Searching for Susu – part 2

by Bill Nelem
April 2008


The search for Susu has become a quintessential part of this trip to Africa for me. In part, the journey has become personal, in part, metaphorical, as you will soon discover.

Being charged by Rosemary to find Susu, I imagine myself embracing him and presenting him with a new bicycle. I imagine his surprise and excitement that Rosemary, who hasn't seen him for 32 years, still cares enough to make this gift happen. In my mind, I see him mounting his bike, male dog style, and riding off in typical African fashion – head high, spine straight, arms outstretched, swerving to avoid potholes as he went.

But, like so many hopes and aspirations in Africa these days, this meeting was not to happen.

Susu is believed to be dead. As they say in Zambia, he's late.

Hearing this news from John Jellis, I am surprised by the sudden sense of sadness that overwhelms me. I find myself grieving intensely for a man I've never met.

As metaphor, the news of Susu's presumed death triggers my grieving for all of Africa.

Why should 70% of all of the world's HIV/AIDS cases be born by Africans?

Why should sub-Saharan Africa suffer a 4-fold increase in the incidence of Tuberculosis in the last 8 years?

Why should hundreds of thousands of African children die each year to quench the collective thirst of the malaria-carrying anopheles mosquitoes?

Being partitioned by avaricious colonizing nations a century ago, without thought or care for pre-existing indigenous sensitivities, why does Africa suffer such post-colonial conflict and torment when finally given self-government?

Truly, 'The Shackled Continent' as Robert Guest writes in a book by that name. Read it.

Susu was about 50 years old when Rosemary's father sold the remaining part of their farm in 1976. Six years ago, at the age of about 75, in failing health, Susu returned to his village to die, accompanied by his wife and by Alison, their son. John has not had direct confirmation of Susu's death, but he can't imagine him still alive given his poor condition when he returned home so many years ago. John does not know the whereabouts of Susu's village. The trail ends.

We can only hope that his wife and son are happy and well.

I return a second tine to Rosemary's childhood farm to visit John and Jane Jellis, on this occasion with Linda Hawker, Family Physician, Gary O'Connor, Orthopaedic Surgeon and Kim Lefevre, Neurosurgeon, all of Kelowna.

Hillary Robinson, now retired British Orthopaedic Surgeon is still visiting there working with John.

As John drives us about his farm in his new Land Rover, his life story unfolds in reverse chronology.

We stop at an artificial dam that he created many years ago to trap the seasonal rains and to enhance the bird life. Picnicking and fishing are John's daughter and son, their respective families and some friends.

They celebrate the birthday of one of John's grandchildren. He revels at the 'Hello Grandpa' greeting.

His daughter manages the 50 or so horses on the property that sustain Zambia's only polo ground. His son, a man for all seasons, manages the cattle farming operation.

John's love for the native habitat and ornithology is clearly apparent.

We cross through a fence, entering Rosemary's original homestead farm.

The Land Rover swings onto a well-maintained airstrip. A brand new hangar houses a gleaming late model Cessna 206. The Beechcraft is away for it's annual inspection.

Supported by the Dutch Government, John operates 'Flyspec', an initiative he began in 1982. Along with Zambia's only Plastic Surgeon and his present and past Orthopaedic trainees, John flies regularly to a dozen or more rural hospitals to consult and operate on patients scattered all over rural Zambia.

In 2007 alone, they flew 67 missions, seeing nearly 3000 patients in consultation, performing about 900 operations. We learn that Zambia's rural hospitals were built in earlier times when they anticipated adequate professional staffing. Now desperately short of physicians and nurses, the countries medical system struggles to cope. 80% of graduating physicians and 60% of nurses leave the country for better pay and lifestyle elsewhere.

John has the only sustainable rural health programme in Zambia.

The cost to the Ministry of Health and the patients for this model service?

Nothing, apart from providing access to otherwise unused surgical theatres, idle for want of surgeons to use them. He flies in all of his surgical hardware as well as the disposables such as dressings and sutures.

Having completed his Orthopaedic training in 1972, John immigrated from Britain with his wife Jane, becoming the first Chair in Orthopaedic Surgery the year Zambia started their medical school.

