Shotgun Alley

Written by: Keith and Ginny Birrell

Highlight of the week: Gid and Adrian, Ian and Alicia, and myself challenge the birthday boy to 3 pin bowls. Keith strikes and wins a bowl. We lose an orange. And the bottles all fall down.

Lowlight of the week: 3 tsetse bites so far and a multitude of skitters. 

Maximum temperature: 30 degrees Celsius

Rainfall: A crack of the whip. Simultaneous blinding light. And a massive tropical downpour.

I travel back in time. The dial stops at 1991. I clamber out and get my bearings. I’m on Newcastle town moor. Surrounded by travelling people. Brightly dressed and wide as you like. Heavy engineering structures hurtle and spin. Sounds and smells assault my senses. They call this a fair. People come here for fun. But my personal opinion is that it is not appropriate to splice those 2 words together. The combination of spin and height particularly offensive to me. But my erstwhile self is here at the Hoppings. Putting on a brave face. Dating the new man in her life. Wanting to impress.

Funfairs are not my thing. They leave me cold and sweaty. If not totally vertiginous.

Every June, the Hoppings, an annual travelling fair, fills Newcastle’s town moor. It’s fair to say that the normally quiet, outdoor space, becomes full of smiling, high spirited people who appear to be having fun. They laugh and often they scream. Music plays and merriment goes round. The screaming might of course have other grounds. Other origins. Negative not positive?  I’ve always chosen to keep my feet firmly on the ground. Hedging my bets.

The buzz brought to Newcastle is apparently infectious. But I am far from being the index case. Perhaps I am protected by herd immunity? This particular bug has not yet found a way into me. Keith naïvely has invited me out for a second date at the Hoppings. Perhaps he wants to whisk me off my feet? He is, as yet, blithely unaware of my aversion to putting the words fun and fair together.

My smile is unreadable. I don’t decline the invitation, and somehow the die is cast. Second dates are second dates. I’m wary of saying no, since I’m not yet weary of Keith’s allure. Inertia results in me standing in a queue for a ridiculous ride tagged Death Roll. My smile is no longer alluring. But Keith is too excited to notice my increasingly agitated state. There is no dignified way out. I sit next to Keith meekly, and a flimsy protective cage is locked around us. The roll starts its deathly march, slowly at first. Within 10 seconds we are upside down and my stomach clenches. The roll soon matches its deathly name. We spin aggressively. My determined silence breaks rank. And my language becomes rank. Nay blue.

Poor Keith’s eardrums are pummelled by my involuntary yells: I scream. And I scream. And I scream. Amazingly no one is sick. Centripetal forces on the trapped occupants inside the cages of The Death Roll would automatically oblige any emetic fluids to be shared equally and in opposite fashions. Somehow we stay dry.

Keith hears the high emotion and feels the tight grip on his own hand. His head is in a dizzy spin. Could this be love? Too early to say, but his date is certainly a live one. The five minute trial by ordeal is certainly not a fair test. Neither is it fun. Keith mistakes the woos and the waahs and the vice like grip on his hand as an invitation to press on. We happily leave the death machine behind. As he guides me down amongst the sideshows.

This is where Keith first shows me the delights of Shot Gun Alley. Emblazoned above a side show he reads the prophetic words out aloud. But the prophecy is for future hazards. Thirty five years away and too abstract for now. Shot Gun Alley for now involves shooting clay pipes with an air rifle. Rewards of primary coloured cuddly toys the immediate upshot. Keith’s misspent youth means that he is confident to impress. A bright blue elephant is an easy prize. But the elephant needs a foster mum. So on Shot Gun Alley I start my dalliance with elephants and another elephant lover. Almost accidentally we begin to identify common threads. African inclinations.

The dial of the time machine is reset for more current affairs. You find us entertaining Mike and Sal at Kwetu this January. After dinner conversation turns dark as we are enveloped in Yorkshire gloom. Sal’s tongue, loosened by wine, challenges our positive outlook. Mike and her have been feeling mortal. Having already entered Shot Gun Alley themselves. Despite wearing good genes on the inside and following doctor’s orders to the letter they have been dodging pot shots from the age of six “O”. Sal fires a shot over our bows. Watch out Keith, from April you will be a marked man. Try to keep your head below the parapet if you can! Ginny also, you will find yourself in the cross hairs from July. Mike backed up the received wisdom with some stats. Actuarial data confirms that 15% of people in the UK are picked off between the ages of 60 and 70. But if Keith can negotiate shot gun alley and reach 70 he should then get to 85 without too much bother. If I can keep my head down as we venture forth from the trenches I should crack on to a ripe old age of 87. That’s two years of making my own coffee in the mornings. Either that or I will need to find a toyboy.

We abandon the time machine to find ourselves in the present. Keith turns 60. I try to distract him from the ever present cracks of sniper fire with a real birthday treat. Fortunately Keith’s long service in the Valley opens doors for us. We take cover in two sumptuous lodges: Chichele and Chinzombo. At least if Keith succumbs at the entrance to shot gun alley he will die happy. And I will at least still have someone to bring me coffee.

