My living quarters were only a few hundred meters from St. Augustine. I stayed in “The Friary”. My quarters consisted of a brick room with adjoining bathroom. The roof was thatched with an underlying layer of corrugated iron. I had a toilet and a “shower”. Unfortunately the hose to the showerhead had been severed, and the shower unit was situated right in the corner. This meant that all I had was cold water trickling down the corner of two walls. As the walls were at right angles to one another, it was very difficult to collect the water in a circular bucket… 

I shared my room with a number of flat-mates. They included lizards, an array of arachnids, and some very fast, very big cockroaches. My favourite however was the frog I found sitting in my sink enjoying the constant flow of water created by interminable drip of the sink tap. 

The best thing about my accommodation is that it was just a hop, skip, and a jump from the “mess” (or staff dining room).  The men who work in the kitchen deserve a big pat on the back. I enjoyed my meals. However I developed a loathing for nshima. Made from maize, nshima resembles mashed potato but is absolutely devoid of taste. The ever-present rape was fine as long as it was mixed in with whatever else there was to eat. Highlights of the menu had to be the Sunday roast chicken, the chicken pie, and the meatballs. The puddings are also more than adequate  (I have been known to eat more than my fair share of the custard). By the way, although it can be done, being a vegetarian at SFH is not to be recommended... 

The mess is supplied with many novels, as well as packs of cards and the occasional board game to help pass the time. Soon, satellite television may be available at SFH – for everyone’s sake I hope it is up and running in time for the Football World Cup. 

Football is a second religion in Zambia. All Zambian youngsters are innately gifted with ball skills. I found playing with the SFH football team to be a good way of staying active. It also gave me the chance to really mix with the locals – although my congenital rhythm deficiency meant I never could fully take part in the intricate dancing moves they use as warm ups. The weekend football games are the height of entertainment at SFH. Nothing equals the unbridled ecstasy Zambians experience when their team scores. A cartwheeling sea of youngsters engulfs the pitch while the large swathes of the crowd still on the sideline burst into song and dance. The SFH team was happy to have me play alongside them, despite my often being left bemused by the erratic bounce of the ball on the moonscape surface. 

The first thing a newcomer to Zambia must do is master the three-part Zambian handshake. This must be followed by the ritualistic greeting sequence of “Hello, how are you?”, “I’m fine. How are you?”, “I’m fine” before anything else can be said. 

Zambians often have very interesting names. Firstly, there is an incredible abundance of people with the surname Phiri, Banda, Zulu, Tembo, and one or two others. Secondly, there is a fascination with first names ending in –son. Rabson, Raison, Wilson, and even Fatson are all to be found. People with the surname Banda seem to have the best names. Examples include Million Banda, Speaker Banda, and Elasto Banda. I have yet to meet Rubber Banda, Brass Banda, or One-man Banda, but I’m sure they are around. Rumour has it that there is an Airport in Chipata, and both of Funeral’s older siblings are believed to have died early in childhood. As for female first names, would you call your daughter “Fatness”? 

Katete is a pretty small place. So small there is not much to say. Just a few shops really. One of the local night-clubs recently held a qualifier for the final of the “Miss Katete 2002” beauty contest. The contest was particularly memorable for the Miss Universe-style contestant interviews – with a twist. There was the usual batch of “what will you do for the poor and starving when you are Miss Katete” questions. But then the MC asked the next unsuspecting girl, “Do you have AIDS?”… “How do you know?”… and so on. 

From the hospital one can easily walk to Tikondane guesthouse. A more arduous walk from close to Katete Secondary School leads to the 1660m peak of Mphangwe hill. From there the isolation of SFH can be truly appreciated. A flat green expanse, occasionally broken by roads or huts stretches to the horizon. From altitude SFH looks about the same size as Katete itself. To the south of Katete lies Boma (home of SFH’s nearest bank and immigration office), and from the hilltop your eyes can follow an undulating ridge all the way into Mozambique. 

I had the good fortune to visit South Luangwa National Park, to the north of Katete, with a group of people from SFH. South Luangwa is regarded as Zambia’s best game park, and is said to rival the best in Africa. We hired a hospital driver and vehicle and headed there for a weekend after passing through Chipata, a town close to the Malawi border about an hour from Katete. The road from Chipata to Mfuwe must be one of the world’s worst. It was more like a six hour drive along a dried up riverbed. Rumour has it that the road is left in this state to encourage tourists to fly to the park. We set up camp at a site outside the park before going on two four-hour long safari drives (one at night and one during the day). As it was the end of the wet season, the grasses were very tall making game difficult to see. Nevertheless, aside from leopards, all the big names were out in force, from zebras and giraffes, to hippos and crocodiles, to hyenas and lions. Watching a triplet of lionesses trying to chase a zebra into an ambush hidden in the long grass was a mesmerising experience – the zebra bolted sideways at the last possible moment, robbing the waiting lion cubs of their lunch. 

