Late life crisis

Training in tropical medicine

So last August, with the cautious connivance of my wife, I tested the water by leaving my NHS post and enrolling on a three month course in tropical medicine. I was terrified that I might not be able to stand the pace, but I soon relaxed in the company of the finest bunch of people I've ever worked with, most of them half my age. I was almost prostrate with fear about the exam (the first I had sat for more than 30 years), despite rumours that nobody had actually failed it since 1999. I remain convinced that I passed on attendance record rather than merit.

On route to Zambia

I had an interview with Médecins Sans Frontières, but they had no immediate “mission” for me. Meanwhile, a friend of mine from the course started emailing me, wondering whether I'd like to take over his post. He was in Zambia working in a rural health centre and as standby physician for the various small safari lodges and camps in the area. He was the only doctor for a population of over 10 000, with the nearest basic hospital 30 miles away. He was one of those “turn your hand to anything” general practitioners, who had the FRCS and had worked in remote areas in the past; he seemed ideally suited to the job. But me? Somehow, in a moment of madness, brimming with confidence from my new diploma, I agreed.

“Why ever did we recruit you?”

Had I really thought about what I was letting myself in for I would never have accepted the post. Once in the air my nerve began to falter. It almost totally failed at Lusaka airport, where I met my employer as we waited for a small plane to fly us to the remote Eastern Province.

“Have you worked in Africa before?”

“No.”

“But you have worked in the tropics?”

“No.”

“Good God, why ever did we recruit you?” Luckily, I had remembered to bring some key textbooks on paediatrics, obstetrics, trauma, and so on—well worth the excess baggage charge. Equally fortunately, I had a 10 day hand over with my friend, who passed on a huge amount of remote medicine experience for which I am eternally grateful.

Malaria was a light relief

Even then, I was ill prepared for the obstetrics and sick babies, and I had rapidly to relearn aspects of medicine untouched since my student days. Malaria, the predominant infectious illness, had been well taught on the course and seemed almost a light relief. However, it was distressing to see terminally ill infants brought in on foot or by bicycle from remote villages up to 35 miles away.

Things were made worse because the midwife had saved up five months' leave, which started just before I arrived. With typical African foresight this overlapped with the maternity leave of the most senior staff member, the clinical medical officer, so that at the height of the malaria season half of the permanent staff were absent.

Growing in confidence

Somehow the two remaining nurses and I muddled through, despite shortages of essential drugs and intravenous fluids and despite the fact that some nights our two four-bedded wards held up to 15 patients, mostly children accompanied by their mothers. As the dry season progressed malaria eased off and the workload became lighter. My confidence gradually improved, though I am acutely aware that one definition of experience is that it merely allows you to make the same old mistakes with increasing confidence.

Mixed feelings about leaving

I will leave with mixed feelings. In one sense I will be glad to go home. The hours are not long but the work can be stressful. Apart from severe malaria, obstetric complications are common in a community where the average family has five children. Trauma from road accidents and buffalo, elephant, and crocodile attacks can be horrific. HIV related infections destroy many young adults. And five months of continuous on call for the lodges and camps takes its toll.

But I will also be sorry to leave. The people are delightful, with ready smiles and easy laughter despite their awful poverty. The clinic staff work impossibly long hours with dedication and humour for paltry pay. This contrasts with their apparent indifference to suffering, which is presumably a vital survival tactic. The paradoxes are both infuriating and endearing. This is a “live the day” world. Tomorrow is another country; they do things differently there. The same applies to the past; they can hardly remember previous illnesses or symptoms. Yesterday they were lucky to survive; it is of no further importance, so forget it.

I hope I do not return home in a state of shell shock and that my wife finds me a more appreciative, rounded, and relaxed person. A little late in life perhaps... but is it ever too late?