Finally Here – Zambia!

7/27/12

Posted by Amanda Thornton, MD (a third year Internal Medicine resident from Kaiser Permanente, Oakland while serving a global health elective in Lusaka, Zambia with University Teaching Hospital).

This elective took several months preparation, all performed while I was still completing my second year in residency.  I applied for the elective, requested the scheduling time and when my elective was approved, contracted a travel agency to book my trip.  That was just the beginning. From there, I talked to other residents who had been on global health electives, to physicians who had grown up in the area and to Ajay– the last resident who had been to UTH to find out what I could expect.  The Kaiser travel clinic prescribed my vaccines and my
anti-malarial medications via a phone appointment. Then I stole time from my busy day managing a Wards team of new interns to be vaccinated and pick up the prescriptions. 

The day after I completed my wards rotation, I packed for 12 hours, cleaned my apartment, stopped my mail and caught a plane to New York. When I arrived in Zambia, I had already been traveling for 2 weeks.  This had been intentional- I took time to visit family in New York, and then stopped in London for 5 days just before the Olympics started.  My sister, who lives in the UK, had scheduled for me to meet with family and friends who had traveled and worked in Zambia.  My parents had lived in Zambia for 2 years before my sister’s birth (My father was a guest lecturer on African History at the University as my
mother completed her PhD research in Angola) but their information was nearly 30 years out of date.  All of the advice I received helped me prepare for a completely new experience in the health care system, and by the time I arrived at Gatwick airport, I was feeling prepared instead of nervous.

I had a delay at the very beginning of my flight to Zambia- the pilot on my Emirates flight fell ill, and by the time a replacement pilot had been found, several passengers had missed the single connecting flight from Dubai to Zambia that day.  The airline paid for us to spend the night in the airport hotel.  

Dubai is Emirate and a city in the United Arab Emirates.  The country is
predominantly Muslim, and is currently celebrating the Season of Ramadan. Ramadan occurs in the 9th month of the Islamic calendar and the whole country observes the day-time fast as part of the 5th pillar of Islam.  Guests in the hotel were not allowed to eat or smoke outside, and were encouraged to dress conservatively. 

I had no trouble with dressing conservatively as the only clothing I had in my carry on luggage was an extra pair of scrubs.  When I ventured outside during the day, the over 105 degree heat slapped my face- worse than the time I spent in deserts in Arizona.  Most of the women who were not hotel staff or foreigners were dressed in the floor length loose abaya and had their heads covered.  Usually foreign women wearing clothing that covers legs and arms are not remarked on, but I as a female traveling alone with skin of an indeterminate brown color, felt a little uncomfortable with the stares of the men in the hotel lobby even in my loose scrub pants and thin long sleeve top. 

I went on a tour of Dubai after sunset, when the heat had decreased to at least 85 degrees.  On the tour I met some of the other groups who were also going to Zambia.  One woman was a Kaiser Physical Therapist who was volunteering on Children of Hope mission trip to meet a child she had been sponsering for the past 4 years.  Another woman was a recently retired nurse from Washington who was going to Southern Zambia to visit a village and help build outhouses that would separate
waste from their water supply. 

The retired nurse commented that it was strange to be going from Dubai which boasts the Armini tower, the tallest building in the world, and all the health benefits of the western world to Zambia.  I didn’t realize how stark the contrast was until I visited the World Health organization website.  United Arab Emirates boasts a life expectancy averaging 78 years and 19.3 physicians per 10,000 people. Zambian people average life expectancy is 48, with 0.6 physicians per 10,000.

When I wandered past a medical facility within a block of my hotel in Dubai, it appeared organized and modern, with several ambulances in the bay, a bright sign reporting that at least one 24 hour physician was on duty.  Already, after 1 day in Zambia, I have not seen a single ambulance.

Instead, today, I saw a patient carried in by a private car filled with family.  The hospital facility at UTH is spread over several buildings, but the internal medicine ward in which I worked today is crammed with more than 6 beds in a small curtained section.  In the hospital, though there appears to be running water, hand washing stations are posted with bottled water.  Hand sanitizer- available outside every room in the Oakland Medical Center is available in the nurse’s supply room. 

In Zambia, where 75% of deaths are due to communicable disease, and 135 people per 1000 are HIV positive, beds at tertiary referral centers like UTH are in great demand.  According to the medical students on my team, patients pay for procedures, labs, imaging and medication if the hospital does not have it in its supply.  The patient’s family may bring in food and supplement the busy nurse’s care. 

Still, today, shopping for supplies in a busy supermarket, I discovered ample food supplies, including luxury items my parents claimed were not available in the late 70s- including cheese and honey.  Watching the national news with the  niece of my host in Lusaka, I heard that Zambia’s prosperity has been improving, but it has not started to decrease the rate of poverty.  I think of the shanty town we drove through on the way from the airport, where my host warned me not to take pictures or we might be stoned by people whose pictures had already been taken to raise aid funds which they never received.  Everything here works
differently and I’m only beginning to see how.