mobile and mwela caves

Our follow up in Kassama was delayed by waiting for the anaesthetist to turn up again. However there was a rather loudly blaring TV in the corner of the reception area which as I settled in to watch a bit of the news decided to highlight some of the sports news (perfect). Even better still they then showed about 15 minutes footage of the netball league that had started that weekend. It seems to be a large affair and I was a bit gutted that it's only started as I am leaving as I would certainly have loved to have gone and tried out for a side... and looking at the skills I think there would have been some sort of niche for me. Great to see minority sports and female sports getting decent coverage out here though.

Green buffalo's playing another Lusaka team in the netball on national TV

However we were there to assess a follow up and after doing so we had a look around the theatre areas too. It was a little shocking - even I have to admit that their storage rooms were very untidy to the extreme that I think were rendered unfunctionable! I hope it wasnt an indication of the general disorganisation of the department! Its probably why there was a preying mantis wandering around - plenty of feeding oporuntities for him!

Storeroom chaos

Preying mantis

 Once we finished the one anaesthetic follow-up we learnt the second one was actually out in the field on a 'mobile theatre clinic week'. It seems that this wasn't as far away as all that so after a phonecall it was confirmed that we could go there and interview him also. We leapt in the car and drove Eastwards towards the royal palace of the Bemba people I'm told and there, in the middle of a school playing field was the whole M*SH set up. I will be honest it was very impressive. Having seen the (very expensive Chinese made) trucs in Chipata (Eastern province) I hadn't seen them all assembled. Victor, the anaesthetist was adamant that I should have a good look at the whole set up as I hadn't been to a field hospital before. I was actually very keen to do so!

Lorries set up in the field hospital

FIeld hospital in full flow

  The trucks were aligned as they each opened up to house not only a theatre but a laboratory and also pharmacy and dental area. There was a big tent between them which functioned as an out patients department where people came with their ailments and were assessed and then treated as needed. There were another three tents - one for female cancer screening, one for male circumscisions and one for recovery. There were loads of people milling around, sitting on the ground and standing in queues. This was likely to be the first healthcare, many of them had accessed for several years.

Queues outside waiting for assessment and potentially treatment

Main tent for assessment/outpatients

Way in to the theatre (truck) from out patient area

We walked up from the main tent and up to the stairs marked theatres (with Chinese inscription above this!). The first thing we saw though was a fully kitted out dental area. A brand new chair, pristine burrs (drills) and various other quipments. I was suitably impressed - maybe a quick scale and polish?! The dental assistant (well that's what he was called - not so sure how much training he'd had) told me the only thing that he offered was extractions... old or young....

We head to the right and then 'enter' the 'main theatre'.... Wow! They had a machine that was fully functioning and oxygen cylinders and in fact had everything you'd need to deliver a safe anaesthetic (was tempted to ask them to drive to Lwingu and set up there permanently!) However as usual, scrape a little under the surface and there is less gloss. The table actually still had blood splattered all over it (I can only assume it was yesterday's blood as they hadn't started that morning's work yet, but I cant be sure how long it had been there).In fact there was rubbish and bits of dirty gauze and even a sharp on the floor. Not so great really. The curtain was there for two reasons - it was to stop the crowd of people outside the truck from peering in and secondly to act as a barrier between the main and second theatre. Second theatre I ask? Oh yes there were so many cases it was faster to have two theatres running than one... I understand the concept of time management but was a little lost with regards equipment and space. 

"Main theatre"

No problem! They found an additional table from the school and brought that in behind the curtain. Trouble is that it was too short for the surgeons to operate  so they improvise (McGuivor medicine as its affectionately know here!) and put it up on four breeze blocks. Crikey! If the fact they only had one machine and monitroing for two 'theatres' was also concerning - its the old adage of using ketamine and allowing the patient to breathe themselves or performing spinal anaesthesia where they dont need a machine. Though I cannot condone no monitoring in this day and age. I ask about the pulse oximeter - ah yes that would have been a good idea says Victor rather than leaving them locked up in the hopsital in Kassama (well at elast they weren't in the storeroom otherwise we'd never have found them ever again!)

McGuivor solutions

When I asked what scope of procedures they carry out in the mobile hospitals I was rather expecting some lumps and bumps and maybe hernias. Yes, the do all of those but also even thyroidectomies and caesarians - whatever's needed. Rather shocked I ask about the availability of blood... oh there isn't any (mind you  thats not much different to being in the hospital if truth be told!) My big concern was the postoperative management of the patients and also pain relief. Again - "most don't need pain relief". I think the difference between not needing and not asking for is rather different. Especially if you've had a caesarian. As we are about to leave the lorry it then strikes me that we have to descend some steep stairs. Dear me, I think, how do they get patients down these stairs when they are awoken from their operation to get to the recovery tent. That is of course very simple it turns out. They employ some local men who manhandle (I mean carry) these patients down the stairs and then dump them on an unmonitored bed in recovery until they are awake enough to walk back to the village they'd arrived from - even if they'd had a spinal anaesthetic. There are times when words fail me!
  

Stairs down from theatre to ground level!

I thank Victor for his tour and also for taking the time to answer the questions. No problems he says he rather enjoyed the attention. I on the other hand found it really wierd to have all these faces pressed againt one of the tent windows to watch us as we were conducting not only the interview but also the skills set up with the mannequin. The neonatal resuscitation scenario resulted in large hand claps and cheers from the nosy onlookers!

Resuscitation dummy in the field tent!

Once we finished we headed back to the car and en route back to Kassama we stopped at another interesting cultural sight: Mwela cave paintings. The car park alerted us to the local wildlife threats... which after actually seeing a 'so-called' wasp in my opinion was fully justified! Eek!

Large wasp!

We waited around for ages as there was nobody at the entrance and there were no further signs of where to go apart from the no tresspassing ones! Eventually, after loud horn blaring the guide turns up out of the nearby huts! They don't get that many visitors (despite it being a UNESCO heritage site) which is a shame as he is incredibly knowledgable. We walk up the hill to where a seemingly unimportant outcrop of rocks appeared in the undergrowth - much like many of the other rocks strewn around. However this is an old bushman cave dwelling and he shows us various areas that it was thought they had slept and ate and sheltered. There were no paintings in this cave but he went on to say that they had currently discovered over 1,700 painting 'panel' and were still discovering more and took us scrambling up through the cave onto a plateau to view the rocks in the near vicinity - it all became clear why they hadn't extensively found all of them by now! There were thousands of rocks and dense scrub surrounding them. No wonder it is the sight of the densest collection of late stone age paintings in the whole of Africa and is therefore an incredibly important site.

The expanse housing the 'as yet not discovered paintings'

Scrambling down the rock face and into the grass to get to the paintings

After a bit more scrambling over rocks we see the first panel. Apparently there are different types of paintings. They are mainly schematic types of paintings (so I'm told!). The colours were made from natural pigments or egg yolks or blood mixed with saliva and the paintings were often under an outcrop of rock which is one reason as to why they've survived so well. It is amazing to see such prehistoric art that depicts the heritage, intellect and cultures of our ancestors still so untouched and in such good condition. And so close!

Our guide showing us a schematic diagram of a likely warthog being hunted by men

Close up of the warthog and the 'hunters'

Scrambling through a cave opening to see a male fertility painting

Depiction of a female and a tortoise (black spider like structure) and a lizard depicting female fertility... he'd lost me a bit here! Didn't quite follow the significance of lizards and tortoises!

Close up of above painting with the female holding the lizard.. .Apparently. Surrounded bu the finger prints of the artist.