Overall I'm really enjoying living in Zambia so far, but the hospital is a bit of a mixed bag. In many ways it's very similar to the Baptist Medical Centre that I worked at in Ghana, although it's about 2-3 times the size and has a lot more longer-term doctors.
I have a really great team of largely Zambian doctors and friendly Zambian midwives, so it's been fun getting to know them a bit, even if I'm struggling to remember everyone's names! I've been able to do a lot more practically than I would do back home, which mostly is great, but I'm a bit anxious that they will expect me to do things independently too early. This week I've been the primary surgeon (i.e. the main person doing the operation, start to finish) for one c-section for breech and one bilateral tubal ligation (female sterilisation), both with a lot of help from my registrars, and have assisted in a few more c-sections and other cases. In England I only did one c-section start to finish in my whole 4 month block on O&G, so it's fantastic to get to do one in my first week.
But there are also a lot of frustrations. The biggest problem on O&G at the moment is that we don't have enough blood. Most of our patients have haemoglobins of 3-5, some even 2, and a lot of the time we don't have any blood to give them. Haemoglobin should be between about 12 and 15. In the UK (in Exeter anyway) we give a transfusion to all patients if they symptoms below 8 and without symptoms below 7... So I've literally never seen such low Hbs in the UK - it's insane. On the whole they tolerate it surprisingly well, I think because they tend to be chronically anaemic, perhaps from recurrent malaria or poor nutrition, so the additional drop is less significant. But there have been women who have died because there isn't any blood to give them, which is so frustratingly unnecessary.
At the BMC, and I think probably many African hospitals, blood was sourced from the relatives at the time it is needed. This is a fairly good system as it generally means the blood is available, but can often take some time. For better or worse, we have a different system. While a quick check for HIV and hepatitis B + C can be done locally, the most sensitive testing is with a PCR machine, which costs hundreds of thousands of pounds. Unsurprisingly we don't have one here, so all the blood that is collected has to been sent for testing to Chipata, a town about an hour's drive away. After testing this then gets put into their general store which gets shared between all the local hospitals. It seems we're giving them a lot more blood than we get back, so although some is coming back it is no where near as much as we need. Even when there's blood to be had it can be a very slow process - today the testing reagent had run out, yesterday there was some other problem...
As well as needing blood for emergencies, the lack of blood means a lot of our elective surgery is getting cancelled. We can't risk having a large bleed and not being able to transfuse them for a surgery that wasn't an emergency.
I hear there are similar frustrations on the medical wards. A lot of patients are dependant on oxygen therapy (e.g. if they have pneumonia), but the oxygen here comes from oxygen concentrators - machines that need electricity. At home we have oxygen taps on the wall, which if I'm honest I have never thought about how that works, because it's ALWAYS available so you don't need to think about it. But here when there is a power cut that means the oxygen concentrators don't work... There is a back up generator, but this takes time to come on, often time that patients don't have. Patients literally die when there's a power cut. The alternative would be to have oxygen cylinders, which don't need electricity. I might look into buying some as a back up, but it isn't really a long term solution as they will run out and need replacing very quickly... I had a long chat with Tim, a British GP who's here for 3 years about the politics of doing something like that - it would likely be a lot more complicated than it sounds.
Working in a hospital like this really makes you appreciate the care and resources we have available at home - that we all too easily take for granted.
I have a really great team of largely Zambian doctors and friendly Zambian midwives, so it's been fun getting to know them a bit, even if I'm struggling to remember everyone's names! I've been able to do a lot more practically than I would do back home, which mostly is great, but I'm a bit anxious that they will expect me to do things independently too early. This week I've been the primary surgeon (i.e. the main person doing the operation, start to finish) for one c-section for breech and one bilateral tubal ligation (female sterilisation), both with a lot of help from my registrars, and have assisted in a few more c-sections and other cases. In England I only did one c-section start to finish in my whole 4 month block on O&G, so it's fantastic to get to do one in my first week.
At the BMC, and I think probably many African hospitals, blood was sourced from the relatives at the time it is needed. This is a fairly good system as it generally means the blood is available, but can often take some time. For better or worse, we have a different system. While a quick check for HIV and hepatitis B + C can be done locally, the most sensitive testing is with a PCR machine, which costs hundreds of thousands of pounds. Unsurprisingly we don't have one here, so all the blood that is collected has to been sent for testing to Chipata, a town about an hour's drive away. After testing this then gets put into their general store which gets shared between all the local hospitals. It seems we're giving them a lot more blood than we get back, so although some is coming back it is no where near as much as we need. Even when there's blood to be had it can be a very slow process - today the testing reagent had run out, yesterday there was some other problem...
As well as needing blood for emergencies, the lack of blood means a lot of our elective surgery is getting cancelled. We can't risk having a large bleed and not being able to transfuse them for a surgery that wasn't an emergency.
Working in a hospital like this really makes you appreciate the care and resources we have available at home - that we all too easily take for granted.
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