The 12th April comes earlier than most days. A 04:45 wake-up call, for once triggered by Apple, rather than our baboons. We pause briefly to scoop our breakfast favourites from bowl to mouth and grab a latte to go. John immaculately dressed is our guide. He offers a smorgasbord of possibilities. We drool at the offerings. Plan A could offer leopards. Plan B would see us happening upon hunting wild dogs and Plan C will depend on the calls of the wild. All of our plans are dreams, but John offers to turn them into reality. As long as we are flexible.

Flexible we are. Keith is already dodging bullets. His habit of being supple surely allows him at least this glorious morning. A short respite from sniper fire bought through regular yoga and occasion fasts. Contact calls fill the crisp bright morning air. Lion. Informing pride mates of their locations. In absence of what3words and google earth, the king of the jungle summons John’s merry men as well as the pride. John is not to be daunted by Somme-like fields, thick bush and ungraded roads. We bump and slide through the mud and splash through the puddles. Somehow we reach the river bank and wait for more calls. But the calls peter out and the trail goes cold. Well, in truth, the trail is too wet. We admit defeat. Plan C is abandoned.

Flexing we head off for other possibilities. Our plan again is plan A, but we soon stumble upon plan B. Wild dogs materialise as we head for leopard country. 12 dogs a lying. Looking lean. John talks up our dream scenario. Lean dogs don’t like to fast. And wild dogs are fast dogs. We watch as they stretch and greet. Yap a little and then sneeze a little. The votes are cast. Each dog sneezes once. All willing and democratically involved. They trot. They have impala on their minds and in their sights. The dogs commit to the hunt. Impalas pronk. No time to send out alarm calls. The hunt is silent. Instinctive. The quarry appears doomed. The impala have no chance to outrun this pack of endurance athletes. But best laid plans today are destined to change. The dogs path is crossed by a herd of edgy buffalo. 200 strong. Impenetrable and unchallengeable. The dogs know of the reputation of buffalo, so the alpha calls off the dogs. The pack trudges off toward our lodge, but via impenetrable bush, swamp and forest. I now have the benefit of a foretold future to tell you this. So John, Keith and I decide to stick to plan A.

Lady Wakumba is waiting for us, but where? We know of many favourite spots. The butcher tree? Two other favourite seats in trees? Our search seems forlorn. Her spots are numerous. Her camouflage immaculate for long grass and leafy trees. At the end of the wet season she is a needle in an overgrown haystack. And we have no magnet. No meat hanging in any known trees. There are too many unknown unknowns. Plan A seems doomed. And yet Lady Wakumba is watching a baby puku. We spy the leopard crouching in long grass. The puku are close, but non-the-wiser. Her leopard-skin coat blends her perfectly into the grass and the trees. There are no baboons to offer an opinion of the location of a hungry leopard. Lady Wakumba steals a few yards. We watch without breathing. The puku family know nothing. But puku are prone to calling false alarms. Dad shouts out to watch out. Paranoia feeds the herd. And despite not being heard nor seen, our leopard knows the hunt is off. She changes her plan, licks her lips wistfully and heads off for a seat in a tree.

Keith’s birthday hunt is over. He jinks and the snipers miss their quarry. Each hunter is out manoeuvred. And Keith lives to hunt another day.

In The Naughty Corner

Written by: Keith and Ginny Birrell

Highlight of the week: We meet our boss in Lusaka and join his alliance

Lowlight of the week: The cat is out of the bag. A 32kg beast breaks out en-route

Maximum temperature: 30 degrees centigrade

Rainfall: Patchy heavy showers

Events depicted in this blog may well be seen through rose-tinted spectacles. Time blurs. Memories fade. Naturally, as a young child I was an angel. With a blemish-free record to all intents and purposes. Without any need for a naughty step at home.

But at the age of four I metamorphosed. At infant school the docile pupa spawned a troublesome moth. Seeking light and heat. Full of chat. Restless and keen to learn. Miss Parr, my teacher, despaired and exercised her right to confine me to the naughty corner. Again and again. I was a prodigy at infant school. The product of scheming siblings. Robin and Sam had convinced me that school wouldn’t have me if I couldn’t already read. They gave me a head-start with home tutorials.

The criteria for admission to school were mis-sold. Consequently, my first year in infants was beneath me. Unchallenging. My advantage became a disadvantage. Easily bored by Peter and Jane (not forgetting Pat the dog). I spent some time reflecting on my aberrant behaviour. Sitting in the naughty corner. It was a bare wooden patch of floor. I had to sit crossed legged and stare into the corner. Even more boring. I soon learnt to contain my impatience. After a few visits, I was never there again. I was a quick learner.

But I digress. More on the naughty corner later.

Getting to Zambia, whilst war is waging in the Gulf, might have been fraught. It would have made good copy. But the truth is rather mundane. We bypass the Gulf on a plane that wins every category in Top Trumps. An A380 spirits us from Heathrow to OR Tambo in Johannesburg. Without a hint of drama. No missiles. Even the anticipated turbulence is cancelled out by our massive inertia. Most of which is surely our 150 kg of luggage. Trump card played. Yet we leave Trump behind. We will be cushioned from his tantrums for the next 4 months or so.

