of amoebic dysentery and giardiasis he tried to treat both of those again last week. But that was before the blood count made things even more exciting.

I’m going to dwell on Keith’s interesting blood count for a while. Eosinophils are special white blood cells that medics normally ignore. They are usually pretty unimportant. But Keith has 100 times more eosinophils than normal. John is clearly excited too. An allergy seems pretty unlikely with these numbers. My money is on strongyloides or schistosomiasis. The former seems more likely since Keith has not been swimming with snails. Strongyloides is more important to treat since the strongyloides worm has a life of its own and goes rampant if you use steroids to treat nasty ulcerative colitis.

I feel vindicated that my homework has paid off. Even if my first exam in 29 years draws a blank, I will have saved Keith’s life (again). Keith has now started a course of Ivermectin. Don’t worry though. He is not depriving Donald Trump of the most important COVID drug of our time. He is using foul tasting orange horse paste. This will be washed down with a chaser of Praziquantel in South Luangwa. Empirical treatment is the order of the day in Kakumbi Rural Health Clinic. Most tests, aside from time, are a luxury that the first world has kept to itself for now.

Learning Latin names has not yet been fruitful for me, but I gather that success in the diploma in tropical medicine and hygiene depends on some fluency. I’ll keep you posted about whether Nyanja or Latin proves to play my trump card in the next few months. Trump, in my humble opinion belongs in jail.

Back to more banal issues: Initially our packing seemed easy. Our clothes are functional and robust. Halved compared to 2021. A shorter tour of duty. Less clothes. But somehow nature abhors a vacuum. Hearing that Proflight has permitted us to fly 155 kg into Mfuwe, free of charge, we have filled our bags with equipment and prepared for all conditions, both medical and otherwise. We even have wellington boots.

In other news: I now have a crystal ball. As an annual event my family like to make predictions for the year ahead. New Year’s Day sees us venturing what will happen in the year to come. The only reward is kudos. I won all the kudos last year. Losing the Queen was an easy win, even if it seemed a little mawkish. Losing Boris was more socially acceptable.

This year we will miss the King’s coronation. I predict that Harry does not even turn up. I suspect Rishi Sunak will still be prime minister when we get home. And I’d give my right arm to see Donald Trump in jail. More importantly, I predict that Keith and I will return with more parasites. Snakes and scorpions will however draw a blank. We are not on their menu.

The bottom line is that we expect to accept Eve’s tempting apples both this year and next. The blog will continue to write itself.

Mama Wowowo bids us goodbye

Glaswegin

MIssion impossible. Donated by Dene healthcare

Keith prepares for his exam

Who wears the trousers?

No room for Sue. Andy takes us to Manchester airport