Zambia: The long reach of David Livingstone

In 1908 Malcolm Moffat, a nephew of Livingstone’s wife Mary, laid the foundations of Chitambo Mission in a remote landlocked territory known to the British as Northern Rhodesia. Although the mission and its hospital occupied a higher, healthier site nearly 70 miles from the village where Livingstone died, its name honoured the people of Chitambo and their eponymous chief, who gave him shelter. Embedded in the walls of the maternity wing is a building block which proclaims itself, in the Lala language, “I am a stone put here at Chitambo in the time of D. Livingstone 1873” – the year of his death. It was tapped into place by the grandson of Chief Chitambo when the hospital was rebuilt in 1953.

When it first opened it had three beds under a thatch roof and a constituency of about 2500 people. For the next six decades it remained a mission hospital with strong links to the Moffat and Livingstone families until the United Church of Zambia handed it over – with some reluctance – to the new Republic of Zambia. Today, with its 12 outlying clinics, Chitambo Hospital is the medical hub of a scattered rural population of some 100,000; and inevitably, in these challenging bushlands of one of Africa’s poorest countries, it is sorely under-resourced.

When we turn up at Gibson Clinic after a bone-jarring ride along a track which becomes a causeway in the rainy season, we find a lonely nurse. Josephine Makiwa is 22-years-old, newly qualified, missing her young son in her faraway home of Lusaka. She looks anxious. In the tiny labour ward a woman is giving birth. Josephine can help with the delivery but if there are complications she is out of her depth. The Chitambo ambulance is two hours’ drive away. The on-site “ambulance” is a motorcycle with sidecar.

“This clinic should be staffed by a midwife, too,” says our escort, deputy matron Delphine Milimo, “but she left and hasn’t yet been replaced."

Josephine’s only back-up is a community health care volunteer and the goodwill of the village women, who have gathered to celebrate a new life. All Zambian health workers do their best to encourage women to limit the size of their families, but in the present Chief Chitambo’s fief it’s an uphill struggle. The chief doesn’t want to limit the size of his tribe. “I do not want to be chief of trees,” he is fond of saying.

Gibson Clinic is marooned on a sea of land which seasonally becomes part of the vast Bangweulu Wetlands. The people who live here are fishermen and their families. In the dry their eerie landscape is studded with spiky anthills, like an edgy art installation. In the wet it’s a world-class habitat for tens of thousands of birds, including rare wattled crane and shoebill stork. In either season it is beyond the reach of any mobile phone network. Josephine can’t phone home to talk to her son. In Zambia, if health workers want a job, they go where they are sent.

But the enduring Scottish connection has brought innovative aid to the nurse and her patients. Josephine still can’t phone home but is now equipped with a VHF radio which keeps her in contact with Chitambo Hospital, where she can ask for help and source information. All the clinics are now linked to the hospital by either mobile phone or radio hotline. This bush version of our own NHS 24 has its genesis in the Midlothian town of Penicuik and the humble traditions of charity fundraising: street fairs, church collections, bring and buy sales. Today it is on its way to becoming a model for emergency health care throughout rural Zambia.

The country’s health authorities, including its skeleton Flying Doctor service (one helicopter, two on order) are taking a keen interest in a project formally called “Strengthening Emergency Care Communications in Chitambo District”. It has support from the Scottish Government’s Small Grant Fund, but it has been conceived and driven by the Scottish and Zambian partners of a modest little charity which is only four years old: Friends of Chitambo. Inspired by the family history of one woman, it is her commitment which brings her volunteers up the Great North Road into the heart of Zambia.

We are no power team from a well-funded NGO, but a disparate and sometimes unruly crew: six women and one man, three over 60, four under 40, five from Scotland, two from Zambia. Our ring-leader is Jo Vallis, recently retired research officer with NHS Education for Scotland. Jo is the charity’s founder and project co-ordinator. She spent most of her early life in Zambia, where both her grandfather and father, medical missionaries, toiled in the lamplit wards of Chitambo Hospital in the post-war years.

Bridget Innes, a member of the steering committee, is a semi-retired Edinburgh GP with rugged experience of voluntary work in Africa. Emma Ndalameta Thea is a medical librarian from the University of Zambia. Nurse Alison Smart, a recent recruit, has just started a new job as lecturer in nursing studies at Napier University; and Consider Mudenda, from Lusaka, is the project’s local co-ordinator and IT specialist.

The other volunteers are “civilians”: Friends of Chitambo’s patron (me) and my daughter Catherine, who has lived and worked in Zambia and misses no opportunity to return to a country which, she says, “changes you.”

