N'cwala Ceremony

Yesterday we went to the N'cwala Ceremony in the village of Mutenguleni a few miles outside of Chipata. This is a yearly celebration of the first harvests by the Ngoni people of the Eastern province.

It's a big deal - even President Edgar Lungu came, with an entourage of armed guards.

His picture is displayed in most shops/establishments so it was fun to see him in the flesh. He had the exact same expression!

The ceremony involved a lot of tribal dancing...

We managed to get into the main area because whilst we weren't technically invited, there were a number of representatives from Saint Francis invited and we blagged our way in...

Inside we got moved on a couple of times for being in the way, so sat behind the tribes waiting to dance, trying to blend in!

Lots of people wanted to take photos with us...

Becky and Nicola with a man called Abraham who was very upset that I couldn't print him a copy of the photo there and then

After the dancing there were a lot of speeches. It was really hot so we decided to make a move. This meant we missed the main event where the chief of the Ngoni people drinks the blood of a black bull... Which might have been interesting to watch, but instead we went to Protea to have a fancy Chipata lunch!

If you thought portaloos at festivals in the UK were bad...!

Thousands of people came from all over the whole province.

The Mystery of the Missing Eggs Revealed...

My chickens haven't been laying all week, or so I thought... Until today I heard a strange clucking noise from Alex's garden. When I went to investigate this is what I found!

They were not pleased when I moved them home!

How to Make Nshima - A Cooking Lesson from Alyda

Nshima is the staple carbohydrate in Zambia. It's so central to their diet that if you ask someone if they've eaten and they've had anything to eat other than nshima they'll say no. On Christmas day, as a 'special treat' instead of being given nshima and beans like they have twice a day, every other day, the doctors served the patients chicken and rice (I was meant to be serving on the paeds ward but couldn't because I had an emergency c-section just over lunch time). Unfortunately this did not have the desired effect, and caused a bit of an uproar with patients demanding where was the nshima!

So having seen how much Zambian's love this dish, it only seemed right to learn how to make it. So on Saturday my friend Alyda from the 'high cost' restaurant gave me a cooking lesson...

Ingredients:

- Mealie meal - Alyda recommends superfine breakfast mealie meal for a nice smooth nshima (ground corn)

- Water

- Your chosen accompaniment 

Method:

1) Prepare a nice hot fire

2) Boil your water

3) Take your mealie meal from the sack... (Yes, I'm really dragging this recipe out...)

4) When the water is boiling add about half a cup and let it simmer for ~15 minutes

5) Add the rest of the mealie meal - it seems about one big cup per person

6) Stir vigorously until it becomes a thick paste, then leave it to steam with the lid on for a few minutes

7) Spoon onto your dish in the traditional shell shaped lumps

8) Remember that the chickens are still alive and that you'll have to wait until tomorrow to have your favourite chicken and nshima...

9) Prepare your chicken with tomatoes and onions, because literally the only way to cook anything in Zambia is with tomatoes and onions

I go to high cost quite regularly, so often see my meal sat beside the restaurant alive the day before I eat it! I literally ate one of those chicken's legs today... which is a slightly strange thought, but really if you're going to eat meat it's a bit hypocritical to not be able to accept the realities of where it comes from. Having said that I would never eat my own chickens!

FAQs

For some reason I wrote this post back in November, and never got round to posting it... I reckon I might be interested to look back on it in years to come, so will publish it now!

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Over the weeks and month leading up to my trip I have talked to lots of people about my plans and they have had a lot of questions, so I thought I'd write a little FAQ blog in case anyone is interested. I'm also interested to see if my answers to this change over the time I'm away, so it's good to document what I think right at the start.

Why are you going to work in Zambia?
There are quite a few reasons. Firstly I strongly believe that every human being should have access to decent, affordable healthcare, as a basic human right. Sadly this isn't the case for huge numbers of people across the world so I would like to contribute towards doing something about that. I realise this this is a drop in the ocean, and not a long term sustainable investment, BUT if my last trip is anything to go by, there will be people who live because of this decision, who would have otherwise died, and I think that is enough of a long term investment to make it worth while.

Secondly I LOVE obs and gynae and this is an amazing opportunity to gain heaps of experience in a very different setting. Working in Zambia will undoubtedly expose me to a number of challenges and situations that I wouldn't experience back home, so it's a great opportunity to grow.

Thirdly I'm always up for an adventure and I love the idea of living in a different culture. A lot of my friends have taken a year out to live in Australia or New Zealand, which sounds fantastic and is something I'd definitely consider in the future, but I really wanted to experience something totally different from life back home. I'm also excited for what will hopefully be a much simpler life with less materialism and instant gratification.