Our relief at dodging the war-zone is tempered by the automatic assumption of wrongdoing felt by all who pass through airport security. The officers manning the scanners at OR Tambo seem agitated. We brace ourselves for the ignominy of having to decant our trappings from hand luggage packed in a less than mindful way. Cables that seem to act like mating snakes. Impossibly entangled. A minute screwdriver enters the contraband bucket. A tiny roll of electrical tape follows suit. Even a roll of flimsy Sellotape and a box of rechargeable batteries require senior arbitration before narrowly escaping the guillotine. But our officer still seems unsatisfied. He needs something more incriminating. And then with a magician’s flourish: he fishes out what he is seeking. A silver sharp stiletto blade. Wait, my imagination is playing tricks on me. It’s merely a dinner fork. Ideal for your average mid-air hijack. It joins the rest of our contraband in the naughty bucket and somehow we are allowed on our merry way. Despite our evil intentions. Dinner at Kwetu in future will be a hand to mouth affair.

Our devil’s horns and tails betray us as we alight in Lusaka. The queue for immigration is shorter than we expect. Our paperwork is inspected and the officer smiles but says no. I can’t help you. Her body language says otherwise, but we swallow hard and expect the worst. You will need a report order, and I can’t do those. My colleague will gladly help.

A report order! The naughty corner pulls me back in. Flashbacks fill my mind. PTSD on steroids. No amount of EMDR will sort this one out. I’m doomed to be in a perpetual  state of limbo. Not wanted in Zambia. Perennially in the naughty corner. Hands on my head. Feeling the class staring at me from all angles. Ignominy. Officer Branston reads me my rights and shows me where to stand. In the corner……… but then I wake from my reverie and realise that Branston is on my side. Although the report order warns me that I face a potential 2 year prison sentence for not heading, tout de suite, to the department of Immigration. All is good and I can breathe again. The naughty corner has been emasculated.

Meanwhile, our own imaginary Schrödinger’s cat is in a state of limbo. Four virtual bags full. Checked in luggage that may, or may not, still be in the hold of our various Zambia-bound aircraft. 3 flights. 3 rolls of the dice. Present or absent. Heavy or light. Each bag teetering on the brink of the 32 kg threshold. Too heavy for the ground handlers to nudge from plane to plane? Niggling lower backs, or aged knees, that might just say “no” at any point. Our cat vaporising in a virtual black box.

Thankfully, our bright red bag and our bright blue bag make an early appearance on carousel number one in Kenneth Kaunda (KK) airport. A promising start. Two black boxes bear fruit. A short interval and we glance around. Other passengers also wait in limbo. Keith spies an odd flash of green inside of a thick polythene bag. He pulls at the bag and realises that the polythene hides a tale. A tale of immense forces. A struggle between 32 kg of bootie, gravity, backs and knees, and heavy machinery. The bag loses its dignity and its integrity. The seam splits and the contents herniate. The heavy duty polythene bag a rush job. Somehow our bootie has arrived in Lusaka. Our third black cat is dishevelled but alive.

Keith begins the job of filing a report. The baggage handlers need to know of this sorry tale. Our cat may have vet bills, or missing innards to replace. Keith leaves me to watch the spinning carousel. So I watch. And I watch. But no amount of watching helps our 4th cat appear. The last box is laid open and the cat has gone.

Dawn arrives in Lusaka city. Magical coffee materialises at my bedside. My breakfast is delivered by an apparition as Keith declares that the day has purpose. We won’t accept the offer of prison. And plan to take no prisoners. A swift walk up the road to the Central Immigration Office. Susan wrestles with a temperamental printer. A traditional part of the immigration dance. And by 9 am we each hold a shiny new 2 year work permit in a sweaty palm. The naughty corner now ancient history. Back in my childhood. Firmly. Guilt free.

Somehow the black box that holds our disapparated cat gives us a second opportunity to explore its contents. WhatsApp informs us that bag number 4 is at KK airport. Further enquiries outline a Catch 22 conundrum: Baggage handlers will not permit us to access the bag within 4 hours of our flight out to Mfuwe. They decline to deliver the bag to us too. They want us to fetch the bag at their convenience and miss our meeting with our Boss!

But serendipity is fighting a rear-guard action on our behalf. Coffee with Pam a crucial move. 37D Gallery a natural venue. Pam introduces us to Claire and Ross who own the gaff. Keith works some magic on Ross’ dodgy leg wound. And within minutes: Claire and Ross’ team have spirited our wayward bag back to our self-catered digs. Permitting Keith and I to join Fastone, our new Boss, at work and play for the afternoon and evening.

Sat in a window seat on the Proflight jet to Mfuwe, I place my shades on my nose. No need to use any rose tinting today. All this talk of the naughty corner is now historical but nice.

Playing Trumps

Written by: Keith and Ginny Birrell

Highlight of the week: Our to-do list looks like a winning bingo card

Lowlight of the week: We leave just as our garden springs forth

Maximum temperature: 17 degrees Celsius

Rainfall: Plenty

I play my best card with a flourish. An ace of spades. But Keith trumps me with a two of hearts. It’s only a game, but Keith’s smile says it all. The winner takes all. My competitive trait runs strong. I don’t want to just take part.

