Honey. It sounds like a helicopter landing on our front garden, but it is the motorbike of the “honey man”, who delivers honey to the door. Last visit, he bought 3 x 20litre drums. Northwest Province is famous for its dark brown, fragrant honey and we use it in the wards and theatre in large quantities on septic wounds with pleasing results. A new use for honey has come out of Kenyan study, where honey is used in bones which are both broken and infected. This has always been a tough problem. We have tried it, filling up the marrow cavity to the hilt with honey, then coating the metal rod implant with honey, which is then inserted down the marrow canal. There is a bit more to the story than that, but the results look good so far; another triumph for honey!

Night emergency. Two sisters arrived in a hired car in the middle of the night. One, aged 16, with her second episode of a dislocated shoulder, accompanied by her 14-year-old sister as the “bed-sider” (a relative who stays with the patient on the ward and is critical for basic nursing care). Though only 14, she was “going on 20” in her calm assistance in the situation. Children here may grow up quickly, becoming competent in childcare and domestic duties at a young age. Another older sister, the caretaker for the family, was away working as a bartender somewhere. There was no adult with them to give consent for the anaesthetic to fix the shoulder, but this seemed to be an occasion to bend the rules since dislocated shoulders are very painful. Often, a recurrent dislocation such as this can be quite easily fixed if pulled on immediately after the event, before too much pain and muscle spasm sets in. So we got the younger sister into theatre and showed her how to do the “reduction”, which she did well and was quite sure she could manage it the next time, should her sister get a recurrence!

Hippos. A tough, wiry fisherman was walking through tall grass to the river to check his nets and came face to face with Mrs Hippo, who had a young one with her. In a twinkling, she latched onto his arm causing a terrible crushing wound. When I got to see it a day later, I could see right through the forearm. Sepsis had set in and though we got things somewhat repaired, he now has a useless, painful, swollen arm which doesn’t bend at the elbow and the fingers have little function. He really needs it off, but won’t have a bar of it. We pray he changes his mind before overwhelming infection sets in.

Nursery. Passing by the neonatal nursery one night, I was moved by the singing coming from within. The dozen or so mothers were harmonising beautifully. Yet there was a hint of sorrow or pain I couldn’t quite put my finger on. Whether missing loved ones at home, or feeling for their little ones in the bassinets, I don’t know. Not all the babies there were going to make it as they well knew. The mothers work as a team, feeding their babies every two hours. It is a bit of a grind and in this singing culture, it is just what people do when together. In any case, the mothers say the babies sleep better if they are sung to.

Snake bites and other mishaps. Cobras and puff adders are out and about with the new rains, biting the unwary at night. Usually the limb is swollen but settles with treatment. It was a delight to assist a 12 year old girl who was struggling to breathe after a bad bite. The anti-venom proved its worth that night, reversing the paralysing properties of the poison. When a man was bitten on the foot, his family put on three tight tourniquets and did lots of deep scarification (traditional cuts with a razor blade). From our perspective, such traditional treatments make things worse. When he came in, his lower leg and foot were ice cold; no blood was reaching them. We made incisions to reduce the pressure inside the leg to allow blood to go down. To the despair of family and medical staff, he suddenly died two hours later; we have no idea why. The chaplains had detected a problem. The patient was divorced and remarried, and had recently visited the home of the first wife. The relatives’ question was: “Did the first wife ‘send’ the snake?” The input of our chaplains is critical in these cases. Surgery at night is dominated by emergencies from the maternity ward, and all day there’s a steady flow of patients with fractures, burns, septic ‘almost anything’. At present, children are falling out of mango trees in considerable numbers, breaking bones or impaling themselves on sticks, while searching for fruit. Your support is enabling us to boost the range of instruments and metal implants so that a larger range of fractures can be stabilised. Just as important are the walking aids. These are prohibitively expensive to buy, but we are now almost self-sufficient in making our own walking sticks, crutches and walking frames out of local materials.

Needle pricks. In surgery we do fear pricking ourselves with needles, risking serious infection. The chance of AIDS being transmitted is very small, but the post-exposure treatment is rather feared due to its severe gastrointestinal side effects – a negative HIV test result is always a relief. Hepatitis C is easier to catch from a needle prick but is fortunately quite rare here. Thank you for praying for protection for us.

Hygiene. When we supplied toothbrushes and toothpaste as part of our local prison ministry, there were lots of laughs and comments such as, “What’s this for?” But the men took to it like a duck to water. Dental hygiene is an issue throughout the country and many suffer terribly with dental disease leading to tooth loss. In the prison, I think the fresh-tasting toothpaste relieves some of the tedium of life and helps self-esteem, though shopkeepers find it a bit unusual when I ask if they have 130 tubes of toothpaste. The bottomless needs of the local prison are as great as the joy in assisting those there. I find myself inexplicably drawn to inside the high walls. Perhaps were it not for the grace of God, I might be resident there too. Supplies of sugar, salt, soap, cooking oil, mosquito coils and toilet tissue are the mainstay. The prison football team is enjoying new boots and uniforms. I think that the social part of the visit is important for the inmate. Many have few, or no visitors. Many prisoners find God whilst there and it is a privilege to be a part of their journey.

The Leprosy Village of 20 houses continues to be a challenge and joy. Despite their broken bodies, the residents’ cheerful greetings belie the pain, drudgery and isolation they may feel. I respect them very much. With them too, the social part of the visit is just as important, to know they are not forgotten.

Maternity ward. Enless is the midwife in charge; heading up the maternity ward is a special calling, with many triumphs and crushing lows when things go wrong. She is a mentor and teacher to the many student nurses who pass through. Enless often accompanies me on visits to the leprosy village and prison, and is an encouragement to those there, communicating at a deeper level; her insights and advice are very helpful. We make a good team! Thank you to all who support Enless and I and the projects. We cannot do it without you; you are a blessing to us and to many here in Zambia.

• Is there a keen surgeon out there who would like to come to Mukinge to make a team?

Much as I love surgery, there’s more than I can keep up with. This has been a tough year as the number of patients gradually rises.   There is a new operating theatre under construction. We can train you up! What is needed is a strong calling, a good sense of humour, team spirit and a shot of courage to take a leap into the unknown. Areas of need include: medical, surgical, anaesthetics, paediatrics, obstetrics and gynaecology and nursing tutors — so many areas one can get involved in at Mukinge. Get in touch! God’s call may be quiet and difficult to hear in a busy life but remaining the in the centre of God’s will, wherever it may take you, brings joy, strength and fulfilment beyond imagination.

– David Friend

To start a conversation or find out more, contact us at nzletstalk@sim.org