Blog 3

3/11/08 The Zambian Presidential Elections and more adventures

The sun continues to burn us and the earth with a vengeance. Much around is brown and the animals are drinking muddy water. The rains are two to three weeks late and we hope there will be some relief in the next day or two. It will then rain on and off for the next six months. This is the growing season when much food needs to be grown and the fields become green again.

We have done very little over the last four days because of the fourth Presidential elections. Voting took place on Thursday and VSO told us to stay at home on Friday in case there was

trouble.

The guys watching the result of the election at our local bar Shakalima's over a beer or two.

Rupiah Banda from the ruling party MMD was elected Zambia's 4th President.

The main challenger Michael Sata who was only 30,000 votes behind (810,000-v-780,000) is very angry because he says the voting was rigged.

In Monze everything has been very quiet so far and most people seem to accept the result including Kenneth Kaunda (KK) and the second President Chiluba as well as the Bishops and the Attorney General.

Swimming at Moorings

We have used the spare time over the last 4 days to catch up on our emails, to do some more shopping, play canasta and ago swimming at a local campsite called Moorings!

The owner of the campsite, which is on a farm, was shot and killed in January 2008 by burglars who were subsequently caught and said to be Congolese. Apparently it was widely known the owner Tom Savory kept cash in the house to pay his farm workers. His family were originally from England and he was the third generation in Africa The family had run the farm for a 100 years and it is now run by his Dutch second wife, with whom he had a second family; two sons now young teenagers who go to boarding school in South Africa. The wife has employed a manager for the campsite. The pool is in front of the family house but the wife is very generous and allows many friends to come at all times to swim. The pool is smaller than ours, is outside but it is very refreshing particularly when followed by a Mosi (lifesaving Zambian beer) at the campsite. The farm was called Moorings by the original owner because he had travelled all over southern Africa but finally moored on this land.

The swimming pool at Moorings

A meeting with the past and more of the present.

On the way home from work recently, having a Mosi in Shakalima (a bar) we struck up a conversation with a Joe Simiegna who was in Kenneth Kuanda's (KK’)s first cabinet as an economist. He had lived in England for over 10 years mostly lecturing in Cambridge. I suggested we meet again but although he grew up and has a house in a local village he spends most of his time in Lusaka so he politely refused but told us he has 8 cars and a chauffeur.

Clinical Cases

Today for the first time we got to grips with some patients! I went to theatre to watch Dr. Engulula (Congolese surgeon) with two of the junior staff, one Doctor Machona

Dr. Machona examining one of the many children with fractures

and one medical licentiate mainly putting plaster of Paris (POP) casts on young children with fractures of their forearms and their legs for club feet.

Supra-condylar fractures before and after reduction!

POP for a club foot. Not so common in our area compared with Northern Zambia where it has a much higher incidence.

They had accumulated (12+ of them) over several days because they had run out of POP,

Michael Breen in another theatre operated on a vesico-vaginal fistula and then helped a medical licentiate do a hysterectomy for cervical cancer.

The theatres work reasonably well with an old but still functioning excellent central sterilising department and once you are operating it feels no different to being in theatre in Portsmouth.

The staff coffee room for nurses and doctors and all others

Scrub facilities. Although there were taps, water rarely flowed from them and we relied on bowls and jugs of water pored over our hands.

The waiting room and recovery also acting as a corridor!

Theatre clogs and storage

The theatre register which contained accurate records of all operations done.

The steriliser kept working by Tony Brand










Irreplacable

Expensive endoscopy kit rarely needed or used. Mostly given to the hospital paid for by various charities.

And finally an operation is achieved!

In the afternoon. after lunch at home and 15 minute walks both ways, mostly in the blistering sun, both Judy and I went on a ward round. Most cases were again orthopaedic or other simple problems but also included a woman who survived a crocodile bite which are apparently highly infective if you survive the immediate assault and a young woman with a very large thyroid goiter.

Tonight was a typical night!!

The electricity went off at 1900hrs before the meat was cooked. The water pressure went down and was off at 20.00hrs. Candles were lit, baths were cancelled, Judy went to sleep after some work on her Apple

and I started this blog until the lap top battery power failed at 21.00hrs. Energy but no water was restored at 21.25hrs. Baked beans on toast were a compromise for dinner with coffee, fritters (a bit like doughnuts but tougher; everything is!) bananas (very good) and treacle and canasta for desert. Judy won for a change. I have never had worse cards, which is the only reason for me ever to lose?!

