Out of Africa

Weather Minimum temperature: minus 3 degrees Celsius

Rainfail: drizzle and snow flurries

Highlight of the week

Lower Zambezi provides us with orange, muddy elephants, striped rain-soaked horses and a magnificent spotted cat.

Lowlight of the week

Emirates cancel our flight home at the eleventh hour. Then they offend us with an offer of £2 as a refund. I feel a fight coming on.

We are now well and truly Out of Africa.

The post of Valley doctor is traditionally a single post. When Keith was appointed as Valley doctor, five and a half years ago, I also committed to share the role. I mean roles. The job is multifaceted. Keith was funded by the Luangwa Safari Association primarily to provide care to the supporters of the medical fund. The Valley doctor also works to assist the staff based at Kakumbi Rural Health Centre. Aficionados of my blog will know that I am simplifying the roles massively. The Kakumbi clinic and its satellites are the emotional heart of our post. Challenge runs through the work in the clinic. Like the words run through Blackpool rock.

Volunteering in Zambia isn’t a money spinner. A modest stipend at least covered some of our living expenses. I reached deep into my own pockets to fund my flights, medical licence and work permits. We gave the Valley a special BOGOF deal. Two doctors with our fortunate skill mix hit the sweet spot. Catering for the young and the old. The at risk and the critically ill. The self-destructive and the vulnerable. The Valley reaped the benefits and has asked for a second helping. But the reaping is a two-way process. We harvested more than we sowed. Our indelible mark has been left on the rural Health centre in Kakumbi and on our sense of self.

Don’t just do something. Stand there. The white rabbit in Alice in Wonderland was panicking of course. But the maxim holds true. Coughs and fever might occasionally need an antibiotic. Faced with uncertainty, and a patient asking for medication, our colleagues at Kakumbi historically erred and did something. Expected by the patient. Obligingly prescribed by the clinician. A downward spiral. The stock cupboard emptied at an alarming tempo. Antibiotic out of stock. A depressing mantra in the notes of many perilously ill patients. Antibiotics for colds and sneezes cause people to die from more serious diseases. An epitaph.

Masters on doing nothing: we stepped in. Armed with a second hand, a pulse oximeter and half a lifetime in the trade. We stemmed the tide of profligate antibiotic use during our six month stint. On a good week we rarely needed to send patients, or relatives, around the corner to Tryson’s private pharmacy for antibiotics. But this was clearly a temporary fix, dependent upon our continued presence. Our colleagues will need a bit of a nudge to stay on track.

Talking of nudges. Our clinician colleagues at Kakumbi have learnt some of the ropes from us by osmosis. But to have a lasting impact on habits we have again resorted to print. African clinicians love the printed word. Our Zanzibari students learnt good habits through a short experiential course. They then requested that the course be committed to print. We taught and wrote Unaumwa na nini? in Swahili in 1996. Diagnosis and Treatment took four further years to translate and iron out the creases. 2000 saw its first publication. Updating Diagnosis and Treatment to make it resonate with the needs of modern day Zambian primary care is a work in progress. Its evolution is catalysed by each iteration having a virtual life, shared instantly with some of its end users. Smart phones and connectivity happily pervade our set of determined and caring clinician colleagues. The final version will be realised as a second edition, published open-source, on the world wide web.

Many of you have opined that our stint as Valley doctors was going to be a prolonged holiday. Jam packed with safaris. Working 24/7 for 6 months, with our movements under constant surveillance, might not fit with many people’s idea of a holiday. We occasionally went radio silent during a lion hunt. Some even found that degree of inaccessibility uncomfortable. We would ask those Valley residents to compare their access to primary care to what now exists in England. My parents despair that they can’t get to see their GP these days. We visited Valley residents, at home, at the drop of a hat. They are a resilient bunch and did not abuse this accessibility. We were proud of the level of service that we were able to provide on the Safari side. Clinic side was a challenge though. Drugs. Tests. Equipment. Often as rare as hen’s teeth.

