A Medical Volunteer’s Experiences of 2003-4

Richard Newell
Medical Volunteer 2003-4 & GP (UK)

March 2005

It is now almost 6 months since we returned home after 366 days at St. Francis’. Our memories are still vivid, but to describe our experiences over that year is daunting. So much changed at the hospital and Katete over that time. It was something of a shock to come back to the U.K. to find everything much as we left it.

When we arrived in Katete we were, unsurprisingly, apprehensive. We had never worked outside the U.K. before, and neither of us had ever practiced hospital Paediatrics (let alone Zambian Paediatrics) – which was our first responsibility at St. Francis’. I knew little about Malaria, Tuberculosis or HIV/AIDS – the “coughs and colds” of Zambian medicine. But what ever our anxieties, they were quickly washed away by the warmth and generosity of our welcome, by the patience and help of the hospital staff and the seemingly limitless support and good humour of Shelagh Parkinson. I have been reading through e-mails that we sent early on in our stay: they all exude excitement and tired happiness.

We were lucky to arrive at a time when medical staff were relatively plentiful. Several Zambian doctors and clinical officers were in training there, and several other volunteers had arrived from the Netherlands. Alas, it could not last and our numbers gradually withered, the clinics becoming longer, the on-calls more frequent. Fortunately we were saved by the support of Zambia’s new “Medical Licentiates” - Clinical Officers who undergo a further 3 years training in medicine and surgery enabling them to work as doctors – but (maybe cynically) no medical degree to export to more lucrative jobs in Europe and North America. They proved very skilled and knowledgeable, and I am really hopeful that this new scheme will provide Zambia with the highly trained clinicians it so badly needs.

Inevitably, the most enduring image of Zambian medicine is that of the countless people with AIDS. On St. Augustine (the male medical ward) at any one time, you would find that between 40% and 70% of patients had a HIV-related condition. Despite our best efforts, we watched so many become weaker and weaker, thinner and thinner, and die. Trying to stay positive whilst fighting a battle that both I and the patient knew would we ultimately lose became increasingly difficult. It amazes me to think that the staff who have been doing this day in, day out for two decades still find the motivation to get out of bed in the morning. It also became obvious why HIV/AIDS remains such a taboo subject in Zambia: to cope in such hopeless circumstances, denial is a very reasonable option. Of course, it is not a solution, and just helps the virus to spread as if unnoticed.

But a revolution occurred during 2004. For the first time, HAART (highly active anti-retroviral therapy) became available to everybody at St. Francis. In June, I was invited on a course run by the Central Board of Health teaching about HAART. At the end of the weeks work, the assembled doctors, clinical officers and nurses broke into excited applause when it was announced that this was not just theoretical: thanks to the Zambian Government and the World Health Organisation, HAART would be supplied to hospitals within weeks.

The Sandy Logie (HIV) clinic took on a new lease of life: at last we could arrest the slow and heart-breaking descent towards death, and offer the prospect of a nearly normal life. The drugs were given for a minimal charge – at most 40,000 Kwacha (£5) each month, but often free. News spread quickly around the district, and soon the clinics swelled from 10 to 20 per week to 50 or 60. And even some of the taboo seemed to be disappearing: now HIV had become a treatable disease, it was becoming worth thinking about. Previously, suggesting that somebody in Out-Patients should consider an HIV-test often meant that you would never see them again. Now people were coming asking to be tested.

The coming months and years will see new challenges. The ever pressing need to prevent HIV becoming resistant to the drugs, and the huge extra resources required to review and monitor the potentially thousands of people who will begin HAART over the next few years. Each man, woman and child needs to see an experienced clinician and have a series of blood test every 3 months – for the rest of their lives. We estimated that within one or two years, we would have some 3000 people on HAART – which translates into 50 review appointments and bloods tests every working day. And there are estimated to be 20,000 people with HIV living in Katete District. The potential demands on the hospital are mind-boggling.

Fortunately, the hospital made a successful bid to access funding from the United States (that which George Bush denied the WHO: tainted money, but St. Francis’ is not in a position to pass it by) which should bring a significant resources to the laboratory, pharmacy and AIDS/HIV team. However, the problems of staffing remain enormous.