We know the way to Mfuwe. Even better than we know the way to San Jose. But getting to Mfuwe involves a few twists and turns. Choices, options and decisions if you like. We have just about tried them all. There are no direct flights to Lusaka unfortunately. So we pass through airport hubs. The hubs funnel us in, and out again. The glitzy terminals in Dubai and Qatar. The European efficiency of Paris and Amsterdam. The functional Addis Ababa. And the shambles of Nairobi. This year it’s Heathrow and Johannesburg. Fortunately, British Airways were offering the best deal. So we have managed to out-trump Trump and avoid both the missiles and the uncertainty of the Gulf states.

Last year our journey was properly Tangoed by the Orange man. One card was played after another. Nuclear facilities in Iran became unclear. Badly spelled, or wiped out with a well-aimed missile. The Ayatollah chose to throw away a dud hand and Doha was targeted with a parried lob. Our timing was off. Our flight from Manchester to Doha was waylaid. We played patience in Manchester airport. The skies off -limit.

Again this year the major league players are gambling big-time. The stakes are high. The Gulf has become a saloon bar, where cards are played and guns are toted. We are happy to avoid the OK Corral. Happy that our flights haven’t been cancelled. Happy that our fares predated the hike in jet fuel prices. Happy that BA has enough jet fuel to fill our tank.

This year we deal out the cards for another hand of patience. We adapt to the expectations of officialdom. One card played last year meant that we had to follow suit with a series of cards to get our new 2 year employment permits. The last card of that series is to be played this week in Lusaka, as we collect our shiny new permits. Lusaka central immigration office our card room. Laying that last card should be a slam dunk, if you can forgive me for mixing my metaphors. Lusaka, like many big cities, is not a place where we would ordinarily choose to loiter. But needs must, and 3 nights in Lusaka will allow us to hedge our bets with the immigration office, as well as giving us an opportunity to meet our boss.

In getting a 2 year work permit we sacrifice a few non-faced cards. Surrender our mid-tour trip to Chipata to collect our usual diet of traditional work permits. The drive to Chipata a burden happily forfeited. Meanwhile our diet both wins and loses. We lose our strawberries and mushrooms from the Chipata market. Our unhealthy Hungry Lion chicken dinner and a pizza stash for our freezer is conceded too. Keith is frantic about where our wine supplies will come from this year. But I still have an ace hidden up my sleeve. Nature abhors a vacuum.

Our one week departure count-down has a familiar feel. Lists are written. The tea-point1 steadily fills. Amazon deliveries arrive daily. Essential equipment comes in big boxes. Decanted into smaller boxes. Or no boxes at all. Clothes are sorted. And re-sorted. Washing washed. Ironing ironed. And somehow everything squeezes in to four big bags. No stone is left unturned. We clean and tidy. Kwetu is readied for visitors. Cars are SORNed. Batteries disconnected. Garden gardened. We walk the paddock daily. Admiring the newly planted trees. All 60 of them. We watch as the daffodils appear. The tree blossom is blown off. The magnolia generously flowers before we leave. Along with the Camelia. The pond is full of frog, toad and newt spawn.

Leaving Kwetu in Spring seems crazy. We will miss the tulips and the alliums. But at least we caught a first crop of forced rhubarb. Enough for a clafoutis. Fraser and Keith celebrate the early harvest. Yet the garden will still be in full flow on our return. Fruiting and a little nutty too. Ample rewards to tempt us to tackle the jungle growth.

Easter Day arrives. Our D-Day. Our combined bags weigh in at 150kg. The airport commute. With typical uncertainties. Passports checked and re-checked. Plenty of time left for mishaps. What ifs. But there is no crash. No calamitous delay on the M62. No break down. Storm Dave a damp squib. Our taxi deposits us 4 hours before departure. Our friend Nina, AKA Mama Chelewa, would bemoan our punctuality. But punctuality calms my jitters.

Once we are checked in, we check out. Check out of UK life. At this point what will be will be. It’s now out of our control. British Airways can take on my time worries. Transition has started. As we fly south for the summer, we go against the grain. And ready ourselves for the next chapter of our African adventures.

Keith keeps a poker face. I call his bluff. He knows that we have stacked the decks in our favour. I follow suit. We expect to be able play our next hands in South Luangwa well. But let’s hope that we don’t fold en route.

Sleeping sickness two

Written by: Keith and Ginny Birrell

Highlight of the week: Our last weekend Sunday in the park with Perry - our top friend and guide who last week passed his level 1 guiding exams - and came top in the country. Nothing but the best for us.

Lowlight of the week: It dawns on us that we are leaving here next week. A house to pack up. Bags to pack. Goodbyes to be said. 

Maximum temperature: 43 degrees Celsius

Rainfall: Looking forward to saying yes next week as we return to a wet cool October

Let’s swap beds for a night! The space next to Keith can easily accommodate any morphology. We have a king sized bed. We use a light sheet and keep the aircon on. All night. And the fan to boot. And yet somehow sleeping in the oppressive Zambian summer is problematic. A sleeping sickness, of a sort, is afflicting me. And so you are welcome to swap beds with me. For a trial run only.