Lusaka, the country’s capital, didn’t make very much of an impression on me. I stayed at “Cha Cha Cha Backpackers” (which I can recommend) for a night before heading to Katete. It seems much like any big city. Ask at the backpackers where to go to get a bus ticket to Katete. The ticket must be bought a day in advance. Also, be aware that banks tend to close their doors to further entry at 1430 hours so sort your money out first. Many visitors to SFH stay at the Zambia Anglican Council guesthouse in Lusaka (which I also recommend, having stayed there on the way home). They can be contacted by email: zac@zamnet.zm. 

Money is a big issue in Zambia. The Zambian kwacha is barely worth the paper it is printed on. At the time of Zambian independence the kwacha was equal to the British pound. Today there are about ZmK 4,500 to the US dollar. As the biggest note is ZmK 10,000, you end up carrying around very big piles of money, and a lot of time is wasted counting it. US dollars can be quite scarce, which makes changing Kwacha back into hard currency quite a chore. Cash advances on credit cards seem to be easily obtained in Lusaka, and I think they are available in Boma. One other thing, if you plan to use traveller’s cheques in Zambia be aware that you may be charged up to US$10 (!) commission, and that Thomas Cook traveller’s cheques are not widely accepted (although they are at Boma, the nearest bank to Katete). 

Time and money issues prevented me from visiting the 100 m-high Victoria Falls and the town of Livingstone. They are considered world-class tourist destinations. 

This list details most of the important expenses incurred during the elective: 

Airfare: Auckland-Lusaka return: NZ$ ~3,500 
Visa (purchased at Lusaka airport): US$ 25 
SFH accommodation, meals, and laundry: UK£5 per day 
ZAC Guesthouse accommodation:  ZmK 30,000 per night 
Airport taxi (one way): ZmK 80,000 
Lusaka-Katete luxury bus (one way): ZmK 50,000 
Safari to South Luangwa Park (total including transport): US$ ~100 
Travel insurance: NZ$ ~300 
 
There are no mandatory vaccinations for Zambia – get advice from a travel doctor – I spent around NZ$500 updating my vaccinations. 

The Zambian climate is moderate for most of the year. Warmer clothing may be needed from June to August, whereas temperatures may reach greater than 35 ?C between September and November. The rainy season is from November to April, so be prepared for heavy downpours during this time. 

Power cuts are part of the routine at SFH, so be sure to have a supply of candles and a lighter or matches. A torch and a good stock of batteries are also essential. The power sockets take British-style 3 square pin plugs. Entertainment is limited at SFH, although satellite television may be on its way. Most people used short-wave radio to stay in touch with the rest of the world. 

Contact SFH before you go to ask them if they need any medical supplies. Free medical supplies can be obtained in New Zealand by contacting Medical Aid Abroad (http://www.not-for-profit.org.nz/MAA/). 

Contact Dr Mark Thomas at Auckland Hospital about HIV prophylaxis. Also take a good first aid kit and appropriate malaria prophylaxis. 

I would encourage anyone planning an elective in Africa to give careful consideration to the risks involved – they are not insignificant. 

If you are going to die in Africa, a road traffic accident is the most likely way it will happen. The roads in Zambia can be atrocious after the rains have fallen, and the locals drive like there is no tomorrow (for some of them there isn’t). If possible, avoid driving at night. During my time at SFH, the inpatient numbers swelled by forty or so patients one night after a bus travelling from Lusaka to Chipata blew a tyre. Apparently the first the passengers knew that something was amiss was when they saw the bus driver leap out of a window just before impact. He had to feign unconsciousness to avoid being lynched. Weeks later the surgeons were still dealing with the aftermath. 

One may be the victim of crime and violence anywhere in the world. Lusaka is far from the most dangerous city in the world, but petty theft, muggings, and even car-jackings are quite common. Remember what your mum tells you: avoid walking city streets at night and stay with the crowds - be cautious and aware of your surroundings. 

The political climate in Africa can be volatile. Keep an eye on current events. Zambia is stable at present. However, Zambia’s neighbours include countries such as Zimbabwe and the Congo, hence there is potential for externally driven unrest. 

An ominous risk of working in an African hospital is the possibility of contracting HIV (or other blood-borne disease such as hepatitis C) from blood exposure. The risk of a medical officer sustaining a needle stick injury is greatly reduced at SFH as the majority of cannulations and venepunctures are performed by nursing staff. However, if you assist in theatre the risk will be greater. I recommend the articles in the British Medical Journal by Dr A. W. Logie(*), who contracted HIV while working at SFH in 1994. 

A medical student who left SFH just before I arrived contracted malaria despite taking mefloquine as prophylaxis. Another visitor came down with malaria while taking chloroquine and proguanil. Anti-malarial prophylaxis provides only partial protection. Be sure to cover up between sunset and sunrise and use repellent and a mosquito net.  Malaria is so common in Zambia, that I’m amazed I haven’t had it (yet). 

Working at SFH inevitably involves exposure to patients with tuberculosis. Such patients are cared for either outside or in a designated ward. At SFH masks are not worn and there are no negative pressure ventilation systems or other means of patient isolation. 

Also, be aware that any scrapes picked up in Zambia (from playing football for instance) WILL become infected. 

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