Maternity Ward

September 10th, 2017 by nitaavrith
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I spent this last week covering the maternity ward. Macha delivers almost 200 babies per month. According to one of the midwives, women here have on average 8 children. As one of the initiatives to decrease infant and maternal mortality rates, the government has been pushing women to deliver at hospitals instead of at home. Women nearing their due dates who do not live in proximity of the hospital therefore camp out at the gates of the hospital waiting to deliver.

Women waiting outside hospital gate.


Delivering in Macha has been different from my experience as an intern on L&D. For one, women are asked to bring supplies for their delivery. Being in a low-resource setting, the hospital does not have enough provisions for all the deliveries therefore expecting mothers are asked to bring at the least 2 clean towels, 2 pairs of sterile gloves, disinfectant soap, and a plastic tarp. The delivery room is a large room with 4 black leather beds separated by a curtain. Women are assigned a bed only once they are in active labor. They lay down their plastic tarp over the bed and deliver on the tarp. Unlike the screams from L&D back home, the women here barely make a peep. Once baby and placenta are delivered and bleeding controlled, the tarp is cleared, the woman stands up and walks over to the post-delivery ward down the hall unassisted!



Working in the maternity ward was a test of patience. It is a waiting game. At the end of the week though I managed to perform 2 c-sections, assisted in over 10 vaginal deliveries, performed 2 vaginal deliveries on my own and resuscitated 2 neonates. We had 2 vacuum-assisted deliveries, several episiotomies (which I think are performed more frequently here than back home) and one post-partum hemorrhage that required intrauterine tamponade with a make-shift condom catheter. Back in the US, the only reason I would ever perform a delivery in the Emergency Department would be if a woman reached the hospital in active labor or if I needed to perform a peri-mortem c-section. Both situations are relatively rare and highly stressful and I am glad that I have more experience and feel more confident delivering a baby.

Maternity ward entrance

First day of work at Macha Mission Hospital.

September 2nd, 2017 by nitaavrith
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Monday August 28th

First day of work at Macha Mission Hospital. Started in the morning by rounding on the women’s medical ward. There were 7 patients in a large open room lined with stretchers. Most of the patients speak little English and so the nurse acts as my translator.


One young woman was there for an asthma exacerbation with diffuse inspiratory and expiratory wheezes. Back home, I would usually order this patient duonebs x3, solumedrol IV and magnesium. None of this is available here so instead the patient received salbuterol, aminophylline, hydrocortisone and amoxicillin.


An elderly lady with a cough, RLL crackles on exam, WBC 19, covering suspected pneumonia with ampicillin. CXR pending xray machine being fixed.


Another lady had a stroke 2 weeks ago with right-sided deficits. She had a known history of hypertension, noncompliant with medications but also found to have an irregular heart rate on exam. Without a CT scanner at Macha, there is no way of knowing whether the stroke was ischemic or hemorrhagic. And so she was started on digoxin for heart rate control, atenolol and enalapril for BP control.


Another young woman with TB. WBC 24, started going into liver and renal failure despite IV fluids, steroids, antibiotics and TB treatment regimen. On exam, the patient was cachetic and staring into the distance.  She was gasping for air and her mother stood by the head of the bed trying to comfort her. Oxygen sats dropped frequently into the 60s with little improvement on 3L O2. Lungs sounded clear. There is no CXR available. No CPAP/BiPAP or resources for endotracheal intubation. I propped the patient up in bed, bumped the oxygen up to 5L. Not much else one could do. There is such a stark contrast in the resources available here versus the US. It is difficult not to get  frustrated. I am told that I must focus on what CAN be done instead of what CAN’T be done.  This is actually a comforting mindset.


