Highlight of the week: Mating lions walk past my open car window.
Lowlight of the week: Ellie goes home.
Maximum temperature: 35 degrees Celsius
Rainfall: Not a drop
I used to play paper, scissors, stone as a child. There was, surprisingly, an equal chance of winning, or losing, whatever weapon you chose. In our valley in South Luangwa, you might accidentally find yourself matched up against wildlife as a human. Your odds are particularly poor if your opponent turns out to be an elephant, hippo, or crocodile. Game over. No best of three.
We are not the first intrepid explorers to venture forth into deepest darkest Africa. Perhaps Dr David Livingstone was one of the first. He found more than his share of conflict with wildlife here. It is 1844 and an early foray for Livingstone. He comes a cropper, getting mixed up with Botswanan herdsmen, trying to protect their cattle from lion. Livingstone pitches in. The lion seems initially to have the upper hand, it crushes and breaks Livingstone’s arm. The lion eventually succumbs, to a combination of bullet and spear. Livingstone’s arm is broken and crushed, but fate is on his side. His wife to be, Mary Moffat, tends to his wounds. The result is two long lasting unions. Bone and marriage.
We don’t take our trips out here lightly. A new will precedes each trip. This is no accident. Medical care is rather thin on the ground. Hazards aplenty. Dr Livingston died just up country in 1873. He lost a battle against malaria and dysentery. Disease his final misfortune, rather than wildlife. But the distinction is moot. The little critters got him in the end. His heart is buried 116 miles away from us. But his body parted company and headed back to Westminster Abbey. Our wills are deliberately vague about the final destination of our bodily parts. We suspect Dr Livingstone had been vague about this too.
Dangers and accidents lurk around many corners. Be you fisherman, nightwatchman or dipsomaniac. Please place your bets on the most perilous role. Night-time seems to beckon the unwitting victims to their unhappy fates. Death or disability. Mfuwe can be a perilous place to be. Particularly after dark.
We have a particular interest in providing a nascent occupational health service in our valley. Keith’s sister, Lisa, would be proud of us. Our preventative program for lodge staff and safari operators kicks off next week. We aim to nip cardiovascular disease in the bud. But we also provide care to the most daring of professionals in South Luangwa. Fishermen and nightwatchmen suffer more misfortunes than most. We provide a patch-up service for victims of conflict with wildlife, in many guises. The last 3 weeks have been quite colourful.
Kakumbi clinic is never predictable. We can arrive to a large crowd, and then have the quietest morning ever. Or, it can look very peaceful and then become chaotic.
Monday morning starts sedately and then jumps track. Ten to fifteen people mill in the waiting area. I predict a quiet day. Schoolgirl error. A single patient needs review on the ward. Nothing too taxing. I notice Keith peeling away as Emanuel beckons him. Emanuel calm. Perhaps someone wants a prescription for haloperidol I ponder. Keith’s side-line.
Ellie seems also to dematerialise. My curiosity gets the better of me. I make my apologies on the ward round and head off to the treatment room. As I enter the room my hum-drum day jumps track.
Joseph is a 25-year-old fisherman. A brave man. But he is not looking so brave today. His eyes are widely open. Pupils dilated. Holding his right arm. A swatch of torn cloth wrapped around the hand and forearm. What happened? We enquire. I was bitten by a crocodile. Now our eyes widen, and our pupils dilate. Dare we take the cloth off? What will we find underneath? Ellie has a tourniquet. We put this around his upper arm. Any amount of mischief could be going on. Bones. Blood vessels. Nerves. Who knows what is beneath the cloth? Crocs have a knack of performing very swift amputations. Can we salvage Joseph’s arm we ponder.
Joseph is in a great deal of pain. A quick peak at Joseph’s mangled arm focuses our thoughts. Paracetamol will not cut this particular mustard. Keith fishes in his pocket for a couple of tramadol. That might help a little, we decide. We take a better look at the wounds. We are delighted that the hand is still firmly attached. No gushing blood. There is visible bone and deformity at the wrist. But the fingers are a good colour. A quick check proves that the major nerves and tendons are intact. Emanuel encourages us to look at Joseph’s arm from another angle. Joseph has been showing us his better side. The underside of the arm is a more sorry state. As we cautiously lift the arm, bone and flesh protrude rudely.
