Blog 7

15/12/08 Two months in Zambia.

Things don’t change - we have an industrial dispute! The six medical licentiates, equivalent to the house men/basic surgical trainees in the UK have gone on strike because the hospital will not pay for their on call, which they say is not in their contract. They will therefore only work from 08.00 till 16.00 hrs.

A large self setting sunflower on waste land grew to over 6 foot and flowered in 3 months from the start of the wet season. An exotic weed.

The management have just put me on the surgical consultant on call rota for four days this month. At 65 I have finally returned to being a houseman again and with no European directive so I will have to work the next day! The consultants will have to come in to change catheters, put up drips and be first attendants to the emergency admissions. I don’t think I will be on the rota next month! This is all very bad for morale and the dispute has been dragging on since June.

While Judy was away I took Dr. Penlope Machona, and two medical licentiates, Theresa and Captain Banda (she is in the army), the leaders of the strikers, out to dinner and learnt a bit about them. Note that in this male dominated society the 2 medical licentiates and doctor at the centre of the dispute are all women. One curious thing I learnt was how strictly their parents treated them all before they left home, with very restricted contact with boys and all meetings outside the family home chaperoned. Some young adults in Zambia, possibly only a minority seem to go from Victorian traditional morality at home to almost complete sexual freedom with more than one partner at a time when they leave. However these young Zambians were clearly all brought up in educated and probably strictly christian families not typical for most young people in Zambia. The vast majority are brought up in rural areas with a more traditional culture.

There has been an article in the BMJ on HIV/AIDS, which suggests the reason for the epidemic in sub-saharan Africa may be because Africans have multiple partners at the same time, which spreads the virus much more quickly than serial monogamy which is more the western style. On average Africans finish up having no more partners in a lifetime that in western cultures.

The visitor for this month.

We had a very interesting lady to stay with us called Hilary. She was in her 50’s had done six years in Belize, starting with two years as a VSO volunteer, some years ago. She is now permanently back in England with her mother and sister. She had been married but was divorced and that was partly the reason for her doing VSO in Belize. She had previously worked in human rights and that’s what she did in Belize, mainly with children. She was visiting Monze because her brother had done VSO near here forty years ago. He had then gone to Cambridge and in his first year died in a climbing accident in Derbyshire. She had been able to meet people here that he had met and worked for and even managed to find the house where he and two friends had lived for a year. Hilary is also a course facilitator for VSO so we had a good discussion on what VSO is all about and what it hopes to achieve. She has met other VSO people in post including Jane Lichenstein who is in Livingstone and is the wife of Sir David King previously the government’s chief scientific advisor. The Daily Telegraph did an article on her that Gill and Dean sent us before we left. In the article it describes her as previously “a highly paid lawyer running a commercial litigation team in Cambridge and is now a charity administrator on £24 per month". Jane's social life consists largely of her Dutch flat-mate, Irma; Irma’s dog, which eats cushions and howls in the early morning, and several hundred Zambian orphans”. Our two new “daughters” Dhun and Natasha, VSOs who live next door to us in Monze have met her on a visit to Livingstone and think she is fun.

Natasha has just borrowed another K50,000, an onion and just enough milk for a cup of tea all in the space of 48hrs. Some things don’t change!

Judy’s trip to the UK 6/12/08

We had bought our tickets for the bus to take Judy to Lusaka and the airport the first part of her journey and then at the last minute got a lift all the way to the Christian Brothers retreat near the airport, where we were staying the night before Judy’s early morning flight to the UK.

The ride was in a very large and luxurious land cruiser (leather seats and air con.) driven by Brother John who is in another brotherhood called the Holy Family. This is an Irish charity based in Dublin that runs homes that treats physically handicapped children. Michael Breen who clearly is well known by all these organizations tipped us off about the lift. Brother John was taking two Irish people to catch the same flight as Judy. John, one of the passengers was one of the people who runs the charity and raises money to fund it from Dublin, and the other a very lively 50+ Irish physiotherapist called Theresa who is going to manage and work at the Holy Family in Monze for 2 years.