Afternoon was spent in ARV clinic and then OPD clinic. ARV is the antiretroviral clinic. 15% of the population of Zambia is HIV+. First line medications for HIV here are truvada and efavirenz. They are started independent of the CD4 count. The hospital used to go out into the community and screen everyone for HIV and the treat those who were positive. They are now screening everyone who presents and is symptomatic or anyone who gets admitted to the hospital or if a patient is found to be HIV positive, the patient will serve as an index case and members of his/her family and community will be screened as well. Macha Mission will soon be changing the screening system so that they will screen everyone who has contact with the health care system.  Many of the patients I encountered at the clinic today were in their late teens,; they were either born with HIV or became infected via breastfeeding. Since the introduction of ARVs to Macha in 2005 and by aggressively screening and treating all pregnant mother, the mother to infant transmission rates of HIV has dramatically declined. With aggressive public health campaigns, effective treatments, and good community support it seems like the face of HIV is making a change.


More to come on OPD clinic another day.

Road to Macha Mission

September 2nd, 2017 by nitaavrith
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Friday August 25th


I started this journey over a year ago. I have had a life long dream of practicing medicine internationally. Throughout the years I have embarked on numerous nonmedical overseas volunteer missions/vacations. I have been to India, Kenya, Tanzania, Swaziland, Madagascar and the Seychelles. My last project was prior to med school. Beginning of second year residency, I decided that I needed to be more proactive in getting the education and experiences necessary for a career in international medicine. So I went online and found InMed, the Institute of International Medicine, and enrolled myself for their International medicine and public health diploma which offers a 10-week online course in the basic principles of international medicine and public health and then the option of participating in an international rotation. Upon completing the online course, I applied for their rotation in Zambia at the Macha Mission Hospital. December 2016 I was accepted into the rotation and now 8 months later, it is finally departure day. I will be spending an entire month in Zambia.


My flight left Tampa this morning to NYC. From NYC I am currently flying to Johannesburg. From Jo-burg I will fly to Livingstone, then take a bus from Livingstone to Choma (3 hours) and catch a taxi from Choma to Macha (1 hour).


I am excited but nervous. Excited because I have been looking forward to this trip all year. I am looking forward to practicing medicine in a low-resource area, learning to rely on my history taking and clinical skills to diagnose conditions and treat people. This will be a welcoming challenge as in the US, we rely heavily on labs and imaging and I often feel like the art of medicine is lost, or in my case maybe never even developed. I look forward to being immersed in a different culture and meeting people from rural Zambia and those who have dedicated their lives to helping the people of Macha.


I am nervous though as well. Nervous because I have very little idea what I am getting myself into. I have seen two pictures online of Macha Mission Hospital and from those images I have created a version of Zambia in my head which is probably very different from the actual place where I am going. I have read through the Macha Mission introductory package several times. I got all my vaccines and purchased all my medications. I packed according to the list I was provided. Items such as duck tape, a swiss army knife which I’m wondering if I’ll really be needing. I hope I have not forgotten anything.


What I know about Macha. Macha is a small town in southern Zambia. The Macha Mission Hospital is associated with a Malaria Research Institute. I will spend mornings participating in rounds on the wards. Afternoons will be spent in clinic and Tuesdays and Fridays assisting in the OR.


What I don’t know. How many people will speak English vs the native Chitonga? What will the weather be like? Did I pack appropriately? Food- What will I eat? I have a peanut allergy, will this be an issue? Living conditions – I know I’ll be staying at the Research Trust Guesthouse. Will I be alone? Will I have a roommate?

What I wish I had done differently at this point?
1. Packed more snacks in my carry-on. I am hungry on the plane. Packed my snack in my checked bag.
2. Gotten visa beforehand – hope this won’t be an issue at customs in Livingstone.
3. Packed my converted in checked bag- should have kept it on my carry-on
4. Should have checked if AT&T had international data for Zambia

Introducing Myself

August 24th, 2017 by INMED
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Hello! My name is Nita Avrith. I am a Resident Physician, and I’m starting my INMED service-learning experience at Macha Mission Hospital in Zambia beginning in August.