Life Medical Zambia

The Good, the Bad and the Ugly

Il buono, il brutto, il cattivo – starring Clint Eastwood, Lee Van Cleef, and Eli Wallach

Working today at Kakumbi Rural Health Centre wasn’t really like being in a Spaghetti Western. The variety of clinical conditions cause me to feel joy, sadness, anger and despair, but this would not have been such a good title.

Not a pretty scar, but at least the ulcer has healed

The Good. I have written about this little girl with sickle cell disease in the past. She had a nasty ulcer on her thigh which stubbornly refused to heal until we started daily wound toilet and dressing. Slowly, it began to heal. She stopped screaming when she saw a nurse or doctor because she could see how the ulcer was responding and she became my friend. I hadn’t seen her for a month or so, but she turned up today to get her monthly supply of folic acid (to help produce replacement red blood cells), penicillin tablets (to stave off infection) and anti-malarial prophylaxis (patients with sickle cell disease are prone to more severe attacks of malaria). Sadly, we have run out of folic acid (even for the first trimester in pregnant women), stocks of penicillin have been exhausted and we have never stocked Maloprim. She ate her breakfast while waiting for the pharmacist to tell her we had no drugs to give her and smiled at the camera. Isn’t she beautiful?

Deep wound from hippopotamus bite, healing slowly but well.
Peek-a-boo behind the bushes, a hippo out of water.

The Bad. This man was bitten by a hippopotamus three weeks ago. Bad because he was acting badly when he was attacked by the hippo. He is a very lucky man; most hippo bites are fatal. The wound was debrided and allowed to heal from underneath (by “secondary intention”). This needs a bit more tidying up and he will have an impressive scar, but he has lived to tell the tale.

Crocodile bite. Shiny, tight skin. The calf is full of pus in the deep tissues.

The Ugly. Late yesterday afternoon, a man was fishing in Kapani Lagoon. He had probably bought “muti” from a sangoma – a magic potion which allegedly prevents crocodile attacks. It didn’t work in his case. He was bitten on the left leg and came to the health centre after normal working hours. Unfortunately, the nurse on duty sutured the main gashes and prescribed antibiotics which were not available.

Crocodile bite – thigh. Deep wounds, sutured in error, now with necrotic muscle visible in the base.

Twelve hours later, he could not walk and had to be carried into the health centre. My colleague, the clinical officer who doesn’t like pus, asked me to sort him out. His leg was swollen and the skin was shiny and tight. The sutures needed to be removed. We have no scissors, so I had to do this with a pair of forceps and a scalpel blade. As soon as I snipped the first stitch, there was a mosi oa tunya (Victoria Falls) of putrid, orange-brown pus which burst from the wound. It stank so much I gagged. It reeked of rotting fish. Crocodile oral secretions are renowned for harbouring multiple pathogenic bacteria. I have never smelled a croc’s breath, but the pus probably smelled like crocodile halitosis.

The second wound I opened up had a different odour, sweet, sickly and fetid. The pus was watery and had bubbles in it. Looking deep into the wound, I could see the muscle had turned brown and black in parts. This is wet/gas gangrene, clostridial myonecrosis (dead muscle). This patient needed urgent surgical debridement, cutting away all the dead, infected tissue. Without a general anaesthetic, this is beyond my skill level. I knew that funds were really tight in the district and there was very little diesel left in store. We begged for an ambulance and were rewarded. I hope that I see him again before I leave and that his leg has been saved.

Because I am morbidly curious, I asked him how big the crocodile was. Like any fisherman, he extended his arms about a metre apart. “That small croc did a lot of damage,” I said. He replied, “No doc, that was the size of its head!”

Medical Zambia

Thursday Doors gets energised

The official invoices from this shop can’t fit the whole title on the form. It is abbreviated to the worrying “FAITH KILLS” – without the misplaced apostrophe

Here is a dody photograph of the door to an upmarket department store in rural Zambia. Upmarket refers to the location, just up from the market. Department means it sells everything.

