April 26th, 2018 by Daniel Boron-Brenner

Things are coming to a close here in Macha and for the first time I feel some stirring of competency regarding what I am doing. When I first arrived, I felt myself clambering over a hump, albeit one with a steeply ascendant, and seemingly perpetual, learning curve carved into its side, in my attempt to treat patients. New medications, new dosages, new responsibilities, all of these accompanied me (sometimes overwhelming me) in my first few weeks in Zambia. Over the last few days though, I finally felt myself coming, however briefly, into my own.

For example, during clinic on Tuesday, another unconscious child was brought in while I was taking care of patients. I quickly moved him to the exam room, called for the doctor, and began examining him while the nurse queried his grandmother about what brought them to our hospital. As the doctor joined us, I started a line, we checked his sugar (and, finding it low, ordered dextrose to be given,) and I admitted him. His eyes were open and he was moving as I finished the paperwork and his grandmother carried him out the door to the pediatric ward. A small victory to be sure but I did it almost without reservation, something that I have worked on (and struggled with) since first learning to follow, and give, orders.

Fittingly, as all this is happening, my time in both Zambia and medical school is coming to a close. Both experiences have moved lightning fast and, in their inexorable demand for personal refinement, have reflected each other more than they will know. On the one hand, Macha is a medium-sized, rural institution in the Zambian bush. On the other, it is still a hospital, with a dedication to healing the sick and aiding the infirm. Like most medical students, I have pushed myself since the beginning of med school, sometimes past the limits of what I think is possible, in order to make myself better for my patients and the world we both occupy. I have felt that at Macha too. The notion that taking care of the people here demands as much skill as I can muster is a feeling that is always at hand.

Some observations then.

Infectious diseases account for most of the fulminant pathology that I have encountered. This primarily includes tuberculosis and HIV (whose diverse presentations I’m starting to count on multiples of fingers and toes). Two days ago, I helped dress the wounds of a woman with HIV whose leg has started to decompose because of her advanced disease. Yesterday, I saw a patient with TB of the adrenal glands, who was sitting up and speaking to me with blood pressure that was not far from unrecordable. Tomorrow? Who knows. The one certainty I have taken away from seeing all this is that poverty, the destitute, living-on-a-dollar-a-day kind that I have seen here, is inordinately responsible for the advancement of such awful diseases.

Another observation. By helping move patients through the wards and clinic, we have made an undeniable quantitative impact on the hospital. But I question if four weeks is enough time to make any kind of qualitative mark on a place, especially one that is used to visitors coming and going in a relatively short period of time. We’ve heard stories of other visitors, people who stayed for just a week or two and then returned home, and I have to wonder if our passage will be recounted with the same kind of half-exasperated laugh. Probably (hopefully) not. Nonetheless, my gut tells me that the next time I leave the country to work overseas, it will have to be for longer than four weeks if I hope to effect any kind of lasting change. Right now, in grand cosmic terms, my journey here has been a blip but at least one that has had a lasting impact on me.

And what is that impact? As a student in the last days of medical school, I am passing through a kind of emotional membrane as I transition from learner to provider. Granted, I will still be learning during residency but it will be an active kind of education, an engagement with patients and hospitals that I have already started to practice here. Consequently, I will be forever indebted to the hospital for encouraging me to think and act like a physician. In years to come, as memories grow short and start to dim, I feel one constant will remain: that I started the job in an unlikely place, with people and patients who put their faith in me because they saw something that I could not yet comprehend. For that, I am grateful.