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!”


In the park again

I had the afternoon free to visit South Luangwa National Park today. The Zambian Wildlife Authority guards on the gate were glad to see me again and we had a long chat about what has flown under the bridge since we last met. But the Luangwa River is extremely full flowing under the bridge into the park. It is almost overflowing. This has been the first “proper” rainy season for ten years, with precipitation every couple of days.

Almost at the brim: the Luangwa River in flood, with rain over Nsefu

The rain makes the grass and leaves grow, so it is more difficult to see game and birds. But it is so incredibly beautiful that it is known as the “emerald” season. The main laterite roads are passable, but dirt tracks are treacherous. I don’t want to get stuck in the mud in the first week I am here. There were ominous rain clouds in the distance and it seemed likely that there would be a shower before the end of the day.

The roads do provide a dry way for some animals. Zebras prefer not to risk walking through swampy grassland for fear of crocodiles, so they trot along the road. Mating lions like to avoid soggy bottoms, and don’t care if the tourists are gawping at them. Actually, there are very few tourists. I only saw three other vehicles seeing animals in the park.

Hippo grazing in daylight – the grass is too lush to miss

First stop was fifty metres from the bridge, where a pair of hippos were grazing just down the bank of the road at the edge of the bush. They are often shy, but these two were just stuffing themselves with lush grass. The flow is so rapid in the Luangwa river that the hippos and crocs prefer to stay in lagoons. A kilometre further along the main road, the lagoon at Mfuwe Lodge was a carpet of green water hyacinths. I could just see the nostrils and eyes of another hippo as I was watching a Jacana (lily trotter).

Male Waterbuck
African Grey Hornbill

I spotted an African Grey Hornbill in a tree at the side of the road. There were the usual zebras, elephants, baboons, warthogs, waterbucks, impala and puku, but no giraffes. I heard a male woodland kingfisher perched on a dead branch, singing gloriously with his mate perching just below him. He was probably boasting about his new match to another male across the forest who was returning his call.

Muddy zebra
Zebra with red-billed oxpecker
Woodland Kingfishers
Long-tailed starling
Female impala, not to be confused with…
Female Puku
Lilac breasted roller

Although long-tailed starlings are very common, they are exceptionally beautiful with their iridescent plumage. I saw my first lilac-breasted roller, no doubt the first of many and an open-billed stork. The yellow-billed storks are ubiquitous at present. The white feathers on their backs develop a rosy tinge at this time of year.

Impala and elephant
Thunder and lightning, with moderate rainfall over the Park

Because of poor roads, I could not reach the oxbow lake, Luangwa Wafwa, which is one of my favourite places. I turned around and headed for Wa Milombe via Zebra Drive. I saw a group of pied kingfishers diving repeatedly at a roadside pool, as well as lots of antelope. Wa Milombe savannah plane is now a lake surrounded by swamp. To drive back to the main road, I had to negotiate a river crossing. I could see a young crocodile waiting in anticipation but it was raining heavily by now and I didn’t want to get my camera wet taking a decent photograph. This one will have to do.


Nairobi National Museum


I had to cross eight lanes of traffic to get to the Museum, but it was worth it. I had to sign in at the gatehouse, show my residence permit (I have diplomatic status, but not like Boris) twice and pay the US$6 fee. This got me into the museum and the snake park. Viewing the dinosaur in the gardens was free.


The main galleries are arranged around a central hall. This has an artistic pile of calabashes, a map of Kenya made from butterflies and a remarkable necklace made from feathers. On the ground floor, there is an exceptional collection of East African stuffed birds in glass cases. The note cards giving the name of the bird, its habitat and snippets of information have been typewritten. This makes the presentation look dated, but the exhibits are phenomenal. Look at all these different types of hornbill, for example (and I only photographed half of them). There are almost a thousand specimens on display.

I could have spent an hour scrutinising the birds, but I had to attend a meeting in the afternoon, which was the reason I was in Nairobi. Also on the ground floor, there was a collection of mammals and a fascinating exhibition displaying skulls of hominids found in the Rift Valley. The oldest human remains found at Baringo date from 7 million years. Kenya was the place where apes evolved into humans. I stopped to watch a flickering video loop showing how scientists investigated the surface of teeth of different hominids using a scanning electron microscope to find out what they had been eating.

On the gallery of the first floor was an exhibition of the life and paintings of Joy Adamson (“Born Free” the book describing how she reared Elsa, a lioness). These showed flowers, fish and fierce warriors from different tribes.

George and Joy Adamson – typical colonial picnic, with HP sauce and big cat

I enjoyed reading about how a traditional healer used goat’s horn to store herbal remedies, keeping all his paraphernalia in a satchel rather than a Gladstone bag.

There were glass cases containing children’s toys, masks and skeletons. A large part of the upper floor was occupied by an exhibition of the struggle for Kenyan independence, with photographs of the mau-mau commander, General China. The exhibits were quite outspoken, openly criticising corruption.

Finally, there were a couple of galleries devoted to modern art – colourful, a bit derivative, pleasant, but nothing I would want to have on my living room wall.

I walked down the hill to the snake park. It was looked a bit drab and needed some renovation, new snakeskin if you like. In glass cases built into the wall were black and green mambas, puff adders, spitting and non-spitting cobras. In the courtyard pit, a boomslang twisted around a sign which read, “Trespassers will be poisoned.” There was a massive African rock python in an open area and another which was housed in a shed. Its keeper brought it out to drape around the shoulders of brave tourists willing to pay a fee. Behind a fence of chicken wire were three Nile crocodiles, looking very bored.

On my way back to the entrance, I strolled through the botanical gardens. A group of workers clad in blue overalls were sprawled on the grass, sleeping in the weak winter sunshine. A park attendant walked past and threw a stick at one of the sleepers. He woke up, rubbed his eyes and went back to sleep.

There was an old, faded red postbox in the garden, overgrown with creepers. It didn’t look as though anyone would be making a collection from it.