A Long Bus Ride:
Oh yes, Africa is different. I don’t want to use better or worse; I just want to say different. The other day
as I sat in a bus at the Lusaka (the capital of Zambia) bus terminal at 9 in the evening - I was beginning
to believe I was in Hell. I even said to myself, “Yup, I am definitely in Hell.” The bus was not one of those
“luxury” ones you see advertised for travels throughout the third world. Then again it wasn’t one of
those run down rusting buses crammed with chickens and sheep. This was a bus that was just slightly
less comfortable that the yellow school buses one sees every morning making the rounds and picking
up children throughout America.
The bus was filled with people. However, because the bus was not scheduled to leave until 6 a.m. the
next morning it was not jam packed, but there was at least one person in every seat. The way things are
done in Africa is that if a bus leaves early in the morning or arrives in a city in the middle of the night the
people stay on the bus until it gets light – it’s a matter of security. So I too was doing the African thing.
So there I was at 9 p.m., I had actually arrived at the bus terminal at noon and had expected to take a
direct “luxury” bus from Lusaka to Lilongwe (in Malawi). When I arrived and purchased my ticket I was
told that the arrival and the subsequent departure were imminent. I heard the often worrying “It’s coming
any minute, boss” and “Don’t worry, boss, you will be in Lilongwe tonight, boss.” “Go have a seat, wait
with these people, my friend.” Well, after waiting six hours we were given a refund with the staff saying
they were sorry but they did not know when the bus was going to arrive. I told them I didn’t want a
refund. I wanted to go to Lilongwe. Unfortunately that was not an option. In fact there were no other
buses to Lilongwe that night or even the next day. Monday, Wednesday, Thursday or Sunday. Those
were the options and since it was Monday I was in a bit of a bind.
One option was to return to the flat of Dr. Goran Jovic, a Serbian plastic surgeon who has worked in
Zambia for over 12 years. I had stayed with Goran and his wife Rada for a few days after meeting him at
the Association of Surgeons of East Africa (ASEA) conference in Harare the previous week. Goran and
other surgeon at the University Teaching Hospital in Lusaka were very interested in working to develop
a project that I had proposed to them. I am calling the project SHARP: Surgery and HIV/AID Response
Program.
The surgeons from Lusaka were interested in further exploring the program which would provide
protective equipment and training for surgical health care workers in developing countries. The crux of
the issue is that at a major teaching hospital in Africa there are roughly five to ten thousand cases
performed each year. With about ten persons in the operating room at a time, including surgeons,
anesthesiologist, nurses, clinical officers, students and teachers, this translates into about 50,000 to
100,000 high risk exposures to HIV annually just for that one hospital. You multiply that by all the
hospitals in a country and then the region and you’re talking about millions of high risk exposures where
people are unable to obtain or afford the proper protection to prevent infection from HIV. So anyway,
that’s one of the reasons that I’m back in Africa.
I went to the ASEA conference (which includes Ethiopia, Kenya , Uganda , Tanzania , Zambia , Malawi ,
Mozambique and Zimbabwe ) looking to get SHARP started throughout the region. ASEA is also affiliated
with COSECSA, the College of Surgeons of East, Central and Southern Africa. The plan is to set things
up at medical schools and teaching hospitals and then take it to all the district and mission hospitals as
well. The proposal includes protective equipment and curriculum development for dealing with HIV in the
operating room and training for local surgeons and clinical officers operating on patients with HIV. By the
way, if anyone is interested or has any additional thoughts, please don’t hesitate to give me a shout.
But anyway, back to the Lusaka bus terminal. So there I was stranded in the bus station and not really
wanting to get in a taxi and go back to Goran’s place to ask for my room back. I mean I certainly could
have, but it just didn’t seem right.
I decided that the “best” option would be to take a bus to Chipata, a city in Zambia just this side of the
Malawian border; from there one can take a taxi and mini-bus combination to Lilongwe. The problem, of
course was that in the evening there were no buses leaving for Chipata. The earliest were at 3 a.m., but
they were fully booked. Luckily a bus was available from the Kos Bus Line. By the way the first bus line
was the “Moonlight and Time Travel” buses whose slogans are “Always shines” and “One time all the
time.” I think they meant “On time”, but hey, welcome to Africa.
