OHSU StudentSpeak is pleased to present this guest post from Malerie Pratt, a medical student in the M.D. Class of 2018 and a Swindells Family Scholar.
I’m thankful for the faculty at OHSU and Dr. Karen Kwong, my global health research mentor, for all the time and effort they put in to helping me have the opportunity to study and learn about the Zambian medical education and health care system for the last three months. My hope is that sharing my experience will encourage more medical students to collaborate with other medical education programs abroad so that we may learn from each other and form partnerships to continue improving access to health care globally.
I’m really sensitive about medical tourism and was afraid my trip may take more resources from the Zambian hospital than I would be able to give back, but I think this has been the best thing I could have done right now in my education, as it helped me cement my current and future goals. Being able to participate in hospitals internationally as a medical student taught me lessons on adaptability and resourcefulness that I will carry in my future work internationally. Over the last three months I made friends with dozens of African doctors throughout Zambia (many of them Congolese, Zimbabwean and Tanzanian). I look forward to collaborating with them to set up future projects.
Here is a journal entry I wrote about the patients and my time there:
Last week we did so many surgical cases. Thankfully, I’m first assist on most of them. The operating room has no AC and it’s about 100 degrees in there. We wear plastic aprons with large cloth gowns. Everyone is literally drenched by the end of surgery. One day I got so hot that I thought I might pass out, right at that moment a Zambian resident passed out instead. Most days the xray machine runs out of films, so the surgeons often go into surgery unsure of what they will find. For example, a lady came in with peritonitis and they were convinced she had a perforated peptic ulcer, however it turned out she had a ruptured ectopic pregnancy upon opening! I wonder if it would be possible to get some medical equipment donated here. I think they would really benefit from an x-ray machine that doesn’t require film. I’m learning a lot here. The doctors I work with are phenomenal with physical diagnosis, and constantly ask basic clinical science questions, which connect everything together. I’ve been assigned to learn from the head surgeon, Dr. Moonga. He’s super happy, enthusiastic and loves teaching.
We see a lot of extreme surgical cases here, including peritonitis and patients who come in daily with abdominal extension and rebound tenderness. Most of them have twisted intestines, or sigmoid volvulus, usually with gangrenous bowel, but the surgeons never really know until they begin operating.
Myocardial infarction (heart attack)
Dr. Moonga and I were doing rounds when we got called into a room. An elderly man was unresponsive, pulseless, but still breathing. Dr. Moonga calmly asked the relatives to leave the room and started doing CPR, gave him oxygen, and injected him with adrenaline (the only drug we had, there was no ECG or dfib). Within five minutes of CPR and adrenaline, his pulse was back, within a day he was laughing and talking, and a few days later he walked out of there. Amazing.
A young patient from Zimbabwe (we get a lot of patients from there), with metastatic melanoma that covered her whole body and created a ulcerating mounded lesion on her head. I felt sad for her because the disease was incredibly advanced and there was little we could do. The lesion on her head was midline which the doctors were worried could also be a meningocele (a protrusion of the meninges through a gap in the spine due to a congenital defect), but again they had no imaging working to confirm it, so they removed it. The girl was then released from the hospital to go back to Zimbabwe. I am not sure if she will ever return for follow up care because it is so expensive to get a visa to cross the border.
A male patient with a history of left arm amputation due to burns during an epileptic episode presents with fourth degree burns on his right upper extremity, chest and face. We have many burn patients at the hospital. Most of them are children that knock over boiling water or porridge, others are from house fires, or are epileptic patients. Unfortunately, like this man, a lot of people are scared to help epileptic patients during a seizure, because they are afraid the seizure is contagious. So when this man fell in the fire everyone was scared to rescue him. He developed an eschar on his chest and ended up having to have a right arm amputation and wound debridement of his chest and face. One day post op I went to visit him. The male ward is a large room with about 30 beds in it. The nurses were in the process of cleaning his wounds with saline. He looked depressed and wouldn’t make eye contact with anyone. He just hung his head down while they were cleaning. Depression is common with burn patients, and most of them here are treated with an antidepressant as well as constantly being talked to and encouraged. I noticed some maggots coming out of his wound, I was horrified thinking they would cause infection. At that moment Dr. Moonga came up behind me and proclaimed, “MAGGOTS? EXCELLENT!! They are helping us with the wound debridement!” I almost laughed at his excitement. Apparently, many places including some places in the U.S., use maggots to help clean out wounds.
After my surgical rotation I moved to a pediatric rotation in Ndola, Zambia (the same location as our non-profit organization children’s home, Vima Lupwa Home). It was a hot and crowded 14 hour bus ride from the Livingstone’s Hospital where I was doing the surgical rotation. I jumped right in with the Zambian medical students here. My knowledge is at about the same level as the fourth- and fifth-year medical students. It’s a six-year program. They have a lecture in the morning, then two hours of rounding, then a case presentation and then free time to see patients or do admissions. I’ve seen hundreds of cases of malaria with some cerebral malaria, a few cases of HIV encephalopathy with Cryptococcus and TB, and lot of neonatal Jaundice, viral dilated cardiomyopathy and diphtheria. During the afternoons, I take histories from the patients, help the nurses, and draw a lot of blood. The doctors here draw all their own labs and read all their own imaging. Their depth of knowledge is motivating and inspires me to study harder.
Unfortunately, we had a very sad night in the emergency room during my night on-call. One child came in having choked on food. The child passed away within minutes of arrival. Another baby needed a blood transfusion and had an allergic reaction to the blood transfusion. The child went into anaphylactic shock and passed away. Zambians grieve out loud and often display their emotions externally. Because I have worked in Zambia before the wailing and screaming is something I have become accustomed to during funerals. However, that night the sound of a mother learning her infant had died was a deafening sound that I will never forget.
My time in Zambia had its ups and downs, but the lessons I learned during my time there will make me be a better doctor and human. I’m thankful for having this opportunity and am happy to help other students have the chance to have similar valuable experiences. I look forward to returning to eventually collaborating with Zambian doctors to improve access to medical care there as well as help teach medical students in Africa and the US to become leaders in their communities.