She plays bridge so she was very happy to play bridge with Mike and to share a gin with Judy. The second aim was achieved but we never got our act together for the first! Perhaps it will happen when we are all back in England/Ireland. We all became very good friends, Theresa, her husband Mo and the various people visiting and working with the St John of God Brothers in Monze.

We had very many happy times together including regular visits to Moorings swimming pool and of course the campsite bar with much drinking of gin and beer sitting around the barbeque in the warm African evenings after watching the sun set.

A not so warm evening later in the year!

We had supper that evening at the Retreat in Lusaka with the brothers. An omelette, chips and some vegetables with the three brothers dressed western style, Michael, Joe and a young native born Zambian. We had fresh fruit for pudding and instant coffee. The simple rooms faced inwards to a grass covered cloister type square shown above with deeply coloured bougainvillea. We had hot showers and had to be up again at 5.30 to help ourselves to breakfast, including boiled eggs, and for Brother John to pick us up at 6.30 for Judy's plane to Heathrow.

It took me almost the rest of the day to get back to Monze with Brother John who had several jobs to doin Lusaka. I did some more shopping including the rare treats of sweet corn, gin for Xmas and a tin of golden syrup. I also had time to read a book by Peter Godwin, 'Mukiwa a white boy in Africa' really Zimbabwe. It’s a great book for us to read here lent to us by Michael Breen.
For me, Judy’s week back in England to see our new grand daughter Celina born just before we left for our year in Zambia and who is now just three months old, started slowly and it was good for me to get used to it. At least there was release from playing canasta every evening! However, and don’t tell Judy, I think I’m missing it??

A boy’s night out!

On Thursday I met the “boys” for a drink and a meal at Nzango Gardens, which is one of the best eating places in Monze. The boys are regular customers of the Gardens. Crispin works for World Wildlife Fund and lives intermittently in the single story house behind us as a part of our small three-housed walled compound. His wife works for the UN and lives with their three children and a nanny in Lusaka and comes to stay in Monze for the occasional weekend. Perry is single and the eldest son of the very large Cornhill family, who have much land and many farms around here. Kitty is a 40+ Zambian born Indian who has a transport business carrying, for example coke (the fuel variety not to drink or sniff) from Zimbabwe to the Congo. They finished off at least one bottle of whisky between them. I stuck to Mosis (Zambian beer) and only succumbed at the end of the evening. Nzango Gardens is always very poorly lit so as well as the usual difficulty I have in understanding their English I couldn’t see their darkened faces and didn’t catch their names which had to be sorted out later. The conversation was also difficult but Perry, who spent some time in England at public school on the Welsh borders was a keen soccer fan (supported Tottenham Hotspur can you believe?) and rugby so we had a very animated talk about that and whether soccer was a more skillful game than rugby! However the food was good, T-bone steak, nshima (mashed maize) spicy sauces and very little if any vegetables. They also invited me to a barbeque on Saturday at Kitty’s “workshop” which I thought must be just a rural barn perhaps with a few animals wandering around and a few haystacks just north of the Golden Pillow. I was much mistaken, but more of that later.

I went for swims on Saturday and Sunday at 16.00 hrs at Moorings' pool. This is surrounded by palm trees and jacaranda and is very peaceful apart from the noise of the guard dogs and cockerels. We always go for a drink afterwards at the campsite bar, which is idyllic! I always have one Mosi and Michael Breen one ginger beer. He never drinks alcohol, in contrast to the manager of the campsite, Dave, who drinks long whiskies with ice and water, only interspersed by taking long draws on a cigarette. His head is shrouded in smoke after each exhaling. Occasionally the young Zambian employees come up and sit on the concrete platform as we sit on our chairs to discuss their work. He deals with them very firmly in a gruff manor but criticizes them in a teasing way usually about money and they go away chastised but laughing. He has good eye contact with them but less with us, chatting about when to set the seed and maize for the growing season, critical to its yield, while peering, unsmilingly out into the paradise of trees grass and brightly coloured flowers beyond the veranda. For us it is extremely relaxing.

Saturday 13th December. “The workshop barbeque”.

