Absent health and safety in Northern Territory

   Northen Territory!

 At long last I'd got to a more rural and 'Zambian' feel after the industrial Copperbelt. The transition through Congo had served as a bit of a watershed as I noticed more and more the houses here were so very different from the rest of the country. These houses are all square and made from mud bricks but are often brightly daubed with various natural pigments to add colour. It made staring out of the window for vast distances an extremely pleasant experience. 

What was noticeable to me was that this was a far more agricultural area but each hut seemed to have a certain amount of land to farm next to it and wasn't the usual collection of huts forming a village. Often each hut would have a small patch of maize growing next to them - a throwback to the good life I'm sure.

Colourful hut decorations

But in keeping with rural life I saw many waterpumps and people gathered around filling their large plastic containers with water before balancing them deftly on their heads and trudging back to who knows how far away. The strength of these (mainly women and children) in walking with that weight on their heads for what looked to be miles as well as the amazing balance is really a sobering thought when I run the tap to brush my teeth. Others had sensibly found a water tap outside the hospital out patient department and were filling up from there. A relief to see that they were making attempts to use clean water becuase the nurmous rivers we crossed en route seemed like the place where all the clothes and dishes were washed (as well as providing a great place to play for children and cattle to drink!)

Walking back to the village with water containers filled

Using the hospital water supply to fill up

Washing clothes and dishes in the river

By now the road was pretty poor - dirt track with often large ruts which made me think how difficult it is for anybody not in a 4WD to get back and forth to hospital in a hurry especially in the wet season. I was pretty thankful I didn't have any broken bones or pain or loose teeth as we bounced along for 4 hours. And they do have a considerable amount of rain here judging by the extreme lush green vegetation I could see at the roadside.

Beautiful lush green grass alongside the road

Bone shaking, teeth crunching dirt road....

Bad picture but worse road with massive ruts

We were travelling from Mansa to Lwingu which is a small town midway across the Northen Province. It is quite likely to be the most remote place I'd been to for a while.  We eventually arrived at the small hospital cut into the mountainous terrain. It seemed only to have three buildings. We had the inevitable wait for the anaesthetist to come to the hospital (protocol dictates you don't ring in advance of arrival that day but turn up and then ring to announce your arrival!). So whilst he was brought to the hospital by a friend I had a look around.  It is true to say  the longer I walked around the worse the sense of the 'Land that time forgot' became. There were numerous ministry of health and malaria control programme vehicles strewn around minus their wheels, rusting quietly in this unlikely scrap heap. There were piles of motorbikes - formerly used for outreach clinics almost camoflagued with the grass that had penetrated every aspects of their broken motors.

I thought it was only in Merthyr hospital this still happened. 

This was on the day of "Super Saturday" in the six nations rugby tournament also. I had no signal so missed most of the tension. However it seems rather tongue in cheek that whilst staring at these derelict vehicles the wheels were actually coming off the chariots in Twickenham too!

Derelict motorbikes

And if I thought the omens were bad from the outside maintenance then the inside was going to be a complete eye opener. The anaesthetist had now turned up and looked about 12 years of age, annoyingly he is actually a year older than me but was at least a foot shorter and wearing an Argentinian football top. We start off well with him instantly asking me if I knew Gareth Bale or Ryan Giggs on finding out I'm Welsh! The tour around the hospital however was eye-opening and also very sad. I didn't quite believe a place like this would house one theatre let alone two. The first theatre I saw is below. For a minute it looks very basic and antiquated (table) but at least it looks clean.

Main theatre Lwingu

I have this nagging feeling that something is missing. It then dawns on me - there is NO anaesthetic machine. There is however an oxygen concentrator (a machine that makes oxygen from the air - which turns out to be the only one in the hospital so if its being used on a ward there is NO oxygen in theatre...). The only monitor they have is the Lifebox and they share the blood pressure monitor with the labour ward. I enquire as to where the machine is. Maybe it's in the other theatre - they often have to share, maybe it's being maintained.... wishful thinking! There isn't one. None, nada, niet, nil, kolibe, dim.

Theatare two: even more basic

Most anaesthetics are done here under ketamine so they breathe for themselves to negate the need for an anaesthetic machine. If the concentrator is around he straps and oxygen mask to their face. This is desperate as they also do caesarian sections here. Pregnant women are very likely to aspirate stomach contents which is why if they have a general anaesthetic and they should be intubated and placed on a ventilator. I enquire as to how many aspirations he has seen - he reckons only a few. I wonder why he doesn't do them under spinal anaesthetise - better for many other reasons. Plain and simple - he barely ever has Bupivicaine (the local anaesthetic) to do them. It makes me very cross that he has to work and suffer under these conditions. He is a bright and good anaesthetist when I chat to him and he has made several requests to the hospital and medical directors at the province to get a machine - but this has fallen on deaf ears....

  Well, rest assured on our way back from our trip a few days later we called in the provincial medical office and spoke to the provincial medical officer where I relayed my utter disbelief and real fears and concerns about the likely mortalities that would be directly caused from this serious omission. I told him I thought the poor anaesthetist was not only operating with his hands tied behind his back but was actually being blindfolded as he didn't have the drugs to deliver alternative safer techniques. It's not on.  It's not fair. They received the message loud and clear! I was assured that they look at this procurement as a priority. And I am pleased to say that having returned to Lusaka, Wisdom has sourced an old, disused anaesthetic machine at UTH and the province are sending a truck to pick it up on Saturday if at least only as a temporary measure. If nothing else on this trip I hope this will at least make the lives of the people of Lwingu safer bearing in mind the large catchment area and the atrocious state of the roads that people needed to travel to get there. Though at present I'm not sure they're getting a good deal!

After such a shocking experience we needed cheering up and luckily enough as we approached Kassama we turned off to view the beautiful Chishimba falls. In fact it's a conglomerate of three separate waterfalls. The first was almost jurassic in appearance.

The second a series of beautiful rapids cascading along

The second was a series of fantastic rapids before we set eyes on the 20ft drop that is the main Chishimba falls. My absolute favourite thing about these falls is that they are one of probably ten different waterfalls dotted around Northern province that are just not visited by the usual tourist as they are so far away and not well marketed compared with Mosi oa Tunya. However some of them are just as breath-taking and also completely devoid of other people!

Main Chishimba falls 

Overlooking the 20ft drop

View down the valley

 My other favourite thing was the complete lack of health and safety! It is so refreshing to actually be able to walk up to and see things without being constrained by fences and barriers.  Mind you having come from Lwingu with no regard to health or patient safety maybe it's a theme.... Though I'm not sure Wisdom would agree as he was having a minor heart attack as I stood on the edge of the top of Chishimba. Patrick (the driver) on the other hand was killing himself laughing - from a safe distance and videoing the whole thing! Maybe he was hoping I'd topple over so he could redeem the footage for "You've been framed!"

Health and safety?!