I tick a few boxes for the possibility of all sort of maladies and hormonal misfires. At the age of 59, I’m well past my natural menopause and my hormones come nicely packaged up in a box. Strike one. My night sweats are not peri-menopausal. Perhaps we should consider TB? Keith has been coughing for an age. He reckons he’s allergic to Zambia. The sneezes are quite a thing. Not quite typical of TB. Strike two. The fatigue that accompanies sleep deprivation, combined with doubly sapping daytime conditions, even has me mooting cancer. But that is easily scrubbed out. Strike three.

The honest truth. On reflection. Is that 24/7 responsibility, in itself, almost has us on our knees. Tired. Burnt out. Call it what you will. A 3 month stint here is quite enough. How did we ever do 6 months in 2021? We really deserved a medal, Muttley-style. For services, above and beyond the call of duty. We left with nothing, but scabies.

I crave a day off. Proper down time. The opportunity to light a fire, on an autumn evening, in Yorkshire. To snuggle under a 13 tog duvet and to need it. To listen to the night sounds, without the constant hum and drone of dual aircon and fan. Even chortling hippos, roaring lions and barking baboons stay masked here. I crave the hoot of my Yorkshire owls and the peace of still cold nights.

Sleeping sickness is affecting our Valley in more ways than one. Tryp is a fussy little fellow. Rare and very niche. But other sleeping ailments also exist. My drenching night sweats might not be particularly pathological, but they mess with my crystals and chakras nonetheless. Perhaps I should move on? This blog is not meant to be all about me.

Let’s talk about William. He is this week’s case study. His need for attention is greater than mine. He is currently out of work and unemployable. All because he has a sleeping sickness. Not tryp you understand. His story doesn’t fit with tryp. William would have you believe that his problem started about a year ago. The rot started well before that. But more of that later. The bottom line is that tryp can’t be the cause of William’s woes. If it had been, William would have been dead and buried at the end of last year.

William is a 42 year old guide. By all accounts, he is the bees knees. Skilled. Knowledgeable. Amenable. A favourite with his guests. But only when he is awake. And here is the crux. William has a tendency to fall asleep. At the drop of a hat. And that hat seems to drop all the time. While sitting down chatting. While at the bar getting a drink. But more importantly, while at the wheel of his safari Landcruiser. A big issue when he is driving guests in the park. Picture this if you will. Narrow dusty tracks. Steep drop-offs, next to a crocodile infested river. Trees. Elephants. Hippos. Too many obstacles for his now autonomous vehicle to navigate driverless. Guests have had to grab his steering wheel. Give William a sharp nudge in the ribs. Relaxing game drives in the park have become white knuckle. Not surprisingly, William has been sacked. Again.

We find William serendipitously. A chance encounter with William’s boss. Keith’s ears prick up at the story. As part of our stroke prevention programme, we screen for obstructive sleep apnoea. A condition linked to hypertension, type 2 diabetes and strokes. Mainly caused by obesity. As a person drifts off to sleep, the muscles in their neck relax. The fatty tissue in the neck becomes unsupported. It compresses the upper airway. Typically, a person snores loudly. And then has a pause in their breathing. Which lasts for 10 to 30 seconds. Followed by a gasping intake of breath. The person has been suffocated by their own body. This happens repeatedly overnight. Leading to a poor night’s sleep. And then daytime sleepiness. A tendency to fall asleep easily. In meetings. Whilst being driven. And occasionally whilst driving. A plan is hatched. Keith will see William. Diagnose his problem. Enrol him in our stroke prevention programme. And help William to help himself.

It's Monday morning. Par for the course, there is already a line of patients to see Keith, as we arrive in clinic. WhatsApp sounds off. Morning Doctor Keith. William here. I am waiting for you. I am wearing a red checked shirt. We scan the waiting crowd. And do a double take. There is just one person in a red checked shirt. A smart, smiling man. But he is the wrong shape for us. He has defied our expectations. Tall and slim. His waistline is just plain wrong. Sleep apnoea seems only an outside bet now.

Keith works his way through his morning queue. William is patient number three. A quiet space is found. William is able to tell his story. He describes some sleepiness. A poor sleep pattern at night. He recollects it starting just about a year ago. After a short illness. Keith asks some directed questions and works out his Epworth Score. Epworth Hospital is a sleepy place in Australia that has 2,000 beds. Their scoring system just tells Keith that William tends to fall asleep a lot during the day. William scores 18 out of a possible 24. But William is keeping schtum about what happens when he drives a car. A common white lie. As Keith documents the tale, William drops off and has 40 winks. And Pinocchio’s nose gets a little longer.

William’s slightly sugar coated tale of woe also involves a poor sleep pattern. Night time comes and he barely sleeps at all. Two hours on. 2 hours off. Perhaps repeat. Never refreshed. Schrödinger’s cat is either asleep, or not asleep, in this particular box. But the cat needs a firm diagnosis to fix this sleep disorder conundrum. For now, Keith parks the conundrum with some melatonin and some sleep hygiene advice.

Keith is a bit of a whizz with sleep apnoea. He has a tool kit of remedies for that all too common affliction. But his gut instinct is that William has something altogether different going on. He decides to phone a friend.

