Controlled Chaos: Surgical Adventures in Chitokoloki Mission Hospital
Chitokoloki Mission Hospital is a remote but remarkable facility in the North-Western Province of Zambia. This book comes from a compilation of daily reports about life in a remote African mission hospital. It is written from a personal and clinical...
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Chitokoloki Mission Hospital is a remote but remarkable facility in the North-Western Province of Zambia. This book comes from a compilation of daily reports about life in a remote African mission hospital. It is written from a personal and clinical angle and with a surgical emphasis because that formed the bulk of the activity that has been recorded. The detailed experiences of many patients has been captured and the author conveys the almost unbelievable reality that their experience reflects. Initially the reports formed a flowing clinical news blog and they have been assembled in book form to include the Christian context as well as insights into the reality of daily life in the local villages. Again and again these stories have been the focus of discussion and enquiry and it has been good to share the experiences to the point that others who become aware are ready to pray, support, give and even visit in order to contribute in some way to the work of the mission.
This book brings together a real life account of day to day activity in a Mission Hospital in rural Africa. I have had the opportunity to visit Chitokoloki in the North Western Province of Zambia several times over a period of five years, spending a month or two each time. Why? Well, I have always had an interest in medical missions but having spent a career serving as an academic Consultant Surgeon in the NHS I really did wonder whether my skill set and experience would be of any real value in the African bush. Having been aware of Chitokoloki Mission Hospital, I made contact with Dr. David McAdam, a surgical colleague who has been based there for many years. Would my narrow specialist practice and experience of high tech medicine and minimal access (so-called keyhole) surgery be applicable there? What about having to work in a setting with severely limited resources? Would I be able to cope – or contribute? It seemed sensible to speak to David. His clinical experience and expertise is quite unlike any other colleague I have ever encountered. Working single-handedly for most of the time means that he not only has to look after patients with diverse problems that would be distributed to a range of other specialists in the West, he also has to keep up to date, maintain records, bear the burden of teaching, and administration, not to mention being available 24 hours a day 7 days a week! He has prepared well for solitary medical practice in a remote setting by training in surgery and anaesthetics as well as obstetrics. Working alone for many years he has had to be capable of dealing with conditions and clinical challenges that cross specialty boundaries and the result is expertise in an astonishing array of disciplines such as surgery (every branch), obstetrics and gynaecology, ophthalmology, paediatrics, intensive care, anaesthetics – the list goes on. There are other colleagues who help out with complex orthopaedics and plastic surgery on an occasional basis. As well as providing expert, Western style medical care David carries the additional responsibility of sharing his Christian convictions as a medical missionary. In addition to the demanding medical work, he is committed to helping people explore and understand the Bible in order to deepen their personal experience of God. As a result he is regularly called upon to lead bible studies, preach and teach in the local church and in the surrounding communities. ‘Remarkable’ fails to adequately cover it! “David, do you think I could be of any help to you? I know virtually nothing about tropical medicine and, like every other surgeon in the UK, my surgical practice has become progressively narrower over the past twenty years.” For him, it seemed to come down to a fairly simple matter. “If you can operate, we can certainly use you here.” On the strength of that and still plagued by a measure of uncertainty and apprehension, I made arrangements to go to Chitokoloki for two months in the autumn of 2015. Quite unable to persuade my wife that it might be a good idea for her to accompany me; she cited teaching duties at home but in reality I realised that the prospect of having to cope with creepy crawlies and other forms of reptilian life forms clinched and confirmed the decision in her mind. The stories and reflections I share here are a personal selection drawn from notes that I recorded at the end of each day. Most of theshort chapters or sections represent a summary of a single day. The actual dates are not especially important but I have left a few details to anchor the accounts in time in order to provide some context. I wanted to try to capture the detail of these patients and their circumstances and to convey the sometimes almost unbelievable reality that their experience represents. When I started to make these observations they were prepared as a kind of daily news blog for the consumption of my family back in the UK but, as is the nature of digital media these days, they found their way around many friends and even did the rounds amongst members of my local golf club. Again and again, they have been the focus of discussion and enquiry and it has been good to share the experience to the point that others who become aware are ready to pray, support, give and even visit in order to contribute in some way to the work of the mission. I welcome the opportunity to offer this account even although it provides a tiny sample of the experience of those working there full time. It would be wonderful if even some of their many stories could be written down and passed on but I fear that the full time mission staff are just too stretched in dealing with the demanding issues of providing care and support in the hospital, church and around the community that I fear the best of these amazing experiences may never make it into print. This therefore comes from a daily stream of the business of living and working in a remote mission hospital and taken together amounts to a total of around six months experience spread over five visits (2015-2020). My daughter Jenni who is an Emergency Medicine specialist accompanied me on my second trip to Chitokoloki (Chit). She had previously spent two months in Chit as her medical student elective. I have included her account of the visit we shared – for each of us our second experience although the fun part was that we were ableto go together and even work as a team. You can read her personal and amusing review on pages 72-88. My hope is that this book will provide an accurate account of the reality of medical missionary endeavour in the African bush. It’s all here; abject suffering in a resource poor setting, staff from many different countries working alongside dedicated Zambians, stories of individual patients and their many and various problems and a commentary on observed aspects of life for a beautiful and cheerful people who have more than their fair share of difficulties. Sometimes the medical work is frustrating simply because conditions which would be readily treated in the developed world are just not manageable in remote parts of Africa. Indeed, the provision of medical and surgical care on the global scene has become an extremely hot topic and many health care professionals now devote a great deal of energy and ingenuity to try to improve prospects for African patients. Beyond the service provision, a number of global agencies like the World Health Organisation as well as individual medical colleges and universities in the US, the UK and Australasia have become active in addressing the desperate need for medical and surgical support from both a policy and practical point of view. It has been a very significant privilege to participate in some small way to provide assistance and encouragement to friends who work in Chitokoloki year round. What they provide is unstinting care. ‘Above and beyond’ takes on a new meaning.