How medical and economic health go together

Gradian Anaesthetic machine donated by Friends of Mufulira (FOM) in 2021 equipped with built-in oxygen concentrator able to remove oxygen from the atmosphere obviating the need for delivery of cylinders
The MMTAs twinned relationship with Mufulira in which we send NHS medical students to the Ronald Ross General Hospital in Zambia is multifunctional.
First, it gives unique insight into the health status of ordinary people at an urban centre of this sub-Saharan country. Second, it provides insight into how a typical general hospital runs. And third – especially of interest to members of the MMTA – it temperature checks (via the economic health of the mine and Mopani smelter complex that dominates the town) the relationship between commodity activity and economic health.
In Mufulira, since Glencore put the Mopani mine and smelter on care and maintenance in 2020 and then sold it to the Zambian Government in 2021 (ZCCM-IH) with a $1.3 billion debt, things haven’t been good.
Glencore’s ownership of the Mopani industrial complex might not have not contributed as much to the Zambian Treasury as it would have liked in a perfect world, but Glencore’s investment in new shafts, winding equipment, mining efficiency, health and safety, its training school, airborne pollution reduction via sulphur capture, lorry parks away from town, new roads, health clinics in the community, had a huge positive and visible effect on the town.
Today, there is renewed hope. By the time you read this, it is possible that the interim government ownership of Mopani may be over. Reuters reported on Aug 29th 2023, that experienced precious metals miner Sibanye Stillwater, with a likely backing by a Chinese investor, was one of the front-runners to take over the mine. If so, the mine could be returned to responsible management by mining professionals rather than government officials.

Dr Tschula Tumba, Dr James Matabile (Superintendent),
FOM Electives: Helen Wanstall, Josh Hulman (2017)
During all this time, since 2016, the MMTAs Charity, Friends of Mufulira (FOM), has funded bursaries for pre-qualification UK medical students to travel to Mufulira for their overseas elective.
Our first two students in April 2023 were Niamh Johnson and Dominik Sadczuk from Edinburgh University and the second elective in August – just completed – were Ben Dare and Rhyanna Morris from Liverpool University.
Just a sentence from Rhyanna Morris’ report provides insight into why the elective can be so valuable, and ultimately to the quality of care in the NHS.
Rhyanna writes of her Zambian colleagues, “The clinician’s acumen of diagnosis was far beyond what we see in the UK, because the available testing is very limited.” It is something we have heard from our electives before – that because of the shortage of working equipment, old fashioned observational and hands-on diagnosis is uppermost; skills not so easily obtained in developed systems.
She goes on to say,
We also saw a wide range of conditions (e.g. TB, PCP (Pneumocystis pneumonia) malaria, HIV and leprosy) which we may never see again in our medical careers.”
As a charity working in a different system to our own, FOM is aware of its limitations. When we have provided medical equipment, it has not always been maintained as well, or used as much, as it might. The electives help us monitor how effective we are being, and they provide feedback as to how we can improve what we do and make informed decisions.
Today, this means we see the need to spend more on training and less on equipment, while always as much as possible on supporting the interaction between our elective students and local clinicians. We feel from all the feedback we have obtained that the elective is an undiluted good for all concerned, and long may it continue.
On the wider front, with copper prices steady, we all fervently hope that the resumption of investment in Mopani by Sibanye Stillwater—or whoever takes over—will bring a resumption of hope and economic improvement to the lives of Mufulira citizens.
Update by Anthony Lipmann
Trustee, Friends of Mufulira
Below we share some highlights from Friends of Mufulira Trustee Dr Robin Gleek and recent medical electives’ visits to Mufulira and the Ronald Ross General Hospital.
On our first day of placement at Ronald Ross, we met with our supervisor, Dr Tumba who after working as a physician had taken on a managerial role at the hospital. We were given a tour around the hospital where we were able to see the various wards; the main areas of the hospital were the male and female medical wards, male and female surgical wards, a paediatric ward, and obstetrics and gynaecology ward as well as a small intensive care unit.”
Nimah Johnson, 2023, Edinburgh University
HIV Dr Chiponda explained that 80% of the population is HIV-positive. Many are successfully treated with antiretroviral drugs and have good immunity against other infections. However, all patients presenting with any infectious illness are assumed to be HIV positive until their status is tested.
“Medications are extremely limited currently in Zambia, and there is also a shortage of the aid-supplied enterovirus vaccination programme for babies, therefore the paediatric ward was inundated with severe diarrhoea leading to sepsis.”
“Another shocking fact is that over two-thirds of the junior doctors at Ronald Ross General Hospital are not paid and are working as volunteers. The government no long guarantees jobs after graduation, therefore graduates volunteer in the hope of getting a job…eventually. The shifts they work are the same as the paid doctors and their responsibilities are the same.” Rhyanna Morris, 2023 , Liverpool University

Dr Gleek, Trustee of FOM, with Dr Charles Chiponda (former acting District Health Officer, for the Copperbelt) in the maternity ward
Meningitis “Cryptococcal meningitis is a serious infection of the brain and spinal column that can occur in people living with HIV. It is caused by a fungus called Cryptococcus neoformans. This fungus is very common in the environment and can be found in soil and in bird droppings.” – Dr Robin Gleek, Friends of Mufulira Trustee

Photo by Dr Robin Gleek, Friends of Mufulira
Malaria “At the peak season, in the single month of February KH dealt with 390 children under five, and 495 older children and adults, presenting with malaria. In the week of our visit, a six-year-old girl died in RRH from cerebral malaria.”
Malnutrition This little girl is the older sister of twin babies who had contracted Malaria. The twin pregnancy had almost certainly accounted for her developing malnutrition as the mother’s breast milk was no longer available for her.
How to donate to Friends of Mufulira
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https://www.peoplesfundraising.com/donation/friends-of-mufulira
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