My elective at Saint Francis Hospital

Selina Ball
(Medical Student - Brighton & Sussex Medical School, UK)
October 2006

I undertook my elective in S Francis Hospital, a rural missionary hospital from August-October 2006 for 6 weeks. It is a 280 bed hospital that not only provides care for local residents but also receives referrals from the whole of Eastern Province a population of 1.5 million people. This area extends along the great eastern road 2 hours south to the Malawi border and 6 hours towards Lusaka both of which are by car. The hospital has 2 medical wards – male and female, 2 surgical wards – male and female (gynaecology is a part of surgical ward), a labour ward and paediatric department. There is also a busy outpatients department in which various clinics are held. Basic investigations are available in the laboratory often depending in if the reagents are in stock. X-rays are available 3 days a week and ultrasound on the other 2 days, except for emergencies.

I spent my time on the Male Medical ward, S. Augustine. Here I was able to become Dr Selina! and see patients on the ward round where I could start and manage their treatments and then discharge them when they were better. I saw and treated a wide variety of medical conditions, many were HIV related including pneumonia, TB, PCP, meningitis, treatment failure and some reactions to medications. The ward had many patients who had severe malaria and gastroenteritis, which can become serious quickly in such a hot environment. I also saw and managed more western illnesses including CCF and diabetes, although treatment is very different. For example most of the population do not own a fridge therefore insulin is a last resort in the control of diabetes.

Mornings would always be taken up by ward rounds, which were often complicated by a patient collapsing and would require the 3 of us (one doctor and 2 students) to help and provide immediate care. Afternoon activities depended on how busy the ward was, sometimes we would return to the ward to do jobs and procedures, when everything on the ward was complete we would always go to clinic. Ward jobs included chasing results and planning treatment accordingly, if any new patients had been admitted from clinic we would aim to see these to prevent the on call team having to do so. The other ward jobs were procedures, this included ascitic and pleural taps and drains, lumbar punctures and administering chemotherapy. I was able to perform all of these under the guidance of the doctor on my ward.

If we went to clinic we could take any which we felt comfortable in doing so, mostly I took General OPD in which any illness or condition could walk through the door. This included similar things to the ward as well as gynaecology such as miscarriages, sexually transmitted diseases, assaults regularly attended some of which could be treated in clinic and some would require admittance. In clinic was the main time that I undertook paediatrics as many children attended clinic. GOPD was where they brought in any A&E patients. During clinic sometimes a trolley would be rushed in with really sick patients and I had to assist in the assessment of patients coming in from RTAs as well as many other emergencies.

We once had 6 patients in room with 2 students! If I did not do GOPD I would undertake Sandy Logy Clinic (SLC), a HIV clinic. All patients are encouraged to have VCT voluntary counselling and testing) for HIV. If reactive they are encouraged to attend SLC where there disease can be monitored for severity, they canbe prescribed ARVs when appropriate and can also receive prophylaxis against opportunistic infections. During my time here I was able to spend time in these clinics and learn how to manage these patients.

Overall my time at St Francis was the most amazing thing I have ever done. My clinical skills were allowed to develop and working here allowed me to see the value of clinical skills over radiological investigations. I was able to gain confidence in the knowledge I have already gained as well as been able to learn so much more such as understanding the skill of prescribing. Very few of the patients spoke English and for this reason it was necessary to have a translator or a nurse available. When this was not possible I did learn to speak some of the local language, this certainly tested my communication skills! I was able to realise how much that can be done with so little equipment and expert consultants. I cannot wait to return when I have qualified.

As well as all the medicine there was definitely a social side to my time at S. Francis. I travelled there with a friend from uni, Emily and this meant that we could share a room, but there was plenty of other people there. Whilst we were there a variety of Medical students rotated through from England, Denmark and New Zealand. There was also Dutch nursing students and some visiting specialists from around the world. There was also doctors returning who also carried there elective out here. Everyone was always coming and going and so there would be plenty of leaving parties. Most people eat in the Mess which allows time to catch up with everyone else on the compound. There was always people going to stores (katete), or to chipata so everyone would get there food/alcohol orders in! Some people had laptops which meant films could be watched/music to listen too. We enjoyed BBQs and cake parties to name a couple. Evenings and weekends were time to relax, go for walks or visit nearby places. Everyone should make the trip to South Luangwa National Park as it’s the best safari park in Zambia.