Relaxing in Luangwa

This month’s update comes direct from the porch of the most luxurious tent I have ever had the pleasure to camp in. The soft background chirrup of grasshoppers contrasts strikingly with the violent snorting and splashing of hippos in the Luangwa river a stone’s throw away. A young impala has just wandered past the tent. A monkey scampers over the roof and swings off through the trees. I have escaped the hospital and am spending a long weekend with Gemma, my surgical consultant colleague, in the South Luangwa National Park, around 4 hours drive from Katete.

Groundnut (peanut) field

Everything is drying out now as the wet season comes to an end and the maize harvest is in full flow. There’s a lovely loop to run from the hospital along dirt tracks past fields – and usually past several heavily laden ox carts with a handful of children running along behind gathering up the maize that makes a bid for freedom at each pothole. Maize crops are heavily down this year though as the rains did not provide enough water – only 57% of the usual according to the local radio. This will have knock on effects later in the year, as one of the nurses said ‘the people will be hungry’.

Gemma, me, 'typhoid boy' and his aunty

I mentioned the boy with the abdominal fistulas and severe malnutrition – affectionately known as
‘typhoid boy’ amongst the doctors and medical students. (See pic above - with his aunty). We have been taking food in each evening for him for months, and a couple of weeks ago discovered to our extreme frustration that his bedsider was sharing the meat we took in for him with other patients, their bedsiders and eating some herself. This wasn’t malicious, she just didn’t understand how desperately he needed calories, perhaps she had become so used to how skeletal he looked that she didn’t see it anymore. Following some bedsider education we are now sure that the contributions from our mess dinners and various other baking efforts are getting to the right place. We have started to see an improvement in him over the last couple of weeks – to start with a flicker of a smile, the ability to hold his head up when carrying him onto the scales for weekly weigh-ins, then the strength to sit up in bed, sit in a wheelchair outside in the sun (for the first time in several months), a wave from his bed when we walk onto the ward, and for the first time last week the strength to walk a couple of metres from his bed and back holding two hands, then one, and then a couple of steps by himself. This was followed by what I thought initially was a fall from exhaustion, but then realised it was him bobbing down to rescue his shorts which had slid to his ankles having nothing to hold them up. (The next day I found a belt for him in Katete market!) It is so encouraging to see a patient like this gradually get better. That first smile was worth more than any box of chocolates or sentiment filled thank you card.

There has been a whole host of weird and wonderful cases in theatre recently, and my bosses are very good at letting me do the operating on some of these under their supervision. A couple of memorable cases include the lady with a tongue tumour the size of her tongue, attached by a small pedicle – when she initially stuck her ‘tongue’ out (just the tumour) it looked like a slightly lumpy but normal sized tongue, but then if she protruded it further you could really see the size of the problem. How she had let it grow so big I have no idea – speaking was difficult and although she did say she could eat she could only manage ‘pangono pangono’ (a little). We’ve also had a selection of foreign bodies to retrieve – a cockroach from an ear, a seed from a nose, a piece of broken wire from under the skin of an arm (present for 5 years but ‘migrating’ and causing the patient worry). Gemma also taught me to perform a bilateral orchidectomy on a lovely old man with metastatic prostate cancer – the medical equivalent that is offered in the UK is not available here and the surgical method does just as good a job. He was incredibly grateful, not quite what you’d expect given the nature of the operation, and wished ‘every blessing be upon you’ after we’d finished.

This lady couldn't stop smiling after this awful tumour was removed

I have inherited a bike from one of the doctors who left around a month ago and have discovered a new freedom as a result. Much as I enjoy the bike taxis into town, being able to get there under my own steam is even better. A few weekends ago a couple of us cycled out to a friend’s orange farm around the other side of the Katete hills – a beautiful ride, and only one minor over-the-handlebar incident that miraculously didn’t necessitate any first aid or hospital visits. If I was one of my patients I would have referred to myself as ‘at least’, the meaning of which is hard to explain but I think it is similar to ‘not bad’ or ‘ok’. I have also taken a leaf out of Prof’s book and now cycle into the hospital if I’m called overnight. Admittedly it is only a 5 minute walk but there’s something very satisfying about cycling along the empty hospital corridors and it means the escape back to bed is quicker once the problem has been sorted out. Also, cycling while wearing a white coat makes you feel a bit like superman as it flies out behind. Of course the illusion is shattered when you arrive on the ward and spend the next 15 minutes trying to solve a problem by creating something out of an empty vial of ketamine, the tubing from a catheter bag and some ‘strapping’ (incredibly sticky tape used for just about everything).

Herbert's orange farm

I have now migrated to a sun lounger overlooking the beautiful Luangwa river. On Monday I will become Dr Charrot (or Challot, or occasionally ‘Carrot’) once again (having an R and an L next to each other in the same word is a bit of a challenge when the letters are interchangeable), but for the next couple of days I will continue to eat my bodyweight in homemade eggybread and enjoy watching some of the most gracious and beautiful animals that roam in the national park. It's not all hard work!