Dr. Nat's Journal

As my time in Zambia draws to a close, I’m starting to feel an ache at the thought of leaving. I can’t imagine not being surrounded by the colour and vibrance of day-to-day African life anymore, and I can’t imagine not spending my days amongst everyone I have come to know and care about at St Francis Hospital.

The cultural anthropologist Margaret Mead said “Never doubt that a small group of thoughtful committed people can change the world. Indeed, it is the only thing that ever has.” Whilst the current bunch at St Francis Hospital may not have changed the world, her quote still resonates. Of late I have been stealing moments to look around me at work… and as we clear through a packed outpatient clinic or attend to a ward emergency with the smoothness of a well-oiled machine despite all the challenges of a rural African hospital, I wonder if there’s anything we couldn’t do as a team if we put our minds to it.

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I’ve always enjoyed learning a bit of the local lingo when I travel somewhere. A repertoire of ‘where’s the toilet?’, ‘that’s too expensive!’ and ‘no thank you’ are often good starting points.

However, moving to Zambia was different. There was an added pressure that I would be doing a lot more than bartering for trinkets in a marketplace, or trying to find a bathroom in a restaurant, I was going to be working as a doctor.

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Back in the UK, a doctor of my age and experience would tend not to be involved in many hospital management decisions. I have sat on committees during my school and university years, but the decisions we were making were about what charity we should raise money for, or where the end of year social should be held.

Here in Katete, with so few doctors, there is really no option other than getting involved in hospital management… and when I say involved, I don’t just mean showing up for a meeting or two…

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Even though I was apprehensive in October about wet season arriving, now the rains are drawing to a close, I feel saddened by the thought of returning to a dry and dusty Katete.

When I arrived, the land was parched and the dust muted everything to a shade of brown. Now, the world looks so vibrant. The sky is a deep blue, the trees and vegetation vivid green, and there are colourful flowers blooming everywhere. It feels dreamlike…

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Zambia is landlocked, and borders with 7 countries (DRC, Tanzania, Malawi, Mozambique, Zimbabwe, Namibia and Angola). See map.

I live in the Eastern province of Zambia, which means that Malawi and Mozambique are the most easily accessible. The Malawian border is only an hour from Katete. Having been in Katete for over 6 months now, we decided it was time to visit our closest neighbour.

So, a few weeks ago, we took our Land Cruiser onto Malawian soil to do a road trip as a farewell to two friends from St Francis Hospital, Geoff and Charlotte, who were returning to the UK from Lilongwe.

As with most land borders, as we crossed over the imaginary line into Malawi, although the terrain, temperature and vegetation were very similar on either side of the border, there were enough differences that made it obvious straightaway that we were in a new country.

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When I was packing for my move to rural Zambia, it was very difficult to know what to take. I didn’t know what I would be able to buy in Zambia, I didn’t know what my day-to-day life would be like or where I would be living… and how much do you need for a year? Friends would ask me questions like “will you have a fridge?” and “are there supermarkets near you?” I didn’t know the answers, and I was just guessing as I added belongings to my luggage.

Now, half way through my year in Katete, it is easy for me to look back and divide my packing into two groups: things I should have left behind, and things I can’t imagine being without.

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Given that Zambia’s average life expectancy is 52 years, and that 119 out of every 1000 babies born here are not expected to live beyond 5 years of age, I knew that I was going to have to face a lot of unwell and dying patients out here in Zambia… but as rainy season gets into full swing, and the anopheles mosquitoes come out in full force, the numbers of deaths climb to new highs.

In malaria endemic areas such as Zambia, most people who reach adulthood have developed a partial immunity to malaria; reducing the risk that malaria infection will cause severe disease. Children on the other hand are still developing this partial immunity, leaving them vulnerable to malaria.

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HIV/AIDS tends to be the first disease that springs to mind when thinking about Africa. However, on speaking to an infectious disease consultant in July 2012 for some last minute clinical advice before my big move to Zambia, it was Tuberculosis (TB) that dominated the conversation.

After I finished picking his brain about some of the things I might encounter in Zambia, his exact words were “you do know what the biggest threat to you is out there?” to which I quietly mumbled the correct answer: “TB…”

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I welcomed in 2013 on a sand dune in Namibia. It was my first time to Namibia, and my first New Year on a sand dune. It was also the first time I had spent more than four days away from St Francis Hospital since my arrival in August.

Having left behind the hot and steamy rainy season in Zambia, it was a huge contrast to arrive in the parched Namib Desert. Temperatures soared to over 40 degrees with almost zero humidity and clear blue skies.

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Christmas has always been one of my favourite times of year. I have spent many festive seasons in hot climates as well as cold, and have always managed to get into the Christmas spirit whatever the weather. However, this year, in Zambia, it’s taking a bit more effort than usual to create that Christmas vibe.

The weather does obviously play a part… blue skies and blazing sunshine don’t often feature on Christmas greeting cards. However, I think it’s that Christmas can’t get under your skin here the way it does back home, where the radio blasts out Christmas tunes from October onwards and the department stores open the Christmas section at the end of the summer! Visiting the supermarket to find aisles stacked with mince pies, Christmas puds and mulled wine helps too.

Well, here in Katete, we don’t own a radio, we don’t have any large shops, the supermarket is over one hour away and none of the Katete shops have heard of mince pies!

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