This is the first of probably a few posts about some of my experiences in and reflections on Zambia and related topics. As a disclaimer, these are all my personal opinions and impressions and there’s no way I’m in possession of all the facts. That said, I can only say what I see.
Perhaps the first warning of how this would go down was when the doctor asked if I had a pen.
I leaned forward, trying to haul myself out of the capacious, collapsed armchair, reached into my bag and fished out a cheap piece of bright orange plastic. He accepted it wordlessly and began to jot notes into my medical record. Occasionally, he would glance up over the rims of his glasses and peer at my swollen, swelling, discolouring ankle before turning back to the school exercise book he was holding to scrawl something else.
Other patients were waiting along the row of low armchairs and sofas lining one wall of the lost property room, or storage cupboard, or filing cabinet, or bin, or whatever the room was supposed to be. Possibly an office was hidden there, underneath the stacks of paper, the discarded notes and scraps of pamphlets.
The doctor had the best seat in the room, an imitation leather desk chair that wobbled awkwardly on its stand whenever he shifted his weight. Posters were sprayed, scattershot, over the walls, haphazard and disordered, like the aftermath of some informational firefight. Ebola warnings, hygiene recommendations, flowcharts on sexual abuse and malaria, mingled with bible quotes, nonsensical slogans and ‘motivational’ quotes.
The quotes about the loving mercy of God were placed in prime position behind the desk, in the periphery of anyone talking to the doctor. The medical information posters, shouting slogans about family planning and mosquito nets, and emblazoned with organisational logos, UNFPA, WHO, the Zambian Ministry of Health, were off to the right.
HIV prevalence in Samfya district, the area of Zambia I was working in, stands at about 8%.
A chance encounter with a muddy puddle in the Zambian rainy season while wearing flip-flops was my path to this particular crossroads. Mix a slip with a previously injured ankle, throw in a pinch of inappropriate footwear, and you’ve got a recipe for a pretty nasty sprain. I limped into work on a Monday morning late and gasping, with a pulsing cricket ball on the end of my leg. Being white, I of course got immediately fussed over and driven to the clinic.
There was a courtyard there. Low walls squatted around the edges of a large space between single story buildings, painted a peeling green, roofed in shiningly bare corrugated iron. A walkway ran across the middle, cutting two damp, yet somehow parched, starved looking, patches of grass in half. Broken windows gaped onto the courtyard from shabby looking wards. Concrete floors sloped slightly, running down towards drains cut in the walls.
Every inch of those walls had someone sitting on it, waiting, staring at another wall. There were at least a hundred people crammed into that courtyard. All of them were black, dressed in varying degrees of westernisation, a couple of the men in collared shirts clashing with the women in their brightly coloured traditional chitenges. Apart from a few crying babies, the courtyard was totally silent.
To get to the courtyard, we had to push our way down a narrow corridor piercing the cordon of buildings. It, too, was lined with people, standing now, still staring at the wall. They mutely made way for us, pressing into the cold concrete as I limped my way towards them. There was at least one man missing a leg.
Our boss, a Zambian, the one who’d driven me there and had taken it upon herself to sort everything out, took one look at the crowded courtyard. She puffed herself up like a frog, marched into the office of the doctor-in-charge. I balanced on my one good leg, eyes downward, unwilling to ask anyone to contort themselves even more to give me a seat. Then she appeared at the doorway of the in-charge’s office and waved me in.
There were a couple of other people sitting inside, but the doctor was standing waiting. He wore a white lab coat over a sparklingly pressed shirt and a crisp tie. His leather shoes were burnished to a fine sheen.
He spoke to my boss in Bemba for a couple of minutes before she beckoned me forward. I hoicked up my trouser leg and showed him the throbbing ball of pain, to which he nodded gravely and asked what had happened. I explained, and he excused himself.
I was motioned by my boss to sit down in an armchair and wait. The other patients in the office, a schoolgirl in her uniform, bright blue shirt and black skirt, a man in a florally patterned shirt, sat and waited as well.
After about five minutes, the in-charge returned holding a brand new jotter. He got my pen, took my notes, then announced what my course of treatment would be.
“You’ll get an x-ray, just to make sure nothing’s broken, then go to the physiotherapist and get some painkillers.”
My jotter was handed to me and we were ushered out of the door. I hobbled back the way I came, past the rows of blank faces, towards the hospital adjoining the clinic.
Samfya Stage II Clinic is the only distribution point for anti-retroviral drugs, those used to render HIV manageable, to all of the 163,000 people living in Samfya district.
The x-ray department was a single, bare room at the end of a single bare corridor, in one of the low assemblage of concrete buildings that made up the hospital complex. The waiting area was large, empty, with blank, grey, windowless walls encircling a single desk standing guard at a door. An attendant sat there, peering at nothing in particular. The walls were lined with racks of the sort of chairs you find in airports, a low metal bar with five or so plastic seats placed on it. There was one other man waiting for an x-ray.
