UK medical doctors should do practicals in Zambia

This article appeared in one of the UK publications, the Statesman.

BY PHIL WHITAKER

I want our health service to be as good as it can be, but the juxtaposition with what I was witnessing in Zambia felt raw.

“Dad’s really not well,” my wife said, voice so low only I could hear.

There were 14 of us having lunch on the veranda. My father-in-law was at the end of the table. He’d been under par for days, but now appeared completely withdrawn. His breathing rate was up. From time to time his arms twitched involuntarily in his lap.

We had a family conflab away from the main gathering and decided to seek medical attention. This being Zambia, there were no GPs: it would demand a long drive to one of the hospitals in the nearby, sprawling Copperbelt town.

Debate ensued as to which. We dismissed the state facility: there would be no drugs, and few staff, if any. The modest numbers of Zambian-trained doctors usually gravitate to the capital or emigrate after completing their year of compulsory rural service. The oldest local private clinic – which my father-in-law had run for ten years before his retirement – had also struggled with recruitment. We settled on the Forward, a rival hospital whose Uzbekistani doctors were gaining a good reputation.

My father-in-law was deteriorating. There is no ambulance service; we manhandled him into the 4×4. The rural dirt roads are as red and cratered as a Martian landscape. My wife and I hung on to him as we were thrown about inside the vehicle; he was too weak to keep himself upright. Things were easier once we reached the tarmac of town, but by then he was semi-conscious.

At the Forward hospital the duty doctor whisked him to the emergency room. My mother-in-law was waylaid by a receptionist seeking a hefty cash deposit. To a Briton, “private hospital” conjures up spotless environments, attentive nursing staff, expert consultants. In Zambia, it simply means a fighting chance. The clinic possessed one pulse oximeter – a standard bit of kit to monitor blood oxygen – which was held together with tape. The floor was filthy with debris and discarded gloves.

Despite the squalor, the doctors were able to carry out basic investigations in-house. A chest X-ray and echocardiogram showed fulminant pneumonia and heart failure; blood tests revealed the resultant clotting and kidney abnormalities that were leading to his precipitous decline. Oxygen and intravenous drugs – including two potent antibiotics I was amazed to find available – produced some improvement. A private ambulance chartered from a South African company took him to visit two other hospitals before a working CT scanner could be found.
Over the coming days we met all five of the Forward doctors, who did their utmost medically. They had no influence on the nursing staff, however, who remained cloistered in their office, emerging only to administer drugs. The call button didn’t work. It was left to family to encourage drink and food, to lift and turn to prevent pressure sores, to toilet, and to raise the alarm on the numerous occasions the oxygen stopped flowing.

After three days, my father-in-law suffered a stroke and died peacefully, his wife and daughter at his bedside. His health had been declining for several years. He had known he would have received better care if he’d returned to the UK, but his love for Africa and its wildlife was too strong for him to abandon his adoptive home.

During his final illness, I got various medical media updates from the UK. I learned that the wife of the Justice Secretary, Michael Gove, was disgusted that her husband couldn’t get his sore foot X-rayed at a minor injuries unit in Somerset on a Sunday afternoon. Hundreds of thousands were signing a “no confidence” petition following Health Secretary Jeremy Hunt’s inflammatory and plain-wrong insinuation that the NHS shuts down at weekends.

I want our health service to be as good as it can be, but the juxtaposition with what I was witnessing in Zambia felt raw. UK medical students undertake electives abroad to gain valuable perspectives on health care elsewhere in the world. Perhaps it’s time our politicians did likewise.

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