Mukinge stories
September-2024

Being a surgical doctor in a district hospital in Zambia brings many challenges, as these stories show. With his wife Enless, our partner David at Mukinge Hospital also supports a local prison and leprosy village.

      Motorbikes offer a cheap, high speed and hazardous local taxi service with up to 3 to 4 adults on a bike. Tragically, there have been deaths of babies who have slipped out of their mothers’ slings. Apart from hitting treacherous potholes, bikes bash into other bikes, bicycles, pedestrians, dogs, pigs, cars, trees, termite hills and road signs. Nothing on the planet is safe.

      As I was called to the hospital one night to see a couple of such casualties, I saw a parked pick-up loaded with goats, legs tied, making a terrible high-pitched bleating. Turned out a bike had hammered a pedestrian, killing him. Four goats and two adults had been on this bike, which a woman had hired to take her goats to the bus station to get them to a distant market. The rider had arrived late, in the dark and somewhat intoxicated — against her better judgment she had still hired him.

      Snake bites are another local hazard, as snakes will enter houses at night looking for rodents to eat. Recently we separately had a man and a child with bites to the arm and the foot. Venom may cause swelling which cuts off blood supply to muscles and nerves, which may lead to loss of the limb or death. Anti-venom helped but “fasciotomy” decompression incisions were needed to relieve pressure. Both the man and child lived with limbs intact.

      Burns: On New Year’s Eve, Abson was stirring a drum of maize porridge on a fire. Seems he stepped on a piece of firewood under the drum, which fell off the fire. Slipping on hot porridge on the ground, resulted in burns almost everywhere. Porridge is worse than water; it sticks on and burns deeper. He was burnt right around the torso, which presented quite a puzzle for skin grafting — where to start? Abdomen, knees and arms were grafted first and the thick skin on the back kindly healed on its own. Lightning strike: James was sleeping when his house was struck by lightning, severely burning his lower leg. He only came to hospital after a delay oftwo weeks. A cloud of flies accompanied him to the ward; the smell was quite something. An above-knee amputation was needed. We wondered briefly if we could get by with a below-knee amputation, which would be better for walking with a prosthesis, but no chance. James just wanted to be healed and free of pain. He greeted me the day after surgery and asked how I was. I could see there were hidden depths to this man. His schooling had only reached grade 9, but as the days passed and conversations were held, I realised that if he had had my opportunities, he would have been capable of far more than I can even imagine.

      HIV/AIDS: Each year in Zambia there are about 28,000 new infections and about 19,000 AIDS related deaths. Treatment is now excellent. If patients are compliant with medicine and look after themselves, they can do very well. Yet old beliefs die hard and a significant number of infected persons may be unwilling to start treatment, or are not willing to let their spouses know. These attitudes were more common 20-30 years ago. It is perplexing to find old-fashioned beliefs still around. We had a patient with bad fractures of both lower legs from a road crash. The bones were not joining; suppurating wounds overlaid the fractures due to his low immunity. We were his last resort. He tested positive for HIV and despite the best efforts of staff, counsellors, chaplains and docs, he resolutely refused to go on treatment until in extremis. Whilst it was worth a try to start anti-retrovirals, the chances were slim and he succumbed. I have now taken PEP (post exposure prophylaxis) twice after needle-prick injuries while operating on HIV positive patients. Hepatitis C is also out there, We do pray for protection from both of these while operating. We are happy that COVID is less of a problem now; we can start concentrating on HIV again.

Pray also for:

• Mukinge Hospital admissions are rising by about 20% per year. Resources and staffing are struggling to keep up. Pray for more of both.

• The Friend family, for safety on the roads and for refreshment in their busy lives, and for son Daniel who has started Reception, a local version of pre-school.

• Resources and wisdom for prison ministry and leprosy village.