Rob Holden, NHS Elective, July 2017
Having grown up in the post-industrial landscape of Northern England, the idea of mines for me had always conjured up images of tough men with pipes, beards and an intense dislike of the colour blue, or anyone named Margaret. When the opportunity to visit a mining community in sub-saharan Africa was presented to me, I was immediately interested.
The opportunity came about as part of the ‘elective’ component of my medical degree, for which I was lucky enough to be funded by the MMTA to visit Ronald Ross General Hospital (RRGH) in Mufulira, a small city in the Northern part of Zambia’s copperbelt. Upon arrival at the hospital, I met my supervisor, the constantly enthusiastic and hard-working Dr Tumba, a Congolese Doctor who could hold conversations with her patients in Swahili, French, Bemba (Zambia’s most widely spoken language) and English (although she insisted that the poetic nature of French meant that was by far the best language for the discussion of medicine). Dr Tumba was one of 9 Doctors at the hospital who between them attended to the medical needs of an area encompassing 130,000 patients, a high proportion of whom were HIV positive; mine workers affected by chronic respiratory disease, and in addition subject to extreme poverty. This meant that Dr Tumba and her colleagues were variously seen in the roles of physician, surgeon, obstetrician and general practitioner.
My first 2 weeks were spent on the female medical ward, where I would clerk patients, provide an impression, and order investigations as I deemed appropriate. I found myself very early on seeing clinical signs that I’d previously heard laughed off by hospital physicians and other medical students in the UK, but in this environment were heavily relied upon. Clerking notes soon became filled with the names of long-dead physicians (‘Kernigs’ sign positive, ‘Pemberton’s’ sign noted etc) who had perhaps worked in environments where the idea of diagnosis via MRI scan seemed as distant to them as it did to those working here.
I found my time in Zambia and the DRC to be enormously interesting and useful. I plan to go into the field of infectious disease, either as a clinician, scientist or public health worker. This elective opened my eyes to diseases that I had only previously seen in textbooks or lecture slides. Although this was the primary objective of my elective, to improve my knowledge of tropical and infectious disease, I also discovered the challenges of managing non-communicable disease in a resource-poor environment. One particular example that I faced on a regular basis was diabetes; the burden of familial diabetes combined with the emergence of type two diabetes in Sub-Saharan Africa, in part as a consequence of the emergence of “Coca-Cola culture”, has led to a rapid growth in dia-betes in the past decade. With the help of Dr Tumba and a number of other doctors from the hospital, we developed a guideline to be used by the nurses for the management of diabetic emergencies, which in Sub-Saharan Africa carry a high mortality rate. This presented enormous challenges in a clinical environment where there was no way of measuring blood pH, electrolytes, bicarbonate, all vital aspects of treating a critically ill diabetic patient. However this guideline was in full use on the medical wards at the hospital towards the final weeks of my time in Zambia.
I would like to thank Dr Tumba and all the staff at RRGH for helping me during my time in Zambia. In addition, I am very grateful to Dr Chiponda and his family who kindly accommodated me in their home for the entire duration of my elective and provided me with the warmest welcome I could possibly have asked for and put up with my constant questions about life in Zambia and the history of their country. This experience has served to increase my passion for tropical medicine and global health issues, as well as serving as a reminder as to the incredible facilities and service we enjoy as a result of the National Health Service in the UK.