Weather - Maximum temperature 40 degrees Celsius
- Rainfall Zero
Highlight of the week
Lions walk towards Ginny
Lowlight of the week
Lions walk towards Ginny in an open vehicle
Photo of the week caption competition winner: Patricia Houghton. There’s almost an elephant in the room.
Tuesday morning. We rolled the dice. Would today be humdrum or high octane? Humdrum would be whiled away under a village tree, checking children’s growth and highlighting which vaccines are due. High octane might involve lions, or snakes, or crocodiles oh my.
The balance seemed in favour of humdrum. Our baboon alarm rudely awoke us as ever at 5.50. It seems so much fun for them to land full force on our roof. No dislocated hips or broken arms this morning. Just a mad half hour of manic chase. The baboons then settled down to watch us do something similar. High intensity interval training. Part of our own morning routine. As we set off to work the pendulum swung.
The bat phone rang. In coming! Hey doctor, one of our guys has had a nasty injury to his finger. He had been working at a safari camp deep in the park. Could the doctor meet him at the clinic? The details were sketchy at that point. Their phone reception was poor. It sounded as if the finger might need some stitches. Keith would need to peel off after dropping me at Fwalu outreach clinic. And make ready his kit to repair the injured finger.
We had time to plan for contingencies. The drive from the far reaches of the park usually takes an hour and a half. Our plan was for Keith to do the needful with our casualty and then he could return to collect the team from under the tree in Fwalu. What could possibly go wrong? The best laid plans…
Somehow time folded. Driven by his workmate Simba, Fortune arrived at clinic 45 minutes after we received the first call. Things at that point were looking good for a prompt rendezvous to collect me and the team from under the tree at Fwalu. The outreach clinic usually finished at about 11.30. But Keith has a habit of not sticking to a timetable. How and why had one and a half hours turned into 45 minutes? The journey had been made at breakneck speed. Keith was now to see why. Fortune, a robust, honey badger of a man, looked broken.
Keith had readied himself at Kakumbi health centre. Equipment and medical supplies are patchy at best in the clinic. But our vehicle, we shall call her the Bush Baby for now, has a vast array of kit lurking in the boot. Keith grabbed what he thought he might need to deal with a finger in peril. Fortune, inappropriately named, arrived at Kakumbi at 9.45. His finger looked beyond redemption.
Fortune is a night watchman. A job which requires nerves of steel. At night, Fortune has to patrol the safari camp, on the lookout for trouble. That trouble comes mostly on four legs. But sometimes trouble slithers. Fortune has to ensure that guests and staff are not eaten alive, trampled, envenomated, or injured in any other way. His only weapons are a torch and his voice. Fortune has a reputation for being a bit of a honey badger. Honey badgers are like energiser bunnies on steroids. On Tuesday morning this particular honey badger was landscaping in the safari camp. They have no mechanical diggers just burly men with nerves of steel and muscles of iron. A 50kg rock had bounced back and pulverised Fortune’s finger. His left ring finger was barely recognisable. Fortune’s boss had done some great first aid and his sorry excuse for a finger came nicely wrapped in a blood-soaked dressing. The finger was even splinted in a vain attempt to straighten it. As the dressing came off Fortune almost fainted. Keith, not squeamish for the most part, flinched. He would have his work cut out to salvage this finger.
Fortune a thickset Zambian looked pale. Quite an achievement. He lifted a bandana to cover his face as Keith investigated the injury. Priority number one for patient, and doctor, was pain relief. They would need time to figure out whether the finger could be salvaged. Fortune would not be able to make rational decisions with shredded finger nerves. Steel or no steel. Keith offered to numb the finger. Fortune chose a ring block for his ring finger. Good choice. Lignocaine was his new best friend. Instant pain relief. Fortune visibly relaxed and his colour returned. But the finger still looked revolting.
