Heading East

Another early start saw us rewarded by a beautiful sunrise as we headed East. Stunning pink and oranges with low level mist against a background of forrest rich terrain became evident as the blackness yielded to daylight. The mist/dew really was spectacular with peaks of hills poking out here and there and then as we descended into the dips we were almost completely blinded by the pea souper nature of them. After an hour or so we turned off left and then we stopped. There was no hospital and a strange smell was was abound and the mist was certainly hanging in the air. It was coming from Chinyunyu hot springs and it really was amazing how hot the water really was on escaping from the rocks beneath. In fact almost too hot to put your hand in the water and certainly too hot for fish. I was rather regretting not buying some eggs in Chongwe as we passed through to boil in it!

Web catching the steam from the hot springs

Sulphuric hot springs bubbling away

In case there was any confusion about the water temperature!

After a brief stop we pressed on as we had over 650km ahead of us. First stop: St Luke’s mission hospital. This was still within about 2 hours of Lusaka but what I hadn’t appreciated until much later that this was the last anaesthetist in this region for over 400km (until Katete).  One anaesthetist for a huge catchment, though he has trained an assistant to help him. Whilst conducting the follow up I managed to unearth quite possibly the biggest oropharyngeal airway I had ever seen. I’m not sure if they make them for elephants or hippo’s – but if not – this size would probably suffice! Normally you measure the correct size for an individual by measuring from mid incisors to the angle of the jaw – this one was pretty close to being from the level of my incisors to the bottom of my neck. Huge!

Huge oropharyngeal airway ( for scale the yellow life box is 123mm in length)

St Francis is however an amazing little hospital that made me feels like I had stepped back in time.   Pictures below show the clean and well kept hospital corridors with theatres to the side and ICU (though it literally had one bed in it an no fancy monitors or ventilators!) and an old style trolley for patient transportation. 

UAM in the background to the baby
resuscitation doll for skills test

 This hospital also had the first UAM (universal anaesthetic machine) I had seen in Zambia. This is essentially a draw over anaesthetic machine (for those not anaesthetically minded: this is a machine that allows the patient to breathe normally – though one can over ride this but essentially as they breathe they pull in the anaesthetic vapours and keep themselves asleep. If they become too unconscious they breathe less and thus the anaesthetic levels lighten until they start breathing again and vice versa. Its simple and easy to use and also and more importantly it can run off an oxygen concentrator – a machine that takes air in the atmosphere and puts it through some filters and takes most of the nitrogen out leaving almost pure oxygen. Simples!!! Basically it decreases the reliance on having oxygen cylinders and so is cheaper and you dont ever run out of oxygen and also it can drive/power the machine and negate the need for constant power supply. A great piece of kit and I was really pleased to see it in use.

 It was then back on the road for several hours. The terrain was certainly changing and becoming far more mountainous and it was a welcome sight after being in the mundane urban sprawl of Lusaka for so long.  We climbed up steep hils with deep drops – apparently a part of the rift valley. We even had to stop whilst a troop of baboons crossed our path, quite indignant at people disturbing their daily exercise routine! We passed through what felt like a border town: just above Lunagwa. It had shops on both sides of the street selling baskets and hats and drinks as well as dried fish! We stopped for some lunch (chicken and chips - it seems that is about the only choice barring Nchima and chicken – but that is likely to make one doze off, not so clever on these roads!). I suspect it has the feeling of being a border town not because its fairly close to Mozambique but it is on the Luangua and Zambezi river confluence. It is also the site of the suspension bridge over the Luangua river which is strictly one vehicle at a time!

Beautiful rift valley mountains

Luangua river and suspension bridge

Fresh fish for sale en route!

Village hut

Once safely across the bridge we ended up on a dirt track as the Great East Road (which runs from Lusaka to Chipata) was no longer great – in fact it was positively awful! The roadworks meant that it was basically a dust/gravel road for almost 300km. Villages were becoming more common sights with their thatched roofs and mud brick walls. There were also more and more bicycles about and even a few motorbikes which I’ve rarely seen out here. The other thing I noticed more and more of was cattle and goats. Big horned but skinny-ish cattle. Some pulling carts along but mostly grazing on the tall grass alongside the fields of maize and sunflowers.

Cattle grazing along the road

Goats roaming free on the road

                                      

                                                  Motorcyclists are pretty rare in Zambia,
                                         even in the rural settings

By mid afternoon we arrive at Katete – our next stop. What welcomed me next was not what I was expecting. The hospital is St Francis, an Anglican mission hospital. It was basically an old British colonial hospital and as soon as we pulled up the drive I could tell that this was the case. There were a few outbuildings built in red brick but the main hospital was a throwback to something one would expect in a film – the ‘English Patient’ perhaps. It was a hospital with not only a rich history but a reputation second to none. The beautiful arched architecture was certainly compelling and the springbok weathervane at the top was the icing on the cake so to speak!

Nasty leg burn

We made our way to theatre to meet up with Lucas the anaesthetist who we were due to chat to. He was alone and running the hectic theatre list. I could tell it was British by the fact that there were protocols and notices of monthly meetings on the walls. There were also three lists up and all patients placed in an order of surgery. Again the only time I have witnessed this so far in Zambia (including the University teaching hospital!). We joined Lucas in theatre for his penultimate case – a burns debridement as we are in the setting of ‘The English patient’ – how apt. She was an epileptic who had had a seizure and then fell into the fire in the village. Then spent a week before coming to hospital – no wonder she was in agony. This seems a common occurrence here – there was another similar case next too. It was interesting to see they also used an UAM. When we were done Lucas saw my interest in the machine and dragged me in to the ‘obs and gyane’ theatre in order to show me the draw over OMV system they had there. They do have a normal machine but as he has been practicing for 17 years he still prefers the old OMV system.  When asked why he prefers it – he looks at me quizzically (as if the answer was pretty obvious- ‘because it’s British. And the British know how to build machines that last’…. So that was me told!

Lucas with the draw over machine

  Not only was it a very old system but it came complete with Trilene (an anaesthetic agent I’ve never seen). In fact I didn’t know they still made it – apparently Lucas gets it shipped in from the UK via an old professor who used to work there years ago! Apparently it helps add pain relief to the Halothane… I cannot argue or agree with this statement I simply haven’t seen it in action! 

Trilene vaporiser next to Halothane vaporiser

Trilene bottles from the UK

We finish the surgery –carried out by a Dutch surgeon who’s been there almost a year (there are lots of overseas volunteers here and I can see why, in fact it would certainly appeal to me to work here too) and then I conduct the follow up. The patient meanwhile is placed in recovery, which is staffed with a nurse (called Atlee - how very apt!) who cares for the patient one on one. A first for me to see in Zambia!

Atlee recovering the patient

Once we finish I get a small tour of the hospital itself – nightingale styled ward arrangements and all the wards are named. Most are local place names but the labour ward is named Bethlehem! Why not?!

We made it to Chipata (the capital of Eastern province situated on the Malawi border amongst the mountains) at night and managed one follow up at 21.00 as he was shooting off to a mobile health/theatre project in the ‘bush’ for a week early on Saturday. (We see the convoy of truck the following morning - literally they are transporting a mobile theatre with all the equipment on board).

Eat your heart out Challenge Anneka: One of six Ministry of Health trucks laden with a mobile theatre 

 He was keen to make sure he didn’t miss out on the interview and refresher. This is the mentality of all of the candidates I’ve met up with so far, incredibly eager to have further refreshers and discussions. This is a real positive for Zambia and shows a real intent to learn but also is a sad fact that there aren’t regular refresher courses in place. However after pulling off an 18 hour day, I was rather pleased to get to bed!