For the uninitiated, a place like Chitokoloki is full of surprises and elusive to one’s expectations – in fact, I would say that to have expectations at all is a mistake. The truth is, I think, that it is quite difficult for those of us who have yet to venture so far to even begin to accurately imagine what life is like in these distant places, where much is different but not always in the ways you might expect. I have found that the reality is always more joyful, always more striking, always more nuanced, and always more heartbreaking.

Up until my trip to Chitokoloki Mission Hospital in Northwestern Zambia, the furthest south I had ever travelled was Florida, USA; I had never been south of the equator, and I had never been to Africa, let alone rural Zambia. I arrived in the capital, Lusaka, after leaving a cold and rainy United Kingdom and proceeded to “The Flight House”, where I would be staying the night before continuing north the next morning on a flight to Solwezi. I was welcomed warmly and enjoyed an excellent T-bone steak for my dinner; I must thank Cornwell and his wife Chrisencia for their hospitality during my stays that bookended my trip to Zambia and for keeping me well-fed.

I left for the airport in the early hours the following morning and arrived in Solwezi after a one-hour flight without issue. Meeting me at the Solwezi airport were Nyondo and Dominic, staff from Chitokoloki Mission Hospital responsible for the running of the laboratory, who had made the 10-hour drive together a few days prior to run some errands and collect me for the return journey. After stocking up with roughly six weeks’ worth of food at the supermarket ‘Shoprite’ (for there would not be another opportunity to get all my groceries), we began our 10-hour journey across the Northwestern province of Zambia to our final destination – Chitokoloki.

The road was mostly tarmacked, though affected by collections of potholes at fairly regular intervals that were sure to keep you awake, and failing that there would be the occasional goat, or cow, or pedestrian in the middle of the road, just to keep you on your toes. But we made it to Chitokoloki safely, arriving at 2200, just in time to unpack and get some rest before a day of introductions and orientation.

It was quite a surreal experience travelling cross-country to Chitokoloki, seeing the small villages along the roads, the mud huts and tin roofs; pictures I had seen, and the occasional appeal from charities on TV, but it was strange being there and seeing things firsthand. Yet, what became clear to me over my visit is that though there is much physical need in these places, there is still an ever-pressing spiritual need. Ultimately, for all the good work places like Chitokoloki do, it is for this reason that they primarily exist – to reach the lost and preach the gospel, which is the power of God unto salvation.

Chitokoloki Mission Hospital is situated along the banks of the Zambezi River, about 90 km south of the Angolan border. The region is sparsely populated, with Solwezi really being the nearest major urban centre. The hospital consists of a male and a female surgical ward, paediatric ward, maternity ward, intensive care unit (ICU), two theatres, a scope theatre, X-ray, physiotherapy, dental clinic, eye clinic, outpatient department, doctor’s clinic, pharmacy, and laboratory. In addition, there is accommodation across from the hospital for long-term patients and their relatives, often referred to as the ‘Old Hospital’. The 1 km² plot also includes a hangar and airstrip, and ‘the Colony’, which used to be the leprosy village, but has now been converted into housing for members of staff and volunteers who work at the hospital.

I spent my first day in Chitokoloki continuing to adjust to the blistering heat and soon discovered the value of a good fan to keep myself cool. Gordon Hanna was kind enough to give me a tour of the whole place, and lunch was generously provided by Dr. McAdam and his wife Lorraine McAdam with one of the missionary nurses, Rebekah, joining us. In the evening, I went to Dr. Ros Jefferson’s house for dinner, where I also met Keith and Gail Bailey and Dorothy Woodside. All in all, a good first day, and I had met most of the missionaries who were currently present on the station. Tomorrow, the hospital.

