Ice Ice Baby

Highlight of the week: The best game drive ever. We are surrounded by 19 lions including 12 cubs. Elephants face off lions. Elephants win. Diddy leopard cub twins win the cute contest. A precious day.

Lowlight of the week: I gain a year. But my birthday party offsets the advancing clock.

Maximum temperature 30 degrees Celsius

Rainfall None

Ice ice baby. No one would expect that Vanilla Ice and I would be singing from the same song sheet. It’s 1990. The year I qualify as a doctor. Vanilla Ice releases a rap song to beat all raps. Collaborate and listen. His lyrics incite. But his chorus is the key. Ice ice baby is the reason that doctors can collaborate and listen. It is as if he is showing me the way.

Ideas. Concerns. Expectations. The 3 key words that guide all budding doctors. Without them we are blind. Without them we are starting from scratch. Our patient’s thoughts consigned to the dump. Did you have any thoughts yourself as to what might be going on? A question that might just save you from going up the garden path on your own. What was your biggest fear with all of this? Did you have anything that you were particularly hoping that we would do together today? Without a repertoire of queries such as these, your patient will likely get little satisfaction today.

Whilst it’s essential that you ask about patient’s own ideas, don’t expect that they will always cough up without a struggle. It’s 2002. I am a year 7 paediatric trainee. Considered to be senior. Only 1 year away from becoming a consultant. Hopefully, trusted by my bosses and juniors alike. It’s Saturday morning. I am working at the Royal Victoria Infirmary in Newcastle. On the Paediatric Assessment Unit. A 15 year old boy comes to me via the Emergency Department. He was out in town with his mates. He suddenly lost the ability to speak. His mother now accompanies him. I’m quizzing the duo to find out what’s going on. I go through the story. In detail. I assess him thoroughly. There are no clues. Apart from an inability to speak, all else is normal. There are no illnesses in the family. No drug use. I am worried about his brain. An urgent scan seems inevitable. To get a scan my boss needs to be in the loop. I am on with the Prof today. He decides he wants to come in and see the patient himself. An hour later, I meet with the boss. I am quizzed. I know all the answers. No history of head trauma. No drugs. No personal, or family, history of migraine. I take the Prof to see the patient. As we walk though the door Mum changes her tune: You know, I have been thinking. His Dad is exactly like this when he gets his migraines. Prof takes one look at me. He smiles. Does a brief assessment. And leaves me in my ignominy.

My career progresses. I become the boss, I watch history repeat itself. Again and again. Skilful juniors embarrassed by inconsistent biographers. I’m quick to offer empathy. Always ready with my migraine yarn.

It’s now Saturday afternoon in our Valley. We are at a concert on the Kalawani Pans. Nchimunya Siachaba has come to play for us. He’s a flautist with flair and presence. I hesitate to call it stage presence. Kalawani Pans is more used to hosting rampaging wild dogs, or browsing elephants and giraffes than flautists. But Nchimunya fills the Pans with haunting melodies. And we are all present.

A small crowd has gathered. We have drinks and snacks. Chairs to sit on. We mill and chat. Keith seems to be playing social butterfly. The music is yet to start. Ian introduces Nchimunya. We take our seats. The concerts begins. I look around. Where is Keith? I am Ginny no mates. Sat next to an empty chair. I feel a bit aggrieved. Keith is probably sat elsewhere. Unaware of me being all alone. The music is soul stirring. The birds are singing along. I crane my neck looking for Keith. Malcolm leans forward. Whispers in my ear. Are you wondering where Keith is? He is behind that bush over there. On the phone. My annoyance dissipates. I relax. But my curiosity is piqued. At the interval, I track down my nomadic husband.

Keith puts the phone down. A 25 year old patient, Julian, is not well. He has a fever. Terrible joint pains. A rash. A headache. His malaria test is negative, but still Julian takes Co-artem. Standard practice around here, but it results in unnecessary delays. Julian and other Valley folk are used to self diagnosis and self care. But some patients are near death by the time they call in the doctor. Keith briefs me on the story, and tells me that Julian is sending a photo of his rash. Following protocol, Keith had already asked Julian what his own thoughts were on the cause of his symptoms. No ideas were proffered.