It is now 23.52hrs so off to sleep under the mosquito nets with the sound of dogs cool air and still no rain. At least we will sleep well and up tomorrow at 0600hrs. for more surgery. An incisional hernia etc (subsequently cancelled 2x and still not done by Thursday. The crocodile bite also needs debriding and has also been cancelled and probably won’t get done until next week.

Tuesday to Thursday 4-6/11/08 The weather changes and we start to do more clinical work

We exchanged our sunglasses and hats for umbrellas on the 4th as it was cloudy and cooler and we thought, to our great relief that the rains were arriving. In fact they didn’t until Thursday the 6th. Better late than never.

Clinical Cases

Today (Tuesday 4th) I (Mike) continued to get a much better idea of the mix of clinical work here. It clearly reflects the age of the population and their activities as of course it does in the UK! The two biggest groups are children and young adults with trauma and women with obstetric and gynaecology problems.

The orthopaedic problems are mostly forearm fractures and nasty humeral supra-condylar breaks in children and equally nasty tibial fractures in young men from sliding tackles in soccer and jumping out of the back of trucks about to go off the road. Some of these fractures penetrate the skin resulting in some cases of osteomyelitis.

Osteomyelitis

The lack of kit and expertise leads to interesting ways of managing these cases from no treatment in very old with impacted inter-trochanteric fractures of the neck of the femur (one old lady actually refused skin traction and said she would crawl home if she couldn’t walk; she wasn’t on the ward the next day!!) to one girl with severe skin abrasions over an open fracture of the forearm draping over her arm over her head as the best way of keeping it out of the way and comfortable while nature takes its course! I don’t know how long she will stay in hospital.

There are a few cases that seem to have no diagnosis and it is just a matter of wait and see. One old unconscious man with severe urinary sepsis, no urinary output and a high blood sugar we tried to help. He took 48hrs to die never regaining consciousness although his blood glucose came down with insulin and we did get a pulse back with a large amount of intravenous fluid. We had no potassium to give but managed not to put him into heart failure and achieved a very small urinary output before he succumbed. He probably died of an arrhythmia of the heart.

There were two men, one young and one old with hemi-paresis (paralysis down one side of the body) after falling off a bike (old man) and being beaten up (young man).

Two patients had snakebites one in a 3yr old girl (possibly from a puff adder) who required an amputation of her arm just above the elbow.

The mother had kept her at home for 1-2 weeks before bringing her to Monze and the arm was mummified, hanging on just by by dead skin.

The other was a young man also bitten by a puff adder who had to have a high, lower limb amputation. Although we had other patients having snake bites these were the only two in a year in Monze.

I operated on my first cases on Tuesday both hernias. The first was on a 5yr old patient called Desca Hakabonze. I operated with Mr. Minyoi who made the incision too lateral. He is a medical licentiate, not a doctor but bright enough to be one.He has a very good manner with the patients who clearly like and trust him and he is very keen to learn. I will enjoy working with him. The licentiates are trained to be able to cope with everything from paediatric orthopaedics to neurosurgery to all medical emergencies and general surgery! Their initial training is for 3yrs followed by a further 3yrs in a recognized hospital after which they go to a specified hospital to work as a generalist. I took over from Minyoi and spent an embarrassing few minutes getting back on track.

The second case was an obstructed hernia on a patient called David Lice. He must have been obstructed for several days and had had a local remedy consisting of multiple superficial cuts to the skin across the lower part of his abdominal wall.

They followed a regular pattern were shallow, close together and skillfully done. They didn’t seem to have drawn blood nor had they cured him!

Mr. Minyoi towelled up for a laparotomy on another patient, he was also cross-matched by the anaethetist who was obviously anticipating some blood loss. However I was able to do it all through the groin and didn’t spill much blood although the tissues were very congested. The trapped bowel was purple but pinked up as soon as it was released. There was then the difficult decision on whether to cut out the damaged bowel but we decided it was safer to leave it and kept our fingers crossed. It was very difficult to dissect the sac off and close it. I did a simple repair of the posterior wall and tried to get him home 2 days later but he was very reluctant because he thought the journey home would be too bumpy and uncomfortable.

In out patients I saw a patient with an anal fistula and a lady with a fairly extensive anal cancer. There are many patients with carcinoma of the cervix and I have also already seen a patient with liver cancer and another with a big spleen.

Last night (7/11/08) I was up until 3am operating on a young boy aged about 12yrs who had a complete obstruction of his bowel due to it being stuck together from chronic appendicitis. His bowel was grossly distended and filled with partially milled maize seed. It took a long time to milk all the seed through the blockage into the colon and fluid and gas back up into the stomach to be aspirated out through a nasal tube. He is recovering well so far!

