While in Livingstone, with the help of the Douglas and Margaret Saunders Scholarship, I aimed to gain a more holistic and global perspective on health by comparing and contrasting the healthcare and health facilities to Australian hospitals.
I was put on each of the four major departments for one week each, which allowed me to be exposed to a wider range of diseases, doctors, patients, and parts of the hospital. In paediatrics, I was exposed to cases of sickle cell disease, malaria, malnutrition, nephroblastoma and even Guillain-Barre syndrome.
Having seen such a broad spectrum of diseases in paediatric patients has broadened my knowledge of diseases and will allow me to consider them as differentials when diagnosing patients.
I felt that I learnt a lot on my internal medicine rotation as well, which allowed for more time with patients to perform procedural skills such as venepuncture, and clerk patients, similar to presenting a longcase. I was able to gain an appreciation of the burden of HIV, causing an exuberant number of cryptococcal meningitis cases, and also observed diseases such as tropical splenomegaly syndrome.
I was able to counsel a patient on beginning insulin therapy for type 2 diabetes, and observe thoracentesis for a pleural effusion in an active tuberculosis patient, and lumbar punctures for a meningitis diagnoses. All of these skills are transferrable to Australian hospitals, and will prepare me better for my future career. Obstetrics and gynaecology allowed for time on labour ward assisting in vaginal deliveries, and time spent in theatre for caesareans and gynaecological cases.
The burden of HIV was evident, particularly in the number of cervical cancer cases in younger women, but I also noted the high rates of post-partum haemorrhage, and even observed a case of placenta increta resulting in a subtotal hysterectomy.
My surgery rotation gave me an appreciation of differences in the culture of medicine and healthcare in Zambia. For instance, there were many motor vehicle accidents involving intoxicated individuals, resulting in femurs fractures, in some cases even bilateral fractures. Patients had to pay quite a high price for the metal surgical pins inserted into their legs, and most simply couldn’t afford it. Best practice only occurs if the funding allows, and so most patients were placed in leg traction devices to heal the fractures instead of surgical intervention.
In terms of Zambian culture, almost all patients and staff spoke fluent English, although one of the local 72 languages would infrequently be used to patients from the outer villages.
Many patients also use traditional medicines to supplement their healthcare. Practitioners of traditional medicine are protected under Zambian law, much to the frustration of the medically trained doctors at Livingstone Central Hospital. There is also a large family influence in terms of decision-making with regards to a patient’s care, something that is also seen in Australian Indigenous culture.
In terms of organising the placement, everything was quite straight-forward and made much easier with the support of the Office of Global Health and the Douglas and Margaret Saunders Scholarship. However, a little research online prior to the elective was useful. For instance, most ATMs and shops only accept Visa as opposed to MasterCard, so knowing this allowed me to prepare before departure. Also, knowing to bring scrubs, shoe covers, face masks and white coats was useful in order to assimilate into the large wave of local medical students that occupy the wards of the hospital.
Challenges faced in the country were minimal. Local people are friendly, and as long as you proceed with traveller’s caution, you won’t run into any trouble.