How many doctors work there?
Staffing is very variable. There are approximately 20-25 doctors, a mix of Africans (Zambian + Congolese) and Europeans (mostly British and Dutch). It has ~370 inpatient beds, and also provides extensive outpatient care. Compared to the hospital I did my elective in in Ghana it is much better staffed, but compared to my old hospital in Exeter - that has 800 beds and I'd guess maybe ~200 doctors.

What kind of hospital is it?
Saint Francis hospital was originally a Catholic mission hospital, founded by a Cornish priest in 1947, the son of the Bishop of Crediton, Devon! It's now run by the Zambian government, but has strong ties and financial support from the Zambian Anglican council. 

What's healthcare like in general in Zambia? 
This is a really difficult question to answer... For Africa, Zambia has a fairly good healthcare system, and compared to its neighbours, relatively speaking it's doing reasonably well. But it's very difficult to make any meaningful comparison to the UK. I suppose maybe it's like how the UK was in the 1950s?

For anyone who's as geeky as me and likes stats, this is a fascinating website:

http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_Total/atlas.html

Apparently the UK has 16 times as many doctors per population than Zambia. According to the WHO website above, Zambia's neighbour Malawi has the second least doctors in the ENTIRE WORLD, above only Liberia. SFH is very near the border with Malawi and also Mozambique so quite a lot of patients cross over to be treated here.

Are you getting paid?
I get paid a grand total of £150/month and have free accommodation and one cooked meal a day.

Are you going with an organisation?
I've gone through an octogenarian couple! He's a retired doctor and she's a retired nurse (I think) and they were career missionaries here for 40 years. They're literally 85 and only left Zambia about 5 years ago. They have a fund that's contributed to by donations which pays our salaries, and then the hospital provides the meal and housing. There's some link between the octogenarian's fund and the Zambian Anglican Council but I don't think they're quite the same thing. In the respect that people are asking, no I'm not going with a big organisation like MSF.

How did you find out about SFH? Why there?
One of the consultants, Rob, from my hospital in Exeter worked there about 10 years ago and really recommended it. Over a few weeks when I was considering this I met a huge number of people who had either worked in this hospital or had friends who had or were about to, all recommending going there. 

I don't know if you can see the tiny advert for SFH under the heading Africa - this is in Rob's bathroom, the BMJ advert that sent him and his wife there!

Did you know anyone else there? 
A friend who worked in Exeter a couple of years ago, Alex, has been here since April for 12 months. He's a senior registrar in general surgery (that means about 6-8 years more experienced than me).

Will you be home for Christmas?
No, I'll celebrate Christmas in Zambia, which should be fun. I had a fake Christmas in the UK a month early with my family to make up for missing it last year as well (I was on nights).

Me, my sister-in-law Heather, my brother Martin and my cousin Sofia celebrating fake Christmas in November!

What does you mum think of this?! (Popular question!)
She seems pretty chilled about it all. She says she'll miss me but she's excited for me. She lived in India and Nepal for a year teaching English before I was born, so I've grown up hearing about her adventures - now it's time for mine!

What's your postal address?
Saint Francis Hospital
Katete
Eastern Province
Zambia

This again is a popular question, but while I appreciate the thought, I really wouldn't recommend you sending me anything now. I received today (21.2.17) a letter my mum sent me on 11.12.16 and friends here report packages have taken 6 months to arrive. So only send something if you don't mind the chance of my friends getting it a few months after I'm gone! (My 6 month contract finishes in the hospital end of May, then I leave the country mid-June)

Tree Surgery = Ward Mayhem

The maintenance men decided one of the huge trees next to our maternity ward needed pruning today. I tried to teach them to shout "Timber!" when the branch fell, not sure they really got it!

The building just to the left is Bethlehem, the antenatal and postnatal ward. Every time a branch fell it hit the roof, so all the patients had been evacuated.

This meant we had a ward round in complete mayhem this morning, with patients scattered across the hospital wherever they could find a space:

Below is the empty Bethlehem ward. The picture shows the left side which normally holds the post-natal patients, and then if the camera turned to the right there would be the same again of antenatal beds. 36 beds all in one big room. We do often have a couple patients on mattresses on the floor due to overload (more in gynae), but never normally as much confusion as this morning!

The Inevitable Food Post

Lots of people have been asking what the food is like... so here's the inevitable food post. As part of my contract I get one hot meal provided each day. These are cooked in the mess, so most of the expats eat dinner together, which is really nice.

