Life In Luangwa , Zambia
“Doctor Emergency”! I had seen the blood spattered wheelbarrow parked on the veranda that served as the waiting room and now the sign of the shuffling flip flops told me I was about to meet its occupant. He entered the room uncertainly, supported between his two inebriated friends. The blood soaked tea towel adorning his head giving a big clue as to his presenting complaint. Removal revealed a 7inch gash across his forehead down to the skull. His helpful friends informed me it had been inflicted by an axe, two nights ago, in a fight and they excitedly asked me to examine his leg which had been stabbed by a spear.
Welcome to life in Luangwa or more accurately the Kakumbi Rural Health Centre. I have just returned from my second three month stint as the South Luangwa Safaris Association Medical Fund doctor. The post provides the unique opportunity for doctors to practice in a developing country whilst enjoying some Western style comforts. South Luangwa is a place where two worlds collide. It is situated in the Eastern province of Zambia, one of the countries poorest provinces in one of the world’s poorest countries. It hosts some of the worlds most exclusive safari holidays and draws tourists from around the globe. The medical fund was formed by the safari lodges as a way of importing expatriate doctors to provide medical services for the staff and guests of the lodges whilst securing access to a doctor for the local population. Kakumbi Rural Health Centre is the only clinic in Zambia to have a doctor working in it.
Work at the clinic is challenging. There is a language barrier, a cultural gulf and very basic facilities. There is no access to investigations and so most diagnosis are made on clinical grounds. A limited number of drugs and dressings are available but supply is often interrupted. The local hospital is over an hours drive away along a very poor quality, heavily potholed road. It is manned by two doctors and has microbiology, some blood testing facilities, an x ray machine and an ultra sound scanner. There is no ambulance service and patients are responsible for finding and paying for their own transport.
The health needs of the local population are huge. HIV/Aids is rife and both it and its complications often present during surgery. Diseases now confined to the history books of the Western world make not uncommon appearances. I saw cases of Tuberculosis, Syphilis and Rheumatic Fever during my three months visit. Other more unusual cases include snake bites, crocodile attack and foot trauma due to entanglement in a bicycle wheel. Trauma is a frequent occurrence in the community: children fall in open fires; builders fall off roofs; fishermen get hooks in their eyes and people assault each other. My stay spanned the wet season and in early March the number of confirmed cases of malaria started to rise. By month end it became evident that a full blown epidemic was likely and by mid April we ran out of malaria rapid diagnostic test kits and Co-Artem, the first line drug treatment. A week later supplies of quinine were down to less than 10 adult doses. On most days the clinic resembled a hospital and resources and staff were stretched to the limit. Sadly deaths started to occur as more severe complications such as cerebral malaria started to appear in young children.
The doctor is constantly on-call for the safari lodges but the workload is carefully managed and fitted around work at the clinic. After hours call outs are minimal and luckily I did not have to deal with any major emergencies on this trip. Zambia lacks medical facilities of a standard suitable for most tourists and therefore any problems arising either have to be dealt with by the doctor or medivacced to South Africa. Thankfully most visits to the lodges for guests are for minor problems; diarrhoea, lost tablets etc but serious medical problems and major trauma have occurred in the past. There aren’t however many places in the world where when returning from a “ home visit” you can come across a sleepy pride of lions snoozing on the road or giraffe gracefully grazing in the bushes.
Life in Luangwa is far from all doom and gloom. The valley is stunningly beautiful and the National Park is alive with wildlife both big and small. The doctor has very graciously been granted free access to the park and after a testing day at work there is nothing better than spending a few hours unwinding with a cold beer watching elephants frolic in a mud bath or a spectacular African sunset across a Hippo filled lagoon. There is plenty of opportunity to really get to know and understand the wildlife of the area and local guides and residents are more than happy to help you make the most of the experience.
I have thoroughly enjoyed both of my visits to the South Luangwa valley. I have immensely enjoyed working alongside the local staff and have learned a lot from the nurses. I have re-honed my clinical skills and revelled in the freedom of the autonomy of working in a very different health system. “Life in Luangwa” gives you a fascinating insight into the challenges that face rural Sub Saharan Africa in the 21st Centaury and I would highly recommend the experience to any doctor who is looking for a clinical challenge: who is willing to adapt to an unfamiliar environment and who has the relevant skills and experience to be able to feel comfortable in such a remote but awesomely beautiful place.
Dr Rhona Whiston May 2009