By David Clayton, Medical Student
Medical electives are an important and hugely exciting part of the medical curriculum – offering a chance to observe and get engaged in healthcare systems round the world and compare experiences to the services we are used to in the UK. Being at the end of my third year of studies at the University of Glasgow medical school it was time to begin the arduous process of organising one of these fabled electives which many students in years above had waxed lyrical about. I had heard stories of jungle clinics in the Amazon; sports rehabilitation medicine in Los Angeles; mountain medicine in the Himalayas – the opportunities seemed endless. Yet due to the specialised nature of medical electives, many of these exotic experiences require a host of local contacts in the country; extensive paperwork and more often than not large sums of money.
After several weeks of searching I was resigned to defeat – I wasn’t aiming for an elective with extravagance comparable to some of the aforementioned examples but merely an opportunity to work in a developing healthcare system and observe adaptations that are made to work in a more resource-poor environment with the inequalities in heath that exist in the world today.
Having lived in Glasgow all of my life – a city in which as little as a mile in distance can mean a difference in life expectancy of almost 20 years – I am constantly exposed to and reminded of the inequalities in health that exist within a developing country as our own. I have always been struck by the fact that even such a developed country as the UK with national healthcare and welfare systems can feature such stark inequalities in health throughout and take a huge interest in the multiple socioeconomic factors that contribute to one’s health. Thus, experience in a developing healthcare system would allow me to transfer this idea of regional health disparity into a more global setting.
As the deadline for elective proposals loomed, I stumbled upon the Minor Metals Trade Association Bursary which offered an organized placement in the town of Mufulira in the Copperbelt region of Zambia and a generous £750 towards travel and sustenance there. I immediately applied and was overwhelmed to hear I was successful and put into contact with my host Dr Charles Chiponda – the District Medical Officer for the Mufulira region.
My supervisor was Dr Tumba – a clinician of indefatigable willpower and determination who would ensure I was challenged constantly yet given a sensible amount of responsibility within my means. On the first day I was merely shadowing and learning the system; by day two I was clerking patients in the ward and presenting them to her and by day three admitting them from outpatient clinics; following them up and suggesting treatments. Dr Tumba accommodated my vision of pushing myself into unfamiliar territories but doing so in an ethical way so that all my experiences were properly supervised and thus I was never unsupported or expected to perform tasks I wasn’t capable of.
I was based mainly in the Ronald Ross General Hospital – a medium-sized Government-run general hospital in the town of Mufulira that featured male and female medical and surgical wards alongside a maternity ward with various out-patient clinics and a pharmacy that ran alongside. However I also spent time in Kaumachanga District Hospital – a smaller primary care hospital just outside the town; the private Malcolm Watson hospital run by the local mining company and some of the clinics that ran for distributing Anti-Retroviral therapy to chronic HIV patients.
This allowed for a very diverse look at Zambian healthcare and the spectrum of quality of care that could be sought by financial means. Although I got to experience a large variety of healthcare environments in Mufulira – I spent most of my time in the under-funded and understaffed medical wards of Ronald Ross as it provided a perfect environment to experience and learn about healthcare in a deprived setting and adaptations that are made to suit patients in that poorly resourced setting.
Around 14% of adults in Zambia are HIV-positive and this percentage is reportedly higher in more rural, low income communities such as Mufulira thus the majority of patients I saw in my time were HIV-positive and presenting with a range of the huge variety of complications associated with a weakened immune system such as Tuberculosis; infections from everyday pathogens like Cryptococcus and HIV-related cancers such as Kaposi’s Sarcoma.
Time raced by and after several exams and placements it was finally June and time to begin my journey to the Copperbelt with several flights, stopovers and unexpected delays along the way – yet after around 2 days of travel I finally stepped off the plane at Ndola and realised the journey was over. I remember feeling slight trepidation from the lack of information I had and from being alone in a very unfamiliar environment but as soon as I met Dr Chiponda I felt instantly welcomed into this sub-Saharan country so far from home. With some time to rest and recuperate before I began my placement – the Chipondas welcomed me into their home for some traditional Zambian cuisine such as Tshima and took me round Mufulira to visit many of the healthcare facilities where I would be placed, meeting many friendly faces along the way.
It was difficult to know what to expect from the placements – I had spent most of the past year in various hospitals around the West of Scotland in very modern, well-resourced facilities with much of my training thus being Western-centric – ie: having seen perhaps hundreds of patients with coronary heart disease but not one with malaria – one of the leading causes of death in Zambia. I expected I would struggle to begin with and in the first few days I did indeed so everything was very new and so completely different from anything I had been taught or experienced before. It was very challenging start with many of the first evenings spent reading on hugely unfamiliar topics such as HIV-related infectious complications; tropical parasitic infections and the Zambian prescribing regimens for various illnesses. Moreover, many of the patients were not fluent in English and much of the clerking I performed was through a nurse translating from English to a regional language such as Bemba or Nyanja and back again. There were many challenges like these stemming from unfamiliarity and a difference of backgrounds but these were challenges that I relished throughout and made every day more exciting than the next.
I became more aware of the social issues associated with tackling HIV/AIDS in countries such as Zambia – encountering several patients that had stopped their anti-retroviral therapy due to intervention from their church; patients that had opted instead for traditional medicine practices such as sewing of herbal remedies in patches underneath the skin and the associated underlying stigma associated with HIV which allows it to remain as a main factor towards the immitigable detriment of the Zambian healthcare system as a whole. With weekends off, I travelled the length and breadth of the country down to the bustling capital of Lusaka and to the idyllic Livingstone and Victoria Falls at the border with Zimbabwe in the South. Placement throughout the week and travelling at the weekends meant that by the end of the four weeks I was completely exhausted but hugely fulfilled at having learned so much. I had felt like part of the community of Mufulira with the welcoming nature of all I met and felt like I had made a new home in such a previously foreign part of the world for me.
‘Life changing experience’ is a phrase often seen as a cliché by many but my time in Mufulira has fostered a huge interest in HIV for me and as a result I will be pursuing an intercalated honours degree in Immunology with a HIV-research project starting this September at my university with a and a view towards a future career as a physician for HIV-affected patients thus I feel like the phrase is truly applicable to my elective this Summer. I will always have endless gratitude towards the clinicians at Ronald Ross Hospital; the MMTA for funding this bursary; the Chipondas for hosting me, and the people of Zambia for being so welcoming and allowing me to learn far more than anything I could ever gain from just reading a textbook.
Building on MMTA links with Mufulira, the MMTA has established a scheme to offer a maximum (at present) of two bursaries of £750 per year to individual medical students to assist with travel expenses on their elective trip overseas to Mufulira. These bursaries do not come out of general funds but are offered by individual members via the MMTA. Any member wishing to sponsor a medical student should contact the MMTA to learn more.