April 24th, 2015 by Taisei Suzuki
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Everything has a beginning and ending.  Today was my last day at the Macha Mission Hospital.  There was no doubt that I learned so much being here for 4 weeks, and got a lot of hands-on experience.  It was much more than an “international medicine” rotation – it was summary of various rotations such as surgery, anesthesia, radiology, OB/GYN, pediatrics, internal medicine, emergency medicine, family medicine, infectious disease…  List continues.  In a way, I was so glad that I did this rotation at the end of my 4^th year of medical school, because I knew a little bit of something, and I knew what I did not know!  However, this rotation gave me the most confident to be a physician, and I definitely got a clear idea of what my near future is going to be like!

I have a mixed feeling of leaving Macha.  I am excited to be back in Lusaka and travel for a few days with my friends and then continue my journey to Zimbabwe for a few weeks, but I also feel there are so much more that I can learn, and there are a few patients I admitted who are still in the hospital – especially a 2 year-old kid with severe malnutrition.  Just before leaving hospital, I went to see him.  He looked much better and is gaining weight.  I wish he recovers quickly.

Today was also the LAST DAY of being a medical student!!  No more short white coat, but no more excuses…  A scary thing!  I decided to leave my white coat behind, and give it to someone working at the Macha Mission Hospital.  The white coat is no longer white, especially being in an African country, but it has many stories.  Good bye, short white coat. Good bye Macha, and thanks for the awesome time!!!

April 23rd, 2015 by Taisei Suzuki
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Though life expectancy in Zambia is lower than developed countries, I have seen many elderly patients in Macha.  Some come for regular check-ups for their chronic conditions such as diabetes or hypertension, but some come for acute illness.  Some come with “weakness” because of their older age.

With limited resources, we do not have much to offer for their palliative care.  Currently, we have an elderly lady at the hospital due to generalized weakness.  She sleeps most of the day, and does not eat much.  But, when I go see her, she smiles and says she is fine.  My Zambian attending and I try to come up with her care plan, but it is very limited what we can do here.  One of the nurses mentioned that there was a nursing home in nearby large town, but it seems that it is not operational right now.  I regretfully ordered to place a NG tube for feeding…

There is another elderly female patient, petite and a big smile on her face every time I go see her in the hospital.  She was admitted due to “a wound” on her breast for more than one year.  It is about the size of a quarter, granulated and had some foul smell, but without pain.  We also noticed that there is a palpable mass on her another breast.  The axillary lymph nodes on the side of the wound are very hard and enlarged quite a bit.  No doubt this is breast cancer, and already advanced.  We performed biopsy, but it takes a while to get the result back.  Besides, the result probably does not change our care plan for her – observation.  We discharged her from the hospital today, and recommended her to get some wound care at the local clinic.  When I asked her to take a picture with me, she smiled, and said yes.  I showed her the picture, and she laughed and made even a bigger smile.  As knowing a close American family friend being a breast cancer survivor, being a cancer patient myself, and just lost my own mother with pancreatic cancer, it was a heart-broken moment to discharge her while she had a big smile on her face.

No good answers or solutions to these situations.  Only God knows, and I hope he helps them all.

April 13th, 2015 by Taisei Suzuki
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My home for 4 weeks in Macha is located in the compound of Macha Research Trust, founded by Dr. Thuma, the son of the founder of Macha Mission Hospital.  It is nearby the hospital, so it is about 5 to 10 minute walk.  Macha Research Trust focused on the malaria research, and because of their excellent work, the incidence of malaria in this area has been dramatically reduced.

The compound is very well established – with generator in case of power-cut, and boreholes with water tower so that all housings have drinkable running water.  The guesthouse is a duplex with sharing kitchen.  Each unit has own bathroom with hot shower, and a bedroom with two beds with mosquito nets.  It is very comfortable and quiet.  I am very lucky to stay in such an established place in a rural area!

Cooking and laundry are done by yourself.  At the local market, you can get some seasonal vegetables, breads, and non-perishable food, but selections are limited.  You tend to eat similar meals over and over, but for 4 weeks I do not complain too much.  Actually, these vegetables are organic, and if you find them in developed countries, they probably cost much more than here!

April 12th, 2015 by Taisei Suzuki
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Here at Macha, your role is endless.  One day, we had an emergency laparotomy surgery, and I somehow ended up acting as an anesthesiologist.  Where there are not many professionals available, you do not say “cannot do it.”  You say “maybe I can try.”  My knowledge on anesthesia is limited, and on top of that, resources are limited too!  The most surgeries are done without intubation (anesthesia machine is currently broken), so we give epidural block.  Then, use some diazepam or ketamine to sleep.  So, monitoring vitals is your main role.  When monitor beeps, you worry, but you just hope that the surgery finishes on time.  Otherwise, the surgeon tells you what medication to give to the patient.  Definitely, OJT (On the Job Training)!

On the other day, I had an opportunity to assist for tubal ligation with a Zambian doctor.  The technique was very similar to ones in the US.  Family planning is well known here, but not much vasectomy – it’s a cultural thing…  Unfortunately, female tends to suffer more than male.  I am at least happy that local people are talking about family planning – a very important public health issue!

April 11th, 2015 by Taisei Suzuki
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Just across the road from the hospital, there is the Macha School of Nursing. Students from the school come to the Macha Mission Hospital for their clinical rotations. Though resources and technologies may be limited, they try their best to improve their skills! It is so nice to see the part of the local empowerment.

