Lilongwe was the first place I came across which I had got to on my previous brief foray to Africa. The chaotic bus stop was much the same, the counterfeit sunglass shop I had picked up some legit sunnies was still there, and Mabuya camp still provided a solid backpacker dormroom to rest weary bodies.The sense of familiarlty provided a warm reassurance that I was nearing my destination, so after some purchasing of hand-carved wooden goods ready to send home as presents with the folks when the visited, I piled back into the last mini-van ride of the trip, making good time to Mchinji, near the Zambian border. The money changing process this time threw a spanner in the works. Since my last trip, the currency had been rebased, with three 0s being stripped from the end, meaning things were now being paid for in single or double figures, not thousands. My paperwork was all in order, and my limited communication with the hospital had been enough to organise the hospital driver to be there to meet me. A few minutes later we were in Chipata, which is the major city of the Eastern province of Zambia. With limited selection of goods near the hospital, a supermarket shop was necessary. Economic progress must be steady in Zambia, as in addition to the pre-existing South African chain Shoprite, there was also a new Spar supermarket providing competition and a widened selection of luxury items like proper cereal, real coffee or cheese. The closer we got to Katete, the more familiar sites we saw. The massive sacks of charcoal ready for purchase on the roadside were something I needed to get amongst. Jaston the driver was careful to select which one was the best. Despite me suggesting each one of the dozens of stalls we came across, his response was confident that ‘that one doesn’t burn well’ or ‘they don’t know how to make it well’, so with the local knowledge, we picked up a sack of ‘the good one’, ready for BBQs in the evenings. The hospital is situated a few kms away from the main town of Katete. ‘Katete stores’ which is where the market and shops are located lies on the cross roads of the Great Eastern Road and a road heading to Mozambique, 30km to the south. Further down the Mozambique road, lies Katete Boma, the administrative and government part of the township, quite separate from the ‘stores’. A few big warehouses had popped up on the edge of Katete, ready to receive maize that the local farmers had made. A few kms down the Great Eastern Road past Katete towards Lusaka lies the hospital compound. On pulling up to the hospital mess, we were greeted by much of the same crew that was holding the fort last time we were there. Seeing Julius, Michael and Cecelia felt like only a few days had passed since we said goodbye to their hospitality four years before. Roast chicken, roast potatoes and cabbage was still the Sunday night treat. And there were even some New Zealand students to provide a familar accent.
I was lodged temporarily in one of the more basic rondavels (round houses) as one of the other expats was leaving a couple of days later, meaning I could inherit a cosy little house, with a pre-existing garden. Being back on the wards was a bit of an interlectual shock to the system. I had a couple of weeks grace before the old guard of UK doctors who we were replacing would head back home. The medical and paeds wards had been run by five British doctors, who had things down pat. Things seemed to be much the same as my impressions as a fresh student four years previous – HIV related disease still ruled the roost on the medical wards, there still weren’t electrolytes available at the lab, pharmacy still seemed to run out of crucial things like insulin on a regular basis, but power issues must have improved as xray was no longer interrupted by ‘the low voltage’ limited the use of the x-ray machines. Having had a few years of clinical experience, and a three month theoretical diploma in tropical medicine under my belt, I was a bit surprised when a lot of the uncertainty that was there as a student still remained. A lot of the diploma was taught from a resource limited point of view, but a significant portion relied on being able to definitively diagnose the specific conditions. Although the hospital has several crucial basic tests, treatment of many of the major pathologies is still presumptive – no blood cultures to diagnose typhoid, no culture to diagnose extra-pulmonary TB, no serology for many of the wierd and wonderful infectious diseases that Africa is known for in medical circles. The couple of weeks with Tom and Jaimie who had been running St Augustine, the male medical ward, were crucial in passing on pointers and suggestions – ‘yeah, we normally just start presumptive treatment for TB in that situation’, or ‘with those blood results and that ultrasound report, this is almost certainly HCC, we see it all the time’ etc.
A few things had changed on site. Mbusa, the paediatric ward was now housed in a recently opened spacious new building, freeing up the old paeds ward to now house outpatients. The outpatients department was still as mental as ever. Seeing Limbikani, one of the staff from outpatients who splits his time between counselling work in the HIV clinic and acting as a translator in medical outpatients, was great. He still had a picture of Tony, one of the NZ doctors we had worked with in 2009 as his phone background. Tony is a champ, but that was next level fan club territory!
A few weeks after I arrived, Yasmin – a friend who I had worked with in New Plymouth – arrived to join the team. I had co-opted her as my partner in crime, partly for selfish reasons of wanting another doctor here on medicine that I could trust, and having a friend around for the good times and hard times. She brought with her some highly valued possessions, sats probes and safety glasses for work, and some black gold – a precious pot of marmite (the NZ variety – not the english imposter) which brought to an end my version of Marmageddon – the national marmite shortage caused bythe disruption to the marmite factory by the Christchurch earthquake in 2011. Marmite with fresh local avocado on my first loaf of hand made bread. I was sussed!