by Stuart & Jess Fergusson

Short-term mission partners at Chitokoloki Mission Hospital, Zambia, February to July 2021

A taxi drew up to the entrance of Chitokoloki Mission Hospital and some agitated people emerged calling for a stretcher. An emaciated lady was bundled out of the taxi and on first inspection it was hard to decide whether we were dealing with a patient or a corpse. The on-duty nurses rushed with us to the emergency room where we saw some signs of life: a few gasps and an agonal heart beat. It was quickly apparent that we were in a hopeless situation. She smelled faintly of smoke and had a swollen abdomen and leg, which was discoloured with patches of large, possibly deliberate, burns. There were fresh chatta marks cut into her leg and abdomen. Her blood pressure was too low to measure and her pupils already fixed and dilated. She had been unwell for two months – Chitokoloki was clearly a last resort following a waste of precious time, money and treatment opportunities on traditional ‘healers’ (witch doctors). We undertook resuscitation but it was clear that battling for her survival was futile and our role was merely to confirm death.

A few months before, a dog in the nearby town suddenly became aggressive and bit many people before he was finally caught and killed. Jess spent multiple mornings vaccinating the screaming children who had been affected. Some days after that, a young boy arrived with his uncle. He too had been bitten but his parents had taken him to the witch doctor first, rather than pay the nominal fee for vaccination. As the boy became sick his young uncle insisted on taking him for hospital care. He was a sweet little boy but unsettled, foaming at the mouth, and the offer of a glass of water sent him into full-blown panic and spasms. This is the classic presentation of rabies, so-called hydrophobia and anxiety, progressing inexorably to increasing mental derangement and death. Over the coming days, we watched him deteriorate and were powerless to arrest his slow descent into terror-filled madness. Once established, rabies is universally fatal and all we could do was try to fog his consciousness with sedatives.

False Beliefs have Tragic Consequences

Although Zambia is ostensibly a Christian nation, many people remain tied to the tenets and practices of traditional animistic belief. In the area around Chitokoloki, river users are regularly lost to crocodile attacks.

Perhaps surprisingly, the response of the villagers is not to modify their bathing behaviour but to mount a witch hunt for the local who must have turned into a crocodile. Even among those who profess a Christian faith, there is great fear around the world of spirits and curses. It has been clear to us that loving the people of Chitokoloki means not only addressing their physical health problems, but addressing maladies of the heart, mind and soul.

Each time an operation is undertaken, we try to use the WHO Surgical Safety Checklist as a prompt for surgical teams to process key safety steps before and after surgery. Our local adaptation of this tool is to remind us to pray for our patients before their anaesthetic. It is a reminder that in this institution, our focus and motivation is subtly different. Enormous efforts are made to deliver the best healthcare possible but it is the beliefs and ethos underpinning this work that are key to its success.

…loving the people of Chitokoloki means not only addressing their physical health problems, but addressing maladies of the heart, mind and soul.

Short-term Service

The mission station at Chitokoloki was founded over 100 years ago with the earnest desire to see this small part of Africa transformed by the love of Christ. From February to July 2021, it was our privilege to join this century-old effort with Stuart bringing his UK training as a general surgeon and Jess hers as a general practitioner. We set ourselves five aims:

  • To encourage and resource the current staff team, offering the opportunity to share some responsibilities and think through ongoing development of the hospital.
  • To show love, care and concern for this particular group of patients by providing the best clinical care we could.
  • To learn and grow professionally, leaving us better equipped to serve patients in a cross-cultural or low-resource setting.
  • To learn and grow spiritually, refining in the heat of it.
  • To experience joy!

Over the five months, we worked alongside the expatriate missionary community and Zambian government healthcare staff, focusing on delivery of clinical care. Although we have both had quite a general training, the enormous range and complexity of cases often meant working beyond our areas of experience. There is rarely an opportunity to refer to specialist centres so for the vast majority of patients, Chitokoloki is their definitive provider of medical care. Since this was Stuart’s first time working clinically in a rural African hospital, he felt particularly stretched by the surgical demands but found it quite exhilarating to deal with such interesting cases in a well-established hospital system. Jess was able to draw on many years of previous work at St Francis Hospital in Zambia, but also developed new areas of practice. We were impressed by the high clinical standards maintained by government and mission staff alike, and it was a joy to serve alongside them.

A gospel message is preached every day in Lunda across the hospital public address system and broadcast directly from the gospel service at Chitokoloki assembly on Sundays. Covid-related restrictions have limited the ability of non-clinical believers to visit the hospital but Christian staff and missionaries have continued to provide individual spiritual encouragement as opportunities arise. Stuart was able to preach a number of times in the local assembly and at village outreaches.

One of the surgical challenges that Stuart took on was a very high-risk procedure on an elderly gentleman. Following devastating complications of surgery in another facility, we felt the only possible route to survival was a long, difficult abdominal operation. As would happen in any context, there was a discussion with the patient about the options before him: take the risk of a huge operation with an uncertain outcome or continue on a path of terminal decline. Another discussion focused on more existential issues. Was he spiritually prepared for the possibility of death? Did he have discussions to have with the Almighty before he went under the knife? Our colleague, Julie-Rachel Elwood, shared with him that death need not be the final enemy.

Faith-based Heathcare

Chitokoloki is part of the Churches Health Association of Zambia, a group of facilities that together provide over 50% of formal healthcare in rural Zambia and 35% of healthcare nationally. The high-profile medical journal, The Lancet, published a series of articles on faith-based healthcare in 2015 and highlighted that while challenges exist for faith-based healthcare providers, they enjoy higher satisfaction rates than both their public and private counterparts, and probably retain an important role in serving the poorest of the poor.

The contribution of faith-based organisations goes well beyond that of simply delivering healthcare capacity. Some time ago, the British journalist, Matthew Parris, wrote a surprisingly frank article for The Times entitled, ‘As an atheist, I truly believe Africa needs God’. The article is worth finding and reading in full, but it concludes: ‘Those who want Africa to walk tall amid 21st-century global competition must not kid themselves that providing the material means or even the knowhow that accompanies what we call development will make the change. A whole belief system must first be supplanted. And I’m afraid it has to be supplanted by another. Removing Christian evangelism from the African equation may leave the continent at the mercy of a malign fusion of Nike, the witch doctor, the mobile phone and the machete.’

From our African experience, we second this conclusion. But we affirm it from the perspective of ones who have been personally renewed by an encounter with Christ. Our Christianity has not given us any pretensions of moral superiority. We know and love many colleagues of other faiths and none who serve with equal or greater distinction. But the true flourishing of mankind cannot occur simply by attending to biological needs and faults. The church father, Augustine of Hippo, put it this way as he mused before God: ‘You have made us for Yourself, and our hearts are restless till they find their rest in Thee.’