This morning we had to try to sort out a young woman with a very large heart in failure with renal failure and a severe iron deficiency who was said to have the nephrotic syndrome and had virtually no urinary output!!? Needless to say we had to go to the text books which weren’t much help so blood transfusion diuretics and steroids and prayer was the order of the day.

The variety of clinical work is amazing and a great challenge to a UK GP and specialized colorectal surgeon.

Barack Obama's Election

It was great to be in Africa for the news of Barrack Obama’s election as the 44th USA President

on 5/11/08, Bonfire Night in the UK. It is tremendous news and has been very greatly welcomed here particularly by young people. I’m sure it will be a great boost for the popularity of the USA in Africa and for the great value of democracy.

I, (J) had had a community trip planned for Monday morning – organized by Sister Kapapa

Sister Kapapa and Judy at Monze Mission Hospital shortly before she left.

who is in charge of a drop in centre called Buntolo, meaning Oasis. She is a very enthusiastic fifty-year-old traditionally built woman who is also the daughter of a local chief. Sister Kapapa is mainly interested in caring for the OVC (orphans and vulnerable children; their parents having died of HIV/AIDS) and started to collect a register of them She collected 800 names, but soon realized that there would be no way she could help them all.

About five years ago she started a scheme to maintain the orphans in the community, looked after usually by grandparents or aunts and uncles. All she is able to support is about 65 orphans in groups of around 10, each of which has a Guardian acting as a group leader. These are local women who are trained at the centre and in turn help the relatives raise money to help support the orphans and extended families. Sister Kapapa also realized how important education is for these children and has helped encourage this by helping with fees, along with providing mealie-meal (nshima) as a staple food.

Children collecting food from Buntolo while eating mangos.

This is either given to the orphans on the way to school or on the way home. It means the children know each other and can build up a social network; they work better because they aren’t hungry and they don’t worry about their next meal. The food programme is important, as these children are not always treated equally by their families. Many of these children are HIV positive. Sarita Brand has stated teaching some of the relatives of the orphans food security, that is how to grow sufficient maize and vegetables without fertilizers, which they can't afford.

Sarita Brand (see below) in the back garden of Buntolo in front of the rapidly growing maize which eventually produced at least 4 cobs per plant using only water, sun, good method and compost!

The Guardians have also been taught additional skills such as beadwork, basket making and tie-dye cloth. Some have also been given maize or vegetable seed and this is all used to generate a little income. The whole programmed does rely on donations however and they seem incredibly precarious.

Judy and Dhun greeting the care givers at Buntolo

Buntolo Centre provides a focal point for the Care Givers and Guardians who are also struggling to grow vegetables in the dry red earth and this is with the help of a VSO volunteer, Sarita (Nepalese) – another story! They also have 248 chickens (2 died) which lay eggs to sell. However these are sold at the current market price and there is no profit. The Peer Educators are also based there, as is the food for distribution. It is an incredibly basic structure with small rooms cramped with chairs, desks or milled maize and other areas with plastic barrels filled with water when it is available. It looks incredibly poor to our eyes, and slightly chaotic, but given the resources that they have it is quite inspiring.

However the chaos is not all of their making, and I was told at 1130h that the trip was cancelled as transport was not available. Petrol is as expensive here as in the UK so causes major problems in funding.

Our frustration is also caused by the intermittent water supply - cold and hot, at different times and also the electricity supply. So Tuesday morning there was no water and none again in the evening. We collected a dribble of cold water in the bath and I had a shower using a jug. Wednesday morning there was hot water at last so caught up with some clothes washing before work. Wednesday evening we planned to go out for supper so it didn’t bother us too much when the electricity was cut at about 1830. It was still off at 2130 and no water – so early to bed. Not so good when we still had no supply this morning. Bananas and homemade yoghurt with OJ for breakfast and yet another cold wash! At least the weather is still warm. Same situation at midday but finally power restored at 1630 though still no hot water. At least we are fortunate in having access to these services. Many still collect from standpipes, and pumps in the rural areas with no electricity.

The hospital also suffers during all of this. They do have a generator, which is started up, for emergencies and Tony, VSO volunteer (he also has a story to tell) – married to Sarita is the hospital engineer in charge of this. It is very costly of course to run so the theatre lists were cancelled and only emergencies could be done.

I have been trying to work out where I can best use my skills – or at least what I might do that is transferable and could be sustained when we leave.