Consider also drives our hired 4WD Pajero, and with impressive skill keeps us safe over 1500 miles of Zambia’s dangerous roads, where figures are high on the global scale of road fatalities. Soon we will be introduced to rural emergencies less familiar to European health workers: burns from cooking over open fires, animal bites which might include injuries from crocodiles, hippos and venomous snakes.

Our first challenge, however, is to shoehorn seven adults and their baggage into a vehicle which only nominally seats seven adults; the fold-down bench at the rear must be fun for children and dogs; then manoeuvre into every nook and cranny 40 medical text books, three tablet PCs downloaded with clinical information, assorted teaching aids, including dummy babies attached to cloth umbilical cords, a wardrobe of home-knitted baby clothes and food supplies for a week. Thus we learn that wrapped loaves of white bread make squashy cushions but bags of rice and dried pasta don’t have the same comfort value.

The journey: We leave early, in the merry mood of an expedition launched. Every enterprise begins with a prayer in this pious nation of jubilant Christians, and Emma is invited to solicit God’s blessing. The secular among us respect the sentiments, but as the seraphic morning light and a bottleneck of road works expose us, in the Lusaka suburbs, to the desperate living conditions in “high-density housing” (as the civic euphemism describes sprawls of dismal shacks and open sewers) we feel God may have more pressing priorities.

Chitambo is some 350 miles north of Lusaka and we aim to arrive before dark, when the hazards of Zambian highways are compounded by vehicles with faulty lights and sleepy drivers. The Great North Road is well surfaced, as befits the landlocked country’s trans-frontier link to the Indian Ocean and the Tanzanian port of Dar es Salaam. Major imports and exports travel this route, and even when we reach the remote bushlands, where the highway hugs an eastern border of the Democratic Republic of Congo, the loneliest stretches of road are rarely empty.

Monstrous 12-wheel tanker lorries and container trucks hobble our progress or charge menacingly towards us, testing the nerves of everyone except our driver. In fact, conscious of the global logos on their vehicles, most of the truckers are as expert and considerate as our own Consider.

We make only two stops. At a popular roadside restaurant we treat ourselves to brunch, and at the town of Serenje we upload frozen chicken, dried fish and other essentials. (I’ve forgotten a towel and Emma has forgotten a chitenge, the traditional Zambian wrap which even stylish, city-bred Emma says she can’t be without when she goes to the bush).

At a filling station four boys try to sell us cakes of soap. Somewhere in the messy mass of luggage are six inflatable footballs which we can’t easily extract, but in lieu of a sale we promise them a football on our return journey. As a result of these distractions our undisciplined crew fails to support Consider’s plan to arrive at Chitambo before dark. Thus all is mysterious as we leave the Great North Road and complete the last 10 miles on dirt, where charcoal braziers glow in the bush, signalling unseen homes, and there are few lights in the hospital grounds. Thus we don’t see the context of our visit until morning.

The grounds: baked earth, which will turn to sandy sludge when the rains come; groves of venerable gum trees (non-indigenous) and a majestic marula (indigenous) breaking out its coppery spring foliage; the old mission church, staff housing, including “the doctor’s house” where Jo grew up; a complex of elderly, weather-worn single-storey wards, male, female and maternity, and a spread of new buildings: Chitambo School of Nursing, where dynamic Levi Chifwaila, senior nurse tutor and a key partner of Friends of Chitambo, has organised the First Aid workshop which, with its focus on the new communication links, is pivotal to our visit.

We are billeted in the nurses’ hostel: modern dormitories built with American money, modern bathrooms afflicted by Zambian problems. For three months throughout the chilly winter there has been no running hot water. (“Boiler broken. We’re waiting for spare parts”). Yet the sun rises to the sound of laughter as the student nurses troop to breakfast, shirts gleaming, dresses spotless, all laboriously laundered by their owners. When we discover there are only cold showers our groans are soon silenced by these morning parades of immaculate young nurses.

There are no cooking facilities at the hostel as the students have their own kitchen, so Matron Hildah Mubanga has offered us the use of her house and the services of her two nieces, Maureen and Nwila. While we take turns entertaining Maureen’s one-year-old they turn our imported food into meals; but not before we discover Chitambo’s market, the hub of this scattered, poorly-provisioned village. Here we supplement our dry rations with juicy tomatoes and freshly-baked bread rolls which – apart from dried fish – is the only produce on sale. Our daily custom is a windfall for the vendors.