We imagine the scene. Joseph against a huge prehistoric reptile. We probe for a story. Justified by medical necessity. Our imagination matches reality. Whilst pulling in his net on the bank of the Luangwa near Chinzombo viewpoint, Joseph’s right arm had been snapped up by an immense croc. No need for fishermens’ tales here. Four colleagues beat off the croc and somehow manage to prise the jaws apart. Chinzombo viewpoint a favourite sundowner spot, almost saw the sun go down on poor Joseph. His friends save his life. Our job, should we accept it, is to save Joseph’s arm.
A compound fracture of the right arm. A deformed wrist. Flesh hanging off Joseph’s forearm. We survey for other injuries. Thankfully Joseph’s arm is the only casualty. We decide to augment the tramadol with lignocaine. Keith sets-to, injecting around the fractures and the torn flesh, to allow us to wash Joseph’s mutilated arm. Ellie puts on an apron and gloves. Emanuel and Ellie wash the wounds. Irrigation with water, or saline, a challenge in our poorly plumbed, poorly stocked, clinic. Happily, we have povidone iodine. The iodine might just help against poor croc dental hygiene. We hope. We hope, but we don’t trust. Co-amoxiclav and metronidazole offer Joseph more hope.
Somehow, within 30 minutes Joseph has a new dressing and a sling. He smiles weakly. Joseph needs skilled orthopaedic care. A deep clean. Removal of damaged tissue. Resetting of bones. We bid him adieu and pack him off with a referral letter to the orthopaedic team in Chipata together with donated antibiotics. He promises to return after the surgeons have done their thing. Infection, or surgical mishap, could permanently maim poor Joseph and end his fishing career forever.
Fast forward 3 weeks. Today is a good day. It’s Thursday. No elephants today. But Joseph sits on a concrete bench, smiling broadly, as we arrive at clinic. A back slab and a sling cradle his errant arm. We match Joseph’s smile. Subconsciously re-counting his limbs. To the untrained eye Joseph appears well. Denying fever and systemic upset. None-the-less Joseph teeters on the brink. His pulse races. His swollen arm hides multitudes. Pathogens gnaw at the edges of Joseph’s repositioned bones. Sensible surgeons have eschewed Meccano style reconstruction, knowing that a crocodile bite, and a Luangwa River lavage, will not play fair with a prosthetic. A back-slab is surprisingly one half of state-of-the-art care. But the Chipata hospital has been unable to supply Joseph with the other half. Nor the antibiotics that my Middlesbrough patients take for granted. Keith’s reaches into his war chest once more. Joseph’s impending osteomyelitis will not gain the ascendancy on our watch.
As a junior house officer in Newcastle General Hospital, spookily I tended to find matching presentations arrived in threes. Three heart attacks one week. Three pneumonias the next. Three asthmatics after that. Having dealt with Joseph on day one, I steeled myself for 2 more croc bites. Instead of 3 of a kind, we get a running flush.
We are nearing the end of a long morning. Winding down. Kakumbi’s duo of consulting rooms represent Ying and Yang. A light room with a large window. And a dark room with one very dull, energy-saving, light bulb. The rooms are separated by the thinnest of walls. Anything said in one room is clearly heard in the other. Especially with Keith’s booming voice. He calls in the next patient. Thomas. I am half listening to the nurse in my room. But nebbing in on Keith’s conversation. I don’t hear the full story. But the word hippo crops up a couple of times. I later get the full story from Keith. Thomas is a watchman. He works at Dorphil’s restaurant, just up the road. He was on duty last night. The moon lit night is suddenly darkened at Dorphil’s by an oversized belly on legs. An immense hippo intrudes and aims to munch through Dorphil’s herbaceous borders. Now Thomas is not a jobsworth sort of chap. But he is affronted by the temerity of the new gardener. Thomas decides to see the hungry hippo off the premises. Brave or foolhardy? Most likely the later. Somehow Thomas gets caught between the hippo and the exit. The hippo realising that his free buffet is over quickly makes for the exit. Barrelling into Thomas on the way. Thomas goes flying. He comes down with a hard bump. Hippos are oft quoted as being the top killer of man in Africa. Thomas gets off lightly. He sustains a badly bruised knee. But nothing permanent. A lucky escape.