Now 72 years old, and working full time in his 'retirement' he can look back on a truly remarkable career. Like Chifumbe, he is another of Zambia's iconic medical characters.

Within the context of his specialty, John has found a way to solve many of Zambia's health care challenges.

Early on in his career, he saw the need to provide a source of added income to retain physicians. With Italian aid, he established the

Zambian Italian Orthopaedic Hospital that allows some private practices whilst providing free care for all children in need.

Also in his early years, he founded an Orthopaedic trust that he uses to offset patient and equipment costs.

During his career, he has trained several Orthopaedic Surgeons. His is the only specialty never to have a graduate leave the country. Zambia must have the only Orthopaedic training programme in the world that requires pilot training as a pre-requisite for entry!

His strategies for education, training, retention and rural health are widely recognised and respected. The only problem is that no one else seems to have his skills and his passion.

We were amused to hear that during one of his rural fly in clinics, he had to break his Orthopaedic list to perform a Caesarean section when no one could be found to do it. We expect nothing less from Gary when he returns to Kelowna!

In my disappointing search for Susu, quite serendipitously, I stumbled onto the gemstone of John Jellis.

Susu is looking down and smiling. As an expert at riding bikes, he thanks you Rosemary for your love and your concern.

Mongu Matters – More than I first thought

Significant synergies are emerging for us with respect to Zambia's Western Province.

The fact that many of the activities are being matched from British

Columbia, our western province, is quite likely by complete chance.

However, I recognize serendipity when I see it and I know how to capitalize on it.

Mayor Shepherd and her Kelowna City Council recently signed off on sister city status for Kelowna and Senanga, Western Province's second largest town.

VIDEA, the Victoria based NGO, with the support of KaZ, the Kelowna Zambia community support group, are providing aid and infrastructure for Senanga.

As part of our now operational Memorandum of Understanding between UBC Okanagan and University of Zambia, and at Margaret Maimbolwa's suggestion, Jessica and Lianne will be going to Mongu, Western Province's capital town, to teach at the community nursing school.

If we are to put two medical/surgical/nursing teams on the ground in rural Zambia for a month each year, why not deploy them in Mongu and Senanga and create a combined synergy with the other BC based activities?

'A comprehensive collaboration between Canada and Zambia's respective Western Provinces.'

The theme will play out well with the media, and, perhaps with fund-raisers.

I haven't forgotten Rebeccah's exhortation that all activities must begin and end with 'evaluation'.

After luncheon with Lusaka Central Rotary, I head off to Mongu again.

The details regarding Jessica and Lianne's tour remain incomplete. Mr Alfred Mandona, the Principal of the Lewanika Nursing School was away when I visited last. I need to compete J&L's arrangements.

The Rotary lunch runs late, so the 6-hour drive to Mongu will put me there after dark.

This time I see live elephants on the road, rather than their evidence of tree destruction and their dung. The women are again cautiously washing clothing on the river's bank.

Again, the same guard at the game reserve checkpoint stops me.

Having neither fish for the market, nor sisters for the next village, he waves me through. Judging from the width of his smile and the vigour of his wave, he's obviously forgiven me for not hauling his smelly fish last time I passed this way. I'm most recognizable. How many white men travel this stretch of road alone in any given month, or year for that matter?

Dusk descends whist I'm still some 100 kms from Mongu. With blinding effect, the sun sets in the west directly in my line of view. I apply the window wipers to clear the grease from the dead moths and flying ants that have splattered on my windshield during the day. To my dismay, with the first wipe, I learn that there is no water or soap in my window washer bottle. Visibility is completely lost amidst a blur of fragmented wings and smeared insect oil.

Arriving late at Cheshire Home for Physically Challenged Children in

Mongu, I receive another warm handshake from Sister Cathy, and the key to my now familiar room.

As Western Province suffers from yet another power outage, I dine with the nuns by candle light, red wine in hand, capturing one of those unforgettable 'Out of Africa' moments.

Jessica and Lianne, they are all primed and pumped for your arrival in Mongu. Andrew Silumesii, Alfred Mandona, the other two teachers, the four clinical instructors and all of the students will receive you with open arms.

With a copy of the now famous Memorandum of Understanding in his hand, Mr Mandona, without prompting from me, proceeds to interrupt a first year student lecture in progress. He marches me up to the blackboard and announces to the startled and surprised student body;

'We are embarking on an international collaboration.'