The First Aid workshop: Ten ambulance drivers and frontline clinical staff have signed up to three days of instruction from Levi Chifwaila and senior colleagues. Alison and Emma will also contribute, while Catherine and Bridget have roles as volunteer casualties. Topics include blood loss and shock, head, spinal and pelvic injuries, protection from infections, bites and burns, and handling and transporting casualties. The ambulance drivers show great commitment, as they are often alone in their vehicles with patients. (No paramedics in these parts; perhaps a nurse, if one is available). And they are most in demand from road accidents and childbirth emergencies.

Despite the workshop’s serious purpose the Zambian appetite for merriment is never long absent. “Energising” exercises, when concentration falters, prompt singing and dancing, and the programme begins with a quirky command from Levi: “Introduce yourselves, and tell us which the favourite part of your body is.” Nervous laughter; eyes, hair, hands and feet are submitted, before one man says solemnly. “Not to be disrespectful, but my private parts are my favourite. They gave me my children.” Approving murmurs.

After three days the ice is not only broken but melting with the warmth of collective enthusiasm. The final show-stopper is the “immersive simulation” of a road accident, with all workshop candidates and volunteers faking the real thing: ambulance and stretcher on hand, serious injuries but little equipment, what to do. Alison is most impressed by the driver who seizes some cardboard and whips out his shoe laces to improvise a splint.

The maternity wing: Here Levi has a tale to tell as he speeds us through the long access corridor called Hippo Alley; nothing to do with the ante-natal silhouette, but named for a panicky hippo which once sprinted from the open entrance to the open exit before crashing into the bush. “When was this?” I try to ask, but Levy is on his way to the cramped high dependency ward and its incubator. A young woman sits beside her premature twins, watching tiny movements, faint flickers behind the closed eyelids. “A boy and a girl,” announces the presiding nurse. No one seems discomfited by an invasion of mzungu (white) women; childbirth is an inclusive event in rural Zambia.

Outside, as darkness falls, ambulant patients and their relatives squat over charcoal cooking fires. The hospital provides food for its patients but there’s nothing like the comfort of a family pot of steaming nshima, the nation’s staple food, made with water and maize flour and eaten bare-handed. Zambians pine without nshima as Italians pine without pasta; and the ritual hand-washing before and after sets a comfortable mood.

Two days later we pay a second visit to the maternity wing to deliver the baby clothes knitted by Penicuik well-wishers. There is sad news, presented unemotionally. One of the twins – the girl – has died. The boy is out of the incubator, swaddled in blankets in his mother’s arms, and her weak smile of greeting says little of her loss. She is preparing to go home. Her mother has spent time elaborately braiding her hair; perhaps the only therapy on offer.

The last supper: Jo has been given a chicken (live) by a family thanking her for a kindness. Daringly she keeps it overnight in a box in her room, forgetting the advice of the snake bite seminar: “Don’t keep chickens in your house. They will attract snakes.” In the morning the bird is relocated to Matron Mubanga’s yard, where it pecks contentedly until sacrificed to our farewell meal. “I couldn’t look,” says Nwila, the younger of Matron’s nieces. “Maureen stood on its feet and chopped its head off.” I shudder; but eat my share of the roasted chicken with nshima and tomato sauce.

The graves: Time to leave, with a wrench of the heart and a touch of relief. We are spoiled Europeans, after all. We are heading for hot showers, meals which don’t include nshima (an acquired taste) and 24 hours of R and R in Kasanka National Park, which is firmly on the David Attenborough radar for its spectacular fruit bat migration and shoebill stork safaris. Near here we can visit the spot where, 144 years ago, David Livingstone died. His 1902 memorial in a lonely grove of marula trees is a national monument.

But first we pay our respects to some historic graves which also belong to the hospital’s story. When Mary Livingstone’s nephew Malcolm Moffat died in 1939 he was buried at nearby Kalwa, a farm gifted to him by the colonial government with the blessing of Chief Chitambo, who wanted him “to remain among his people”. And Kalwa is where his Moffat successors and other family members remain today, their graves maintained in an informal woodland cemetery.

We think, too, of the fresh graves in Chitambo cemetery. In the space of our visit a newborn has died and the village headmaster has had a fatal car accident. The dry, withering Zambian winter is already retreating before spring, and soon the summer rains will make the bush explode in a green rampage, overwhelming headstones and crosses; until the seasons turn and they rise again from the shrivelled elephant grass.

More details about Friends of Chitambo on www.friendsofchitambo.blogspot.com. Its patron, Julie Davidson, is the author of Looking for Mrs Livingstone (St Andrew Press, 2012). She is currently working on a second book about women missionaries in southern Africa.