Before numbing the finger, Keith had checked that Fortune could feel his fingertip. Fortune could even bend the finger. The tendons seemed to be pretty functional, although it would be an exaggeration to say that he could straighten the finger. The terminal phalanx was visible through a large, jagged wound. And the end of the finger, with splint removed, wanted to lie at ninety degrees to the rest of the finger. And not in the traditional way.
Keith could not help himself. He is on personal mission to introduce shared decision making to South Luangwa. What were you thinking, or hoping, that I would do for you today, Fortune? Fortune’s English is scanty. Keith’s Nyanja is poor. They relied on Simba to translate. Simba relayed that Fortune would like an x-ray to see if he had broken his finger. Fortune’s wound gave Keith the equivalent of x-ray vision. Keith told Fortune some home truths: Your finger bone is visibly broken Fortune. We don’t have an x-ray machine here. There is one at Kamoto hospital, another hour down the road. But an x-ray picture will not change what we need to do for you today. You and I need to decide whether we should try to fix your finger, or whether to amputate the end of your finger. Keith failed to vocalise that he did not want to send Fortune to Kamoto. Keith knew one solid fact: If Fortune took his finger to Kamoto for any reason, the finger would stay there.
Do you remember the opening sequence from the six-million-dollar man? We can rebuild him! Fortune did not need running repairs. He needed reconstructive surgery. Keith is not a surgeon. However, he is skilled in the art of stitching. But he studiously avoids non-surgical forms of needlecraft. The wound came clean and rinsed with iodine. Simba held Keith’s iPhone light to bring the operating field into focus. The finger’s deconstruction became evident. Bone shattered and visible, nail ripped in two, a jagged wound spiralled around more than half the circumference of his distal phalanx. As a boy, Keith had mastered the Rubik’s cube. Thirty-nine seconds was his record. He talked Fortune and Simba through the possible reconstruction. Keith slowly worked out what went where. Was Fortune interested in trying to salvage the finger with a high chance of later still losing it to infection or poor circulation? The rehab might also be painful and slow. Keith cleaned the wound and started to work out what went where. Mr Rubik would have been delighted with the complexity of the puzzle. Keith slowly pulled the bits of mush together. Twenty-seven stitches later, the finger was almost finger shaped. But the transected nail might still be hiding a multitude of sins. Keith asked Fortune’s permission to remove the nail pieces. His nail would die for sure and create a hiding place for bugs. Keith took a pair of artery clips in hand and gently peeled the nail pieces away, sardine lid style. The nail bed needed some running repairs. The grand stitch total was 29. This particular Rubik’s cube had consumed an hour and a half of operating time.
Keith’s nursing skills are second only to his Nyanja. Rudimentary. He botched together a finger dressing, a splint and some strapping. Finally, Fortune was sent through for a tetanus booster and then onto the pharmacy for antibiotics and painkillers. He would return daily for dressings and review.
Out in Fwalu, I was blissfully unaware of the unfolding drama. Many of you know, I don’t do fingers especially where nails are involved. The clinic was quieter than usual and we were done by 1100. But where was our taxi ride home? I called Keith using a colleague’s phone. What’s keeping you? Keith predictably was in the doghouse again. How long could it take to put a couple of stitches in a finger? My call to him was met by a brief: I’m just finishing up Gin. I should be with you in about 20 minutes. Like the Queen I rarely carry money. So, no drinks for the team as we waited under our tree. Of course, as many of you know, Keith’s 20 minutes is plastic. He did eventually arrive for us. I held my tongue. I am kind of used to waiting for Keith. He filled me in on the finger story. I could not criticise his poor time keeping!
On Wednesday, Fortune was waiting for us as we arrived in the clinic. Time for me to see Keith’s handiwork. We took the dressing down. The finger looked a mess. But it was at least finger shaped. We were worried about the blood supply to the fingertip. It was pale. Stained yellow with iodine from the dressing. But Fortune said he could feel the end when Keith touched it gently. So, we re-dressed and re-straightened his finger and crossed ours.
