Doctors change over day

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Highlight of the week

Managing medical complexities in the tropics

Lowlight of the week

African Wi-fi

Once upon a time, at the beginning of time, when we first qualified, doctors rotated from one job to another on the 1st August and the 1st February. Chaos reigned for a week or two. New medical staff were clueless. It wasn’t their fault. They had no induction and little support. February and August were a poor time to fall ill. Fast forward. British hospitals and GP practices have long since pulled up their socks. But what of Zambian health care workers?

Nobody thought to warn the patients of the South Luangwa Valley not to get sick this week. I had planned to write about our gentle introduction to our work here. I wanted to describe the clinic where we are working. But instead, I’m going to cut to the chase. It’s been all guns blazing here. We’ve been saving lives already.

On Monday, instead of working in the Kakumbi Rural Health Clinic, we drove out into the community and parked under a tree in a nearby village for a child health outreach clinic. I will share our early experiences of the child health clinics in a separate blog in due course. They deserve some attention. This Monday, our community outreach clinic finished early, so we drove back to the Health Clinic to meet our new colleagues and to see if they needed any help. It was 11.30am and the clinic looked empty. The only queue remaining was for COVID immunisation. The clinicians were delighted to see us. Although they were genuinely welcoming, they were in rather a rush to share their clinical responsibilities. Any port in a storm.

I was asked to review a little girl. A 10 year old. She had a short history of fever, vomiting and breathing problems. A quick assessment revealed that she had sepsis. Appendicitis in all probability. I made some suggestions for management but did not expect to have much joy. This is Africa for goodness sake. To my surprise, I was handed a small cannula, given intravenous fluids, Ceftriaxone and Metronidazole. In the next moment I was brought swiftly back down to Earth. There are little, or no, tests available in Kakumbi. I could not ask for a blood count, a C-Reactive Protein blood test or an ultrasound scan. Neither do we have surgeons or reliable referral hospitals. In England this girl would have had her appendix taken out that afternoon. We took advice about the best option for her, and sent her to Kamoto hospital, an hour’s drive away. She was then transferred to a bigger hospital in Chipata, 3 hours away. They avoided doing surgery by continuing her on antibiotics. The jungle telegraph tells us that she is doing well. Fingers crossed that she stays well.

Kenneth Kaunda, the father of the Zambian nation was buried the week before last. The Nation mourned. The country stood still. Last week we were playing catch-up with the child immunisation programme. On Tuesday, we did another outreach child health clinic. Lots of babies to be weighed and jabbed. Important work, but largely routine. Routine quickly became drama. Keith received a call from a safari camp. A young lady had fallen ill after eating a peanut cookie. She knew that she was allergic to peanuts, but the guide had been given the wrong cookie jar. The drama plot unfolded: Where was the camp? How sick was she? But the drama had no need to evolve into a crisis. Keith’s GPS phone app quickly mapped out the route to the camp. This is Africa but not as we know it! It was only 4 miles away – but we had no green flashing emergency doctors light – nor a tarmac road to speed along. The camp manager phoned with regular updates. We drove safely but with resolve. Our arrival was greeted with considerable relief. Patient, spouse, camp staff and medical team all exhaled as one.

Luckily, this was not full-blown anaphylaxis. Just a pretty nasty reaction. We were able to assess and treat her. With prompt care she quickly improved. Whilst giving her time to respond to our treatment we were obliged to stay a while. The camp staff insisted that we have lunch as we waited. We were treated to a delicious 2 course meal in camp, on the bank of the Luangwa River. Hippos grunted in the background! Every cloud …

I think it’s pretty unusual to see appendicitis out here. Not to mention severe allergy. Two dramas in one week. On change-over week? Here’s hoping that this is just an aberration. As many of you know: during my years working at James Cook University Hospital, in Middlesbrough, as a consultant paediatrician, I had a reputation for not attracting work. I had the quietest shifts known to any doctor. I am now hoping that it is not pay-back time!

Waiting to re-assess our patient.