Meanwhile, we happen upon William’s ex-boss. We tell him that at least William is playing ball. Engaging in the medical process. But his boss is still worried. The story from William does not add up. This problem has been recurring for years. William has lost a good few jobs from falling asleep at the wheel. He has gone to other parts of the country to work. But his sleepiness has travelled with him. This bad penny keeps cropping up. Perennially out of work.

Everyone needs friends. And many of you know that we aren’t always the best of correspondents whilst we are in Zambia. Except, that is, when we really need you as a friend. And so our friendship is rekindled. Shamelessly. Our first friend Simon recommends that Paul might be a better friend to us than he. Paul happily, is a sleep specialist. A friend indeed. We set up to rejuvenate our friendship.

We hate to admit that Mr Musk has any virtues whatsoever. But his starry connections guarantee a decent chat online. For social intercourse and even for work. Paul is a mine of useful information. William likely has narcolepsy. In effect William gets a tertiary specialist opinion, In Africa. Within a week.

Paul shares that the proof of the pudding is in the eating, as far as narcolepsy is concerned. There are some tells. Vivid dreams, especially during the day. Poor night-time sleep. Positive emotions triggering sleep or blank episodes. But Paul advises that tests are rarely important. My ears prick up at this. This is right up our street. Well down our sandy track at the very least. We specialise in not doing tests. What have you got to lose by trying him on the right medicine for this? says Paul

Baclofen, an underused drug, is available here, at a pinch. It helps people with narcolepsy get some restorative sleep. And modafinil. Basically an on switch, to combat William’s perpetual tendency to be switched off. William will need to be paced, to get the balance right between the ons and the offs. After being on for 4 hours during the day, he will need to nap for 30 minutes. Off. That could be just right for a guide who’s drives last for about 4 hours.

The ink is barely dry on the first page of William’s notes. As a guide, he gets to be part of a private medical programme, that should pay for his drugs. There is light at the end of the tunnel for him. A bright light during the day, to keep him awake, and a soothing dull night light to cushion him, as he takes restorative sleep. Medications and good sleep hygiene. Hope for William. To allow him to take the wheel again. To allow him to share his passion for nature with his guests. His Landcruiser currently off limits.

William and I are in a not so exclusive club. Sleep disorders are a motley collection of some common or garden varieties and some rare and fascinating maladies. But more people have occasional sleep issues than not. And more than one in ten of us is chronically afflicted. Sleep apnoea for example, affects 10% of our camp staff. William’s problem on the other hand is almost esoteric. He is special. Perhaps only 1 in 5,000 people are affected. But it’s not esoteric to William. William needs to know. He needs to know about his sleeping sickness. And so do Paul and Keith.

Tryp... tryp... tryp. A pain in the bum

Written by: Keith and Ginny Birrell

Highlight of the week: We dance our way out of clinic. There is no cure for our strange gyrations. We are compelled to dance for our lunch. But at least it’s a free lunch for our staff.

Lowlight of the week: The party is over. This is our last full week as Valley docs.

Maximum temperature: 42 degrees Celsius

Rainfall: The forecast suggests that our seasonal rains will be lower than average. Average at best.

t’s 1905. South Luangwa is in splendid isolation. Dual forces are at play. Forces hell bent on depopulating our Valley. A deadly illness is affecting colonial settlers. Sleeping sickness. Colonial authorities declare South Luangwa a no-go area. Cattle and men go home. The wildlife go wild. This is the beginning of South Luangwa as a conservation hotspot.

It’s Sunday. One hundred and twenty years later. Our day of rest. We charge double rates on a Sunday. To deter the not-so-sick from calling us. We plan our day: a drive in the park; a bush breakfast and coffee; home for a late brunch; a relaxing afternoon; a dip in the pool to cool down; a comforting evening meal; early to bed.

But our Sundays rarely go to plan. It’s Zambia, don’t you know? We start with a kerfuffle. None of our guide friends are free. Their open game viewing vehicle is double-booked. Plan B is a self-drive. It’s Joel’s last day here. We can’t not go in the park today. Breakfast is made the night before. Bags readied. Kettle full. Coffee grounds await.

05:00. The dreaded alarm clock goes off. Still dark. Silent. The baboons are very sensibly still sleeping. We drag ourselves up. Shower. Dress. Boil the kettle and make coffee. Fill the cool bag with breakfast and cold water. In the car by 05:45. At the park gate by 06:00. We glean some info from a guide. There may still be a leopard up a tree. With a kill. On the way to Wafwa. I saw it last night. It’s 50:50 that the leopard is still there. 

The uncertain post prandial habits of a leopard determine the direction of our drive. We turn right down Mushroom loop. En route to Wafwa. The Dead Luangwa. A now dry oxbow lake. But our instructions are vague. The candidate trees numerous. I swear I look up all of them. No leopard to be seen. But that’s fine. The park is peaceful. We watch a herd of elephants lazily walk to the river’s edge. Drink. And turn around. Three giraffe go one step further. Into the water. They cross the river, right in front us. The water barely laps their ankles. Scarcely. Drought the word on our dry lips.

We continue to head north. Chipela Chandombo Lagoon our breakfast oasis. One of the few lagoons in the valley still holding water this year. Mzungu’s doors open cautiously. A lone hippo plays dead in the lagoon. No threat here. We alight and drink in the scenery. We drown our breakfast muesli with milk. Coffee also rehydrates us.

