The Most Dangerous Activity!
I know what you’re thinking. Walking with lions? Sneaking around elephants? Wading with crocodiles? Well, maybe, but really the gravest danger in Africa, at least where tourist health and happiness is concerned, must be riding in an overland truck especially with a rookie driver. An overland truck is an odd amalgamation of a school bus on top of a 4-wheel-drive truck chassis that carries a load of adventurous passengers on tours around southern Africa. The drivers are an intriguing gallery of adventurers, rogues, and University educated Europeans opting for a life different. At their best, they are a remarkable combination of All-Knowing tour guide, master chef, expert mechanic and problem solver extraordinaire. At their worst, well I’d rather try my luck with the lions.
Sometimes the rookie drivers only endanger tourists’ happiness, like the driver bringing twenty Italians here from Malawi who “missed the turn” for Mfuwe in Chipata and would have ended up in Lusaka 350 miles away if his passengers hadn’t noticed they were on the wrong road. Fortunately he only managed to take them 120 miles out of the way, and they finally rolled into camp before the kitchen closed that night.
About a week after that incident, I was ready for a relaxing night of dancing on the Flatdogs bar after returning from a busy Friday in clinic followed by two “safari” patients. I was just hanging up from talking to Bill on the magical invention called Skype when Jess, the lovely, genteel Flatdogs manager, came up to me and said she’d just heard that an overland truck on the way to Flatdogs carrying twenty-two British high school kids and their teachers had an accident with “several injuries” an hour away (really in the middle of nowhere at all). Now those of you close to someone in medicine will know that doctors tease each other with sick jokes about buses full of injured patients driving up to the emergency department door. Well, this accident was no joke, and the “emergency department” was me!
A short time later the truck pulled up to Flatdogs reception in the darkness and clumps of disheveled and shaken teenagers began to pile off. One kid had a deep cut across his forehead and seemed a bit dazed. Another girl had a not too serious cut on her face. I climbed up the bus steps to find a scene out of a disaster movie with belongings strewn everywhere and seats spattered with blood. The most seriously injured sixteen year old sat very still on a seat where the trip leaders had placed her. She was alert and cooperative, but she had an impressively large gash on her scalp and complained of severe neck and back pain.
So what does all this have to do with overland truck drivers? Well as the story came out, the brand new Dutch driver had never driven the notoriously terrible road from Chipata to Mfuwe. Apparently he was falsely reassured by a rare smooth paved patch in the road and stepped on the gas. He hit what must have been a gigantic pothole at warp speed launching all of his passengers out of their seats up into the metal roof of the truck. (As I write this part, I realize that stupid human behavior seems to be a recurring theme in my stories.)
So it was left to me to care for this kid with a possible spine injury in the middle of the night in remote outer Zambia. Two of the safari camp managers handily unscrewed the front seat of the bus to make room for our extrication, and after we failed to find a suitable plank or door for a backboard, we sent for the “spine board,” basically some planks nailed together with handles cut in the sides, from one of the other safari camps. After some discussion and planning we carefully transferred our remarkably calm patient from her bus seat to the backboard and carried her in to the floor of the office. I stitched up her scalp as I kneeled on the floor while trying to fend off the marauding malarious mosquitoes buzzing annoyingly around my head.
Meanwhile, the trip leader began making phone calls to arrange for an air evacuation since I quickly made the obvious decision that this young lady needed x-rays to look for a spinal injury. “Medivacs” as these flights are called must be arranged through the patient’s travel insurance company (thank goodness she had one) for the fee of $20,000 and up to be covered. We were disconcerted that the young chap answering the phone in England didn’t seem to know exactly where Zambia is. He asked questions like “Is it dark there now?” (at 2 am Zambian time). He also refused to believe that medivac companies exist in southern Africa, but instead insisted on calling Flying Doctors based in Nairobi. Despite our assertions that Kenya is NOT in southern Africa or even very close at all, he persisted. He also refused to believe that Mfuwe had an international airport (as you might if you actually saw “Mfuwe International”), insisting that the plane would have to stop and clear Zambian customs in Ndola, an hour away by air. It was clear at that point we were in for a long wait.
