“The most we can do is to write — intelligently, creatively, critically, evocatively — about what it is like living in the world at this time.” Oliver Sacks. “To take a photograph is to align the head, the eye and the heart,” Henri Cartier-Bresson
Jester – I am not sure if this is meant to be Chester, or Jester. Maybe the parents are fans of Top Gun.
Hunky – The baby was not particularly big, just over 3kg at birth. And is growing normally. I wonder if the parents are fans of Marvel Superheroes and the Incredible Hunk. Or perhaps they see him growing up to be a bodybuilder.
Donoraold – This is how it was spelled. But Zambians have trouble with “R” and “L” consonants, often mixing them up. It is clear that this is Donald, as in Trump.
Arthur Chizzy – Arthur is a fine name, but partnered with Chizzy makes it sound like a spiv.
Ebeneziah – I called out for the next patient, “Ebenezer Zulu?” and a young lady came forward. “No, I called for a man, Ebenezer,” I said. “This is my book,” she said, “My name is Ebeneziah.” Okay, I am all for inventing new names, updating the Biblical classics, such as Jehosophat and Isiaiah. But who wants to be called Ebeneziah?
Gudlak – At first it sounded Norwegian, but then it became obvious as I said it.
Proud and Praise – Twins, P and P. Alliteration.
Prince and Princess – Twins, but premature and not doing very well at present.
Prince and Prosper – Twins, P and P again. I reckon that they have found inspiration from Jane Austen.
Destiny – Ambitious
Sagacious – and I have met a Wisdom, too.
Golden – I have heard of an American football player called Golden Tate
Marvellous – But of course.
Bottle – This man told me that his previous two siblings had died in infancy, so he was given the name Bottle as his life was going to be poured out soon. He was in his 40s now. I recall another lady from Swaziland who had a similar tragic family, with nine children not surviving to adolescence. She was called (in siSwati) “Sorry going to die soon”. She was over 50.
Fatness – Delicious, no issues of body image here in Zambia
Loveness – I asked the health inspector what he would do if he had been called Loveness as a child. He said he would change his name to Derrick. Which is what it is now.
It was A’s idea. “It sounds like you’ve been doing
great work vaccinating in the schools. Why don’t you get the message out there,
blow your own trumpet?” And what better way to do it than getting on local
Mnkanya Radio 88.3FM is our local Mfuwe station. It is situated half way between the national park gate and the airport. There is a cluster of modern huts on one side of the compound (the owner is trying to start up a lodge business as well), a reception and a recording studio. Towering above is a red and white radio mast. They mainly play music from Zambia, South Africa, Zimbabwe, Nigeria and the USA. Although they broadcast the news in English several times a day, the disk jockeys and station announcers speak in local dialects. Their Facebook page is a bit sparse but contains some news items such as
“ “police in kabwe has gun down two criminals de other one has died at de spot and de body dead has taken to de mochary in kabwe hospital while de other one z at kabwe central police wth severe injuries this has happend wen two criminals broke into acertain shop wen security officer phonnd de police without delayment and de police dd according to their works thus was around 24hrs on 20th january 2019”
At the clinic, I discussed the need to publicise our work in
the community, to explain to parents exactly why we were vaccinating their
children in schools. Mr C, the public health inspector in charge of community
programmes, thought it was an excellent idea to use radio to do this. But he
thought that the radio station would charge us as they charge advertisers. I
insisted that this was a public service, the public had the right to know, and
there was hardly any decent local news to broadcast. C wasn’t convinced.
He brought up the subject at the next clinic meeting. The nursing officer in charge agreed it was a good idea, but only if it didn’t cost anything, because the clinic could not afford to advertise. We agreed that once C had finished compiling the vaccination report, we would pay a visit to Mnkanya Radio in Mfuwe.
Armed with the figures, we decided to drop in unannounced. If we had written a letter or email, it may have gone unanswered or we might even have been rebuffed. During the short drive to the station, I discussed strategy with the health inspector – key points, short sentences, snappy answers. I spoke about the ABC technique with tricky questions – Acknowledge the question (answer it if it is easy), Bridge to your safe ground, the area where you want to answer questions, and Communicate your key messages.
C wasn’t convinced. He was so worried that the radio station
would want to charge us that he wasn’t listening to my advice. “You have
done this before, doc,” he said, “You can represent the clinic.”