Kitty picked me up at 20.30hrs in his very large 4WD vehicle, which coped well with the speedy 30mph exit from the police camp, the name of the area we live in on deeply rutted sandy tracks. Five minutes later we pulled up to some very large locked and battered high iron corrugated double gates and within seconds of sounding his car horn a tall slim Zambian (I will call him John) opened the gates making their characteristic deep loud reverberating drum like roll.

We drove into a secure fenced 2-acre site with a large 20 foot high covered workshop at one corner. There were offices down one side of the structure open on the other three. It had a grey concrete base half covered with parked trucks, one very long one stacked with bags of coke for the Congo. Most of the rest of the 2 acre site area was filled with broken down trucks and other heavy vehicles needing repair. At the edge of one side of the covered area a flat brazier lit by strip lighting was intermittently attended by John who emerged on Kitty’s bidding from the deep shadows in the otherwise completely darkened compound. The “work shop” was just that and not specially designed for late night entertaining although all attending seemed to think it was an appropriate place for a Saturday night barbeque.

Standing by the brazier was Marina, Kitty’s friend and neighbour who frequently gave deep loud chuckles. The only other person present at the start was Deepak, another Indian who was very quiet but I think, had prepared the marinated chicken and salad that we were to eat. As the evening wore on there were further arrivals all let in by John who emerged from the surrounding darkness at running pace to the sound of a car horn. Perry, still in a suit from a wedding, another Zambian and his tall elegant Angolan wife, another Indian whose family was in England, and two younger Indian women one of whom we had seen in the local Indian “supermarket”. Her small boy seemed somewhat bored by the whole evening and didn’t really know what to do with himself. The saving grace was his hand held computer.

Distracting himself with computer games the same the world over for the richer kids

The music came from the 4WD I arrived in which was left with all its doors open so we could hear the music which was mostly western pop. The chicken was very spicy, hot and delicious. There were one or two plastic chairs on which the women eventually sat. The conversation was mostly about the difficulties in the local area and quite a lot about corruption, which seems deeply embedded in almost all activities. It is probably an integral part of any very poor society and can destroy all traces of trust in almost any situation. Perry was supportive of Mugabe and feels he has had a bad press from England!

Kitty continued to cook layer after layer of chicken, the local supermarket manager brought some bread rolls and very long thin sausages which respectively were toasted and grilled and between us including John and some rather scraggy timid well nippled dogs who also intermittently emerged from the outer surrounding darkness onto the strip lighted covered concrete platform managed to make sure that neither a tender morsel nor a chicken bone was left. I was taken home at midnight and I gently refused an invitation to go with Perry and a friend to the club at the back of Tooters fast food restaurant, of which I would suspect most respectable residents of Monze were completely unaware. Perry and his friend assured me I would find very good company there!

3 days to Judy’s return on Tuesday

A lot of my spare time this weekend has been spent doing the washing and ironing which I have enjoyed. I took full advantage of the electricity and water, both on, and took a chance with the weather and was lucky although it required one or two dashes to save the washing from the rain. Anyway the house is as clean as it gets and there isn’t a dirty sock, shirt, sheet or towel in the house. Overall it was good drying weather.

My 30-minute jogs on Sunday mornings get easier and my knees now don’t play up at all. The skin over my knees has healed after being caught and tripped up by three dogs 2 weeks ago. The dogs didn’t appear today!
I wondered whether the jogs are easier because of all the gentle exercise we do walking or perhaps I’ve just adapted to the 3,000 feet and it is much cooler with the great increase in cloud cover. We sometimes walk 6 miles per day when we go up to the Golden Pillow for the Internet. I jog under trees providing deep shade lining an avenue to the golf course, which I’m sure has seen better times.The road has tarmac and a line of high stooping gently leaning but elegant poles with lights that probably haven’t worked since independence in 1964. This is probably where all the Europeans lived in colonial times and where the Italian Bishop lives now. At this time of the year the roadside is littered with the stones from mangos still partly covered by the bright yellow fruit, which when I try to eat, irritatingly leaves fibrous strands between all your teeth. You rarely see a child not eating one now. They must be a great treat for hungry kids and are so easily available from trees which grow everywhere in great numbers. On the golf course side of the road the locals have built up the soil in a series of longitudinal ridges to grow potatoes. I’m sure this never happened in colonial times when the houses opposite the golf course with names like Fairview were occupied by the colonial masters.

