Clearly the infection had spread inside my finger. I decided to use the time in Mzuzu to go see a doctor. It was the right thing to do. The doctor was quite impressed with my bandaging skills, but was glad that I had come to see him. He was concerned that, because of the activity I was doing, the infection was about to spread deeper into my finger, possibly into the bone or worse yet, cause sepsis. After a thorough discussion on the best course of action, and being OK with the possibility of losing my nail but not with the possibility of losing my finger, or worse, I agreed on a course of broad-spectrum antibiotics.

It seems that every time I write a blog about my cycling adventure from Nairobi to Cape Town it involves some challenge that I had to overcome. The thing is, one does not simply traverse the African continent without needing to summon your inner Chuck Norris. Cycling from Nkhata Bay, Malawi, to Livingstone, Zambia, was no exception.

I left Nkhata Bay feeling refreshed and excited. I had a route planned that would see me cross the border into Zambia in no less than four days. But I didn’t know that I would be back in Malawi on that same fourth day.

When I arrived in Mbalachanda, the last town in Malawai before crossing the border, the locals informed me that the town does not have an immigration office. Not to worry they said, all I needed to do was get a letter from the police office and present it to immigration in Chama, Zambia. This sounded a little too easy, but as the alternative was to backtrack and cycle an additional 200 km southwards I decided to let it play out.

A group village headman just outside of Mbalachanda inspecting my passport before allowing me to set up camp in his village.

A group village headman just outside of Mbalachanda inspecting my passport before allowing me to set up camp in his village.

With the letter from the police in hand I set off towards Chama. The 50 km road connecting the two towns was more like a trail on the Malawian side, but it wasn’t too tough and I loved every minute of it. When I arrived in Chama I easily found the immigration office and presented the letter along with my passport to the lovely immigration officer. That’s when I realized it was all to easy. She told me the letter was sufficient for Malawians living on or near the border without passports and whom crossed into Zambia for a day or two. However, since I was traveling through Zambia I needed an exit stamp from Malawi before she could legally stamp me into Zambia.

Fortunately, a friend that I made told me there was a minibus-taxi about to leave for Mbalachanda and that it would get me there in plenty of time to catch the late night bus to Mzuzu. Mzuzu is a small city just 60 km away from Nkhata Bay, but it was the closest place in Malawi with an immigration office.

Obrine, my new friend, arranged for the minibus-taxi to meet me at the police station. I figured I could leave my bicycle and all my gear there and just take the minimum with me to Mzuzu. I figured right, and soon I was on my way to Mbalachanda in the minibus with Kelvin, the driver, and his best friend, Steve, as the guy who hangs halfway out the window to find more passengers. I guess you need to know African minibus-taxis to know what I am talking about.

Obrine guided me to the immigration office and then helped to organize a minibus-taxi back to Mbalachanda.

Obrine guided me to the immigration office and then helped to organize a minibus-taxi back to Mbalachanda.

The bus left Mbalachanda at 2:30am. It was a long wait but I had my Maasai blankie with me and made myself comfortable on the porch of a building next to the bus. I got a good few hours of sleep in. I also slept most of the uncomfortable 7 hours on the heavily overloaded bus to Mzuzu. Sleeping anywhere is my superpower.

Early morning on the bus to Mzuzu.

Early morning on the bus to Mzuzu.

Once I found a place to stay in Mzuzu, I cleaned myself up and made my way to the immigration office where my passport was stamped without any issues. It was Wednesday. That coming Thursday in Zambia was presidential elections and the Zambian immigration officer had told me that they would be closed that Thursday as well as the Friday after elections. So I had to wait a few days before returning to Chama. With an exit stamp from the Malawian immigration office in my passport I was technically no longer in Malawi, nor was I in Zambia. I was where you observed me to be, just like Shrödringer’s cat 😀

At the same time I was also struggling to deal with an infection in my left middle finger. A small, sharp wire from my bicycle’s front brake cable pricked me just above the nail while I was fixing it a few weeks back in Tanzania. I noticed that the small wound had become infected while I was in Nkhata Bay and immediately cleaned it up and bandaged it. However, it never healed despite my best efforts to stop the infection, first with iodine and later with crystal violet. It became progressively worse and by this time, while I was waiting in Mzuzu, puss was constantly coming out around my nail in addition to where the original wound was.

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The infection in my finger while I was still in Nkhata Bay, about two weeks before I saw the doctor in Mzuzu.

Clearly the infection had spread inside my finger. I decided to use the time in Mzuzu to go see a doctor. It was the right thing to do. The doctor was quite impressed with my bandaging skills, but was glad that I had come to see him. He was concerned that, because of the activity I was doing, the infection was about to spread deeper into my finger, possibly into the bone or worse yet, cause sepsis. After a thorough discussion on the best course of action, and being OK with the possibility of losing my nail but not with the possibility of losing my finger, or worse, I agreed on a course of broad-spectrum antibiotics.

I would have preferred the Staphylococcus areus, the microorganism typically responsible for these kinds of infections, be sent for antibiotic susceptibility tests first so that the appropriate antibiotic could be prescribed. But that kind of service was not available at the public clinic I attended and sending it away to the nearest pathology lab would have taken more time than I was able to stay in Malawi.

Sadly, the unavailability of services like that in most of Africa, and the exorbitant expense thereof in countries such as the USA, means that antibiotic susceptibility is seldom determined prior to prescribing antibiotics. Instead medical practitioners tend to prescribe broad-spectrum antibiotics in the hope of killing the disease-causing organism. However, these antibiotics also kill or inhibit the growth of many other types of bacteria and increase the chances for the evolution and spread of antibiotic resistance. If we want to manage the evolution and spread of antibiotic resistance more effectively, practices such as this really need to change.

By the time I was making my way back to Chama the infection in my finger was visibly clearing up. And when I arrived at the immigration office early on Monday morning, with my bicycle packed and ready to go, the same lovely immigration official stamped me into Zambia with a smile. I guess, although this back-and-forth business cost me nearly a week, it may just have saved my finger and possibly even my life – no jokes.

To be continued.

Loftie

p.s. While I am having great fun with these extraordinary adventures I am doing it to raise awareness for #AntibioticAction, the need for better antibiotic stewardship and also to highlight some of the great science that is being done here in Africa. And I could not do without the help of my fabulous sponsors, Global Academy Jobs.

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