We drove into the compound and walked to reception. The
small building was empty. A gardener noticed us and alerted one of the
reporters. He took us over to the recording studio where they were broadcasting
“What do you want?” the reporter asked.
Mr C looked to me and I motioned for him to answer the
question. He rambled on for a few minutes, using jargon (“TT” instead
of vaccination against tetanus, a disease which can kill adults as well as
young babies) and getting rather muddled. It is common for Zambians to pad out
their English with bland phrases while they search for the right word.
I could see the reporter was looking less than impressed. Mr
C turned to me and said, “Doc?” I emphasised that this was a good
local news story; many families with school aged children would be interested;
we had vaccinated 1,205 school children during February; the immunisation
coverage rate was better than in the UK. The punch line was that we will be
returning to the schools in March to give booster doses.
The reporter got out his iPhone ready to record an interview. I said, “It wouldn’t be right for a muzungu to talk in English to your listeners. The Zambian health workers and volunteers are responsible for this work and they should speak in Kunda or Cinyanja.” He agreed and pointed the iPhone microphone towards Mr C, who suddenly looked terrified.
“Can you give us a minute?” I asked. The reporter went inside, while I discussed interview technique with Mr C. “Martial your facts, speak in short sentences, don’t use jargon, tell them what a great job we have done,” I said. “You can do it!”
The interview was very short, less than five minutes, but for Mr C it seemed like it was half an hour. The reporter blindsided him with a question about the vaccination schedule for schools in March. We didn’t have the vaccine in stock and there were some public holidays just to complicate matters. But Mr C went through his papers and eventually came up with a schedule for the listeners. “I will edit that last piece,” said the reporter, kindly.
Just before we left, I asked the reporter if he was
interested in any local health stories. He told us that he was always on the
lookout for anything that would get more listeners. On the way back to the
clinic, Mr C was enthusiastic. “We could do plays with health messages…
we could warn people about malaria… we might get a regular health spot,”
“That will be a great deal of additional work, Mr
C,” I told him.”You are already working flat out. And remember,
actions speak louder than words. This is only newsworthy because it has been
such a success.”
“Ah, you are right, doc!” he replied.
When we got back to the clinic, Mr C made sure everyone knew
that he would be on the midday news, and the afternoon news, and the evening
news, and the late night news. Perhaps even tomorrow morning’s early news. He
was a radio celebrity now.
Dusk in South Luangwa National Park. It had just started to rain and visibility from the safari vehicle was limited. The spotter’s searchlight picked up something in the middle of the laterite road. We had been flushing nightjars along the road, but this was different. At first, I couldn’t see it because it was facing away from us. It turned and gazed at the intruders who had interrupted its hunt.
Spotted eagle owls are infrequent visitors to the park, but are widespread over southern Africa. It is easily recognised by its small size (for an eagle owl) and the horns on each side of its head (which are composed of feathers).
This bird is a night owl, hunting by sight for rodents, lizards, insects, small snakes and birds. Usually, they perch on a favourite bough above a popular thoroughfare, but this one was in the middle of the road, searching for prey at ground level. Once they pounce, they devour their food quickly, gulping it down in one, rather than tearing it apart.
When you see one, there is often a mate close by. Like many
birds, they mate for life. They nest on the ground, under cover of a bush,
rather than in a tree.
The bird flew off and we moved forward slowly. It then landed closer to the vehicle but the spotter’s light startled it and it took off again, hiding in a leafy tree.
Compare this bird with the Verreaux’s Giant Eagle Owl, that I photographed in the car park of the lodge at the end of the game drive. The pink “eye shadow” on the upper eyelid makes me smile every time I see it, as if this bird is not glamorous enough without “makeup”.
In Zambia, eagle owls are regarded with suspicion. They are widely believed to be involved with witchcraft and black magic. Harry Potter understands this very well, of course.
Just before dawn at 5:30am, he was emptying the ashes from
last night’s campfire into the pit latrine when he felt a sharp pain in his
foot. He looked down to see a small snake rearing up ready to strike a second
time. When he saw the hooded neck, he knew it was a cobra. He retreated quickly
and the snake slithered off into the bush. There was no thought of revenge, no
need to kill the snake for identification purposes. There were two small
puncture wounds on the outer border of his little toe.
I didn’t get word of this until 7:30am when I was en route
to Mambwe to see the District Medical Officer. My appointment was for 8am and
it had already been cancelled once so I opted not to turn around. The nurse in
charge at Kakumbi is very senior and no doubt had managed many snake bites in
the past. I alerted him by SMS that the patient would be arriving by boat from
a bushcamp at about 8:45am.