It’s 08:30. Breakfast is serene. Birds flying. Impala drinking. Peaceful. Quiet. We listen for alarm calls as ever. Expecting the bush telegraph to warn of danger. But there are none. Our breakfast time sacrosanct. We savour our breakfast. On cue the serenity is broken. By an unwelcome harbinger of doom. An annoying little ringtone. An insistent chirrup. An alarm call of sorts. The Doc phone. Hi guys. Sorry to bother you. My husband has a bite. I think it might be a spider bite. But I am worried it could be a tsetse bite gone bad. All this talk of sleeping sickness has us worried sick. Can you come and see him?

A picture arrives through the ether. A lesion of interest. A possible chancre. A purple ulcer surrounded by redness. All that is missing here is the story of a painful tsetse fly bite in the preceding days. Our interest is piqued. Mzungu becomes FAB1. I become Lady Penelope. Parker, my loyal chauffeur, engages the Rolls Royce thrusters. We head off to clinic. Thunderbirds are Go!

Let’s take a short intermission here to tell you a bit about Trypanosomiasis. Easy for you to say. Most medics here call it tryp. To avoid tripping over their tongues, most likely. Sleeping sickness is the lay spin on it. Tryp is a parasite spread by tsetse flies. Bastard flies sums it up. With chainsaw mouthparts. They bite through clothes. Boy flies and girl flies both bite. At least they aren’t sexist. Neither gender gives a figs arse about DEET. Not caring that they hurt when they bite. Oh and tsetses are almost immortal. Armour plated. A full Newton force is needed to crush their robust bodies. An apple dropping from a decent height onto hard ground might just do it.

There are 2 forms of tryp. In West Africa tryp causes a chronic, protracted illness. Trypanosomiasis Gambiense takes weeks to months to wear you down. Leading to a gradual decline in health. Your brain function muddies up. Altered sleeping patterns. Eventually it is fatal, if not diagnosed and treated. But Trypanosomiasis Rhodesiense is much more aggressive. Found in Eastern and Southern Africa. A fast burn. Symptoms appear 7 to 10 days after a painful bite. Then comes an ulcer surrounded by anger. The chancre is often not especially painful. But it usually looks angry. Fever. Headache. Muscle and joint pain follow in short order. The parasite makes a beeline for the brain. Wreaking havoc on brain functions. Confusion. Delirium. And death is inevitable without treatment. Within 4 weeks or so.

When we first came to the valley in 2021, tryps seemed to be asleep. Our predecessors knew nothing about its latent ways. The received wisdom being that sleeping sickness has been properly put to bed. I won’t be needing to know about that. I delude myself. The tryp parasite disorganising my thoughts already.

Two years tick by. It’s 2023. I am doing my DTM&H course. Tropical medicine. And let’s not forget that critical hygiene part. Diseases around the world are now my daily diet. I want to cope with the bugs and nasties found in South Luangwa. But I’m forced to take in the also rans. Fascinating and alien-like parasites, but surely they’re all irrelevant to me? My remote course in Glasgow goes big on Tryp. A whole week of my timetable seems focussed on this niche ailment. I plan to doze through the lectures on tryp. This could be a big turn off.

The timetabled tryp week kicks off. I have a pillow at the ready. Next to my computer. But as I practice closing my eyes, Professor Lucille Blumberg appears on my screen. From Johannesburg. South Africa. Lucille opens my eyes. Wide. She presents a series of cases. Tourists on holiday. Many from South Luangwa. At this point I cancel the day dreaming plan. I’m in the room. Well, the virtual room, at least. Six cases since 2011. Not common. But ever present. After the lecture, I stay online. For a private word. I explain that we have been told there is no tryp in our Valley. This seems to be a mistake. Closing our eyes to the sleeping beast. Potentially this approach is responsible for late presentations and avoidable deaths. I now have a hot line to the Human African Trypanosomiasis expert.

This year the sleeping beast has awoken in our valley. The first confirmed case of tryp in 6 years was in April. Three months before we arrived. The diagnosis was delayed. The incumbent doctors were late to the party. Confounding factors confounded them. A plan is made, to play things better next time. Experts in South Africa arrange meetings. Zoom clicks into action.

It’s June. We are at Manchester airport. Being Trumped by the Qatar air traffic control shutdown. Fireworks cross the Gulf skies and we are stranded. I stand in a queue for 2 hours at the Qatar desk. Keith is on a conference call with Lucille and Evan Shoul amongst others. About Tryp. They discuss education campaigns. Raising awareness. How do we ‘fess up that there is still tryp in the valley after all? Might the tourists stop coming? A plan is made. Tourists and locals should watch out for painful bites going bad. Increased surveillance. Information sharing. And a plan of action for suspected cases. Photos of lesions of interest. Communication.

There is a new kid on the block. The tropical health block that harbours our specialist colleagues Lucille Blumberg and Evan Shoul. A wonderkid. A new, safe, drug that kills tryp, dead. Treatment these days for tryp should be straightforward. But there is a but. Delay in diagnosis, or delay in starting treatment, and our noxious, antisocial, parasite has a field day. Munching up brain tissue. Irreversibly scrambling neurones and their vital connections. The wonderkid is taken as a course of tablets. A little monitoring is needed. But otherwise the little Pac-Man style brain munchers are sent packing in short order.

