April 5th, 2018 by jamiefelzer

As I lay awake in the middle of the night, trying not to listen to the sounds around me so that I didn’t have to think about what they could belong to, I reflected on why I made the decision to leave my life in comfortable suburbia and spend a month in the bush of Africa. In our modern era of medicine in the developed country, we often rely on fancy laboratory tests and complex imaging to make our diagnosis. And while it is not wrong to rely on the wonderful technology we have come to create, I wanted to become a better clinician using my standard history and physical skills.  I also thought about what drew me to public health, which was HIV/AIDS awareness and education.   At the hospital I am working at, they have the Malaria Research Trust which not only investigates malaria, but also HIV and there is an ART clinic at Macha. They have made such strides in malaria here that the number of cases is significantly decreased this year. They are also making remarkable progress on HIV here, with prompt diagnosis and readily available treatment. It makes me so happy seeing how much of a difference some public health campaigns are making, and then realizing that we still have a long way to go.  

My first day at Macha hospital was somewhat different than other first days. First, I was surprised at how Macha is actually a fairly large facility. They have a men’s and women’s wards, OB, Gyn, Paeds wards as well as the operating theatre, outpatient department and ART clinic. The wards are large rooms with beds lined up for the patients, and their families sit around the bed to help feed them. If you need to give someone privacy, there are standing curtains that can be moved around the bed. Additionally, there are some lab facilities for basics, important ones of which include a full blood count, malaria smear, HIV rapid test, syphilis, urine pregnancy. We are also able to get x-rays and ultrasounds of limited types. Already the x-rays proved quite helpful, as we diagnosed a kid with a retropharyngeal abscess that needed drainage and as well as an impressive chronic osteomyelitis.   Things here run on Zambian time, meaning people show up whenever they want and there is no set time or schedule for anything. Hospital rounds on the wards typically occur only a few times a week and surgery happens twice a week. Families of the patients typically have to cook food for them, and sleep outside in the back of the hospital on beds made of branches.

I am staying in the Research Facility housing with a fourth year med student, Dan who just matched into EM (who is also blogging) and we are the only ones at the entire research hostel facilities. I’m really glad to know there is at least one other human in the building with me! So far we’ve been making a great team and improvising when we need to. We needed to pop open the sim card holder in hopes of a sim card that would work (but alas, after hours of frustration, the local sim card we were promised would work, in fact did not). Nonetheless, he whittled down a toothpick with a knife to open the sim card. Accommodations are modest and my room has 2 bunk beds, each equipped with a mosquito net (mine had a few holes, but of course I brought some tape so it’s like new now), a sink in each room and communal bathrooms for each gender. There is electricity and I’m told they have a backup generator here, which is nice. There are fans that generally work in each room to keep us cool in these warm months. There is a communal kitchen which is useful for cooking meals, as there are no such things are grocery stores that are nearby. We did stop at a grocery store in Livingstone to buy canned foods and some produce, but now the nearest stores are an hour away (even though it’s only 12Km it is a terribly bumpy dirt road). There is a local market that sells some tomatoes and a few other minor items. There are a few places around where you can get a home cooked meal, and we plan on doing that once a day or so as a break from the instant rice and canned chicken I brought.

Fruit market on the road to Macha (note: they recently had to change their selling practices due to the cholera outbreak to have all food elevated)

Generally, the preparedness freak in me did well being equipped for being out here, as I was glad to have brought all my essentials plus all the survival items and the OCD items. Additionally, I made sure to bring some masks and gloves so that I could best protect myself, although I’m coming to find out that I may be the only person who wears an N95 when I’m sitting next to a person with active TB. The one place where I majorly failed was that we went to Victoria Falls my first full day, which was an unexpected surprise. Given that I wasn’t prepared for the torrential downpour that is Victoria Falls and did not have any of my water proofing items, I thought my poncho could protect my fancy DSLR camera, but sadly I was dead wrong. The lights started flashing and by the time I had reached dry ground it was too late for my poor camera. I tried soaking it in rice, but alas, the damage was already day on day 1 on my trip and I won’t be able to capture the spectacular animals on safari later in the trip, which was the whole reason I brought it.  RIP in my dear camera, my first adult purchase once I got a job. So, no matter how prepared one can be, it doesn’t matter if you still don’t use your brain in the moment! Live and Learn!

Stunning rainbow at Victoria Falls