Thursday was a big worry. The wound smelt horrible. Pseudomonas perfumed the air. Infection was setting in. But Fortune was well. It was just a local infection. We cleaned the wound and shared our concerns with Fortune. Please try to save the finger doc, Fortune insisted. Fortune’s first batch of antibiotics had been a poor choice. Forced on Keith by necessity. But today we realised that we had a stash of clindamycin and metronidazole in the boot of our car. A kindly American tourist had donated some excess medications. These would be just the ticket to tackle the infection and might hopefully bring the finger back from the brink.
The fate of Fortune’s finger was on a knife edge again. He teased us by telling us that he was planning to go back to camp later that day. Who would dress the finger and look out for things going south? Could the camp manager be trusted to do the dressings and splints? Fortune promised to watch out for worsening infection and the suggestion of gangrene. There had to be a better way to deal with our own uncertainties.
Keith found a win-win solution. He WhatsApped the camp manager and asked for a special rate for the valley doctors to stay for the weekend. Bingo. The manager was happy to play ball. The most observant amongst you will already have spotted a flaw in this plan: The valley doctors must always be within an hour of the park gate in case of emergencies. It usually takes a good hour and a half to get to Fortune’s remote camp. Even if Simba’s Paris-Dakar style driving had halved that time would the charity that funds our post tolerate us being so far into the Park? We spun the WhatsApp wheel of Fortune (sic) again. The Med Fund Committee said yes! (Just like the man from Del Monte.) We could stay at one of the most remote camps in the park.
Mate’s rates for camp stays and the finest game in Africa is how the Med Fund sell the post of a volunteer doctor. Although our commitment is 24/7 and our skills are stretched close to breaking point the rewards in our job are immense. We love being in the bush. The camps are luxurious and it was no trouble to play doctor for 20 minutes a day whilst in Fortune’s camp. Fortune’s finger got better day by day. The smell quickly went. The daily dressings became less torturous for Fortune. Our anxiety abated. He is not out of the woods yet. He needs his stitches removing this week. We reckon that 4 weeks of clindamycin might be enough to prevent ongoing bone infection. Soft tissues can heal quickly in a finger, but the broken bone will probably take 3 months to knit into any sort of useable fingertip. Fortune is nominally a watchman, a job potentially doable with one arm tied behind his back. But the reality is that Fortune is a crucial part of a workforce that is continually performing hard labour. Building, reconstructing, renewing. The next challenge is protecting his finger from the perils of forced labour. Forced by the guilt of an employee conscious that he might be letting his work colleagues down. Discuss.
So, you may ask – was it all worth it? Would it not have been easier just to amputate the finger? I mean he has got nine others! The decision to try to save the finger was made with Fortune. He agreed to a salvage plan. He agreed to an investment in time and effort. To take medications and attend reviews. He has a great boss out at camp who has willingly taken over the daily dressings and care. Without any of this, an amputation would have been the only option. Thank goodness Keith has his finger in so many pies.
Nice bit of needlework Keith. However I think you should have used a cotton colour which was less visible!
As for the car, well you know I’m not much of a car bloke but I was thinking it might be one of those new Toyotas which are known for having huge luggage space……I think it’s the Toyota Jumbo?
I love the revealing details woven into the story. For example- the baboon alarm at 5:30, or being cross with a late arriving spouse. The dedication to Fortune's recovery took ingenuity. It is quite the house call you gave Fortune! Now I would say he is aptly named; he ran into the right bush doctors.
Btw if you are in possession of the Batohone should the car not be the Batmobile? x
Glad I wasn’t eating when I read that one! You are a magician Keith 🧙♂️ I can’t corroborate the Rubik’s claim. But who knew how that game might prove so practically useful? Mine perhaps helped with my mini sewing project skills - definitely non- surgical though! Well done Steve Austin - you did it without $6 million!!
What a repair job! And a great ready again Ginny.
i think you should name the car the Mystery Machine, you never know what mysteries are hidden inside to save the next injury. Karen x