My jotter was surrendered to the man at the desk, who squinted at it before waving absently at a seat. To the mute fury of my boss, we each took one.
I sat and waited. This time, the man who had been before us went first, disappearing behind the curtain when another attendant appeared, beckoning. After a couple of minutes, he emerged, then the attendant, wearing a lab coat and carrying a brown folder. The folder was handed to the man at the desk, who pulled out a couple of filmy slides and flapped them at the light. He handed them back to the man, shooed him away, and beckoned at me.
“You can go in now.”
I stood and dragged my foot over to the door, which was opened for me by the man in the white coat. The room beyond was another grey concrete bunker, cold and sterile as a morgue. There was a high table to one side with an x-ray camera hanging over it, and a curtain wall concealing the business end of the equipment. I was motioned onto the table and posed for the camera, stretching my ankle and rolling this way and that to get a look at every angle.
A metal tag in the shape of an ‘R’ was placed beside my foot in each of the photos. TV images of tagged bodies and crime scene photos rose unbidden in my mind.
It only took a couple of minutes for the prints of my foot to arrive. The man at the desk took a look to check they had come out properly. When he was satisfied, he tucked them into another manila folder with my name, body part, and the date written on it, then waved me on to shamble down more bare concrete corridors to the physio department. At least these ones had windows.
We wandered around for a while, searching for an attending physio. The department itself consisted of one office with ‘Physiotherapist’ clearly marked on the door. The only problem was that it was locked, the blinds on the windows were down, and the waiting area beside was full of people sitting quietly, clutching their own brown folders and jotters. It was even more full of people standing, or squatting uncomfortably, shifting uncomfortably from side to side on their injured limbs.
Clearly, this wouldn’t do. I was bodily seized by my boss and we marched off down other corridors, demanding our way back and forth. Well, she marched and I traipsed. There was nobody to find, nobody to command, and eventually we had to slink back to the waiting area. I was given a seat on a bench.
After a few minutes of waiting, another man in a white coat rounded the corner, unlocked the office, and disappeared inside. My boss pounced, stealing in through the door before it had closed behind him. She shut it firmly behind her.
A moment passed, then the door opened just a crack and she called me in. I stood and hobbled past another full waiting area into the office,then the door was closed and I was sealed off again. The smiling physio motioned towards a seat.
His office was scattered with paraphernalia, boxes and bandages and an examination table. The computer was on, a powerpoint about spinal injuries up on the screen. Apparently, he’d been reading up on what a disk was.
Again, I described what had happened, and then handed over my x-rays. The physio held them up to the light one after another, squinted a little, and pronounced that I had nothing broken. He took a look at my ankle and diagnosed ‘soft tissue damage’.
My prescription was to stay off my ankle for two weeks, ice it regularly, and keep it elevated to minimise the swelling. The physio loosely wrapped a bandage around it, offered me a box of ibuprofen, and wrote a few things in my jotter. Then he smiled, his eyes flicking to the door behind my shoulder.
“So, that’s it?” I asked.
“Could I maybe get a pair of crutches or something? Just so I can move around for the next two weeks or so?”
“Crutches?” His brow furrowed in thought, and there was silence for a moment. “Maybe in Mansa?”
Mansa is the capital of Luapula province, an hour’s drive away from Samfya and in an entirely different district. Samfya District Hospital is exactly what the name implies.
“Oh.” There was nothing more I could say. “Well, thanks then.”
By now, the computer had reverted to a screensaver of bible quotes flashing across the monitor. I was encouraged to have faith in the grace and mercy of God. My ankle hurt like hell.
We shook hands and I hobbled out of the door, past the mass of people patiently waiting their turn. If anything, even more people seemed to have arrived in the five minutes I’d been inside. I was hurriedly bundled out of there by my boss.
I shuffled back outside to where the car was parked, sitting alone in an empty space in front of the clinic. The corridor leading to the courtyard was still packed with people. Ignoring them, we climbed into the car so we could drive back to work for lunch.
On the way back, we passed the massive earth movers and teams of hundreds of workmen flattening the ground and digging ditches for the new roads being built. Within the space of a couple of weeks, half of the main roads in the town had been dug up, evened out, and re-laid with a new coating of bitumen. Infrastructure improvement project signs were everywhere detailing exactly what the development funds contributed by various governments had been donated for.
Within the first couple of weeks of our working in Samfya, we had exhausted the hospital’s supply of condoms. No more were forthcoming.
I got my crutches a week later, paid for by our organisational health insurance policy. They were rough wooden planks hammered together by a local carpenter, ugly and uncomfortable, leaving scrapes and sores under my arms. I left them behind to be given to one of the many disabled people in the town who didn’t have any way of getting around.