A prolonged 'oooooh' can be heard arising from the students, followed by a respectful silence.

Some jaws hang in disbelief. Some eyes squint, wanting more information.

The drooped shoulders of some express perhaps a little anxiety. But, make no mistake, all of the students are riveted by this news.

'You're going to love your Canadian instructors', I enthuse.

As Mr Mandona and I leave the classroom, the entrance door still open, an outburst of chatter and the clapping of hands tell me that the international collaboration already has it's beat!

Margaret's on to it Beccah. She has an evaluation plan in mind with

Respect to the nursing school status prior to our nurses' teaching activities there. She wants to talk to you about it.

Cameron O'Connor, should you choose to accept the challenge, there is a 6-week volunteer job awaiting you in Mongu. Your assignment: Teach computer skills to the first year nursing students.

The good news, Cameron O, is that there will be two very attractive young Canadian nurses on site.

The bad news; you'll all be staying with the nuns!!

More later, Bill

The places you go – the people you meet

by Bill Nelem
April 2008


By far the three most influential people we've met are Dr Stephen

Simukanga, the Vice Chancellor at the University of Zambia, Dr Puma, the Deputy Minister of Health, and Dr Peter Mwaba, the MoH appointed administrator of the University Teaching Hospital. Peter is also charged with development, capacity building and infrastructure support in rural Zambia.

All are personable, accessible and interested in who we are and what we can potentially do in support of Zambian health care.

The UBC Okanagan UNZA Memorandum of Understanding opened doors everywhere. I had to go to the Supreme Court to get more copies of the MoU notarized because they all wanted multiple copies distributed to their various departments.

Even though the MoU was signed at the dinner we held for the occasion, I was summonsed to attend the VC's office the next day just to 'chat'.

Holding a map of Canada, the VC asks me to show him the whereabouts of Kelowna. How big is your town? What industries do you have? What is the 'Okanagan' add on to UBC?

How do you run two campuses under the one UBC flag?

Then with the MoH hospital administrator and the Deputy Minister of Health:

'If we bring a doctor/nurse team to work a rotation in a rural regional hospital, can we bring a documentary team to film and record the experience?'

'No problem - the Minister will issue a Directive.'

'What about the logistics with respect to transport, supplies, etc, etc.'

'No problem - the Minister will issue a Directive.'

Other significant contacts include Dean Mulla, Margaret Maimbolwa, the physicians and surgeons we met, the Mongu connections including the Regional Secretary for Western Province, Mr Mandona, the Principal of the nursing school in Mongu, Dr Stewart Reid, the Canadian Internist working at CIDRZ, an Alabama based NGO with a $15 million annual budget.

Emily at Women for Change, the NGO supported by VIDEA and KaZ is an important connection because she is so well connected as to how things work within the rural and urban communities. She's also a fierce and persuasive local negotiator for almost anything one might need at the grass roots level.

Of course, we always triangulate everything through Professor Chifumbe Chintu, my former medical school classmate! In all matters, it's always Chifumbe's call.

I’ll be off to Mongu again soon – Bill.

Searching for Susu - Part 1

by Bill Nelem
April 2008


I'm not sure exactly when Rosemary left Zambia for England and then Canada, but it was probably in the 1970's.

Born in Zambia, she lived as a child with her family on a large farm on Leopard's Hill Road, some distance outside of Lusaka.

When her parents sold the farm, it was divided in two parcels. I don't know who bought the larger part of the farm along with the original family house, but Dr John Jellis and his wife Jane bought the smaller part. Jane and John lived initially in a summer house that later burned down. Rebuilt, a newer house now stands on the ashes of the old site.

Rosemary remembers that Susu was the cook employed by her parents. Susu and his wife had a son called Alison.

Knowing of my upcoming trip to Zambia, Rosemary charged me to find Susu and, if he is still alive, make sure that he has a bicycle. If Susu is dead, I am to find his wife. If she is dead, I'm to find Alison, and to make sure he has a bike.

As I set out to find Susu, I'm about to discover more about Zambian health care, past and present, than I have during all of my visits and interviews conducted over the past three years-and that includes my many visits with Chifumbe.