There is no doubt that the HIV /AIDS issue pervades everything. Cultural beliefs go alongside religious beliefs. The no sex before marriage and faithfulness message is lost, and superficially it seems that all the men want to believe is that they shouldn’t use condoms and they have a right to sex. Certainly it is heartbreaking in the clinic to see a 21 year old HIV positive woman who is about to break off her engagement because she cannot tell her fiancé of her status. He has been married before – she thinks he might take medication but she has had previous affairs. The counselor was very empathetic (he is HIV positive) and said that it didn’t mean she couldn’t fall in love and marry, but it did mean any partner would have to always use condoms. Pregnancy was not discussed. The clinic sees these sorts of people all day everyday – babies, children, young and old. There is often no privacy and they may wait for hours. It’s difficult to know where to begin.

Tomorrow I hope to go on the community trip- transport willing and see some more rural life.

Well its time to finish this epistle. We think about you all a lot and know even more how lucky we all are. It’s now 21.30 we are tired and its time for bed. It rained a lot this afternoon with thunder and lightning and the difference in temperature is such a relief. When I went out for the Mosi-oa-Tunya it was quite refreshing!

Blog 2

Our Programme in Monze 1/11/08

We continue to be very happy and well apart from Judy’s mild cold.

There is never a dull moment with constant new experiences, battling with the heat, keeping on top of the process of purifying our water and keeping the red dust and potential burglars at bay. We haven’t started work yet, partly because of the Independence Day celebrations, our trip to Lusaka to register with the Zambian Medical Council, the Presidential elections and the continuing induction process. We will probably start work the week after next unless there are any riots with the results of the election imminent today. However we both have a good idea of what we would like to be doing. Judy, homecare of HIV/AIDS patients and mothers and children in the community in association with the Buntolo project, more of which will be in later blogs. Mike hopes to be involved in the surgical treatment of sigmoid volvulus (twisted colon) which is said to be common and the vesico-fistula repairs at which Michael Breen

Michael Breen

must be one of the world experts. He does about 150 a year and visits other hospitals to do the same and other gynaecology operations mostly hysterectomies some for cervical cancer. He has been in Monze for over 7 years and before that in Africa for several years including South Africa. His life is committed to his patients and was drawn to work at the Monze Mission Hospital

by its founder Sister Lucy O'Brien an amazing and inspiring nun, doctor and gynaecologist. Michael plays a very active part in the local Monze Catholic community but finds the hospital managers difficult and manages to be effective by being fairly independent.

One of Michael's other interests!

Several of the senior managers running the HIV/AIDS service, including an accountant at the hospital, were arrested for financial irregularities just before we arrived and it is likely that the government will insist on a complete change in the senior managers over the next year or two. The Hospital is owned by the Church with the Bishop at the top of the pyramid, a board of trustees overseeing the running of the hospital by the senior management. However most of the funding seems to come from the government including our wages. We both get 1,850,000 Kwacha per month (how lovely to be multimillionaires!), or £308 (£ 616 for the two of us) per month, which we think will be more than enough until we buy a car probably a 4WD Pajero Mitsubishi or Toyota RAV 4 (we never did and did a lot of walking instead). The problem is that petrol is expensive and distances you need to do to get anywhere long.

So back to the end of the last blog.

PM started as our cleaner and did a good job including stealing a few small items from our pantry. We were advised that we shouldn’t ignore it and Judy advised Mike to phone PM which he did and in a face to face meeting 2 days later she totally denied she took the goods and another item we hadn’t noticed was missing! We asked Father Rogers

Father Rogers and two alter boys on Palm Sunday processing to church.

for advice as he new her family and he has promised to talk to her. We hope we can still employ her, as she is a widow bringing up young three children.

Unfortunately that was never possible but meant that were able to have Bridget who was 21 and still at school repeating years she had missed probably because she having her daughter who often came with her. Bridget was very bright very thorough and reliable and as normal asked for advances, but never extra in her salary, to take exams. She also helped look after her sister's daughter and it was sometimes difficult to work out who was who. We never quite worked what her living arrangements were although she probably lived with her grandma. Neither she nor her sister were married.

I'm not sure which the two girls was Bridget's daughter, probably the one on the left.

Bridget


We will leave the potted histories of many of the lovely and interesting people we have met, to later blogs. Many of them are very disappointed that we are only coming for a year.

So what about two of the major events in the first 2 weeks.


Independence Day Celebrations. 23rd and 24th October in Monze.

The Thursday leading up to Independence Day turned out to be more interesting than we had bargained for. Still reeling from the concentration and intensity of our induction programme – eg half a day looking at various hospital departments then – ooh er – why don’t you take the afternoon off? Who are we to argue in this dust and heat? It was to be an arduous morning with meeting both the Roman Catholic Bishop of Monze and the District Commissioner!

