A brief introduction
My name is Elizabeth and I’m a final year medical student at Liverpool University. This is an article written about my elective, which I carried out with my fellow student Laura, in Mufulira, Zambia in July 2018. I am going to talk about the town and Laura will take over to tell you about the hospital we worked in. First of all, a medical elective is an internship at a hospital which can be anywhere in the entire world. Lots of students go to Asia, Australia or even stay in the UK, but Laura and I applied for and were fortunate enough to be granted a bursary funded by the Friends of Mufulira charity to visit Ronald Ross hospital in the copperbelt of Zambia. We were both over the moon and started to plan our month-long trip to a part of the world neither of us had ever been to before! We were both very interested in tropical diseases and wanted to experience medicine in a different culture, so although there was some trepidation about jetting off on our own, it was far outweighed by excitement.
Our main objective was to witness how the treatment of HIV and TB differed in a developing country to the UK.
We flew from Birmingham to Dubai, and then from there to Lusaka, finishing off our 20-hour journey on a tiny little plane that looked as if it had just come out of the film Indiana Jones. Landing in Ndola on the final leg of our journey, we were picked up by our housekeeper’s son, Mabvuto, and driven to Mufulira along the Congo Road, a very, very, bumpy dirt road (welcome to Zambia!). We were staying at 7 Julius Nyerere, which is a hostel kept by IntroZambia, an eco-tourism entity that has been introducing people from the UK to Zambia for the last two decades. The Bungalow is a large house that could have slept 20, so it was very big for just the two of us! Our housekeeper, Ethel, took us under her wing and made sure we were welcomed into the town. She even bought us both Chitenge (local dresses) and cooked us dinner!
Finding our feet
We arrived on a public holiday, so had a full day to get used to the African heat and find our feet. We worked out where everything in the town was, including the supermarkets, and the hospital which was roughly a 2.5km walk from the house. We quickly learned that the dust around the town stuck onto everything and was never going to wash out, and that the holes in the road were too big to even be called potholes!
With impeccable timing, we also found ourselves in Mufulira for an international rugby tournament and watched Zambia play both Madagascar, as well as Botswana. Mopani, the main mining company in Mufulira and a subsidiary of Glencore, recently renovated the old colonial Rugby Club including stands and Club house! The result was we were able to experience a real African party whilst supporting the national team of Zambia, many of whom were mine workers from Mufulira.
My name is Laura and I am going to try and sum up our time spent at Ronald Ross General Hospital. As Beth has already indicated, we walked 2.5km each morning to arrive at the hospital for an 8am start. We started to get to know the local faces who greeted us each morning on our commute – our particular favourite was walking past the local primary school to be greeted by crowds of chattering children!
Our primary placement was on the female medical ward for women over the age of 16 with a wide array of problems. We were responsible for clerking in the new patients, as well as reviewing admissions with a wonderful team headed by a clinical officer (equivalent in the UK to a Physician’s Associate).
Medicine in Mufulira
We were very much thrown into the deep end with respect to our clinical abilities – my first patient was a 32-year-old lady who had a very low level of consciousness and was struggling to breathe for herself, whilst Beth was faced with an elderly lady with acute heart failure. To say this was a baptism of fire would be an understatement. After swiftly realising that the hospital was not equipped like at home, Beth and I used our training to stabilise the patients to the best of our ability and seek help, which came in the heroic form of Dr Tumba. Dr Tumba is a Congolese lady who has worked in Ronald Ross hospital for many years. We found out over course of our stay that she is one of the best clinicians we have ever encountered – it is just a shame there is only one of her running
almost the entire hospital, with almost no diagnostic tools other than her hands and brain.
A few of the challenges
As our time at Ronald Ross progressed, we got into the swing of the way the hospital was run, but were saddened to see that basic tools such as accurate thermometers, blood sugar monitors and chest X-Ray films were lacking; items which were sorely needed to improve the patients’ care. One of the most shocking things we witnessed in Ronald Ross was the emergency room. In the UK A&E is one of the most highly staffed and equipped departments in the hospital, while in Mufulira, A&E was just a small room with a bed covered in old blankets; no staff and no life-saving equipment. I wouldn’t like to think about how they manage to treat patients arriving in this department…
To end our trip
After working in Mufulira for four weeks, Beth and I planned a travelling holiday to explore the rest of Zambia. We were blown away by the sheer majesty of the country and privileged to see four of the big five animals of Africa in South Luangwa National Park as well as the Mosi oa Tunya of Victoria falls, ‘the smoke that thunders’ (which also happens to be the name of the local beer…).
A few things to reflect upon
It is very easy to go somewhere like Ronald Ross General Hospital, compare it to the UK, and just wonder how it can be acceptable that people are expected to work with so few resources. What we need to keep in mind is that Zambia is a developing country, and for all its flaws, Ronald Ross has many assets. The treatment of HIV, TB and Malaria are as good – if not better – than in the UK. For them, these are bread and butter conditions, and the staff know exactly what to do. However, we also noted that care for cardio vascular issues, which we take for granted in the UK, are hardly provided for. We returned with a list of items which while costing very little would improve outcomes dramatically – items such as sphygmomanometers and an ECG machine, and instructor text books in this field.
Even items such as cuddly toys for the children’s ward would make a big difference to children who had nothing to play with. Another area we noted was mis-prescribing of medications and the lack of the equivalent of the BNF (British National Formulary) book, which would have assisted in this regard. Amongst the clinicians there were a number of exceptional people who would benefit from further study in the UK, which we understand is a future aim for the MMTAs bursary and would bring reciprocity to the elective programme.
One of my learning objectives was to find out about the most common presenting conditions in Zambia. Most patients presented with: complications of diabetes, heart failure as a results of extreme hypertension, anaemia, malaria and HIV related infections. Before my elective, I had imagined that most patients would be presenting with the latter 2 and TB ,but I was surprised to find that the presentations are actually very similar to the West.
Nshima (local maize-based food) and sugar cane are the most widely consumed foods in Zambia and both are very high in carbohydrates and sugars contributing to the high prevalence of diabetes in the community. Food in Zambia is relatively expensive since most fresh produce and meats are imported to the country from South Africa meaning that many of the locals have a very limited diet. Some products such as Coca Cola and Fanta are not available in the ‘low sugar’ form found in the UK, and in many shops they are cheaper than water meaning that they are widely consumed.
Despite the resource-poor conditions in which patients were treated, the management of HIV and TB were much better than I expected and the medication to manage both were freely and readily available. The government hospital has a service dedicated to the diagnosis and management of HIV. There is a ‘test and treat’ initiative in place in most hospitals where patients with an unknown (not tested in the last 3 months) HIV status are to be tested irrespective of presentation and if their results are positive they are to remain in hospital until they are initiated on an anti-retroviral regime.” Laura Stenhouse
Beth Wardle and Laura Stenhouse, Medical Electives 2018