Dr. Nat's Journal

Before arriving in Zambia, whenever anyone heard about my plans to move here to work in a hospital, the conversation would usually move onto the topic of HIV/AIDS.

Non-medics: “Is there a lot of AIDS there?” “Are you sure you want to go there with all that AIDS?” “Do be careful!”
Medics: “Are you taking PEP (post-exposure prophylaxis) with you?” “Don’t forget to double-glove!”

I worked at Ealing Hospital in Southall, London for 3 years, and I thought I had seen plenty of HIV/AIDS there. Since arriving in Zambia, I realize that prior to my arrival here, I knew almost nothing about HIV and the potential devastation it can bestow on a person if diagnosed late or not treated.

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To be a good wildlife photographer, you need to have a lot of patience. Patience for the animal to move into the position you want, or for the sun to get lower in the sky, or for the elusive creature to finally show itself.

To be the wife of a wildlife photographer, you need to have a lot more patience than that. Patience for the photographer to come home! Wildlife typically avoids humans. Therefore, wildlife and wildlife photographers are usually found in remote locations far from civilization. Spouses of wildlife photographers are often found alone at home!

I am currently home alone in Katete. Will is with the animals of South Luangwa.

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When watching me try to decide what to order in a restaurant, it would be easy to assume that I am a person who is incapable of making a decision. I sit on the fence pondering over the chicken burger or the pasta of the day… At work, faced with slightly more pressing issues, I leave the indecision at home. Doctors need to make decisions, and quickly.

In the UK, the complexity of the decisions that a doctor is required to make increases with the doctor’s seniority and prior experience. That concept is tipped on its head when you uproot to an understaffed, rural hospital in Zambia.

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Doing shift work is tiring, with nights and weekends taken up traipsing around wards tending to the sick. However, one of the positives is that you really appreciate a weekend off when it comes around.

Last weekend was busy for me, with a 36-hour shift from Saturday morning to Sunday night. This weekend was also busy, but in a different way.

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Communication (from Latin “communis“, meaning to share) is the exchange of thoughts, messages, or information, as by speech, visuals, signals, writing, or behaviour.

For two people to fully understand a conversation that has taken place, as well as words and actions, there needs to be a rough awareness of the cultural and social context of the other person.

One of the big challenges in doctor-patient communication is that doctors tend to ask about objective symptoms, trying to sort and sift problems in order to formulate diagnoses. Patients, on the other hand, want to tell you about their illness and its effect on their life. Communication breaks down if the doctor doesn’t understand the patient’s world, and the patient doesn’t understand the doctor’s question.

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Most people have had to listen to someone from an older generation reminisce over the good old days, with a conversation that starts something along the lines of “back in my day…”

In the medical world, this kind of conversation occurs when a ripened consultant talks of the pitfalls of the modern NHS. They harp back to ‘their day’ when they worked 48-hour shifts and lived on hospital site, when matrons ruled the ward, and doctors really knew the meaning of continuity of care.

The more time I spend at St Francis Hospital, the more I believe that when I boarded the airplane at London Heathrow, it wasn’t really a plane, but a time machine that has transported me to a bygone era of doctoring.

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Although we are a long way from home, our weekend had parallels with that of a lot of people in the UK.

The last weekend of August in London sees crowds of people flocking to the Notting Hill Carnival to dance, drink, eat some jerk chicken and jostle through crowds.

On the same weekend in Katete, crowds of Chewa people flock to the Kulamba festival from all over Zambia, Mozambique and Malawi to dance, drink, eat some dried fish and jostle through crowds… as well as pay homage to Paramount Chief Kalonga Gawa Undi and give thanks for a good harvest.

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St Francis’ Hospital is a large and busy hospital serving the local population of Katete District (over 200,000 people) and receiving referrals from all over the Eastern Province of Zambia (about 1.5 million people).

In Zambia, the concept of a GP or family physician only exists in the private sector. The public health system provides primary care through health centres, staffed by clinical officers, nurses and ancillary staff. These people have been trained to identify and manage common clinical presentations such as malaria, but they are not doctors. The patients who are referred to the hospital to see a doctor usually have had little or no treatment started. Therefore, although my work involves seeing patients in a secondary care setting, it has a feel of primary care to me.

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Until today, I’d only ever owned one type of car, the reliable, easy-to-park and incredibly girly Renault Clio! I’ve had 3 lovely Clio’s in my time, and I’ve loved them all dearly. However, I have become the owner of the antithesis of a Clio… Will and I now own a Toyota Land Cruiser, and it is a beast!

However, my Clio shouldn’t feel too betrayed, because it was clear from Will’s big grin and boyish excitement when we collected the car that the Land Cruiser is really his.

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It is fairly easy to romanticize the idea of an African house… for example by painting a picture of Karen Blixen’s house in your head, and then putting yourself on the porch in a rocking chair, listening to a gramophone beside your very own Denis Finch-Hatton! It is also very easy to do the opposite and conjure up images of a dark, dusty hut filled with more bugs than you can shake a stick at.

Well, we have moved into our new house, and although there is no gramophone, it is closer to my romanticized version than my nightmare one. After only two nights here, I know it is one of those houses that I will remember fondly forever.

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