University of Edinburgh 2019
Starting my elective placement in obstetrics & gynaecology at the hospital in Lusaka was daunting and exciting in equal measure, but I was quickly made to feel at home and part of the team.
The medical staff at the hospital are organised in a firm-based system and I was attached to one firm for the whole 5-week period. This structure means you really have the chance get to know the doctors with whom you’re shadowing and they are keen to get you involved: whether that’s clerking their patients and presenting on rounds, brushing up on your obstetric examination skills in ante-natal clinics or assisting them in theatre. You never get lonely in the hospital as you’re doing all of this surrounded by supportive local medical students who are happy to share their notes, show you the ropes on the ward and, perhaps most importantly, show you where the best places are to get lunch!
The hospital I was placed in is government-run and they struggle with a lack of resources. Before my placement in Zambia, I took for granted the abundance of equipment we have at our fingertips in the UK. There were times when the limited resources in Zambia could be very frustrating. From the water running out while you are mid-scrub; CTG machines not having any paper; and running to the blood bank in 30-degree heat in your white coat only to find they have run out of the blood product you need to save your patient.
I learned three important things in this setting:
- You don’t need fancy kit to get the job done: if you don’t have a Rusch Balloon to manage a post-partum haemorrhage, a condom filled with normal saline is just as effective.
- The nature of healthcare in the UK is quite wasteful: there are definitely ways we can minimise the amount of waste we produce and still maintain a high standard of infection control.
- Our reliance on technology is causing us to become deskilled. While at the hospital in Lusaka I learned how to listen to the fetal heart rate manually using a Pinard stethoscope, a skill I didn’t learn at home because there was always a Doppler ultrasound machine nearby to do it for me.
The greatest resource is the staff themselves, the doctors are highly knowledgeable! A lot of the teaching is oral in nature and happens on rounds; keep an O&G handbook in the pocket of your white coat, you never know when you might need it.
you will be exposed to things you’ve never had the opportunity to see back home
During my placement the depth of my O&G knowledge improved significantly, as did my ability to think on my feet and structure my verbal answers in a coherent way. A ward round at the hospital can feel like the contents page of the O&G textbook, and you will be exposed to things you’ve never had the opportunity to see back home for example, stage 4 cervical cancer, severe symptomatic anaemia of pregnancy, eclampsia, TB and HIV. Unfortunately, the severity of disease seen in Zambia is often because the women can’t afford antenatal care or are from rural areas where no such care is available.
The Lusaka house is a welcome sanctuary from the hustle and bustle of the hospital. After placement it is great being able to relax by the pool, share hospital stories with the other students or simply slip away to the terrace to read your book. The weekly BBQ is a highlight and a great way to get to know your housemates, and the Work the World team, a bit better.
Visiting the spectacular Victoria Falls in Livingstone was an amazing experience as was the boat and land safari over the border in Botswana, where we were lucky to see a whole range of wildlife and get up close to a family of swimming elephants. Closer to home, Lusaka is a fun city to spend time in at the weekend and overindulge at a fancy steak restaurant before hitting the busy local bars and clubs.
The Village Healthcare Week was the cherry on the top of my time in Zambia. We were welcomed into the home of a wonderful host family which provided a valuable insight into what life is like outside the capital for many Zambians. Time spent at the small district hospital is an interesting comparison to the hospital in Lusaka as it is better resourced, and you get exposure to a variety of specialities and conditions. Bring your dancing shoes as the local school kids will show you how to bust a few moves… or at least try to.