All I know about Jane and John Jellis is that they have a post office

box in Woodlands, and that they live somewhere out on Leopard's Hill Road on part of the land where Rosemary grew up. I don't have a street number, nor can I find a telephone number.

Well, for starters, no one lives in a post box - scratch that.

Discovering Leopard's Hill Road on the map is easy.

I start by driving out of town.

It teems with people walking, with cars, bikes and trucks. I notice that there are no street numbers. That's probably why I have no street address for Jane and John.

An occasional building displays a business name, but otherwise there are precious few signs. Along the road, there are what look like farms or small estates. Some have gated entrances, but none have name signs. At some one must enter only with prior appointments, but there are no clues as to how one might make an appointment. '

Beware of dog' signs abound, as do stray dogs.

The road heads straight out of town. Not surprisingly, the traffic lessens as one proceeds. After many kilometres, the paved road gives way to dirt. The two-lane dirt road gives way to one lane. The pothole score rises from a 6 to an 8 - and then a 9!

Finally, whilst circum-navigating a particularly confluent cluster of potholes, the car shudders, and my left front wheel falls into a deep hole. My front axle comes to a grating rest on a rock. I am now pot-holed out at 10.

At the outset of this journey, throngs of people crowd Leopard's Hill

Road. Now I'm alone. No one is to be seen anywhere.

Knowing Africa, I am assured that faces will appear from somewhere soon.

First imagined, then done. Four young men bound along the road on foot, clapping their hands, laughing and pointing to my left front tyre.

I laugh with them.

One hefty heave from these lanky lads and I turn back to Lusaka. This is the end of Leopard's Hill Road for me!

Just as I regain the paved road, I see a sign that I missed on the way out, too busy dodging potholes, no doubt. 'Ann's Books'.

I surmise that Ann must be an educated person if she sells books. Maybe she will know of the Jellis house. Beside the main book sign is a smaller sign, 'Beware of Dogs'.

I approach Ann's house. Four large Rhodesian Ridgebacks, growling, barking and gnashing their teeth, surround me. I stay in the car.

The house door opens, and Ann appears. She clicks her fingers and the dogs are tamed. She is an older white woman, perhaps eighty. Her long hair is uncombed. As she walks towards me she limps, her left ankle wrapped ineffectively in a tensor bandage. She wears a loose smock, open at the front.

She speaks with an English accent; 'Ah, Jellis. About a kilometre back to town, Chifwembe Road, turn left, go four kilometres. You will see a sign on the left - the Lazy J Ranch'.

As I enter the farm where Rosemary once lived as a child, I see why she has such fond memories. On the right is a dedicated sanctuary. Straight ahead, I see a football pitch, a polo pitch and stables for 50 horses.

Jane greets me and introduces me to Hillary Robinson, an Orthopaedic Surgeon out from Britain to help John. John rises from his afternoon nap, and it dawns on me that I'm about to meet another of the country's iconic medical figures.

I know that I'm still searching for Susu, but my lessons on Zambia's health care history and present status are about to begin.

To be continued in ... 'Searching for Susu - Part 2. Bill.

Chifumbe Chintu – The Professor!

by Bill Nelem
April 2008


I first met Chifumbe in 1962 when we enrolled as classmates in Medical School at the University of Toronto. He had come from Northern Rhodesia where they had no Medical School at the time.

In 1963, four events occurred that were relevant to both of us.

First, we both passed our exams and moved into second year!!

Second, I was playing rugby for U of T at the time, and I was appointed to put together a track and field team from Medicine to compete at an inter-faculty track meet. We were a motley crowd with little apparent talent. I urged the lithesome Chifumbe to join our medical team.

'No, I'm out of shape, I'm not fit, I haven't run for a long time'

Chifumbe responded.

But I persisted, and Chifumbe did run.

In fact, he ran and he ran and he ran. I can't remember now how many races he entered, but I do remember that he was unbeaten in any race he ran, setting two university middle distance records.

He went on to train with the Canadian track team. At the Olympic

qualifying trials, Chifumbe won two middle distance races setting

Canadian records. The coach wanted him to compete in the Olympics for Canada. But some bureaucrat in Ottawa who noted that Chifumbe had entered Canada on a student visa blocked this request. A petition was sent to the Minister in charge of sport at the time. The application was lost in the giant hairball that is our Federal Government.