Meanwhile we log-rolled our patient to keep her spine straight while we padded the hard wooden board with blankets from the safari vehicles, brightly colored chitenges (Zambian sarongs) usually used to keep dust off the office computers, and towel rolls around her head and neck all tied down with duct tape and bicycle inner tubes split and tied together which we borrowed from the luggage rack of the airport vehicle. Thus “packaged” our patient was as comfortable and secure as we could make her. With a lead “torch bearer” to warn us of encroaching hippos or elephants, six guys carried her the few hundred yards to a riverside safari tent, our temporary hospital. Once she was tucked in for the moment, I left her with the trip leader while I attended to the other injured kids. Fortunately both of them had deep cuts but no other serious injuries. They seemed delighted (“chuffed” I think is the proper British teen slang) when I confirmed they would each bear a scar from their injuries. Both were already imagining the mileage and party prestige they could massage out of the “scar they got in Africa.”
After finishing with them at 3 am, I carefully threaded my way through the hippos grazing in the campground to my most concerning patient. She remained relaxed and tolerant for the most part, but the prospect of hours lying restrained on her back waiting for her flight to Johannesburg brought completely understandable though brief bouts of tears and anguish. I sent everyone else to bed, but about every hour or so, I had to brave the roaming hippos again to rouse two of the adults in her group to help log-roll her onto her side for some relief of the pressure on her skinny teenage back. The night dragged on endlessly for both of us as she dozed fitfully in her restraints and I fought to stay awake by listening to the hippos snorting and honking close in the river just a few feet away. I felt so relieved to finally see dawn breaking over the Luangwa.
Our morning was made a bit more challenging by the fact that ZESCO (the Zambian government power company) had announced a planned (for once) outage beginning at 8 am which meant our phone wouldn’t work. Finally at 9 am (12 hours after our first phone call), we received word via radio that the medivac jet from Nairobi would be arriving at the airport in an hour. We loaded our relieved patient, arrayed on her board with her blankets, towels and chitenges, into the floor of the airport van, and with David, one of the Flatdogs managers, driving slowly over the pot-holed roads, we headed for the airport, 15 slow miles away.
Fortunately we arrived safely at the airport with time to spare since the Zambian immigration officials seemed determined to make the process difficult. They demanded paperwork be completed and most adamantly “their” $25 per person international departure tax. David calmly then more firmly in his ex-soldier manner reminded them that this flight was an emergency medical evacuation and time was of the essence.
When the Flying Doctors’ Citation jet landed, the immigration officials escorted our Landcruiser onto the tarmac just to stay involved in the day’s excitement. The crisply dressed Kenyan doctor and her male nurse introduced themselves, asked some questions then examined our patient before we began the transfer. We gently unloaded her onto the tarmac as they pulled out their state of the art total body vacuum splint for spinal immobilization, their spanking new orange foam head bed and their collapsible “scoop” for the transfer. Comparing our makeshift gear to theirs embarrassed me briefly, but then I thought ours worked just fine. David jokingly said he knew they wanted our equipment but we absolutely weren’t parting with it. Just then they began putting on the “head bed” which was equipped with elaborate Velcro straps. As we watched in raised eyebrow silence it became obvious that the straps had been put on wrong and wouldn’t close properly. The doctor and nurse glanced at each other, fiddled with the straps then managed to improvise an arrangement that seemed to work. Otherwise they were the picture of professionalism and efficiency, and soon they were loading our patient’s stretcher through the tiny door of the jet. In a few moments the jet was climbing towards Johannesburg and “proper medical care.”
Relieved, we headed back to Flatdogs. Later, I talked to the South African doctors caring for our young lady who confirmed that she did have a spinal compression fracture, albeit a thankfully stable one. Her travel insurance company rallied in the end and flew her and her mother back to England first class on Virgin Air. I have a sneaking suspicion that the rookie overland truck driver who caused all this trouble is now out of a job and that the chap at the “worldwide “ travel insurance company is reviewing his high school geography – or one can hope!
(PS As I write this story surrounded by the thick Zambian night, a leopard is calling its surprising sawing call just outside my house. What an amazing sound! Pardon me while I pat down the hairs on the back of my neck. I wonder if smearing Jell-O all over the floor by the door would do any good. Who knows, but I think I’m glad I’m not sleeping in the campground tonight! I’m afraid a leopard might be one creature my vaunted REI Bug Hut couldn’t repel!)
This page was last updated 08/18/07