So, did we hit the mark as Valley doctors? With an estimated 80 courses of antibiotics avoided, per week, for self-limiting coughs and colds, my antibiotic stewardship permitted lifesaving treatment for serious infections in this challenged land. Perhaps because of his co-authorship of the resurrected Diagnosis and Treatment, or perhaps because of his secret surgical inclinations, Keith was described as a legend by one of our Kakumbi colleagues. But arguably our greatest achievement is to join the Valley doctor hall of fame. We have been signed up to join the regular Valley doctor rotation with a planned annual commitment of 3 months.

Our flight out of Africa seemed ephemeral. Ethiopian Airlines provided us with Bond’s final hurrah. A poor substitute for Mozart’s clarinet concerto. As 007 signed out for a final time we continue to reflect on the end of our second African campaign. Shaken not stirred.

Abandoned by Emirates, we phoned a friend. Sel dropped everything and rescued us from the end of the Earth. Manchester airport to be precise. A breakfast bap, and a coffee to go, meant that we didn’t need to linger in Manchester. We might otherwise have pondered in what way Manchester contrasted with deepest darkest Zambia. The sun shone. If I recall correctly. A Mancunian first. The beginnings of a culture shock?

One of my recurring nightmares has me returning from travels to a cinder pit, masquerading as our home. Regular WhatsApps from our house sitters, Andy and Sue, have repeatedly assuaged this particular fear over the last six months. Mindfulness brings me nicely back to the present day. Sel drives us through strangely familiar villages. Sutton on the Forest and Stillington disappear into his rear-view mirror. Sel’s Volvo turns unerring into our driveway. Our own perfect, custom-built niche. Kwetu is unscathed. Wol, our resident barn owl, greets us with an immediate fly-by.

Expectations of culture shock have been the main theme of the questions asked of us following our return. Our answers gravitated bizarrely to parallels rather than contrasts. Although South Luangwa and North Yorkshire are 7427 miles apart, Keith insists that they are not totally dissimilar. Our neighbour Nick’s dairy herd mimic the ever-hunted South Luangwa buffalos. This week Nick’s restless cattle broke free from their confines. Keith, and my father Peter, offered help to corral them back to their quarters. Another one of my nightmares sees my nearest and dearest crushed by overanxious bovines. Keith chose to be economical with the truth when I asked what he had been doing outside that day.

We miss the baboon alarm clock and the bright, light mornings of Kapani. But our Kwetu rooks provide a similar irresistible wake up call. They fight with their mirror images on our glass front door. We even have a scrabbling creature on our bedroom roof. It’s unlikely to be a monitor lizard but Keith has so far declined to investigate. Winter gales lick our zinc roof at night and I have decided not to push it.

3 days after landing back home, two shy deer leapt across our path in Yearsley Woods. We were immediately transported back to our South Luangwa park. Might they have been impala or puku? Unlikely. The warmth of the Valley was missing. And we didn’t see a single elephant. The benchmark for a good day. Our grading system might need to be redefined. On Wednesday evening we charged our glasses with G&T and summoned our sundowner partners in crime via WhatsApp. We were rewarded by images of elephants in our old garden. At least Wednesdays can still be good days

Back to that nightmare of mine. Keith was barred from riding a bike for almost an eternity. Near eternity ended this week. But near eternity had started with an apparently innocent question from Keith: Will it be possible to buy, or hire, a bike in Kakumbi? I won’t mention my dead body here. Fortunately, I was backed up by our erstwhile boss, Gid, in being a naysayer. Visions of Keith impaled by an elephant’s tusk might not have adequately deterred him. But Keith has respect for Gid’s opinions, if not my own. The elephants have priority in both Kapani camp and Kakumbi village. Four dead cyclists every year in Kakumbi can attest to that particular local byelaw. Bikes and elephants don’t appear to be happy bedfellows. Happily, our biking famine broke this week. We are now both saddle-sore, but smiling. However, both of us are slightly disappointed to not be sharing our Yorkshire roads with elephants.

