Living in & Leaving Yuka

And now, back to our story...

Live in Yuka is one of severe isolation. They struggle to get people to work here for that reason alone. The doctor here is on bond with the government, and had no choice but to come. On the other hand, he grew up in western Zambia, so it's not so bad for him. The other doctor, an Argintinian, is on medical leave having a hernia repaired. He gave it to himself after lifting an engine without asking for assistance.

Futher complicating things is payment of salaries. See, there is no bank here. In fact there's no bank in Kalabo either. The nearest bank is back in Mongu, and that's going to take 1/2 a months salary to pay for gas to ride to the bank. So, if you choose to do this, you lose 1/2 your salary just taking your salary to the bank! "Why not just get a safe at the hospital?" I asked. Becuase no one trusts any ONE person to be in charge of keeping the safe, well, SAFE. Petty theft is nearly the norm out here, even among some of the hospital workers. It's largely, in my opinion, why places like this can't grow or flourish. The solution for now is that the accountant takes everone's money on ONE boat ride at the end of the month and puts all of it into the bank, returning with records for each person who made a deposit.

I spent one afternoon trying to clean out their O2 concentrator. It was about 2000 hours overdue for maintenance, and I didn't have any replacement filters for this thing (made in Colorado, USA, c.a. 1980). We did actually get to do surgery on that guy I mentioned in the previous post... the volvulous (torsion of the bowel). Here's how it went down.

After the doctor's meeting finished, we went over to the Kalabo district hospital, and went into the OR. I found a state of the art, new, Japanese anesthesia machine (with O2, CO2, and anesthesia agent analyzer), 2 new portable vital sign monitors, and an oxygen concentrator! Too bad there was no compressed air, oxygen or halothane that's required to actually USE such a system. In fact, there is no anesthetist at this hospital. And no muscle relaxants to use on this guy's massively swollen, bigger than 40 weeks pregnant abdomen. Sheeze. This was going to be fun.

So, I used what I had. I gave him the African triumverate of: 5 mg of diazepam (Valium), 600 micrograms of atropine (to counter the drooling-like-a-dog side effect of the...) ketamine! No intubation, LMA or mask, no inhaled anesthesia, no local anesthesia, no morphine. Just a nasal canula, an IV and the aforementioned drugs. I used what I had, and I had to use it well.

The bowel lunged out of the incision and looked to be about the size of my upper thigh. 4 hours and 2 GRAMS of ketamine later, we rolled him out to the medical ward minus most of his large bowel (there is no such things as a post anesthesia care unit here). I hoped they would check vitals on this guy, though he'd done quite well for me during surgery. (We heard that the next day he was doing well.)

So after a total of 3 days in Yuka, we awoke at 0530 to go to the dock and take the boat to Mongu, and catch the 9 AM bus to Lusaka. Of course, since we weren't the only ones going from the hospital to Mongu, we had to wait on them to arrive on African time (meaning anywhere from 45-90 minutes late). We loaded onto the little boat as it began to rain and pushed off into the river.

The boat wouldn't start. After a dozen or so attempts, it did fire up. Which kinda surprised me, since this wasn't the nice boat we came on. It was the hospital's boat, which had the gearbox drop out of the bottom of it a month or so ago and had been under repairs. Repairs had been delayed since the fishermen who retrieved the hunk of metal from the bottom of the river held it for ransom to the tune of 3 million Kwatcha. This had recently been negotiated down to a more reasonable price, and then the boat "fixed." Yeah, fixed. Fixed like a cat taken to the vet.

So we're idling up to speed, leaving 45 minutes behine schedule, and the pilot announces that we have too much weight on board. We go back and spend 15 more minutes to the dock and put 2 people and their luggage off (which was smart since we didn't have enough life vests for all of us anyway), and restarting the engine... again, and again, and again.

We arrived at Mongu 30 minutes after the bus was to leave. In reality, this is usually enough time to get on the bus before it leaves. However, we had to wait for a taxi to drive by, flag it down and get to the bus station. And, that took time. After getting to the bus station at 9:45 , we saw a lovely, huge, yellow bus idling and pointing in the direction of Lusaka. You can imagine the combination of comic disdain I felt when they told us that yes, that was the bus to Lusaka, and it would be leaving at 2200 hours. Lovely.

We had to take a mini-bus (16 passengers) that was scheduled to leave at 11 AM and headed TOWARDS Lusaka. We'd transfer at some other place to take another bus that was SUPPOSED to be crossing paths with us SOMETIME between 1400 and 1500 hours. It was the best we could get, and Jim and I HAD to be in Lusaka that night to catch the 6 AM bus to Chipata the next morning, so we could then leave the day after that for lake Malawi. So, I layed down on the concrete porch and rested my head on my backpack, pulled my hat over my eyes and chilled until the minibus showed up.

We loaded up around 10:45. I saw an albino load up, and tried not to stare. It had been years since I'd seen an African albino... the white skin, almost yellow hair... pink eyes. Then there was another passenger... a boy, about 5 years old climbed in too. It didn't seem as though he was with anyone. His face appeared as though it had been melted in fire, the sink now hardened like previously dripping candlewax, about a quarter inch lower than youd expect the facial features to be. He had no read ability to express emotion anymore. He sat behind me, as we faced the front. I wondered if he looked at me, like I looked at him.

Of course, we left late again, and we ended up driving around town to find fuel. We found some, but not legally. See, there is no gas out here. Or at least none left. What I saw the driver siphoning out, by mout from a used 10 gallon corn oil jug, and flow out a cut garden hose and through a rag/filter before filling the fuel tank, was actually Namibian gas brought over the boarder and sold on the black market. Without this fuel, Mongu has no transportation system.

We FINALLY got off TOWARDS Lusaka. With 21 people in a 16 person mini-van. What I wouldn't have paid for a small privat plane at that moment. Dude, these poeple smelled like phys-ed left over from last month!

About 3 hours later the driver pointed out the front window and said, "There's your bus." It was aobut 1/3 of a mile ahead of us, driving on the same road, belching diesel fumes out the tail pipe, looking all the world like the one I had seen on MacGyver 25 years ago that he had to repair before escaping from Mexico. Well, I thought, at least a bus in that bad of shape shouldn't be too hard to catch up with.

We did catch it, and after paying the extra 1.50$US bribe to have my bags underneith the bus instead of carry-on, we settled in for another 7 hours to Lusaka. I couldn't complain. I had an isle seat, and had brought enough kwatcha this time for a packaged snack (shipped over from China probably 6-12 months ago), fresh water, and some left over to pay for a couple first class pee-breaks (worth every penny when compared with the cleanliness of the free versions).

Total costs for the day were about 15$US per person.

I slept face d0wn again that night, my butt was so sore.