The ward round starts at around 0730 on all days apart from Tuesdays and Thursdays, when the day begins with a time of singing and devotion instead. I must say that the hospital staff sang beautifully, and I only wish I had recorded their version of Amazing Grace to share with the folks back home. Though some of the hospital staff are believers, there are still those who have not made a profession of faith; the devotions serve twofold therefore – to encourage the Christians, reminding us of who we labour for and through whom we enjoy every blessing, and to witness to the non-Christians, calling them to repentance and saving faith in the Lord and Saviour Jesus Christ. Furthermore, often someone would give a short message over the Tannoy system, preaching to the patients in the hospital about the gospel and their need for a Saviour. For though medical professionals are in the business of preventing death and curing disease, there is only One who can bring the dead back from the grave and give true newness of life.

My commute to the hospital each day consisted of a very short walk, where I was able to briefly enjoy the coolness of the morning before joining the ward round in ICU with the sickest patients. Of what I have been taught at medical school in the UK, there wasn’t much that could have prepared me for the kind of illnesses and diseases present on the wards – one of Dr. McAdam’s many sayings come to mind: “When in Africa, expect zebras, not horses.” One patient in particular was a sorry soul who had the ill-advised notion to drink battery acid in an attempt to make someone feel guilty for wronging him – not much more needs to be said here. The end result was that he was in ICU with two chest drains and less-than-ideal observational readings – we shall come back to him. Moving on, there were post-operative patients being nursed back to strength, patients with oesophageal varices because of chronic schistosomiasis, some who had come in from a recent motorbike accident, and in the days to come, a few of the beds would be filled with children who had fallen out of mango trees, for mango season was on the horizon.

The male and female wards saw a wide array of all kinds of presentations: traumatic injuries, bacterial infections, cancers, heart conditions – you name it – though the cross-section would be quite different from what you might see on a ward back home and the average age was much lower. In one instance, there was a sad story of a lady who had gone to a different hospital on two separate occasions about a small skin lesion on her face. She was told it was nothing and sent home. Unfortunately, by the time she came to Chitokoloki, it was evident that it was indeed something, and this small skin lesion had grown to quite a significant size, turning out to be a basal cell carcinoma that was now inoperable. In the UK, this kind of thing would usually be treated swiftly with an excision and would see excellent outcomes. Late presentations and delay in treatment was sadly a common occurrence, decreased chances of survival were a result in what could have sometimes been a preventable and/or curable condition. Sometimes late presentations would be complicated with ‘treatment’ given by the witch doctor or healer, as in many cases, the hospital was seen as the last resort. The paediatric ward was full of a similarly diverse cohort of conditions that I might have seen in old textbooks (or not even) and the maternity ward was a constantly revolving door of ladies about to give birth or just after.

My first morning in the hospital was an ever-widening eye-opening experience and there was no sign of letting up. It was about halfway through the ward round of the whole hospital when the crash call went out for a rapidly deteriorating patient in ICU. In these scenarios I’ve learned it’s a sensible idea to walk and not run (especially considering the floors of Chitokoloki Hospital had been freshly polished – you could have had a good game of curling going at times). The young chap who had ingested battery acid had gone into septic shock with his blood pressure in his boots. He was quickly taken to x-ray, then to theatre – for there we could ventilate him if needed and had ready access to anything we might need. He kept deteriorating and went into cardiac arrest. I started CPR (this being the first time I had performed CPR on a real patient). We got him back, but it wasn’t to last, and he sadly passed away. Why do I tell you this? Well, for these places, death is all too familiar and unfortunately not uncommon. My experience of life surely differs from many, but as a generalisation, we in the West are not confronted with death at anywhere near the rate seen in places like Chitokoloki. The reality of our mortality and the brevity of life is an uncomfortable truth that we can often ignore and when it does present, it’s typically people older than us, not a phenomenon of the young or younger – it appears as a distant thing, far off, out of sight. The man who died was in his early twenties, and he was only one of a handful at a similar age that I saw pass away. We have our allotted time and then we stand before the Judge. The question, ‘Where shall you be in eternity?’ is all the more poignant when you can hear eternity knocking. Tomorrow is not a guarantee, and every day is a gift from God. A question for us then: Are we using the time given to us wisely? And to those unsaved: Are you ready for eternity? Are you ready for tomorrow? For all those quickly approaching life’s final breath, the burden laid upon us is clear: Have they heard the gospel? Do they know Jesus as their Saviour? It’s the same here as there, but there, tomorrow can feel so much more uncertain. I would hate, however, to let you think that this is the lot of all the patients at Chitokoloki, for the many that come to the hospital, there are countless stories of successful treatments, lives saved, and new lives safely delivered.