His home country did not have an Olympic strategy at that time, and was not able to send him.

And so it came to pass that the fastest middle distance runner in Canada at the time did not go to the Olympic Games. His friends were thoroughly aggravated, to say the least.

Third, Sir Alec Douglas-Home, the British Prime Minister in 1963, announced in the House of Commons that Northern Rhodesia would be released from the Central African Federation, paving the way for the country's independence. Thus, the following year, Northern Rhodesia became the sovereign state of Zambia. Chifumbe became a Zambian citizen, a First Zambian so to speak. His pride in his newly formed country would take him home one day once he completed his training. He committed himself to serve his country and his fellow citizens. The United Nations would one day award him with a medallion recognizing his contributions to medicine in Zambia and all of Africa. Zambian President Mwanawasa recently honoured him in a special ceremony, an act akin to our ‘Order of Canada’.

Fourth, on a fateful day in 1963, Chifumbe and I were attending a lecture at the Medical School. Professor Ritchie was giving a lecture in Pathology on Cancer of the Esophagus. He was a dour, autocratic, humourless New Zealander. He had a stunningly pretty wife and none of us could even remotely imagine what she must have seen in this overbearing man.

The day's events were memorable for two reasons, both of which I can remember as if they occurred yesterday.

First was the content of the lecture and second was an event that everyone alive at the time will relate to.

Now, a Thoracic Surgeon having performed hundreds of esophaheal cancer resections during my career, I remember my Professor of Pathology's words every time I begin to operate on an esophageal cancer patient.

With his sombre Kiwi accent, he said that 'cancer of the esophagus is not really such a bad cancer, it's just that it is located in such a bad location. Unlike other gastrointestinal structures, the esophagus has no serosa. Accordingly, esophageal cancers have one less barrier to prevent its spread. This disease has an unfortunate propensity to spread quickly to the gastro-hepatic and gastro- esophageal lymph nodes.

Surgical removal is fraught with technical difficulties and surgery is associated with a high incidence of complications and a high mortality rate'.

Forty-four years later, I can attest that everything Professor Ritchie said at the time remains true, with the possible exception of lower surgical mortality rates!

What was the other event of the day that was so memorable?

As the lecture drew to a close, the door to the classroom swung open and the janitor whom we knew well burst into the room. Professor Ritchie was indignant about being interrupted. Nobody, I mean nobody, ever disturbed this alpha male.

'President Kennedy has been assassinated!'

Professor Ritchie, Chifumbe, our classmates and I sat in silence. After what must have been a duration of several minutes, the Professor quietly folded up his lecture notes and tiptoed out of the classroom. The janitor and my classmates continued in silence for several more minutes, no one knowing what to say or what to do.

I went on to train in General and Thoracic Surgery, whilst Chifumbe went to Toronto's Hospital for Sick Children to train in Paediatrics.

Now fully trained, Chifumbe returned to Zambia shortly after the creation of the Zambia's only Faculty of Medicine and the building of the University Teaching Hospital (UTH).

Being the only certified Paediatrician in the country, he became the Professor of the fledgling Department of Paediatrics.

In the 1970's he went to Japan and presented the case to Japanese

foreign aid that they could assist in the building of a Paediatric ward

at UTH. They did. The ward today stands as a monument to Chifumbe.

A dozen or more years later, he returned to Japan and presented the case for a Neonatology ward. Again, he was successful. Now there is another monument to Chifumbe where hundreds of critically ill neonates owe their lives to him.

If you perform an Index Medicus - Pub Med search on the Internet, and key in 'Chintu CR', you will be flooded with the titles of several hundred articles that he has contributed to the medical literature during his career.

He was strategic in his planning. Collaborating with research teams from the US, Canada, the UK and Europe, he made his burgeoning Paediatric practice available to research, and his international recognition soared.

He has published on the state of Zambian Paediatric Oncology, Paediatric TB, Paediatric HIV/AIDS, the status of orphans, and a host of other relevant topics.

At different times he has served as the Professor of Paediatrics, the

Dean of Medicine, the Vice Chair of Zambia's Anti-Corruption committee, the UN appointed Chair of the Pan-African Ethics Committee, and the list goes on.