So after being told that the “Moonlight” bus was probably never going to show up and looking
unsuccessfully for a bus to Chipata I almost gave up. I had gone back to the original waiting area near
the plywood kiosk and ‘luckily’ some of the other waiting passengers with whom I had commiserated
mentioned that Kos had seats available for Chipata. I confirmed that the bus was indeed going to
Chipata, although not until 6 the next morning. But now remember its dark and the bus station is not the
safest place even during the day. So I paid the fare, climbed into the bus and took one of the bigger
seats on the right hand side of the aisle. I figured I would try to sleep.
Well, then the lights went on, they kept turning over the engine for whatever reason and once that
stopped, the music began. Not traditional Zambian music and certainly not at a normal volume, but hip-
hop radio: Nelley, Dr. Dre, 50 Cent, Eminem and a host of others; all blasting through a speaker directly
over my head. It was at that moment I thought about Hell. But here I was enjoying a very African
moment.
In fact by now many of you may be thinking that I certainly have lost my mind, but looking back I am even
more satisfied with the entire process. This was really the first time that I had taken public transport in
Africa and really got to experience what the general population has to undergo. Sure I had known about
it, but to actually be faced with the reality that buses are cancelled, security is minimal, facilities sub-
optimal, well there really is nothing like experiencing it first hand. In some ways it makes it easier for me
to understand how someone can present to the hospital with a perforated appendix after having four
days of abdominal pain. These people are used to waiting and enduring things that back in the States
or Europe we would never even come close to experiencing. Let alone tolerating.
Fortunately, the music did not last too long, maybe the battery was draining, but by 10:30 p.m. or so I
was able to take a nap - only to be awakened by the loud conversation in the local language by two
woman at different ends of the bus, one seated one row behind me and the other by the door. Their
conversation continued for probably the better part of an hour; again I dozed.
At 1 a.m. or so, a woman a few seats down began reciting what I imagined to be a poem. I didn’t
understand the words, but for some reason the tone and an English word here or led me to believe that
it was for a child of hers that had fallen ill and recently died. To be honest, I’m not even really certain if
it was real or just a result of the Larium, the anti-malarial medicine that I take which tends to enhance my
dreams.
By the way, the inside of the bus was filled with men in shabby clothes and women in traditional dress,
brightly color robes and shawls in which they warped their children to their backs. Mercifully the children
were quite. By 2 a.m. the rains began. A downpour that continued until about 5 a.m. at which time it
began to get light and I was able to safely leave the bus.
I walked around a bit and though my back was sore and I was a bit sleepy, I was ready get on the road.
As I exited the bus, I noticed a man working on the engine and I was a bit concerned. I again boarded
the bus and waited for our “scheduled” 6 a.m. departure. As the appointed hour came people began to
get up and leave. One older woman turned to me and said, “We have to take another bus.” So I stood
and exited with the others. I asked one of the Kos staff what the story was. He said, “Don’t worry my
friend; I will take care of you.” A certain sign for me to begin to worry. So, I got my bags and followed
my “friend” to another bus. They figured that their bus wasn’t going to be leaving anytime soon and
were nice enough to get me on to a competitor’s bus. A more “luxurious” bus, run by the “Zoom Line”
their slogan: “You snooze, you loose.”
Zoom had a bus going at 6 a.m.; of course it didn’t leave until after 8. While I waited I had hopes that
the seat next to me would remain vacant. There were two seats on the left side and three on the right.
The seats did go back a bit though the leg room was not much better than flying coach. I also really
liked the interior design, aquamarine with splashes of navy and orange. The seat next to me was
eventually filled. In fact the entire bus was filled, including a few standees. But finally the bus did leave
the station, a mere 20 hours after I had arrived.
