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What happens if you fall sick on safari? Dr Ivan Cox, from Birmingham, UK, is the latest ' Valley Doctor' to complete a volunteer stint in the Luangwa Valley. This unique scheme ensures that on- the- spot healthcare is available for all visitors to Zambia's premier national park. Mike Unwin asked him what the job entails. Interview What did you expect when you signed up? Doctors preparing for a sabbatical in Africa expect to deal with ' exotic' tropical disease, such as malaria, tuberculosis, HIV/ AIDS, snakebite and attacks by wild animals. All of these and more are possible, of course, and do indeed affect the local population. But, apart from malaria, the valley doctor encounters very few of them among visitors. This is great for visitors, of course, if less than exciting for the doctor! So how far do your duties extend? You have to be on call 24 hours a day, seven days a week for a population of around 500 individuals distributed over an area the size of Southwest England for the period of your tenure - usually 12 weeks. What takes up most of your time? Most calls are for coughs and colds, traveller's diarrhoea or cuts and bruises: the basic stuff of general practice anywhere. Ironically, visitors tend to bring their bugs with them; virtually all the gastroenteritis is acquired en route to the valley. Of course no safari is without its minor hazards, such as abrasions and sprains, all of which the doctor is amply equipped to deal with. Indeed you can be stitched up or plastered at no extra charge. Anything more serious? Fortunately major problems rarely occur. For emergencies, such as a broken leg, heart attack or appendicitis, there is a very effi cient air evacuation service to modern facilities in Lusaka or Johannesburg. The critical factor here is the travel insurance company: sometimes their representative cannot believe the valley is 900km from the nearest western medical facility - a nine- hour drive to Lusaka along some of the roughest roads in Africa. That's why insurance with a reputable company is essential. What about insects? Mosquitoes can be a problem. Some visitors fail to provide for what should be only a minor inconvenience. Covering up on walks and drives, with frequent and generous use of insect repellents ( most lodges stock them), keeps them away - and mosquito nets are essential at night. Tsetse fl ies - in those areas where they occur - can occasionally be worse, as normal repellents don't work. Anecdotal reports suggest that antiseptics, such as Dettol, sprayed or rubbed on limbs or soaked in socks or scarves do deter them. Sausage tree balm gives wonderful relief if you do get bitten. And malaria? Malaria - and, more frequently, fear of malaria - is a common call. Many visitors think that any fever on safari must be malaria. Fortunately there is now a rapid diagnostic test that, with just a fi nger prick, can usually determine the truth. And current treatment is very effective once the diagnosis is made. Prophylactics are very reliable and, if taken religiously, will protect nearly all 28 Travel Zambia May 2009 BUSH DOCTOR Dr Ivan Cox Local nurses at work in Kakumbi Rural Health Clinic

The safari medical service, run by the Luangwa Safaris Association Medical Fund ( LSAMF), is an invaluable resource for residents and visitors alike in the South Luangwa valley. The service was set up in 1997 by Jo Pope of Robin Pope Safaris ( RPS). It is funded by subscriptions from members of the LSAMF, fees from clients and additional donations. The doctor is a volunteer, usually from the UK, other parts of Europe or the USA. LSAMF meets travel expenses, and provides accommodation and food, a vehicle and fuel, and ' pocket money' for local needs. For more information contact Gid Carr at kapani@ normancarrsafaris. com or Dr Ivan Cox at ivancox@ blueyonder. co. uk A unique service visitors. Current studies suggest that one in ten visitors still doesn't take them, however, and this needs to be remedied. Do you get involved in local health care? In order to meet Zambian medical registration criteria the doctor's duties must include an active volunteer role at the Kakumbi Rural Health Clinic ( KRHC), in Mfuwe. This clinic is run entirely by local nurses. The doctor has mainly an advisory role, helping them with difficult cases or getting stuck in when the clinic is overwhelmed. This is where the doctor might encounter something more dramatic, such as snakebite or injuries from elephant or crocodile attack, though more common problems are pneumonia, malaria and minor trauma - and, increasingly, the full spectrum of AIDS. It is a challenging working environment, with moments of inspiration, but also frustration and despair. What else can doctors contribute? Most doctors find there is something extra they can give. Some have introduced new equipment, such as a microscope for malaria diagnosis or a nebuliser for the treatment of asthmatics at the clinic. A few have made substantial contributions: Dr Juergen contributed a valuable section on managing snakebite to a guide on Zambian snakes; Dr Gerd organised an ultrasound machine for the local hospital; Dr Johnny and his partner undertook - with remarkable grit and energy - a total renovation and rebuilding of the rural health clinic. So how does a retired English GP cope with life in the African bush? There is a magic about the valley, and the very remoteness that attracts most visitors also seduces many doctors. Several have come back to do more than one stint. The sense of community amongst the park residents and the local villagers, and the value they place upon having a doctor, makes South Luangwa a special place for those of us who have served there. We become part of a vibrant community, and also get to explore the park - usually for free - through the lodges and camps. Any special memories? Living and working in this environment is a constant delight. Daytime at the ' doctor's house' brings elephant, giraffe, baboons and half the bird species in the valley passing by. And there can be few places in the world where a doctor's night call entails dodging elephants and hippos, only to be confronted by the green flashing eyes of a leopard walking down the road towards you. May 2009 Travel Zambia 29 Clockwise from top left: the doctor's house at Flatdogs camp; renovating the health clinic with a lick of paint; an uninvited visitor in out- patients; all spick and span at the surgery