During the round, I get a lot of help from Zambian nurses – translations to the local dialect, name of medications (there are some medications that we do not use in the States, or names are different), dosages of medications, etc etc… They are very knowledgeable and eager to learn. When my attending explains some clinical applications to us, they also listen very carefully and try to learn. One day, I commented to one of the male pediatric nurses who have been working for 5 years, “you can almost be a doctor!” Then he replied, “No, I like being a nurse.” I asked why. He continued “because nurses know patients very well, and we see patients as people. Doctors view patients as cases. They do not remember names, but soon after we mention about ‘malaria kid’ or ‘broken bone kid’ then they say ‘oh yeah.’” He then turned to one of the pediatric patients, called her name, and started playing with her. She smiled back at him. He is absolutely right. We tend to be caught up with diseases and illnesses, and register patients as “cases” especially in foreign countries where names are a bit harder to remember. After that day, I tried to remember patients’ names as much as possible. Still hard to pronounce them time to time, but the concept of patient care should be borderless.

April 8th, 2015 by Taisei Suzuki
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Macha Mission Hospital has been operational more than 30 years.  Currently, there is an American physician (has been there for more than 30 years too) who does majority of surgeries, and a Congolese physician and a few Zambian physicians who take care of everything from in-patient to out-patient care.  There are some Zambian “interns” who are getting more clinical trainings under the supervision of these physicians as well.  My preceptors change depending on which department I am involved in at the time, but I too mainly work with the aforementioned physicians.

Macha Mission Hospital has mainly four wards – Men’s, Women’s, Pediatric, and OB.  They also have ART clinic and TB ward.  As a medical student, you can choose which department you want to work.  Since I am here only one month, I picked pediatric for my first two weeks, and then Women’s ward for the rest of two weeks.

Tuesdays and Fridays are surgery day, and you will spend the most of the day in the OR.  If you finish early, you may go to the out-patient clinic and sees whoever comes in.  On the other days, you will round in the assigned ward with your attending, and then go to the out-patient clinic to see patients.  Attendings will challenge you, and you get a lot of autonomy!  On Wednesdays and Thursdays, we have meeting/didactic for 30 minutes in the morning before the round.

Today was a quite busy day for me.  It has been a week and half since I started to work here, and my attending asked me to do the round in pediatric ward by myself because several physicians were out of town and we were short in physicians…  With great support from Zambian nurses, I was able to make clinical judgement for about 20 kiddos, and discharged a few.  Then I went to the out-patient clinic to see walk-in patients.  They come with various complains – headache, chronic back pain, hypertension follow-up, vaginal infection with pregnancy, fall from riding a motorbike, etc etc…  There were so many patients so that I had to work until 2pm then go back to home to have my quick lunch.  When I went back to the clinic, there were no walk-in patients, but there was an emergency C-section.  I helped to clean and stimulate the newborn.  I was amazed how much Zambian clinical staff members can do by themselves!

April 6th, 2015 by Taisei Suzuki
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I am a 4^th year medical student from A.T. Still University Kirksville College of Osteopathic Medicine (ATSU-KCOM), the founder’s school of the Osteopathy.  I have an unique back ground – born in Japan, completed a high school and a university in Portland Oregon, got a master’s degree in International Public Health at the University of Sydney, Australia, worked about 8 years as a humanitarian aid worker in developing countries including Zimbabwe.  I came back to the US as an international student again with a student visa to go to a medical school.  My passion to serve in developing country continues, and I decided to do an international rotation as one of my elective rotations.

After spending 3 hours on the road to Kansas City airport, a few hours to waiting for my flight, 2.5 hours flight to Washington DC, 4 hours to connect, 17 hours (!!) flight to Johannesburg, South Africa (including 1 hour at Dakar airport to get some more people and fuel to the plane, 2 more hours at the airport, and then 2 hours flight later (total of 32.5 hours…), I finally arrived in Lusaka, Zambia!!  Though it was night and I could not see the scenery well due to the lack of (or no) street lights, the smell, the slight humidity, and comfortable temperature woke up my memories being in southern Africa.  Very excited to be back in this region, and I cannot wait to face some challenges in the next 4 weeks!!

My first day at the Macha Mission Hospital began with rather surprising case.  I arrived just before noon on Tue, and it was surgery day.  My attending-to-be was already scrubbed in, so I changed my cloths quickly and went into the OR.  There, I found a 4 year boy with an open wound in his right forearm, and all of his fingers were cyanotic, considered “dead”.  My attending explained to me that this poor boy broke his ulna and radius, but the care wasn’t enough that he developed compartment syndrome, but never recovered from the complication.  Now, he has a dead right hand.  My attending, who has been a “bush doctor” for more than 30 years, amputated the forearm…  It was something to observe.  Moreover, the boy underwent anesthesia with only ketamine and atropine.  No intubation, no pulse oxygen monitor because sensor was not working.  This is the “normal scene” of an established hospital in a very rural area of Zambia.  But, my attending saved his life – took care of the problem before it gets infected and becomes septic.  It was the opening scene of my “bush medicine”.

March 2nd, 2015 by INMED
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Hello! My name is Taisei Suzuki. I am a medical student at AT Still University, and I’m starting my INMED service-learning experience at Macha Mission Hospital in Zambia, beginning in March 2015.