But until this week the wonderkid drug is a little hard to come by. Fexinidazole. Held centrally by WHO. Apparently there is no Fexinidazole held in Zambia. That’s all well and good if you have medical insurance and can get to Jo’burg. Where Lucille and Evan will guard your back. And most importantly they will guard your brain. But it’s not so good for lowly Zambian farmers and safari staff. Who might just languish on understaffed wards, waiting for an elusive test. Dying in want of a diagnosis. Invisible to WHO surveillance. No disease. No drugs. Chicken. Egg.

Testing is also an issue. There are no quick and easy tests for tryp. Skilled laboratory technicians are required. Most lab staff have been taught from the same faulty song sheet. With the wrong music. They tell us that blood needs to be taken between 01:00 and 04:00. Plain wrong. Any time of day will do. No one wants to be up during the witching hour. So many don’t test. And that usual test is pretty tricky to do well. The sleeping tryps stay cloaked, masquerading as common or garden malaria or meningitis. No known sleeping sickness. No notification to WHO. No need for drugs to cure it. Get the supply chain wrong. And no supply. Unknown unknowns our problem here.

Let’s return to Sunday morning. We beat a hasty retreat from the park. Our patient, Bruce,  meets us at clinic at 09:30. He looks chipper enough. Walking wounded. A pain in his bum. At the site of the bite. No fever. A mild headache. General aches and pains. We examine the bite in more detail. And share the uncertainty. WhatsApp style. Our WhatsApp group is super high powered. Lucille, Evan, ourselves and Franklin. Franklin the top tryp doc in Zambia. And then we place our bets. Each of us ventures our opinion.

Certainly it’s not typical of a tsetse bite gone bad. Still a tryp chancre is at the top of our list. It needs to be ruled out. The story, and the lesion of interest, both point to a spider bite, or a tick eschar. Spider toxin leaves doctors all at sea. We have no tools in our kit for that. But at least tick bite fever is easy to treat. We’ve talked a lot about our favourite test before. Time. But tryp steals time. We can’t wait for time to make our diagnosis. We can’t wait for the deadly Pac-Men to munch on Bruce’s brain to give the game away. Time waits for no man. Our problem is time critical.

It's Sunday. There is a skeleton staff in the clinic. No duty lab technician. Lucille’s words echo in my head: Get a drop of blood. There’s no need to stain it. Look down a microscope at a low magnification. Fresh tryps will dance. But my enthusiasm is instantly dashed. The first hurdle too high. The lab is locked and the key is out of town. Drat. And double drat.

But Keith holds the ace card. He plays it with a flourish. Gloria promised me that she can test for tryp should the need arise. He announces with a smile. He barely supresses a smirk. I’ll message her to see if she is available. I stay quiet. Not wanting to dash Bruce’s hopes. Sunday remains the Sabbath in Zambia. The best we can realistically hope for, is a test on Monday.

I close my eyes to let the sleeping sickness take me for a moment. But when I open them Gloria fills my view. In her Sunday best. Straight from church. Lady Penelope stands down. Gloria who works for the fisheries and wildlife department, has access to the holy grail. A laboratory with microscopes and a PCR kit. To cut a long story short: she even has the ability to detect the minutest particles of tryp DNA in blood. It will take a few hours. It needs laboratory graft. But if we provide the blood, Gloria can do the tests. Our patient rolls up his sleeve. Blood is drained from a vein. And off Gloria goes. Promising to contact us in 4 hours. With the result.

Nobody has placed a bet on Tryp. Yet it’s still on the table. Our WhatsApp group plans for contingencies. We chase the elusive Fexinidazole. The word on the street is that, despite assurances that it can be made available within 24 hours, it would take 5 days to arrive in Lusaka. Five days that Bruce does not have. We treat Bruce for the treatable. That includes doxycycline, a simple antibiotic that does for tick bite fever. Best taken on a full stomach and not just before you sleep. We warn Bruce not to sleep after taking his antibiotics. And we say a silent prayer, on the Sabbath, to ward away sleeping sickness.

Its 17:00. We are driving to the airport. Joel is off on his adventures. After a month cooped up in Kapani and Kakumbi. Joel leaves our nest a little empty. He fledges and aims to flit around. Two months of fluttering around Botswana. Namibia. Possibly South Africa. The phone starts to warble again. It’s Gloria. The PCR is positive. Bruce has tryp.

Organising Bruce’s ongoing care involves a familiar and frustrating battle. Another insurance company trying to save dollars. I can’t bear to describe the convoluted dance that Bruce’s wife, myself and the monkeys representing Bruce’s insurance company have over the next few hours. We have grumbled about this process before. A battle I always seem to win. But the protracted campaign tests my grit and Bruce’s wife’s resolve. Bruce’s unscheduled trip with tryp to Jo’burg is magicked as a consequence of my 13 years training to be a doctor and my 18 years in practice. This Valley has invested in Valley docs for one main reason. We can do magic.