The Valley cossetted us for six precious months. We escaped from the hum drum of near lockdown. Since our return home we have been playing catch up. This British version of the world works differently from end of the road Africa. Tax bills. Pension forms. Road tax. MOTs. Booster COVID jabs. Flu jabs. All very grown up and serious. Put on ice during our escape. The next phase of our rehabilitation sees us catching up with family and friends. We are currently ensconced in Bruaich, our family getaway by Loch Tay. My mum is cooking with great aplomb but never without an apology. My dad, Peter the energiser bunny, does everything else to make sure that Bruaich is a perfect bolt hole.

I don’t miss the Valley heat much. The wind chill factor yesterday by Loch Tay had us feeling minus seven. It felt more manageable than 48 degrees to the good. Last year Keith’s dogged determination to achieve air-conditioned nirvana saved our sanity in Kapani. Even the pool felt like soup at times. Not gazpacho. Little wonder that I awaited the rains so keenly. But I do miss the Valley craic hugely. Even the curveball questions at Mfuwe Day School girls club.

Our friend Graeme highlights that Kakumbi is at the end of a road. The end of a road attracts personalities that might not fit in elsewhere. Not misfits. But individuals and trailblazers. I’m not sure how well Keith and I fit in to that particular mould. As I sit looking up Loch Tay, it is hard to believe we have spent 6 months living at the end of a very different road. Our lives have been so enriched by the experience. During our road trip to get here, we have reflected on life in the valley. Friends. Support. Work satisfaction. The natural wonders. Life bright and vivid.

We have entrusted our beloved elephants to our friend Ellie, for the time being. They now have a new matriarch. A namesake. Our patients are also in her ever-so-competent hands for this next 4 months. Ellie is supervising all of our other wild creatures too. Our obsession is also her obsession. As we emigrated, we were also bumped off the Kapani sundowners group. Ellie, and her husband Crispin, are now standing in for us to ensure that our quota of wine, or Mosi beer, is consumed. The jaw dropping views of the Luangwa Valley go with the deal. Fortunately, some of our other Valley withdrawal symptoms have been obviated by frequent updates from Ellie, Kapani stable mates and our Kakumbi workmates. Hopefully, architect and handyman Crispin, is now hermetically sealing our erstwhile house against skitters, bats and scorpions.

Whilst we mark time in advance of our third African adventure we need to focus. We have two books to write and a film to script. I’m going to investigate doing the Diploma in Tropical Medicine and Hygiene. Parasites and tropical nasties are a bit of a blind spot for me just now. Whilst I get up to speed with the names of unpronounceable freeloaders Keith has pledged to work on his Nyanja. We are both going to be speaking in tongues before long. We might even find a moment to process 6 months’ worth of photographs and videos.

Sustainable development is at the heart of our hopes for our adopted Valley. Some of you have offered to pitch in with financial help for the Valley. Crowd funding for training materials would fit the bill. We have an able team ready to mould an ideal publication. Our co-author Doctor Ian Cross is a repeat offender. Called again and again to serve as Valley doctor he is a font of all knowledge. VSO and Professor Bertie Squire from the Liverpool School of Tropical Medicine are providing us with moral support to get the new web edition of Diagnosis and Treatment on the road. Our back-room boys Dave, Daniel and Alan will need funding to ensure that our clinicians can access materials via an indexing system. Interactive tools would be the icing on the cake. Please feel free to share your positive vibes with our mission. If you are in a position to support us with this, please let us know.

I am now signing off from this series of blogs. The plan is to re-join the fray in April 2023. I only hope that I can hold your attention for the second opus.

My last words should belong to someone else. In 1937 Isak Dineson predicted my own secret obsession: You know you are truly alive when you’re living among lions.

Striped rain-soaked horses

Magnificent spotted cat

Orange muddy elephant

Out of Africa - the movie

Not a scorpion in sight

Wol greets us

The famine ends

Well and truly Out of Africa