He has three children. A daughter is trained in Paediatrics and works for a Zambian NGO. A second daughter is a Rhodes' scholar studying Economics at Oxford. A son is studying computer sciences in New York.

Three years ago I went to Zambia to find Chifumbe. I am the only classmate to have done so. This initial visit launched my desire to

pursue humanitarian work in Zambia.

Chifumbe is a revered icon in Zambia.

Recently, when visiting very rural Mongu, the hospital's Executive

Director was giving me a tour. Spontaneously, he said; 'Professor Chintu recommends this treatment with those patients. Professor Chintu recommends those treatments with this patient.'

When I told the Director and his entourage that I was a classmate of

Professor Chintu, I found myself walking on reflected water, such is the respect with which Chifumbe is regarded even in the most remote and rural parts of Zambia.

I am honoured to list him as one of my friends. He is a Pan-African icon, a reputation he justly deserves.

UBC Okanagan - University of Zambia - Memorandum of Understanding - Signed

by Bill Nelem
April 2008


After many months of hard work by Gene, Alaa, the two Joan's along with Dean Mulla and Vice Chancellor Simukanga, the MoU between UBC Okanagan Faculty of Health and Social Development and the Faculty of Medicine at University of Zambia, has been officially signed.

At a dinner party where we hosted 11 Zambians, including the Dean and the VC, amid flashing of cameras and much hoopla, the signing took place, using a UBCO pen(!).

I was just the courier in this process, but happy to play my role.

Much credence is given to MoU's here. Ours is not the first they've signed, nor will it be the last.

For them, the document means more than a casual offer to collaborate, it conveys a commitment to work with them in a productive way.

For us, it provides a flag around which we can rally people ideas and resources.

The fact that all the important dignitaries without exception showed up for dinner means that they see promise with our MoU.

Also, not lost on their Dean and VC, is that we have had some immediate success thanks to the planning that has gone behind the scenes by Gene, Alaa and the UBC Okanagan Faculty of Health.

Returning to Canada with Linda, Gary, Kim and I is Dr Margaret

Maimbolwa, the Assistant Dean of Medicine, a nurse, also head of their nursing school. Margaret will spend three weeks in Kelowna working on 8 different initiatives within nursing.

Gene has circulated an agenda that looks quite daunting. Did you know that it takes 7 or 8 years for a degree nurse to graduate in Zambia for want of an integrated curriculum?

Well, with some idea sharing and some curriculum support from

UBC Okanagan Nursing, Zambian nurses will soon have a 4-year degree programme!!

Given the high attrition rate over the 8 years it takes to complete here, I suspect that we'll double the nurse graduates within a few years.

The other immediate success we've had is with young Donald Kalolo. He's the Chief Pharmacist at their newly opened Cancer Hospital that's attached to the main University Teaching Hospital in a manner very similar to our cancer centre.

Laurel Kovacic has been helpful in getting Donald a membership in the International Oncology Pharmacy Association.

Concurrently with his full time job, he's doing a Master' degree in

Public Health. His thesis is to develop a palliative care model that he hopes will one day become national policy for Zambia.

Under the umbrella of our MoU, Donald is attending the annual international pharmacy meeting in California in June and then coming to Kelowna to do planning exercises with Carole, Barb and others at UBC Okanagan as well as with our KGH/IHA palliative care teams.

They have some cultural and legal issues here with respect to the use of narcotics for pain control. Not only do the have no palliative care programmes for the painful dying, they use virtually no analgesics for post surgical pain management. Physicians and nurses are concerned about being charged with narcotic abuse and consequently narcotics aren't used.

There are high levels of support for this culture to change, both within the MoH and with some key physicians.

We will help Donald to design his palliative care plans. He will embed it within their culture and then we will help him develop some regional pilot implementation programme.

This model could become a Zambian policy.

Also, there is the issue of supporting the appropriate use of analgesia following surgery.

Yet another success that this MoU will be the placement of Jessica and Lianne in Mongu where they will be involved in the teaching of the 2 year nursing diploma course. They start in Zambia this June. We need to get them some financial support. No, we will get them some support. This is a very important activity since it is our entry to rural Zambia where the needs are high.

