Six weeks at Saint Francis’

Emily Bolton
(Medical Student - Brighton & Sussex Medical School, UK)
October 2006

On the 25^th of August 2006 I arrived in Zambia, a poor country in Southern Africa with a population of 11,261,795 people and an estimated 1 in 6 adults living with HIV. I worked in St Francis Hospital, Katete a mission hospital, which provides free healthcare to the Eastern province. It is the largest mission hospital in Zambia and takes patients from the Malawi border to the edges of Lusaka a 60 km radius but the doors are open to anybody who needs medical attention.

I worked in a range of roles during my time at St Francis I was a student, a general practitioner, a gynaecologist, a paediatrician, and a physician.

I spent most mornings as a paediatrician. We always started ward rounds at the Special Care Baby Unit (SCBU), which really consisted of tiny premature babies in light boxes. It was sad to see such tiny babies in such poor conditions with roaches, medical intervention didn’t really come in here you just hoped they had the strength to gain weight an hit the magic 2 kg.

We then went onto Mbusa the children’s ward to the treatment room where the sickest children spent their time. I saw and treated many cases of Malaria, sickle cell crisis, severe pneumonia, Congestive heart failure and the dreaded meningitis.

We then moved onto the baby room all children in here were under the age of 6 months, At one point it was completely taken up with babies with hydrocephalus with head circumferences of up to 60 cm these babies stayed for a long time and were very neurologically compromised, so much so they could not have a shunt which may have changed their outlook. All together 7 babies were admitted with hydrocephalus in 6 weeks and only one of these was fit for a ventricle peritoneal (VP) shunt. From what I saw in Zambia rates of hydrocephalus seem to be higher in Zambia than in the UK, this lead me to wonder what is the cause for this difference. There were also alot of ethical issues surrounding which patients were put forward for VP shunting.

The malnutrition ward was next they always brought me joy! These patients would stay for about a month slowly losing their oedema and putting on weight the change in them when they went home was lovely to see, and you hoped that the education that you had given their mother would ensure that they wouldn’t return.

Lastly the general ward where the uncomplicated malaria patients stayed as well as rare conditions such as spinal Tuberculosis and surgical patients. Children never stayed here long which is how we liked it!

The afternoons were spent in general out patients clinic. And I mean general! People would queue all day just to be seen by the doctors anyone could walk in the door from assaults, to paediatrics, to H-Pylori infection, to heart failure, to miscarriages and pre-eclampsia. You had to be a true generalist and think quickly on your feet relying on your clinical skills as tests and investigations were extremely limited.

I also took part in outreach clinics, HIV teaching from AIDS relief workers, an audit on paediatric deaths and a teaching presentation on paediatric heart failure.

My learning objectives were to learn about medicine through improving my clinical skills and learning about new conditions. But I learnt so much more than that. I learnt how difficult it is to communicate though a translator, how important it is to have knowledge of ones culture before explaining to them what is about to happen. How important education and health promotion is in areas of health care such as HIV and Malaria. I learnt so much it is hard to put it all down on paper.

Above all I learnt to be thankful for all that I have and not always think about the things I don’t have.