Last but not least!

The follow-up trip is nearing its end. That's in more ways than one.... 

• I have one last anaesthetist to follow-up (number 58 from 64)
• I have two more days left before I fly home
• We really are at the Northern most end of Zambia and I cannot go any further, unless I buy a boat! And the boat I found at Lake Tanganyika wasn't moving anywhere fast!

                                                        Lake Tanganyika port

However, we weren't going to Lake Tanganyika - we were off to Mbala - a smaller town about 50km south of the lake. We were treated to beautiful lush grasses alongside country lanes (bumpy country lanes - thank goodness rainy season was at an end!) There were plenty of goods for sale along the roads too underlining how fertile the area is. I enjoyed seeing the plentiful rows of colourful buckets (old oil containers) full of delicious ground nuts (not too unlike Monkey nuts) to attract the potential buyer.

Lush grassy lanes

Ground nuts in colourful old oil tubs and pumpkins for sale en route

Now, Mbala is a really interesting town for many reasons. For me, the biggest draw was that it was called Abercorn back in the days of colonial rule.  Now if this isn't a Welsh-influenced name then I'll eat my hat or mosquito net! Its described aptly as a backwater town these days. I like the description sleepy myself! The colonial influences were still very evident in the buildings - some typical brick built town halls, post offices and all with corrugated iron/tin roofs. Though this roofing extended to all buildings in the town - even the old prison and the 'newer' shop complex!

   

Town hall

Shopping complex

Old prison

Old prison accountability slate

At least our last accommodation was a little more upmarket than the prison!

 It also has other important historical and cultural influences. It is the town where General von-Lettow-Vorbeck [who had marched down from German East-Africa (Tanzania)] handed over his prisoners to the British at the end of WW1 (4-5 days after the war had finished in Europe - it was a little more cut off in those days!)

Monument commemorating the fallen Northen Rhodesian soldiers in the war as well
as commemorative plaque to the surrender of General von Lettow-Vorbeck

It is also the Moto Moto museum - arguably the best museum in Zambia. It certainly had a really interesting and extensive collection of Bemba history and artefacts. I particularly enjoyed the traditional ceremonies and witchcraft section.  I was very interested to see the traditional remedies section which included Kaselelele or as its known in many of the rural hospitals, African Oxytocin. Oxytocin is a natural hormone that stimulates labour in pregnant women and used extensively all over the world. This root is however chewed by ladies to start labour in the village and they undergo very powerful contractions which is not always a good thing if their body is not ready to start labouring - and was described to me as being a causative factor in quite a few of the emergencies and sadly deaths when I visited hospitals both in the East and the North.

"African Oxytocin"

 And if I thought that was interesting the next exhibit on witchcraft taught me a few new techniques.  It seems as with the smart phone revolution throwing up apps for any eventuality there seems to be a Zambian witchcraft charm for any occasion.

Who knew that Baby Lotion could be so potent.....

I moved quickly away from this one....

 But I wasn't there to be a tourist - honest! So back to work! The anaesthetist was free in the afternoon so I went in to the hospital  and had a good long chat and a tour round the hospital. I was really glad to see that they are keeping the Lifebox out, fully charged and easily accessible. I was less glad to see that it was kept on the newborn baby resuscitaire. Voicing my concerns (it leaves no space for the baby to be resuscitated and also the big heater above the bed would surely not be good for the electrical devices below) the anaesthetist quickly jumped in to assure me that neither of those are problems because the heater doesn't work and they don't use the resuscitaire in this theatre very often - so they use it as a table! Nothing like forward planning for an emergency eh?!

Neonatal Resuscitaire/table for equipment

 We move on to the recovery room - unusual to have a recovery room with beds in it to be fair. I've seen plenty of hospitals and theatres during this trip. I have seen plenty of mattress beds on the floor in the wards but this was a first in a recovery room. I enquire as to what the mattress is doing on the floor. Clearly, I'm told it's for patients to recover on. An interesting concept bearing in mind there are two perfectly functional beds next to it. It must be when they're really busy, I thought, though it didn't seem likely looking round the theatres. Nope, its where they put any/all of the patients - they don't use the beds. I find myself sympathising slightly as the motive is sound. They've had a few people fall out/climb out of bed post operatively whilst they're waking up as there is no recovery staff or nurse to watch them - so they find it causes less harm to have the patients lie on a mattress on the floor whilst they are still in theatre trying to keep an eye on them. Agree or disagree its a practical solution for a difficult problem.

Recovery 'bed'

And with that the theatre tour ends and with it the end of the follow-up. It's a strange feeling. It's been an amazing experience. The welcome and genuine excitement and thirst to learn that has been displayed by all of the clinical officers in quite often very difficult circumstance has been humbling to  witness. I know I'm privileged as I can return to the UK in a few days and resume with my fancy technology and drugs and uphold all the international standards whereas the guys here - they're the real hero's, the real soldiers of improving healthcare. Anybody can deliver a quality service if all the tools and equipment and education is provided. It's a darn site harder without that back up and I think these guys are doing a fantastic job. Yes, there can be improvement and yes there are things that need to be changed for the better and that's the beauty of on-going education and courses and empowerment of Zambians to take forwards anaesthetics in to the future. 

  But for now, I'm going to sit down with my Mosi beer, surrounded by frogs and crickets and toast all the anaesthetists of Zambia under the stars.

Ursa Major over the lake