Finally, this MoU will be essential for planning other ideas, some of which are in preliminary mode.

More later. Bill

Whither Mongu?

by Bill Nelem
April 2008


The road to Mongu, heading 600 kms due west from Lusaka, is characterized by two unusual features.

First, on the Zambian scale of pot-holed roads of 1 to 10, it scores a low 1, very few potholes. Most unusual, and almost for sure, this road has 'worn well' because it lacks the heavy transport truck traffic that has ruined the Great North Road that links Livingston to Lusaka and the Copperbelt. As one drives this remarkable road, another reality emerges from the subconscious mind. If this road is so well preserved, it's lack of traffic portends that perhaps the destination of Mongu is 'far from the beaten path', so to speak. Isolated, one might surmise. No great tourist Mecca this. Don't expect any 5 star hotels at the end of this road.

The second unusual feature of this road is that it is so 'Germanic', so un-British.

Roads built in Africa in the German colonies such as Namibia or

Tanzania, for example, runs in absolute straight lines for hundreds upon hundreds of kilometres. This is unlike those built in British colonies where the roads simply meander haphazardly back and forth, modelled as if they looked like the curvy unplanned back roads of south London. Here you have a road to Mongu in a former British colony that must have been built by German sub contractors!

Along the road I pass clusters of children and I wave. Enthusiastically, they wave back.

A woman squats at the roadside to void, breast-feeding a contented infant. Strapped to her back, a second infant screams uncontrollably, impatient for his or her turn at the breast.

A man wears a rugby jersey with the number 13 on the back. Above the number, incongruously, is embroidered the name 'Smith'.

Two boys push toy wheel barrows made out of wire coat hangars.

I pass mud houses with crudely thatched roofs. Eight-foot high corn crops grow, planted besides villages. Nourished by this year's heavy rains they bear healthy cobs of corn that will be needed during the dry season that follows.

A diesel truck spews out clouds of black smoke, completely oblivious of its impact on global warming.

Sticks of sugar cane, bananas, mangos and live chicken are for sale at the roadside.

Some ride bicycles, some ride tandem on the back of bikes, but most of the people walk.

A young man proudly holds the only motorcycle seen today, surrounded by a crowd of admiring and envious bystanders. In turn they respectfully touch the orange painted beauty.

A bus is stopped at the roadside, broken down, no doubt. The passengers stand aimlessly by waiting for something to happen. Who knows how long they will wait.

More ominous is the fully loaded freight truck, also stopped at the roadside. There is air in the tyres, but the crankshaft has been removed. Forlorn and forsaken, it lies on the ground alongside the stranded truck. Now this is a major problem.

The road to Mongu passes through the Kafue National Game Reserve.

Clusters of monkeys and baboons scurry into the long side grass to avoid the car. Vultures scavenge on a road-killed jackal. Impala stand in herds at the roadside, furtive and pensive. Their lives depend, literally, on their instinct to bolt on a nano-seconds' notice.

A tree pushed over by an elephant covers one of the road's two lanes.

Like giant pancakes, elephant dung litters the road. With all of this elephant activity, one senses that a large body of water nears, recognising the elephants' proclivity to bathe in water during the heat of each day.

Sure enough, over the next hillock lies the Kafue River. It is a large river, it's water moving slowly, tranquil.

At the river's edge, aware of lurking crocodiles, women cautiously wash clothing.

On leaving the reserve, I'm stopped at a checkpoint. The guard advises that a sister needs a ride to the next village. Now a sister's need is a request to heed. For the next ten minutes my front seat passenger sits motionless, respectful, silent.

Perhaps I was a bit hasty in suggesting that there may not be good accommodation to be found in Mongu.

Arriving in town, I notice the 'Cross Roads Lodge - good accommodation'.

Aptly, it's located near the cross roads between the road to Senanga and the road to Lusaka. Nearby are the Mongu General Butcher and Mini Mart.

What more could anyone want?

Next I see a sign for the 'Majesty's Lodge - Best luxury rooms – where guests have the opportunity to relax in peaceful surroundings'. Well, that says it all. Who could argue with that?

I'll make sure that Joe knows about this one when he sends people to Mongu.

At noon I approach a sign that says 'Mandanga guesthouse - accommodation - restaurant - bar'. Aah, a good spot for lunch. I pull into the drive to find the front door and the windows boarded.