I instructed the camp manager to get some polyvalent (it counteracts
envenomation from the most common snakes in the region) antivenin from the
medical refrigerator in my house and bring it to the clinic in a cold bag.
The important thing to do in these situations is for both
the patient and health care worker not to panic. Gone are the days of slicing
into the fang marks and sucking out the poison; the patient is likely to get a
nasty infection and it has no effect of the outcome. Tourniquets are only
useful if you know that the venom is neurotoxic, to stop the spread of the
poison around the body before the doctor can administer antivenin. Wash the
wound to remove any venom on the surface, then keep calm and rest is the
At Mambwe District Health Office I met our former pharmacist
from Kakumbi. “Does Kamoto Hospital have any antivenin?” I asked him.
He said no, while remarking that they had had more snake bites than usual this
I received a text that the patient had arrived and discussed
the management plan with the nurse in charge. He set up an intravenous infusion
which we would need if we were to give antivenin, gave the patient some
diclofenac anti-inflammatory pain killer, a tetanus toxoid booster and insisted
on complete bed rest. The initial observations were encouraging and I felt I
didn’t need to rush back to the clinic.
About half of snake bites are “dry” and don’t contain significant amounts of venom. The snake is just protecting itself; it is not planning to eat the person it has bitten. In my patient’s favour were the following factors – he was a 70kg man and the snake was small, less than a metre in length; the bite was on the foot, rather than the head or neck; he received prompt first aid.
I have written about snakebites in Swaziland in my blog in the past if you want to learn more, click here. In simple terms, venom from vipers causes local pain, swelling and necrosis around the bite and venom from cobras is a nerve toxin which causes paralysis. We were closely observing the patient on the lookout for signs of paralysis which can begin upto five hours after the bite.
The decision to start antivenin is tricky. Ideally, the best results are when antivenin is administered soon after the bite, but it may not be needed and there is a high likelihood of the patient developing anaphylactic shock and dying. Some experts give adrenaline before the antivenin. We didn’t have any adrenaline at the clinic. The antivenin that the camp boss brought to the clinic was past its expiry date, so I told the nurse in charge that it would be my decision whether we used it or not, not his. He gave some hydrocortisone instead.
As an aside, what would you rather have if your life was at risk from envenomation – antivenin which was out of date (and possibly less potent as a result) or no antivenin at all? I’d go for the expired stuff, personally, evn though my safari supply of adrenaline was also out of date.
When I got back to the clinic, I reviewed him. His blood pressure and pulse were stable, his pain was controlled and the bite site was not swollen. He was hungry and had eaten a late breakfast (patients with significant neurological damage cannot swallow or open their mouths). His breathing was relaxed and not laboured. An early sign is drooping eyelids, but his eyes were normal. This leads on to respiratory arrest and I would have had to intubate and hand ventilate the patient until we could get him to an intensive care unit, probably at Chipata Hospital a few hours away.
When I left the clinic at 1pm, there was no change in his
condition and he had passed the critical five hour period where “cobra
syndrome” can occur. I felt he should remain on the ward for at least 12
hours, possibly staying overnight, just to be on the safe side.
I was surprised when I opened the cold box containing the antivenin when I returned home. The camp boss had just brought one vial. Sometimes it can take ten vials to control mamba or cobra envenomation. I discovered that the fridge sorely needed defrosting and now I know exactly where to find adrenaline for injection. Even if it is expired.
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.
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.
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).
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.
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.
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.
I have a love/hate relationship with air travel. Despite being a seasoned traveller, I still feel uneasy and anxious. Despite using a checklist, I wonder what essential item I have failed to pack. I try to give myself enough time to get to the airport, but there’s always the possibility of a crash on the motorway or the vehicle breaking down. Then there’s the wait at check-in. Does my luggage weigh less than the permitted maximum? What heavy items can I take out at the last minute to stuff into my pockets (this makes going through security even more tiresome)?
I managed to leave my home in a reasonable state,
refrigerator emptied, central heating set to deal with a cold spell, bed linen
washed and dried, personal video recorder primed to record Les Mis for when I
get home, all electrical appliances unplugged. The bus was on time, but most
seats were occupied. We arrived at Heathrow on time and I breezed through check
in. Security checked my hand baggage as I had left my Kindle in the rucksack,
but the officers smiled benignly and waved me through. I had a sample of whisky
in the duty free – White Walker (Johnnie, of course) – to reward myself, before
going to the gate. Why does everyone rise up and queue as soon as the
stewardess announces that boarding will start with passengers needing
assistance or travelling with children?