This fine door has been made in the village. A bargain for US $50. Perhaps the bottom needs to be levelled off a bit, no extra charge

In a recent report from Reuters reported in The Guardian, sildenafil or Viagra, as it is more commonly known, has been added to energy drinks in Zambia. I am not surprised that a drink called “Power Natural High Energy Drink SX” was adulterated with Viagra; the name says it all really. However, given the high price of Viagra, I’d hazard a guess that only minute amounts were used to spike the energy drink. The manufacturers exported the drink to neighbouring countries. 

The article says that the Uganda National Drug Authority had found Viagra in the drink following a complaint by a customer who suffered a six hour long erection accompanied by constant sweating. In the British National Formulary, priapism (prolonged erection) is a very rare side effect of sildenafil. I have prescribed the drug to hundreds of patients and have never seen or known of a case. Night sweats do occur (independent of vigorous nocturnal activity), but again this is not common. So I found it surprising that the Ugandan authorities went ahead and analysed the energy drink following just one complaint. Perhaps scores of other Ugandan men were not complaining. After all, Private Eye used the term “Ugandan discussions” as a euphemism for sexual intercourse.

Sildenafil is a prescription only drug in Zambia, although it can be bought over the counter in the UK without a doctor’s authority. In practice, the drug is on sale in a variety of forms in our local pharmacy. I give out private prescriptions for men who are “lacking power” which the pharmacist fills. Honest, who works at the pharmacy, tells me it is very popular and he had never had any complaints. But how many men are going to come back to complain that the drug didn’t work?

Looking at the provenance of these sildenafil preparations, I am not convinced that they contain much of the genuine article. But there is often a large psychological component in erectile dysfunction, so a costly drug recommended by the muzungu doctor will have a significant placebo effect.

It’s a pity that Power Natural High Energy Drink SX has been taken off the market. I would have been advising patients to try this cheaper option first before buying the drug.

This preparation can only be prescribed by a urologist, endocrinologist, psychiatrist, dermatologist or STI specialist – that covers me in three of the above categories!

Radio News

After just two months, I have now managed to master the controls of the radio in my car. The instructions are written in Japanese script, which complicates matters. There is just one radio station, 88.3FM Mnkanya Radio Mfuwe. It plays a wide variety of music, including Country & Western, sloppy ballads, reggae, hip-hop, Afrobeat, gospel and Western pop.

The disc jockeys invariably talk over the beginning of each track, but often with their microphone set too low, so you cannot hear what they are saying when the music goes quiet. They have phone-in sessions, but I have never heard a conversation take place without the caller being cut off or giving up. This morning a wife was making a plea to all married women to prepare a bowl of warm water for their man to wash himself when he gets up, instead of being lazy and letting him use a cup and a bucket of cold water. Both male health workers and the female HIV counsellor in the vehicle agreed wholeheartedly with this sentiment.

House husband who warms his wife’s washing water each morning

We had a house-husband at the clinic this morning and I asked him if he prepared a bowl of warm water for his wife to wash in the morning, and he wholeheartedly concurred.

The commercials are all in Kunda or Cinyanja local languages. One general store tries to cram in all the items it has for sale during the 60 second advert. The listing is rushed and random: rainboots, inverters, baby blankets, schoolpens, food warmers, batteries, track suit tops and down. It ends by saying, “And Jamakani General Dealers is very, very.” Which makes perfect sense to Zambians.

The advert for the local minimart “Mayana”, lists all the meat cuts in English, with an “y” on the end. “Steak-y” and “T boney”, for example.

NIKE slogan in Zambia – “JUSTY DO IT”

The news should be at noon, but today it was five minutes late. I was surprised when Betty the newsreader apologised for the delay. Five minutes late is neither here nor there in Zambia. There is usually a human interest story in the headlines. A few days ago, a wife was arrested because she beat up her husband when she discovered he was sleeping with her best friend. Another woman was arrested because she had thrown her child into the fire for eating the sauce which accompanies maize porridge (N’shima) without asking permission.

I find it difficult to understand when the newsreaders are just talking the words, often mispronouncing them, and using no natural pauses or phrasing.

PS I enjoy seeing the messages plastered across vehicle windscreens. One of my favourites is “God is in control”, even if the driver doesn’t seem to be. I liked “Paradise” on one bush taxi. And best of all was a broken down truck bearing the message “Living the Nightmare”.