Dr. Marcus Hollyer
Final year medical student Marcus had the privilege of experiencing the highs and lows on his medical elective in Zambia in 2019. Here he recounts his experience of working in a resource-poor setting; from obstetric emergencies; to daily life in Lusaka; to weekend tips to Victoria Falls and safari in Botswana.
Lusaka Hospital, Zambia
Starting my medical school elective placement in Obstetrics & Gynaecology (O&G) in Lusaka was both daunting and exciting in equal measure. Upon arriving at the hospital one of the most immediately obvious differences was the ubiquity of white coats. The white coat has been long banished from the wards of NHS hospitals; but worn universally amongst doctors and medical students in Zambia. Wearing this white cloak felt like assuming a mantle of responsibility – a physical manifestation of a professional identity. It did little for my Imposter Syndrome, however in tough situations it felt like a suit of armour; protecting me from mosquitoes, but not from the Zambian dust!
Despite my initial nerves I was quickly made to feel welcome and a valued part of the team. The medical staff at the women’s hospital are organised in a firm-based system and I was attached to one firm for the whole five-week placement. This structure enabled me to get to know the doctors I was with. They were keen to get me as involved as possible; clerking patients and presenting on rounds, brushing up on my obstetric examination skills in antenatal clinics, as well as assisting in theatre. I also had the pleasure of being surrounded by a supportive group of local medical students. They were more than happy to share their notes, skills, and (perhaps most importantly) the best places to grab lunch on campus!
Difficulties presented in a resource-poor setting
The hospital in which I was placed was government-run and they struggled with a lack of resources. Before my placement in Zambia, I took for granted the abundance of equipment we have at our fingertips in the UK. There was no running water on the labour ward; nor were there bottles of alcohol hand gel sitting proudly at the end of every bed. Women laboured in open wards separated by thin curtains, lying on plastic sheets and brightly coloured local fabrics they brought from home. There were times when the resource limitations did become very frustrating. A CTG machine would be wheeled out only to find there was no paper on which to record a trace. The tap to the scrub-room would cut out while you were soaped to your elbows. Running to the blood bank in temperatures over 30 degrees Celsius only to find they have no blood available.
These were but a few of the problems we experienced in our short five weeks. However, our Zambian colleagues walked this scalpel edge every day. They strove hard to do the best for their patients in a setting that often worked against them. Sometimes women would queue for an emergency caesarean section due to the lack of fully trained anaesthetists for more than one theatre to be operating at a time. This often led to tragically poor outcomes for mother and baby. One day a young woman exsanguinated to death following a placental abruption simply because the blood bank was empty. Experiences like these were a haunting reminder of our privilege and how dangerous childbirth can be in resource-poor and lower-income countries.
Despite all the obvious difficulties, the greatest resource in the hospital remains the staff themselves. The doctors I worked with were highly knowledgeable and in turn, demanded high standards from their medical students. The vast majority of teaching is done on the job, informally on daily ward rounds, where students would routine be grilled at the bedside. As well as developing my clinical knowledge, I learned more practical skills such as the ability to think on my feet and problem solve with limited resources to hand.
A ward round in Lusaka can feel like the contents page of the O&G textbook at times, and I was exposed to many things I would never see on placement in the UK. Stage 4 cervical cancer, severe symptomatic anaemia of pregnancy, eclampsia, and mothers suffering from malaria, tuberculosis and HIV but to name a few. Unfortunately, like many other areas in Africa the severity of disease was often due to late presentation to a tertiary centre as well as either the lack of, or financial barriers to antenatal care.
Away from the highs and lows of the clinical environment, the Work the World house in Lusaka feels like a sanctuary. After a hard day on placement we would share hospital stories by the pool, or relax out on the terrace with a cold drink and read or reflect on the day. Weekends offered opportunities for amazing travel experiences. From visiting the spectacular Victoria Falls in Livingstone to crossing the border to Botswana for a safari; with my highlight being getting up close to a family of swimming elephants. Closer to home, Lusaka itself is a fun city to spend time in at the weekend; often finding ourselves overindulging in the busy and vibrant local bar, restaurant and club scene!
Work the World’s Village Healthcare Week
Relocating from Lusaka to Chirundu; a bustling border town on the banks of the Zambezi; this week was the cherry on the top of my time in Zambia. Following a warm welcome into the home of a wonderful host family, we were able to gain a valuable insight into daily life for many Zambians living outside the capital city. If you ever visit Chirundu, remember to bring your dancing shoes; the local school kids will show you how to bust a few moves – or at least try to!
Daytimes were spent at the small district mission hospital which was a stark comparison to the government hospital in Lusaka. Facilitated and ran by the Catholic Church, this small-town hospital is better resourced and has greater facilities. As well as O&G, I was able to spend time in the paediatric department, giving me insight into conditions such as childhood malnutrition.
I would encourage any student or qualified healthcare professional alike to take the opportunity to travel to Zambia. My experience provided me with valuable experience in a low-resource setting with the support of friendly and highly skilled medical staff. Even when I felt a long way out of my comfort zone, Zambia was a home away from home.
- You don’t always need fancy kit to get the job done. If you don’t have a Rusch Balloon to hand to manage a post-partum haemorrhage, a latex glove filled with normal saline will do the trick just as well!
- Our over-reliance on technology can cause UK doctors to become de-skilled. In Zambia I learned how to listen to the fetal heart rate manually using a Pinard stethoscope, a skill not often not taught in the UK as there are usually Doppler ultrasound machines available!
- The healthcare service in the UK can be very wasteful. Reflecting on my time in Zambia, I started thinking about the ways in which the NHS could minimise waste production and still maintain a high standard of clinical care.