During my Work the World placement I was based in the largest teaching hospital in Lusaka, Zambia which contains approximately 1,600 inpatient beds. I had a look at some pictures of the hospital online so I had an idea of what to expect. The hospital provides services similar to those found in District General Hospitals in the UK such as accident & emergency, maternity and paediatrics. In addition to this, their cancer care department not only provides services to local Zambians but also neighbouring countries such as Malawi.
I did my placement in the maternity department and accident & emergency. In the maternity department, I was able to assist with obstetrics examinations during antenatal clinics, cannulate in emergency situations in addition to drawing up medications and administering injections under supervision. These were procedures I was familiar with and had been practicing in the UK, so it was great to experience these in a different setting. Spending time in the emergency department made me aware of common cases that present and how to manage them, especially how to manage hypoglycaemia and immobilise fractures. I found the staff resourceful in terms of immobilising fractures using just a piece of carton and bandage.
One of the most memorable cases I saw was a case of hypoglycemia, which I initially thought was a stroke given the age of the patient who was in her 80’s. The patient presented mainly with slurred speech and weakness. After testing her blood sugar, it was revealed she was hypoglycaemic and was given 50ml of 50% IV glucose. This is no longer the practice in the UK, instead lower concentrations are more commonly used. The doctor explained to me that the only concentrations available to them in the emergency department were 10% and 50%. Since 10% was too weak, 50% was the only concentration that could be used for hypoglycaemia. In addition, the doctor cannulated the patient’s right internal jugular vein (IJV) as he was unable to cannulate the patient in her arm. I was very surprised by this practice as the internal jugular vein is only used when inserting a central line, which is done under sterile conditions. I observed that cannulating the IJV was common practice in the emergency department because they had no ultrasound scan available to help locate veins in the arm.
A striking difference between the hospital in Lusaka and hospitals in the UK was around the availability and use of guidelines designed to manage common conditions such as acute asthma and eclampsia. These guidelines, common in UK hospitals, are evidence-based recommendations that advise suitable management. In Lusaka, I observed there were a few guidelines posted on the walls and treatment was made on what was available. For example, due to the limited supply of medications such as magnesium sulphate, it was only provided to the department that needed them most. In this case, the maternity department was given sufficient supplies due to the common scenario of eclampsia, but this then meant there was not as much available in the emergency department for cases such as life-threatening asthma.
There are seven official languages in Zambia, but the dominant language in the capital city of Lusaka is Nyanja. Work the World organised language lessons to teach Nyanja, so I learned how to ask common phrases such as ‘How are you?’ and ‘Good morning’ which helped me to build rapport with patients before I took a history. I didn’t find any difficulties with the language as the patients I spoke to could speak English. But, if there were situations that became difficult due to the language barrier then the lovely Zambian medical student I moved around with helped to interpret.
The world is large and not many people get the opportunity to see the other side. Using an elective placement period to experience a different culture, language and lifestyle will certainly be a rewarding experience wherever you go. Aside from the different clinical experience gained from an overseas placement, it also gives you the privilege of exploring tourist destinations that you may never have had the chance to visit.