I settle on the 'Cheshire Home for Physically Challenged Children' run by the Presentation Sisters. Rosemary put me onto them. I'm greeted at the door by Sister Cathy, she of Irish accent. I'm given a warm handshake and a key to my room. There's no need for registration or for any payment. 'Come and go as you please', I'm told, but they insist that I join them for meals.

This is where Jessica and Lianne will stay when they teach at the nursing school. It's spartan, clean and safe. It's perfect! There is no way that they will be staying at the nurses’ hostel adjacent to the nursing school where none of the above parameters hold.

Gene will be pleased to know that the disabled children at the home all have mosquito nets. The Sisters say that there has been widespread distribution of nets in Mongu. They've even had an insecticide re-impregnation programme for older nets. The biggest problem now that all have been given nets is that of compliance failure. The nets do make the hot nights hotter.

I don't have time to go to Senanga, but I drive south along the Zambezi flood plain for a short distance. The road has a Zambian pothole score of about 7 or 8!

For kilometre after kilometre along the road to Mongu, I see telephone posts loyally suspending three flimsy wires, presumably the power source for all of western Zambia. Yes, there is electricity in Mongu, but how effective is their communication network?

Waiting for dinner and holding a glass of wine offered by one of the

Sisters, I startle when my Blackberry phone rings. Unaware that I'm in Zambia, a friend in Kelowna dials my local cell phone number just to chat. Here I am in Mongu and the call comes in loud and clear.

I send myself a test e-mail message on my Blackberry. Within three minutes the message returns!! Now that is impressive. I wasn't able to do this in Beirut.

I later learn that Mongu is on the satellite telecommunication network grid linking Africa north to south.

Here's another pointer for Jessica and Lianne. When they go to Mongu, they will take with them a trusty Canadian Blackberry. This way they will be in constant communication by both phone and e-mail without needing access to an Internet source. Even here in Mongu, the Blackberry does it all!

The hospital is basic but remarkably functional. Two operating theatres have been recently refurbished. Despite the presence of 11 doctors and 108 nurses, they are severely manpower depleted. They are constantly short on medications and dressings. Out of oxygen last week, they 'borrowed' the last remaining O2 cylinder that they try to keep on hand at Cheshire Home. They don't expect that it will be returned or replaced. The Health Partners Canada supply kits will be most helpful here - so too would oxygen concentrators.

Always looking for the opportunity and not the problem, I see that this place has significant unused capacity, potential for third world development initiatives - think fistula programmes, community surgery, circumcision, prevention plans, palliative care etc. This site is typical of at least a dozen other regional community hospitals scattered around Zambia, all offering the same opportunities. The need is overwhelming.

I spend two hours at the school of nursing, and I come away with two impressions. First, they are very dedicated to doing the best they can, and second, this place will never be the same after Jessica and Lianne have come and gone. The Principal, one of the teachers, is away today and so I will have to return before I leave to set up the details for Jessica and Lianne (JL). Alfred Mandona's absence allows me to spend time with the other two teachers, Pelena Phiri (she wants to do a Master's- I suggested UBCO) and Mumbuwa Silumba, a fine young man. They will welcome with open arms two Canadian sisters (!) to their teaching ranks. They are short of teachers. They also have 4 clinical instructors. They have a two-year diploma course, graduating about 45 per year. School year starts first semester July - December, 2nd term January - June.

'What are your needs?' I ask.

Curriculum development - Action Jessica and Lianne

Library completely outdated - Action Jessica and Lianne (JL)

Teaching aids almost non-existent - Action JL

As I said, this place will never look the same once JL strike!! It's a great opportunity that awaits them.

Leaving Mongu for Lusaka, I'm stopped again by the same guard at the entry to the game reserve. On this occasion, I see no silent sisters standing still. The guard's request; 'Please take a carton of fish to the market in Lusaka'. I look down and next to him I see four fly-swarmed cartons of smelly fish rotting in the noonday sun. From the cartons ooze rivulets of clotted blood and slime that mingles with the red rusty African sand transforming the mixture into a yellow – green slag. Much to the guard’s dismay and disappointment, I decline the request!


I’ll write again soon. Bill