The flight was full and there were no aisle or window seats
available. A Kenyan lady was sitting in my place, oblivious to her allocated
seat. She moved to another seat, and had to move again. I sent my final SMS
messages and shut down my cell phone. Why do the touch panels on the
back-of-the-seat entertainment system always fail to respond to your first
deliberate touch? I selected a film which I hadn’t seen and must have nodded
off for a few minutes because I cannot remember anything about it.
I don’t mind airline food. It is not cordon bleu but it
fills the gap and gives you something to do (eat) during the flight. We touched
down at Nairobi a few minutes early and I settled down in the transit lounge
waiting for my connection to Lusaka while the sun rose. I took advantage of the
free internet to send more messages before we were called.
On board, I couldn’t resist a secret smile when two
traditionally-built African ladies tried to squash past each other in the
aisle. Even they found it funny. En route, I could see the summit of
Kilimanjaro poking above the clouds. We landed in Lusaka and I took my time as
I had seven hours to kill before my flight to Mfuwe. I was last in the queue
for immigration and noticed that the officer had a problem with his arm. I
remarked on this and we had a mini-consultation while he wrote out the receipt
for my 30 day business visa. My luggage was ready for me and I breezed through
There is a new Chinese-built airport a few hundred metres
away from Kenneth Kaunda International Airport, ready to open in late 2019. The
old airport is rather cramped with few places to sit and wait. I managed to
offload my bags at the Proflight office (the boss had pity on me). I wandered
around, chatted with some South African businessmen, sympathised with an
elderly lady whose visitor did not turn up, watched some planes taking off and
landing, had some lunch, read some material I had downloaded onto my phone and
sat staring into space, nodding off with fatigue.
Finally, our flight was called and I was relieved to find
that my luggage weighed almost exactly 30kg, meaning I didn’t have to pay
excess baggage. I accepted the offer of a window seat and someone impatiently
pushed in front of me. After I went through security to the gate, I thought it
was strange that I wasn’t given a boarding card. I went back to check in and
the receptionist told me that she had given my boarding pass to another
passenger, but it would be ok as she would fix it for me. And I believed her.
Meanwhile, there was a minor incident at security when a man
tried to take a cow shin bone onto the plane in his hand luggage. The lady
checking the x-rays of the luggage must have been rather shocked to see it on
the screen. The bone was huge, plastic-wrapped and had a prominent label from a
pet shop. He had brought it in his hold luggage from Namibia, but had
transferred it to his carry-on luggage to avoid excess baggage charges on the
local flight. Bad choice.
“What is this? Is it from a wild animal?” she
“No, it’s just a bone for the dog, a gift for him as we
have left him at home for two weeks while we were on holiday,” he replied.
This raised several cultural issues for the security
officer. “You bought a gift for your dog?” she asked. “What will
the dog do with this gift?”
“He’ll probably chew it for a few hours then bury it in
the garden,” he said.
Her eyebrows arched even higher in disbelief. “It is
not permitted to bring animal parts onto a flight,” she said. The
passenger objected to the bone being confiscated and appealed to me to provide
a rational explanation.
“It is securely wrapped and unlikely to be a health
hazard,” I ventured.
“I will check precisely the wording of the law,”
said the security officer. “This might involve a prison sentence.”
Immediately, the man apologised and abandoned the bone.
“It only cost 70 rand, I don’t want to go to a cell for that!”
Meanwhile, the manager of a safari lodge managed to bring a box of machine tools on board, saying that there were no sharp bits inside. This made me wonder if the official might have thought the cow bone could have been used as an offensive weapon by a terrorist. But it wasn’t exactly the jaw bone of an ass.
The flight for Mfuwe was called and I approached the
receptionist who had given my boarding pass to an African man. She saw my face
and it dawned on her that he had already passed through. She called him back
and switched the passes. He clearly hadn’t read the pass, and neither had she.
We touched down in Mfuwe an hour later. The warm, fetid air
oozed onto the plane. The sun was setting behind the clouds and it looked like
it might rain again soon. The grass beside the runway was dazzling, emerald
green. I felt the joy of arriving at a place I loved. This was the pleasure of
travel – arriving safely.