Later in the day a young boy was brough to the hospital, by his mother, having difficulty breathing. A few questions revealed that this young lad had fancied a nut, bolt, and washer as a tasty treat and had got the whole lot stuck in his throat, an x-ray of his neck showed this quite clearly. To theatre we went. These kinds of procedures can be quite tricky sometimes I am told and carry the risk of further damage to the throat. However, the steady and skilful hand of Dr. McAdam retrieved the metallic snack without a hitch, requiring only a little sedation. This was faithfully followed by the resounding boom of Katota’s iconic and encouraging catchphrase, “Good Job!”. Katota is one of the excellent scrub nurses that works at the hospital alongside Jack, Kayombo, and Nema - they make a great team. I had a fantastic time working with them all, Jack being a joy to serve alongside, with his cheerful disposition and willing hand always ready to help and assist at every moment.

There were so many wonderful people that I had the privilege to meet during my time in Zambia. Rebekah, one of the missionary nurses from Northern Ireland was a great source of practical advice and teaching, getting me up to speed with the way of things and getting me involved. JR, who arrived about halfway through my time in Chitokoloki, just as Rebekah was leaving, was in a similar likeness such a helpful person to have around, and I know I personally benefited greatly from her direction as a very experience nurse, come midwife, come anaesthetist. Zambian locals, Charity and Philemon, were likewise another appreciated wealth of experience, answering my many questions, and guiding me through a few newly learned practical procedures. On the ward rounds, Dr. Felix Chibwe was another seriously experienced Zambia doctor, always engaging myself and a few of the junior staff members with helpful and insightful teaching points. Kawanga and Nevers made up some of the more junior members of the team and kept me company on the rounds, always ready to share in some good conversation. Dr. Ros Jeferson was a great help; specifically, as I worked on my project required for the University and generally, as she shared her knowledge as a very experience physician and paediatrician. And of course, there is Dr. McAdam to whom I am deeply thankfully for the many practical opportunities to grow as a medical student and for indulging me in a hearty discussion. Certainty, I can thank him for many iconic sayings that I have taken with me and tried on a few of my colleagues back home for my own enjoyment - a favourite of mine: “Pigs may fly, but they’re not a likely bird!”. One other I shall mention is Jeff Speichinger, who I was able to meet towards the end of my time there, and with whom I shared many interesting and encouraging conversations. It was a particular joy to be able to meet Jeff and his family, as he had worked with and knows well my Aunt and Uncle who used to live and work in Chavuma, a small village north of Chitokoloki. I was glad to be able to bring greetings from Aberdeen to him and his family and return them when I reached home. There are many more people I met in Zambia; I am sorry to those I have not been able to mention, and I am greatly appreciative of you all and the Christ-like hospitality and kindness you showed to me during my stay.

Returning to the medical happenings at the hospital, a few more weeks into my time at Chitokoloki, I remember well, being awoken during the middle of the night with a call from someone telling me there was going to be an emergency c-section. There was a lady who was failing to progress in labour with twins, she had been struggling away at home for some time before she presented to the hospital, and now there was nothing left for it, it was going to require a trip to the operating theatre. I arrived bleary-eyed and mostly awake, got myself changed into some scrubs, and waited for the rest of the team to start arriving. Soon enough, everyone was ready, including the patient, and I was scrubbed in with a gown and mask ready to assist Dr. McAdam to deliver these twins. The operation was a success, with two new healthy young boys safely delivered and a stable mother.

Moments like this are fantastic to be a part of and a great boost to morale for the whole team.

