Controlled Chaos

by David Galloway

David is a Consultant Surgeon and Honorary Professor of Surgery at the University of Glasgow and a church leader in Dumbarton, Scotland.

I had forgotten about the sounds and smells of Zambia. As I arrived at the CMML Flight House, I was aware of the contrast between suburban Lusaka and the village of Whiting Bay on Arran, Scotland, where I had spent most of the previous week. Arran is almost silent but for the distant crashing of the waves. Lusaka was a cacophony of dogs barking, roosters crowing, music blaring, traffic surging along and people shouting. I flew from Lusaka with our pilot, Chris Brundage, arriving several hours later in Chitokoloki. It was great to connect with David McAdam and Joey Speicinger again, and I met Alison Brundage and baby Jack who had come to welcome his dad home.

It is rare to see vehicles of any kind along the dirt track that leads out of the village towards Zambezi, but there are loads of people walking along. Almost all of them are dressed in filthy and worn rags, and few have proper shoes. The houses scattered along the track are simple grass or mud brick structures with thatched roofs.

Chitokoloki Hospital is like a strange museum of obscure diagnoses, from nephrotic syndrome to cholangiocarcinoma. The number of patients is overwhelming. One man was brought in from Lukulu, having been attacked with a spear. In Glasgow I have encountered abdominal wounds from guns and knives, even axes, swords and machetes, but never a spear. After the first ward rounds, we spent the day sorting out a list of surgical cases for the next few weeks. The most poignant moment came at the end of the day. I was introduced to Moses, aged five, with the most awful facial tumour imaginable. It is hard to conceive that anything could be done to deal with this. He came marching up to me, full of energy, and shook my hand like an old friend.

Lack of Blood

The lack of blood supply for transfusions is a huge problem in Zambia. Due to high HIV rates, using locally sourced blood, even in a life-threatening emergency, is not allowed. Even in situations where urgent transfusion is considered essential to save life, it cannot be given. Firstly, because there is often no officially screened blood available and, secondly, because staff are threatened with dismissal if they give un-crossmatched, or matched but not virally screened, locally sourced blood. This national policy is disastrous. Hospitals cannot function properly without blood. It would be hard to conceive of a policy that would be more likely to lead to unnecessary deaths for the purpose of preventing conditions that now pose much less of a threat than they did a decade ago. In a population threatened with chronic anaemia producing diseases like malaria and bilharzia, patients with the latter commonly suffer a sudden and dramatic requirement for blood transfusion.

Dangerous Influence

People typically take recourse to local healers and village medicine rather than coming to the hospital for treatment. To treat troublesome wounds, they will often consult the local witch doctor. Even patients who ought to know better will do so under duress from their family. The end result is often chatta marks or superficial wounds made by old razor blades, compounded by rubbing all sorts of non-sterile material into the cuts. Little wonder that the outcome can be dreadful. There is a culture of genuine fear that going against the local healer will result in a bewitching and no one wants a spell cast on them. All of this is doubly frustrating for the medical mission because there is not only physical help available, but spiritual help too.

For example, a woman with a relatively mild eye complaint consulted the witch doctor who poured battery acid into both of her eyes, permanently damaging the cornea and blinding her for life. When she heard the outlook, she was beside herself in anger and distress. Yet, they never report or complain about the witch doctor. The culture is based on fear and these dangerous charlatans continue to influence the community.

Surgery Begins

Every couple of months, Dr David McAdam’s considerable surgical repertoire is augmented by visiting surgeons. The orthopaedic surgical team arrived and set about seeing a huge number of patients who came from far and wide. A total of 85 patients were seen in consultation in a clinic that ran until about 9:30pm. They set up 20 cases for surgery the following day. Even with two theatres running and two surgeons operating, we worked from 7am until late in the evening.

The hospital electricity supply is normally secure. However, as the source is solar energy it has to be rendered usable by means of an inverter. Later that week, the system appeared to be overheating, so for most of the day we had either limited or no power. That meant no ventilator, no suction, no light and limited oxygen. In these conditions, surgeons are forever complaining about the position of the operating light. Light, it turns out, is a luxury in the bush. We completed the first surgeries of the day without light or power. Mercifully all went well.

We completed the first surgeries of the day without light or power. Mercifully all went well.

The decision to operate on some patients can present a real dilemma. Weighing up the risks of taking on a dangerous procedure in suboptimal conditions considerably raises the stakes. For the young boy Moses, it was evident that the advancing facial tumour would take his life – at least surgery offered the faint hope of a solution. We resolved to have a go at removing it, despite the risks.

As we prepared to operate, the major worry was the lack of blood for transfusion. Not to operate would have meant certain death, whereas a risky procedure provided the only chance of survival – a difficult conundrum for carers and families alike.

To deal with a death on the operating table is never easy. When it looked as though the worst of the procedure was over, things suddenly became especially difficult. Despite giving Moses fresh O negative blood, he suffered a cardiac arrest. We struggled until finally his system succumbed and Moses passed away. Everyone left the theatre after a very long day, feeling utterly dejected at the outcome. In a hospital with proper lab facilities and blood supplies he would likely have pulled through. That night I called home to chat to my wife and children, and was particularly thankful to see my own grandchildren, each enjoying excellent health – what a comparison!

Demonstrating God’s Love

Several distinctive factors contrast sharply with any other hospital in which I have worked. The entire ethos in Chitokoloki is based around medical mission: a desire to communicate the importance of faith in Christ. The full-time mission workers at Chitokoloki are driven by the desire to demonstrate God’s love for people by investing their time, energy and resources through the provision of free medical care. I am full of admiration for those who sacrifice the opportunity to have a lucrative and comfortable career in the West to serve where they are so needed. An important way in which this ethos is manifest is that we pray with each patient before they go under anaesthetic. Imagine that happening in the NHS. There would be a secular outcry. In Zambia, that practice and the attitude that underpins it are deeply appreciated and valued by local people, especially when they find themselves at one of the most vulnerable times of their lives.

These features help to make this place and the greater endeavour so valuable. There is a bigger picture in view at Chitokoloki, one that transcends the limited secularism that has become typical in the Western world. This is the demonstration of genuine Christian love in practical action.

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