We set off with Mrs Y who obviously loves these social visits.

Mrs Y and her son outside the rondavel she grew up in and she was proud to show us. Her father was the headmaster of the local school which she attended and she eventually spent a year in Cardiff studying hospital management after training as a nurse. Mrs Y was the senior hospital manager of Monze Mission Hospital and was very good to us arranging our introductory programme and generally overseeing our stay. She had 10+ sibs her brothers sleeping in one rondavel and sisters in another. Although she was now a committed Christian in the RC church, clearly her early years were spent in a very simple rural community and she probably grew up with many of the traditional cultural traditions.

Dhun, who is a VSO colleague working at the hospital doing monitoring and evaluation of HIV/AIDS services came with us on these trips. She is uncertain about her role as four of the HIV service and one accountant have been arrested for fraudulent activity. This might add a slight challenge to her job as her potential line manager/partner is in prison.

The Diocese has a wonderful new red brick building just out of town. It is well designed, light and cool. The reception area appeared welcoming and we were warmly greeted and offered drinks and biscuits. We were shown around various offices and then taken to meet the Bishop. He was an elderly Italian with wild white hair, a black polo-type shirt and black trousers. He greeted us very formally and Mrs Y kept calling him My Lord and curtseying. We made typical conversation about why we were there and our impressions so far and it all seemed a bit of a formality. How ever the unsuppressible Michael couldn’t resist asking more personal questions as we made our way out and discovered he is a great football fan and supports Juventus. Michael is now fantasizing about watching matches on Sky with his new best friend the Bishop (this never happened, the bishop was a bit of a recluse).
After that we met the District Commissioner (DC) in her office which is next to the hospital. She is a traditionally built woman who we are sure rules with a rod of iron. All the men are afraid of her! I was unable to see a packet of red bush tea but I am sure that is what she drinks. Her office also has a front room quality to it with red plush chairs and sofa. Again we sat for formal conversation but towards the end were invited to join in the beginning of the Independence celebrations, which would begin at midnight with the raising of the Zambian national flag.

This was to be preceded with song, dance, marching and a speech by the DC. We felt very honoured – but knew it would be quite a challenge as we are becoming used to bed at nine thirty and rising at six thirty.
You may not believe this but in spite of knowing better we were actually on time for the celebrations in the gardens outside the DC’s office. And we sat for over an hour waiting for something to happen! People slowly arrived and a group of young students were dancing to recorded music – probably pop African. Eventually the DC arrived, in gold splendour with blue turban accompanied by some of her staff.

She sat down and our hopes were raised that we would not have too long to wait. We were seated in rows of seats facing each other with a space for performing in the middle. The DC was in front of us on the front row, a table in front of her with a great bowl of artificial flowers on it – removed from her office/parlour - adding a sense of splendour. The M.C. was a very slim glamorous young woman in a close-fitting shiny pink evening dress, a gold shrug and gold high heels. The celebrations were ready to start – or were they?
The young students started with the ubiquitous drumming singing and dancing. The dance is the only one we have seen in this area and consists of the men and women lining up in rows facing each other. A woman then selects a man to dance with and a lot of bottom wiggling and pelvic thrusting occurs with the man standing behind the woman.

Each pair takes it in turn and then the dance is over. The singing and drumming gave real atmosphere under the dark Zambian skies. However all was not to go smoothly. The next group was called on to prepare – no response. Then an adult peer educator group – no response, and finally a group called The Matantala Cultural Club who also failed to appear. The M.C, was becoming more and more irate at these upsets to the programme and finally called on a youth Cadet Force to go through there paces. Again there was no response, and understandably so, as they had shot up the programme order. There was some shuffling around off stage in the dark but our M.C. made a few sarcastic remarks suggesting the cadets were either lost or even asleep. At that the older portly officer in charge of them, rather like Captain Mainwaring, emerged at great speed out of the dark, marched forward, saluted the DC as he passed her and demanded an apology or else from the elegant M.C. She apologised saying “of course everyone knows the army never sleeps” which caused some merriment from the audience and in spite of this the cadets eventually emerged from the dark in their sand coloured uniforms and floppy brimmed hats. They marched with small shuffling steps and lopped sided walk we thought caused by the restricted space in front of the DC. However having seem another group in a much lager arena it turns out