On the jog I also saw two classic African/Zambian scenes. One an old man wearing a smart black suit and huge smile perched on the carrier over the back wheel of a bike, both legs out front to clear the ground, holding a motionless live chicken by its wings in one hand and a cheap bright plastic case held out in the other as if to balance himself and the chicken. The second was a tractor pulling an open trailer transporting khaki green uniformed prisoners to do some public works. They must have regarded me, a white haired old man jogging in skimpy shorts and shirt at 8 o’clock on a Sunday morning with equal incomprehension. They didn’t make any comment. We greeted each other with stares and silence.


One bit of bad news is that Andrew Moulson, a GP and Gabby his wife assigned by VSO to St Francis Hospital near Katete, who we have mentioned in previous blogs, have gone back to the UK because they did not get on with the surgeon and administration running the hospital. It is a great shame and surprise as, if anything, they were more determined and excited about doing 2 years than we were, and they had previously worked at the same hospital many years ago when they had a young family.

Clinical Work

Clinical work for M remains interesting but not much of it. The 10-month-old baby with pyloric stenosis went home and somehow they got some money for a taxi to avoid the 5-hour walk. Mum and baby were very happy.

My right hemicolectomy went home in 5 days not quite up to the standards of an enhanced recovery programme and I did an 18cm diameter retroperitoneal tumour in a 23-year-old HIV positive woman. The only work up she had for this easily palpable tumour was an IVP, which showed the ureter draped around it. It also had the external iliac vein and artery stretched over it. Fortunately it shelled out relatively easily and was either a liposarcoma or a lipoma.

She is recovering quickly. Almost the only other surgery I do are on patients with piles and fistulae most of whom are HIV positive and hernias and persistent processus vaginalises in young boys.

Judy makes it back safely 16/12/08.

I arrived back safely, with no problems getting my two heavy suitcases filled with medical equipment on the plane. I was within two kilos of the forty-six kilogram allowance for the flight. I was fortunate with my trip back to Monze with all of it. First of all there was a taxi ride to the very hectic and African bus station in Lusaka.

Michael had said, “find a friendly taxi driver you can trust”. Well, they were all friendly – but as for the rest! The asking price for the 30 minute journey was expensive at K150,000 (£21) but I explained I was a resident volunteer doctor working in a rural hospital and the price was reduced to K100,000 (£14). In actual fact that did only leave me just enough for the bus fare and possibly a taxi in Monze. At the bus station I boarded a down market Zamsef bus to Monze, a three-hour journey for K65,000 (nearly £10). Otherwise I would have had to wait another hour or two for our usual bus, Mazhandu’s Family Service. I was met by Michael at the Golden Pillow, the bus station just a half a mile outside Monze, which also has a hotel (of internet fame).

We shared a very tasty chicken pie with a bag of chips and red sauce, at the Golden Pillow’s fast food emporium, an extension of Tooters’ Centre of Entertainment in town, and then were able to use the motel internet to book our holiday in Livingstone. We have booked with Tongbezi for three days over the New Year in a thatched cottage by the side of the river Zambezi; it is very expensive but includes all food which is said to be excellent, river trips to see the sun rise and set and canoeing up the river! It will be our Xmas present to each other and will include the trip to Livingstone Island and a swim in the Devil’s Pool I mentioned in Blog 6.

Well J’s asleep on the settee at 20.30 after her big adventure. She has nearly un-packed, the lens filters are on my camera and its time to finish this blog. Many thanks Emms!


So with the rattle of our corrugated iron gates in the wind its goodnight from me, and kamucaala kabotu (keep well) from both of us until the next blog.
(Kabotu pronounced ca, as in cat bot as in bottom and oo as in too. Tonga for good as well as other things!)

It will be quiet here with just Christmas Day as a holiday, and the majority of folk too poor to buy decorations or presents, even if there were shops selling them. We will miss family and friends greatly, but not the hectic run up to it all and the cold weather.

We wish you all a Very Happy Xmas and Healthy and Prosperous New Year.
(as much as that is possible).