Greetings from Chitokoloki,

Covid issues continue to be at the forefront of discussions. Since my last newsletter just one month ago, Zambian statistics have doubled. The country reports 78,534 and 595 deaths (compared to 42,313 cases and 233 deaths at the end of January). Extrapolating what is happening in our own area, the real numbers are likely to be considerably higher. We are only able to test a small selection of people as tests are in short supply. Of the tests we are able to do, 10% are positive. Other places in our province have 50-75% positivity of their swabs sent. There were no PCR swabs available for the whole of this last week. Nationally, they were reporting about 1000 new cases a day but this seems to have dropped over the last few days on the Zambian health dashboard but I think it is likely due to lack of testing rather than an actual drop in numbers. It takes about 7-14 days for results to come back – by which stage they influence our management very little. So we are having to isolate and treat based on clinical pictures rather than wait for results.

The rapid tests we have been using over the last few weeks provide an immediate result but have a 50% false negative rate. This is quite frustrating as it is hard to persuade staff and the community to isolate following such a result – even when they have identical symptoms to those testing positives. Most of our covid patients present with a headache and sore eyes which progresses to a cough around day 5. Few people have a fever. Some teachers tested positive at the beginning of February just as schools reopened for a new term. As a result, we are now seeing a lot of pupils testing positive. There is little we can do to prevent spread in the community as there is almost no adherence to the covid prevention rules. Group activities like local football matches continue, social distancing, handwashing and mask wearing are non-existent. And so our aim is to try and protect the vulnerable by adhering to the rules within the hospital setting, testing inpatients, isolating symptomatic individuals and reducing elective activities.

We have been starting to see sicker patients with chest x-ray changes and low oxygen levels. Thankfully these are attending hospital in only small numbers and so we are managing well to cope with the cases. Our 101 year old with covid was barely symptomatic. Interestingly the sickest covid positive cases we have had have been young men in their 20s. We received two young men (a 16 year old and a 21 year old) from the same village with exactly the same symptoms, covid picture on chest x-ray and low oxygen levels. Both tested negative for covid on rapid test but positive on PCR swab two weeks later. The 16 year old died within a few hours of admission but the 21 year old recovered after a few critical days and has since gone home. This sad case has been our own known death due to covid although we had three folk with palliative conditions who were positive at the time of their deaths although it had no influence on their cause of death. Several of our neighbouring hospitals have also had some deaths and are also struggling with the community attitudes. We are thankful to the Lord for sufficient supplies of PPE, drugs, oxygen and CPAP to be able to help those in need.

To date at Chitokoloki, we have had 134 positive cases – although there were multiple more with the same symptoms who were treated as covid. About half of our staff have been off with covid or covid symptoms. Thankfully this has been in groups of about 6 at a time so we have been able to maintain reasonable staffing at hospital. Most of our staff share housing with another member of staff so when one tests positive we have two off isolating.

I will be most glad to see the end of covid restrictions and not have to wear PPE any longer. It is hot in theatre at the best of times but we have had some 16 hour days operating recently. Whilst we are used to wearing surgical masks normally, the N95 masks are considerably tighter and it is nice to feel “free” at the end of the day when we can remove them. It is also hard to communicate with patients in a second language at the best of times – non verbals are crucial. Behind a mask this is much more difficult and it will be lovely to be able to remove this barrier to help show patients our care for them more easily. Please do pray for us as seek to share God’s love and the great news of salvation. We are kept busy with the medical work and there are always sick individuals and those requiring our help. But ultimately, it would be a very depressing state of affairs if our only goal was to treat and heal. Despite our very best, each week some dear soul heads into eternity. Our medical work, if anything, only delays the inevitable.

Praise the Lord for His faithfulness – new every morning. Every challenge we can face with Him by our side. Please do continue to pray for us. There is much work for the Lord in this little place but we have a powerful God.