it is just their style. It seems that almost a dance routine has been created from marching manoeuvres such as “ about turn “, “ at ease” and “present arms”. The evening continued with more of the same – literally as half the entertainment had not turned up and the M.C. kept urging those there to perform again. We were served soft drinks and beer and valiantly tried to stay awake. At last it was decided the time had come for the DC to give her speech and for the flag to be raised. It was in fact about ten to twelve but it had been a long evening and no one pointed this out. In our experience so far the only time anything has been early in Zambia. And so to bed.
We were up much later than usual the next day in spite of the parade being scheduled for 7.30am. The sun was hot as we made our way to the Harry Mwanga Nkumbula Stadium. It is about twenty minutes from where we live and is simply a large rough field with a mixture of earth, grass, stones and goal posts. The crowds were gathering in a large circle around the field. The DC was on her red plush sofa under a make shift awning which could shelter about thirty people on chairs. Splendidly dressed again – this time in an embroidered silver fabric and turban.

She made her speech and after she had sat down spotted us, and we were invited to sit in the shade with her.

Judy is to the left of the left hand pole I'm behind the camera!

Most of the local schools performed with dancing ,drama and poetry. Some of this was very powerful with different themes ranging from the brutality of colonialism, (a little uncomfortable) to marriage of girls too young and issues regarding HIV/AIDS. There was an impassioned poem by a young girl who had been orphaned due to AIDS and another by two girls pleading for young folk to be aware of health issues and to take responsibility for this. Towards the end of the morning we were ‘Cordially invited to an African luncheon. Venue – Truckers Restaurant'.

Mike outside "Truckers" on a different occasion. We never had another meal there!

We were transported with the DC to a large partially open room at the back of the Truckers Restaurant. The lunch was food we had not had before – chicken or fish stew. The fish is interesting – dried but when cooked is eaten bones and all! It was the best meal we have had so far, eaten with fingers only and served with nshima (maize or mealy meal with texture of mashed potatoes). The first meal we have had without chips and tomato ketchup -Dawson eat your heart out, bet you can’t wait to visit us!
It was then back to the ‘arena’ for an afternoon of sport – football and netball. Such a challenge on a hard uneven pitch with a very bouncy ball , bare feet and a strong wind. It was entertaining however and the boys’ energy in the heat was quite amazing. Michael is taking his role of Pompey scout in Zambia very seriously, especially as we have been let down so badly by Harry. In fact we were at the GP (Golden Pillow) doing emails when we saw him on the BBC World News. Ironically the clip shown was of him on the bus with Kanu (Nigerian) post F.A. Cup victory. THAT is how important it was in world affairs! An even more cruel blow is that he has gone to Spurs. We think it is just as well that we aren’t sharing a home with Tom at present.
Our day there ended as the DC left with an elderly rich local farmer and businessman Mr Cornhill. He must have a story to tell, as his father was a white Zambian (possibly Scottish) and his mother Zambian. He had several wives( serially), many children and countless grandchildren. He use to own 5,000 cattle now down to 2,000, hard times. The local prisoners arrived to take down the awning and we set off home in the lengthening shadows. The sun sets at six o’clock and it is dark by six forty five with all the stars and the moon out. We arrived home hoping there would be water after a long dusty day and power long enough to cook supper if we timed it right. I think we face a future of romantic candlelit but possibly uncooked suppers.

The trip to Lusaka for our interview and registration with the Zambia Medical Council (ZMC) 27-28/10/08.

We rose from our beds at 6.30am followed by the now usual rituals of tea (Rooibos for Judy, Mike thinks he is getting to like, or Earl Grey) watering the small oasis we call a garden,

if we haven’t the night before and washing ourselves, if we are lucky in warm water followed by breakfast and then before leaving the house checking that all the taps and lights have been turned off (they may have been on when either or both failed), closing all the windows and double locking the front door (mortice and padlock), and finally removing the padlocks on the

The window and front door of our flat with the padlocked corrugated iron gates you can just see 7 yards in front of the window.

9 foot high sliding corrugated iron gates, which open with considerable reluctance and noise probably similar to that heard by the prisoners in Alcatraz! These are set in an equally high, cement covered white concrete walls which surround the compound to include ours and another semi-detached bungalow and a mostly unoccupied smaller residence owned by WWF and lived in by Crispin when he is working in the area,(and occasionally by his wife, 2 children and nanny also) all connected by a small red dusty garden. Our small oasis growing a few hopeful tomatoes, very dry and brown cucumber plants and a few brave emerging seedlings is between our bungalow and the high white wall. We hope our garden will provide greater variety to our diet in the near future. (it was aforlorn hope!)