As the working day draws to a close, I start to think that my set of 3 will not materialise. But a snake completes my atypical running flush. Loyd, our clinical officer, asks me to see a young girl who has been bitten by a snake. Tanzi is in a lot of pain. A single puncture mark suggests a stiletto snake. The description vague but consistent. Our friend Choti, on speed dial, attends the scene of the crime. Choti quizzes Tanzi and confirms our suspicions. She backs up our clinical decisions to dole out some tramadol. Rest, elevate and hydrate. Oral rehydration salts are our low-tech approach. We check her clotting time, rather than the bleeding time. And keep her overnight. Fortunately, there is no lasting tissue damage and no paralysis. Tanzi’s fears are allayed by Choti’s experienced demeanour and Keith’s calming tramadol. Another Ying and Yang.
Snakes love this time of year. Or perhaps they hate this time of year? The water and wet ground draw them out of their lairs. They migrate through thick bush. Masters of camouflage by day, their stealth is perfect at night. Many lurk near outside loos. Searching for deep, dark holes. Torchless villagers brave long-drops shoeless. Misfortune favours the brave and the shoeless. We have yet to see a bad snake bite. But weekly, since our arrival, a snake bite has presented to the clinic. Legs and feet mostly. A shock for the patient. They are terrified. Pain the main symptom. Mostly stiletto snakes or snakes on the mostly harmless list. But many villagers share stories of a neighbour permanently injured by a puff adder, or another who died hideously after a black mamba, or a boomslang bite. Partly because of this mystique, but mostly because identifying snakes in the dark is nigh on impossible, we tend to assume that our snakes are not harmless until time has passed, and our patients are in the clear.
Keith thinks that a black mamba slithered across the road in front of our car this week. I prefer to think that it was a harmless African bush snake. I like to minimise drama. My head is in the sand. Venomous snakes don’t exist until confirmed by an expert. Choti couldn’t be more expert. She is Director of Operations for Save the Snakes. An NGO that works with communities to conserve snakes. She sees all of our snake bite victims. She supports victims and novice snake doctors. She also offers a snake removal and rescue service. She’s a real snake charmer. Our Kakumbi clinic is delighted that Choti lives just around the corner.
These fearsome encounters with wildlife were echoed when Keith had a chat with the local chief of police this week. Mark* confirmed that nine people were killed by elephants last year and two by crocodiles. These are the official figures, but it is likely that some fishermen get taken by crocs without their fate being shared on the bush telegraph. Although the police statistics are alarming, we still crave the company of elephants. Our big grey gardeners remain AWOL. We have been waiting patiently for our trumpeting pets to return home to Kapani. You may remember that we define a good day as a day in which we see an elephant. Almost every day, during our last tour of duty, was a good day.
But this year has been very different. A different season. A different landscape. The park is lush, but the crops have failed. Slowly, the elephants are starting to cross the river. But not in the expected numbers. Weird weather. Late rains drowned budding crops. Many tell us that the elephants will not come this year. Why come when the grass is greener on your own side? Hungry villagers. Higher prices. But there is a silver lining for our villagers. Elephant conflict with man is likely to be minimal this year. Still, we shed a selfish tear for the loss of our hulking long-nosed garden pets.
Mark checks with head office. He suspects that yet another culprit is responsible for even more violent human deaths. Head office confirms Mark’s instinct. Humans themselves win the mawkish competition. Man is named our Valley’s most fearsome creature. Death on the single road that forms Mfuwe’s spine, comes from a poor combination of man, vehicle and insobriety. The police are seeking resources to tackle this issue. How should the police best use their paper, scissors and stone do you think? The law is clear about sobriety and driving. A single traffic officer might cut deaths. No stone should be left unturned to find one.
Between the photos, finely told stories, your blog is not just fresh air, it's like reading the once-famous & dominant weekly news magazine in the US, LIFE MAGAZINE. This is high praise for you non-Americans. 🤣 It took a staff of hundreds of professionals to get that magazine published.
Great update, it almost feels like we are there but with the description about the number of snakes I think Irene will take a visit of the bucket list !
gosh - your description of the wildlife and lack of immediate "sophisticated" medical care makes me aware how much we take for granted about our safety and access to help in our cosseted western world! 😮
Incredible post. Makes me want to do an elective again!
However, for once our own encounter with new life in spring here would keep me here. Take care and keep a good look out.
Another cracking epistle Ginny. As someone who baulks at taking the skin off a chicken breast, I can’t put myself in your shoes, gazing with concern into a croc mutilated limb’s mangled flesh! Im simply left in awe once again.
Wildlife highlight of week: woodpecker on nut feeder while kestrel hovers above.
Rainfall: nil. Continuing nagging NEly wind .
Temps: Yet to reach above mid- teens out here in the Wild East!
Pictures of local wildlife & verdant spring pastures.