The sociableness of eating dinner together is great, and really the only reason we eat there, because the food is kinda terrible. Maybe that's not fair, but it's VERY repetitive and bland. There are generally three meals - chicken, beans or bouncey beef. Known as that because it's so chewy if you threw it on the floor, you'd expect it to bounce. This is then served with either rice or pasta and always the same vegetable - rape, which is about as appetising as it sounds. It's a green leafy vegetable that's like a bitter, gritty version of kale. Yum...

At one point we went through a terrible phase of having the WORST meal - rape stew. Instead of any protein it's just rape in this watery tomato and onion sauce on rice. So disappointing! Luckily not had it for a while.

Beans and rice and rape #instragramthat

For lunch, two or three times a week I go to what we (ironically) call "high cost". It's a little restaurant next to the high cost out-patient department (private out patients). For 10kwacha (80p) you can get a traditional Zambian meal of nshima (pronounced shee-ma or en-shee-ma in full), which is ground, boiled maize. This is served with chicken, beef, beans, liver or sausage and comes with a tomato sauce and a green vegetable, which traditionally would be rape, but my friend Alyda who owns high cost knows I don't like it so gives me a variety of other Zambian greens.

Nshima, chicken and pumpkin leaves

A clearer picture from the internet of nshima, chicken and rape

A lot of my expat friends don't like nshima, but I actually prefer it to the mess food. It's definitely the nicest starch base I've had travelling in Africa. 

I have quite a well stocked kitchen now since I brought back tonnes of food from UK, so I've been cooking quite a bit. Also it's avocado season at the moment, and the avocados are SOOO good! Only 5 kwacha (40p) for each huge one - not quite as cheap as mangos which were 5 kwacha a bucket, but I think they'll get cheaper as the season gets underway.

Garden Pics, Curry Night and Chicken Drama...

In case this blog is getting a bit medical, here are some pictures of the garden. I know my mum wants to see them, even if no one else does! And let's be honest, the whole point of blogs when you travel is to keep mums happy!

This is the front where I've planted some sunflowers, and the first one has just come out. I think the plants on the sides are cannas.

Then at the back I've got courgettes:

Sweetcorn:

Mange tout:

Basil:

And a few other bits that haven't grown much yet (tomatoes, carrots, swish chard). It's funny how some things have grown really well and some things have completely failed - I also planted chillies, salad, peppers and sweet peas which haven't grown at all.

Look what I brought back from home! Sorry about the mess, the grass is left from Benson fixing my fence.

I'm keeping the hammock in doors, but left the ropes on the papaya trees and annoyingly someone has nicked them... but I'm sure I can find some more rope somewhere.

Over Christmas we had a lot of storms and a lot of my fence completely fell down. I got Benson to rebuild it while I was away. He did a great job, but then I woke up the other morning to find my neighbours papaya tree had fallen down and broken it again! (Knocking down one of my sunflower too...) Luckily the leftover grass meant Benson could fix it again without too much trouble.

We get a lot of power cuts so I bought a fire pit in town. It's quite difficult to light, but once it gets going it's great. Made tandoori chicken tikka on it for our curry night last night.

(No this is not chicken...)

We had so much food, it was great! We've had a lot of new doctors arrive since I last put up people photos, I think all in medicine.

 Left to right: Raqib (medicine F5), Pete (medicine F4), Adam (surgery CT3), Kars (research officer), Nicola (medicine F3), me (O&G F3)

Sammy (surgical F3), Tim (GP), James (O&G ST5), Kate (physio), Becky (medicine F3)

There's also Marloes (surgery F4), Alex (surgery ST6), Ken (medicine F4) and James (medicine CT3) who are in various places ranging from South Africa to the hospital! And 4 medical students who are in Malawi/Livingstone at the moment.

There's some sad news about the chickens... since coming back from UK a couple of weeks ago Martha hasn't been seen - she's missing, presumed eaten! Pete's trying to persuade me that Chicken Run is a true story ("Apple pie? My favourite!") and that she's off enjoying life in a field somewhere... but I'm sure she's become someone's dinner. Possibly someone human, possibly someone dog!

Chicken photos as promised!

Martha, RIP!

Nkuku and Chicken Licken actually seem happier without her; I think she was a bit of a bully. They seem friendlier and are now BOTH laying most days, which is the most they've laid since I've had them. I was thinking of buying a replacement, but I don't actually need more than 2 (small) eggs per day so probably won't bother.

Chicken Licken getting extra friendly! They're also worryingly interested by the fire pit...

And since I also promised sunset photos...

I brought a volley ball back from UK and have made friends with a lot of the local kids who LOVE playing basket ball with it.

Sammy plays basket ball with a bunch of men, but the kids are definitely more my level!