We expected a lift in the hospital bus to our first meeting with Dr. Mvulla the medical Director (MD) at 0800 hrs. At 8.20 after a failed attempt at phoning Mrs. Yamba the senior hospital administrator to enquire what has happened to the transport we struck out for the hospital, a 20 min dusty walk in the glorious, fortunately only warm sunshine, in our formal gear including tie and shirt both for our meeting with the MD and our interview in Lusaka with the ZMC with our kit and documents in a rather weighty rucksack. We arrive at 0840hrs to discover Mrs. Y and the MD in a meeting, which lasts to 9.00. At 9.30 we are introduced to the MD and have a very nice chat with Dr. Mvulla. He is a Zambian trained Doctor aged about 33yrs. He resigned from medicine 3yrs after qualification did training for the priesthood in South Africa then changed his mind again and returned to medicine and two years ago was selected to run Monze mission hospital. He does not have too much time to do clinical work but does 1 day a week doing outpatients. He seemed fairly vague about definite plans for us and as we are still familiarizing ourselves with the hospital departments it is difficult to be quite sure where we will eventually fit in.
We then had to wait another 30 minutes for hospital transport to the coach station mostly in the rapidly warming sun. The trip to Lusaka is a fairly tedious one; hot, dusty, bumpy and lasting at least three and a half hours. We had to include an overnight stop as the ZMC had given us all an appointment for 0900hrs the following morning.
Life then started to become difficult. We were dropped off at the Golden Pillow (GP), the best

This is not the Hotel itself, which was much less impressive and of which I didn't have a photo!

hotel, restaurant and fastest internet connection in town that also has the coach stop to Lusaka and discovered, as the hospital bus was disappearing, fortunately not completely, that all the clean and comfortable and cool coaches for the journey to Lusaka were fully booked for the rest of the day. Before the hospital bus completely disappeared, the first lucky break of the day, I raced to the road in my formal shirt and tie and long but fortunately light trousers raising only mild perspiration and persuaded the hospital driver to come back and help us try and get round the problem. It turned out that the coaches were unusually busy with folk not only returning from celebrating Independence Day but also travelling to where they were registered ready for the election of a new president.
We also had the faint hope we might get a lift to Lusaka in the not so cool but at least comfortable hospital transport.

We then returned to the hospital to negotiate with Mrs. Y this alternative form of transport. However at her suggestion we returned again to the coach station in the hope that the 13.00hrs coach may have spaces and if not the hospital bus would return and take us to Lusaka. At 13.00 we established there no spaces in that coach or indeed any of the others leaving that day. Mrs. Y then asked whether we would be willing to travel in the smaller less cool and perhaps more crowded but cheaper blue buses used by the poorer folk. In a moment of weakness we agreed

Our bus (above) and a similar one but even less salubrious!

and on our way back to the small blue bus station our second lucky break occurred, as they were able to flag down one such bus just as it was leaving. We were ushered on to this not completely full rather grubby clearly quite well used older type of bus with flapping curtains that had to be restrained to stop them from hitting us repeatedly in the face and were fortunate to find two spare seats right at the back. The drivers assistant suggested we each pay 50,000 Kwacha (about £8) which we knew was excessive and eventually beat him down to 45,0000K which was still excessive but we didn’t have the heart to negotiate a further reduction.

It was now around 15.30 hrs, nine after getting up and all we had achieved was a 45min meeting with the MD but at least we would now make it to Lusaka?

Four hours later after being bumped and bounced along the long very straight, potholed and now hot road with very changeable companions, including young women with much luggage that was skillfully packed into the boot beneath and pushing up through our seats and a sick one- week old baby, we arrived in a very busy and congested bus station in Lusaka. Unfortunately we were still 7 kilometres from the Combroni Convent House where we were staying. However the driver and his mate, after otherwise emptying the bus insisted that he knew where the convent was and insisted in motoring us back out of Lusaka. The journey seemed longer than it should be and I could tell that Judy was getting a little anxious!

However our trust was rewarded and down an unmade road and after overshooting it we eventually found number 9. By the time we returned Sister Conceilia was already outside to conduct us through the 9-foot corrugated iron gates (sounds familiar?) to a lovely quiet clean and very reasonable hostel with a lovely garden where we spent an excellent night and for the first time since coming to Z. slept without a mosquito net. Another VSO Doctor and his wife, Andy and Gaby

Andy and Gabi on the left who unfortunately had to return to England after only 3 months in Zambia.

joined us for dinner in a restaurant within walking distance from the hostel called “Comfort Zone”. As we arrived there was a power cut but undaunted, our simple meal was cooked on gas and we dined by candlelight in a lovely garden by a pool and drank two small bottles of beer each. We had a great chat about our experiences in Zambia so far, its amazing how quickly you build up quite close friendships in these situations and were back in the Hotel and to bed by 10.00 to build our strength up for the battle the next day.