The drive to Chipata was pretty uneventful; we took “The Great Eastern Road” that leads directly east
out of Lusaka to Chipata. We drove across flat plains that changed to gently rolling hills and green
forests. Occasionally we would pass small villages - small collections of conical thatched roofed huts
with rounded or square bases made from trees lined together, or weaved to have an appearance of
wicker. Some of the walls looked to be made out of mud brick. All were one room and were a
brown/grey color. The villages ranged in size from five to ten of these structures to one or two villages
which looked to contain almost a hundred dwellings.
During the trip the driver would lean almost constantly on the horn. As there is no shoulder or sidewalks
people walk down the center of the road. They would constantly need reminders that there was a fast
approaching bus.
My seat mate was Kelvin. Kelvin lives in Lusaka with his wife and his 7 and 9 year old sons. He was
heading for Chipata because he has a shop there. I asked what he sold and said it was a boutique
where he sold curios and woman apparel. It was a cyclical business and now things are not so good.
But they will get better in April. He concentrates on higher quality products than the competition and
imports only from South African and Kenya not China like his competitors. Unlike the competition, he
feels that it is important to stock a variety of sizes. He asked me about George Bush, security in the
states, and my thoughts about Iraq. He then proceeded to tell me how much he wanted to visit the US
and the problems of getting a visa. This of course led to him saying that it would be very helpful for him
to have a letter from someone in the States saying that they knew him. He insisted that he only wanted
to visit and understood that many people went there to visit and they stayed illegally to work. Needless
to say, I politely avoided the subject and didn’t write a letter.
The trip took 8 hours which included a few bathroom breaks and stops at the few towns along the way.
We crossed a suspension bridge over the Luangua River. For some reason we had to cross one car at
a time. Not really the most reassuring thing.
But I made it to Chipata. Got a taxi for the 30 kilometer trip to the border, went through customs, and
then got another taxi for the 12 kilometer trip across the no-man’s land to the Malawian border. The taxi
deal here is 150 Malawian Kwatcha per person, but the catch is that the taxi must be full with 5
passengers. As there were only two others when I arrived I paid for three. Once across the border it
was a mini-bus ride to Lilongwe from the town of Michinji.
This was also another African first for me. These mini-buses are the primary form of travel for many
locals. They are small vans with five benches in back that hold four people each and then more people
are crammed into them. We left when we were full and had about 30 people in the van. The ride took a
bit over an hour. We made multiple stops with people getting off and on, bags piled in. Stopped at a few
police check points and a few times had small children run up and sell grilled corn on the cob to some of
the passengers. Again a bit more leg room would have been nice.
I arrived in Lilongwe and got a taxi to the Riverside Hotel, my old home in Lilongwe where the staff all
greeted me enthusiastically. I made a phone call to Dr. Muyco, the surgeon at Lilongwe Central Hospital
with whom I had previously worked and had dinner with him and his wife. It was good to be back.
So for the moment I am in Lilongwe. The plan is to stay here for a few days and then on Sunday head
to the south of Malawi. While I was in Harare at the conference I learned that the Seventh Day Adventist
Mission Hospital (Malamulo) was in desperate need of a surgeon. I was in contact with their medical
director, Dr. Santos and the plan is to go there on Sunday and stay for a month or so. Should be
interesting, no alcohol, and no work on Saturdays. Lots of surgery.
By the way, the conference was actually of a very high caliber. I was impressed. It was good to see old
friends and meet new ones. Everything went very smoothly. The only questionable issues was during
the last formal dinner when we all stood for a toast to the President and we all thought it was for the
President of the Association of Surgeons of East Africa. When the speaker continued and said
President Robert Mugabe, there was a bit of hesitancy, but no major issues.
Anyway, Lilongwe is about the same. The surgical department is one thing that is quite different. There
are now four general surgeons: Arturo, a German, a Russian, and a Tanzanian, and two urologists, one
from Sierra Leone and one from Egypt. So I haven’t even stepped foot in the Lilongwe operating rooms,
despite the pleading from the nursing and anesthesia staff. It was very touching to see their reaction
when I dropped by for a visit.
Well, best to everyone and I will keep in touch.
Adam