Written by Payvand Milani, MD, PGY-3 at Kaiser Permanente Santa Clara Internal Medicine Residency Program while on Global Health rotation at University Teaching Hospital in Lusaka, Zambia in February-March 2018
I feel so lucky to have had the opportunity to travel to “UTH”, or the University Teaching Hospital, in Lusaka, the capital of Zambia, for a few weeks. It was my first time in Zambia, and Africa, for that matter. Exciting! UTH is a public hospital and is the largest in the country. It is considered the referral center for all other hospitals in the country and many of the country’s specialists work there. My goal for the trip was to develop a sense of what healthcare is like in Zambia, to learn how physicians operate in a resources-limited setting, and to explore the country/culture.
From SFO, I took a 16-hour flight to Dubai and another 7-hour flight to Lusaka. It was quite the journey, so I was relieved to arrive in the relatively small airport of Lusaka. I battled with jetlag the day I arrived and made it out to UTH the next day.
Just by walking around, it quickly becomes clear that…
UTH is a public hospital in a third world country. The hospital thankfully provides medical care at minimal/no cost for patients, as the government covers these costs (patients would otherwise not be able to afford medical care, as a majority of the country is quite poor). I spent my time rotating with the endocrine, wards (internal medicine), and infectious disease teams during my days here. Thankfully, most folks speak English in addition to the local language/dialect named Nyanja.
In endocrinology, we predominantly saw clinic patients and focused a great deal on diabetes and diabetes education, especially the latter, which was quite refreshing. There were also a few interesting inpatient cases of pan-hypopituitarism and primary hyper-aldosteronism. The endocrinologist I worked with spent a few hours leading teaching rounds for residents on wards each week (they would save their more complex/challenging endocrine-related cases for him). He informed me that he is only one of a few endocrinologists in the country! It was quite remarkable to see the clinic hallways packed with patients—some were even sleeping on the ground as they waited their turn to be seen by clinic providers. I learned that clinic appointments are made for a particular date, but the time of the appointment is not set ahead of time—patients are seen on a “first-come-first-served” basis on the day of the appointment, so those who want to be seen in the morning arrive as early as 5 or 6 a.m. to be at the front of the line!
During my time on wards, I rounded with the team on a daily basis and had the opportunity to help admit patients on their “call day”. I still remember feeling startled when I saw how many patients on the wards floors were in the same big room together. Their beds were only a few feet apart from each other and in a room that in the U.S. may have housed 3-4 patients at most, I found 12-16 patients. However, the available curtains helped create a physical barrier between patients and provided for some sense of privacy. I found it interesting that often times, unless it’s a very critical blood test (in which case the physicians will walk it over him/herself), the physicians ask family members of the patient to physically take the patients’ blood sample (along with paperwork clarifying what labs should be run on the sample) to the hospital laboratory for efficiency’s sake. Often times, the residents would perform these blood draws. Similar to the U.S. system, there were a number of wards teams run by residents who were overseen by attendings.
While I was with the infectious disease team, I noticed there were a few situations in which there was a shortage or temporary absence of an antibiotic. Thankfully, we were often able to find an adequate replacement. Also, facemasks and gowns did not seem to be available at the hospital. Clinically speaking, and not surprisingly, there were many patients with a prior (or new) diagnosis of HIV or tuberculosis so the residents seemed quite comfortable managing these cases. A few of the more unique cases I encountered included disseminated blastomycosis in an adolescent male and tetanus infection (and subsequent tetany) from stepping on a piece of scrap metal. Given the relatively poor health literacy of patients and their families, I really felt that they placed the utmost trust and hope in us as their medical providers. This was empowering.
Outside of the hospital, I had the opportunity to visit Livingstone (one-hour flight from Lusaka) to see Victoria Falls, one of the Seven Wonders of the World, along with experiencing my first safari. I had a chance to walk lions and cheetahs—truly amazing and exhilarating. Sinus tachycardia in an instant J–especially with walking the lions (not on a leash).
Perhaps the one aspect of the trip that I will never forget is how pleasant, warm, and kind the Zambians are. I was truly touched by this everywhere I went, whether in the hospital, the store, the street, the airport, etc. The locals always asked me how I was doing and greeted me with a big smile. I was also moved by how positive and happy everyone was despite having very little (materially) and living lives of hardship because of this. Witnessing this on a daily basis was quite moving and can serve as a lesson in contentment for us all (certainly for myself!). I strongly recommend the UTH global health experience to anyone.