We woke to a dust free world and were able to have a shower – wonderful! We helped ourselves to the breakfast provided and at 7am set off for the VSO offices so that they could get us for our interviews in plenty of time. We have to say here that we now KNOW that there is no doubt where Thompson Time came from. Some of us have retained our African genes more strongly than others and even we are having great difficulty in not being incredibly EARLY for everything. I know some of you may find this difficult to believe and it certainly is a strange experience for us.

It is now 01.00 and I must go to bed with the noise of surprisingly loud croaking frogs and barking dogs. It is now quite cool and I wont have any trouble sleeping.

I didn’t and Judy has now added some paragraphs, can you guess which ones?

The taxi in Lusaka took us through the busy early morning traffic and we arrived at the VSO offices which are in a very large airy six storey building standing in extensive gardens with brilliantly red Flame trees. The building is one of the higher buildings in Lusaka, is close to the main bus station and city centre. We had time to do some emails although the system is incredibly slow compared to home and the Golden Pillow in Monze.

We arrived at the Faculty of Medicine Office which is in the Medical School in the University Teaching Hospital (UTH) in Penn time at 9.00am only to be told that the interviews were in 14hrs which I initially thought meant it would be at 11pm!! Fortunately this is the Zambian way of saying 2pm and we suddenly had only 3hrs of shopping time! This extended to 3hrs+1hr of coffee further shopping and wondering whether we should have lunch. We had a considerable amount of luggage including a brush, iron, ironing board, toaster, electric kettle, hammer, nails and a lot of food. This was because we were expecting the hospital Land Cruiser to pick us up. This eventually arrived too late at 2.00pm (sorry 14hrs) 30 minutes after we had left to get to UTH in a taxi with all our purchasers left packed into the VSO car we had been using to get around.

We arrived at the Faculty Office at 1400hrs, waited until 1500hrs, were all interviewed (Judy, Michael, Andy Moulson, and Hiran de Silva) within 30 minutes by three impressive Zambians including the Dean, Professor Mulla an orthopaedic surgeon, the Professor of Medicine and an obstetrician and gynaecologist. We are now registered on the Zambian GMC to practice in Zambia. Professor Mulla asked Michael to email him his main interests, as they would like him to give a lecture in Lusaka so we can have another enjoyable journey to Lusaka!! (this never happened)

After the interview our hospital transport was still nowhere to be seen all six of us squeezed back into the in the VSO car with all our luggage to drive back to the VSO office with the gear lever indecently close to Michael’s upper right thigh. He did suggest to Eleanor that he would change gear if she wished but she managed with Judy watching, tightly squeezed between Michael and the near side door.
We looked forward to getting our kit and rapidly melting provisions, (leaking fishy water) out of the VSO vehicle and the into the more spacious hospital Land Cruiser. To our surprise this was already half filled by six large Zambians with some of their provisions and kit for the hospital pharmacy and other departments.

The Land Cruiser with Judy and our buys before Mike and the three more Zambians piled in!

They were very apologetic for missing us at the shops, were fortunately friendly and most of the extra passengers worked for the hospital. We had interesting chats with our knees close to theirs facing each other across the back of the Land Cruiser, provisions and household goods amazingly stashed away we hurtled back on the long very straight 2 track main road south with many other vehicles going in both directions. Initially this was in sunshine but we watched the sun rapidly set and most of the journey was in darkness the car intermittently lit from the front and back silhouetting its passengers. Two were drinking whisky diluted by what looked like lemon juice, which we politely refused when it was offered! They were happy and not too the worse for wear. They looked together at something on a cell phone, which highlighted their chins, noses, eyebrows and shaven heads with a bluish glow in the deep black night as we were bounced and bumped back to Monze with just a brief stop at Masabuka. Here there were youths packed into the backs of lorries waving flags for the imminent Presidential elections. The only way to stay cool was to have all the windows open and the air rushed through the Land Cruiser at 60mph tugging at what’s left my hair making my scalp itch but the overall feeling was very relaxing.

On arriving in Monze at 2000hrs all the boys helped us unload, all the provisions survived and are keeping us alive a little longer. We know our chats with the physiotherapist and nurse (the whisky connoisseurs) will have built a few bridges, it was great meeting our VSO colleagues again in Lusaka which we hope to visit in the Eastern province and once again many adventures in what should have been a very straight forward trip to register with the Zambian Medical Council!!!!!

Sorry this is so long, the blogs will get much shorter when most of these things begin to be more mundane??!! ( that never happened!)