As the rash appears on the doc phone, a light bulb appears over my head. Nine months of tropical medical brainwashing crystallise. Ask him if he has been bitten by a tick. I chirp. This triggers Julian to unload. His hidden history is opened up with the magic key. Keith’s clumsy ice breakers had failed. My learned, single question, cuts straight to the chase.

Oh Yes, I used the heat of a cigarette to make it let go. That was 2 weeks ago. I started going down hill on Wednesday. I am on day 3 of doxy now. Just in case it’s tick bite fever. Julian had been leading a morning bush walk and the hitchhiker had hidden itself just below the sock line on his left ankle. Julian starts to feel a bit rough a week later. He opts to treat himself, but wants to lead his doctor on a merry dance. Let’s see what the new doc is made of. The thought bubble above Julian’s head betrays him.

Thankfully we pass Julian’s test. Julian’s symptoms are typical of African Tick Typhus. Caused by Rickettsia africae. Spread by the bite of an Amblyomma tick. Treated with Doxycycline. Keith thanks me for another good save. He sits back to enjoy the second half of Nchimunya’s recital. Absently Keith scratches his left ankle. My real world assessment is marked within a week. Julian thanks us both for our sharp detective work. Our reward, a latte at Tribal textiles cafe.

Safari-side patients seem to be a circle of spinning plates this week. One particular very sick patient tests our metal and our resolve. We keep the patient in the Valley, and provide round the clock medical and nursing care. We even sacrifice sleep. A first for me in 20 years. Thankfully all of our plates stay spinning. The plates are now safely stacked in the cupboard. A busy week in clinic also takes its toll. But we stay on message. Ice ice baby.

Our morning in clinic is coming to an end. Margaret appears. 33 years old. English speaking. Well, whispering. She croaks. She has obvious laryngitis. Doubtless a bad cold. Keith goes through her story. What do you think is going on? What were you hoping that we might do today? Keith checks. I think I may have COVID. I would like a COVID test. Margaret rejoins. Her lab test is swift and positive. Margaret happy, but unhappy. Vindicated by her own idea. She got want she expected. She fishes in her bag and dons a mask. COVID is now so last year in 2023. COVID is still rife. But mercifully it no longer reaps a grim toll. Largely undiagnosed, our lab rarely tests. And our stock of steroids stays intact. And yet, we continue to offer tests. People like to know. But few wear masks these days. No more contact tracing. It’s a test for which the writing is on the wall. We reassure Margaret. Talk through warning signs. Provide a safety net. She leaves with nothing. Happy to leave without a prescription. Not on her agenda. Ice gives her what she wants. Ice gives her what she needs.

As England jolts into the era of better virtual GP access, so does our Valley. More convenient. Better value. Greener. No traffic jams here, but the green credentials of online consults are strong. Of course we still favour a face to face encounter. A commute through the park is hard to beat. But WhatsApp gives us options, particularly when our pundits are out of town. Today’s consultation is with Pamela who is in Chipata. Three hours away on a dodgy road. We opt for audio. We haven’t quite donned our Zoom outfits yet. Pamela is 30 years old. She feels dreadful. A fever. A cough. Her joints are painful. A stinking headache. She’s a very unusual Valley resident. And takes heed of her negative malaria test. Her transphenoidal COVID test negative too.

This is where we step in. We probe a bit more.

What do you think is the issue? We ask.

Malaria and COVID were at the top of my list. Now, I don’t know.

Our virtual assessment from last week is still fresh in our minds. We realise that ICE isn’t going to work again today.

Any unusual bites in the last 2 weeks? Any ticks? We go for the jugular.

She pauses. I got a strange bite on my thigh 10 days ago. It looked a bit black in the middle. It was odd. I thought it must be a spider bite.

Our answer once again is thrown up from the left of field. Another case of tick borne typhus. Pamela is going to be just fine.

African tick typhus is a new one on me. My art for art sake Diploma course now has me on point. Within a week we have diagnosed Typhus twice in ex-pats. But how many cases have we missed in the clinic? Ice won’t suffice anymore. In future we’re going to need to be more explicit. And now that we are on a roll, we will need to look out for a third tick to complete the set of 3. Tick, tick, tick.

Photo of the week

Nchimunya, our flawless flautist

Kalawani Pans

Tick

Another photo of the week