Another important morale boost is the morning tea break that happens just after the ward round without fail – I would think that nothing could interrupt this sacrosanct time bar the return of the Lord Jesus himself. Such a custom could seem strange and inappropriate to some, for the line of patients waiting never gets shorter and there is always work to be done, but one must remember that life is a marathon, not a sprint, and when faced with a task of this magnitude, it is not only important, but essential to pause for a reset before sallying forth. Furthermore, who doesn’t like a good seat and a delicious home-bake? And personally, I was relieved just to have a glass of water to cool me down. In no time, the work would continue: clinics, theatre, scopes, and with a blink it would be time for lunch.

There would be times of course where there was nothing left for it, and the work would go on into the wee hours of the morning. One of these occasions was ‘Ortho Week’. Regularly throughout the year a very experience orthopaedic surgeon from Lusaka would make a trip out to Chitokoloki to do as many cases as possible. Often travel to Lusaka for procedures is expensive an impractical, and for the majority that would likely be unable to afford the cost of surgery, the services provided by this surgeon was a lifeline to many of the people of Northwestern Zambia and beyond. On the days leading up to his arrival, the hospital would see a steady increase in the number of patients and inevitably ‘floor beds’ would be deployed in the wards and along the corridors to accommodate the flocks gathering for a chance at being seen and operated on.

Thursday brought with it a small single prop plane with Mr Collin West arriving with his surgical trainee and boxes of equipment. Over the rest of the day he would see just over 100 patients and would have to whittle this number down to fill the Friday operating list. In the end, there were 14 cases identified: a hip replacement, some ORIFs, a patellar tendon repair, corrective osteotomies, and sequestrectomies. The first case was to start at 0800 with the last case expected to be finished by 0500 the next morning. The day was long, and to this day I don’t know how they manage. Lunch and dinner were generously prepared and provided in the break room and the whole day ran like a well-oiled machine. I helped prepare the patients pre-operatively and then monitored them post-operatively until they were well enough to return to the ward. There was unfortunately one patient that had to be cancelled due to the time pressures, and understandably she was terribly upset, it was hard to see. Yet, there were still many who had had a successful operation and were on the road to recovery, where otherwise they might not have. All of us slept well the next day, and I was greatly appreciative of a restful Sunday.

I was great encouraged and blessed to be able to join with the saints in the assembly at Chitokoloki and enjoy fellowship and listening to the beautiful hymns sung in Lunda and Luvale. One Sunday I had the privilege to preach the gospel in the gospel meeting which happened to coincide around the time of Remembrance Day. The day is officially observed in Zambia, but many are unaware of it, even though Zambia had an important part to play in the most recent World War. I shared a few thoughts on Romans 5:6-8 and linked this in with the idea of sacrifice and Christ sacrifice – how he laid down his life not for those who loved him, nor those who were good, but for those who were his enemies, namely, us. It was a new experience speaking with a translator, as though many could speak and understand English, there are those who can’t, and so one of the elders of the church kindly translated my thoughts into Lunda. The meeting there is faithful in their gatherings and the preaching of the gospel - they regularly go out into the village to preach the gospel there also. Another aspect of there ministry is the Sunday school that some of the members of the church run, where many young children come to sing songs and hear stories from the Bible. I was able to join the older class and enjoyed hearing them articulate and affirm the truths of the Bible as we discussed who God is and who Jesus is from Philippians 2:5-11.

Soon, 6 weeks had past, and it was nearing my time to begin my journey home. I had left the UK with little idea of what I was to find in such a far-off place and found a place very different, yet oddly familiar in that, wherever people are, sin and suffering follows, and a need for a saviour never diminishes. I was able to share in joy and share in sadness, I made friends that I shall miss and discovered a place I hope to return to one day. The UK was just as cold and rainy as I had left it, and I was indeed glad not to be concerned about getting malaria or finding a spider under my pillow (this happened), but my experience in Chitokoloki has been an informative one and one that I shall remember. Please continue to pray for those who labour on tirelessly for the Lord, providing much needed healthcare, and the desperately needed gospel. How beautiful are the feet who preach the good news, how beautiful indeed.