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A Glimpse of medicine in a far away land
The part of my “job” that pays for me to be able to volunteer at the local clinic is being the doctor for all the safari lodge guests and staff. Saturday morning I was roused from my African-sized cold-induced haze by an emergency call from Mfuwe Lodge, which is just inside the park. The call was to come see a guest who was hit in the face by a branch on the morning game drive in an open safari vehicle. They sounded desperate! So I tossed on my clothes and “raced” in to the park to respond. When I arrived at the lodge I found a calm young woman sitting in the top seat of the three-tiered Land Rover holding a very tall Italian man slumped over in her lap. He had been hit across the nose by a branch/vine, the exact size of which remains in dispute, during the drive. He reportedly said “Ouch that hurt” and “That’s very painful” then proceeded to faint away on top of her -- out cold. Her description of the incident was of more of a gentle scratch across the face than a real blow. The tall Italian's eyes were rolled back in his head, but he had a pulse and responded to pain, which was encouraging. Examining him in the sun slumped over in the seat was pretty challenging, so I decided he needed to be moved. With the help of about fifteen people, we lifted all six feet five of him onto a door with a cushion on top, and he was borne to his room by about twelve of the camp staff. It looked like a scene out of some movie where they carry the great white Bwana to the funeral pyre, which fortunately for him was not where we were taking him. Later his girlfriend said, “I wanted to take a picture of that procession, but I thought it might seem insensitive.” When he was safely arrayed on his bed, I examined him fully even performing the only lab test I have available, a blood sugar (well I have a pregnancy test too, but I didn’t think that would be too helpful), and I really could find nothing physically wrong with him except for a superficial scratch on his nose. What to do? In the end, I used all my skill to sit and watch him until he finally “woke up” about an hour later complaining of “feeling dizzy” but otherwise fine. It turned out that he had “done this before” a number of times when he had painful injuries. It was all quite dramatically odd but ended happily.
The charge for all my expert ministrations for swooning Italians or feverish Norwegians is $150 including medications if needed. Some guests balk a bit at that figure, but really it’s not an unreasonable price to pay for the privilege of seeing a western-trained doctor in the middle of nowhere (medically speaking). Staff and Mfuwe residents pay less. The locals at the clinic pay 2000 kwacha (about fifty cents) to be seen there. Children under five, pregnant women and adults over 65, who are sadly very few since the average life expectancy is 33 -- yes 33 -- are all free. “Medical records” are kept in little flimsy paper “books” like ones you might have had at school in the second grade or for me like I wrote exams in at Harvard. I’m not sure what that says about my beloved alma mater! The patient is given a little scrap of cardboard, made by cutting up the boxes medicine comes in, with their “number” written on it. They are supposed to produce this little scrap of information whenever they come in, and the “chart” which has been filed by number is magically retrieved. As you can imagine this very simple system has many obvious downfalls. Sometimes if an old book can’t be found, the staff finds someone else’s, tears out the used pages and writes in the new patient’s name. I can only imagine what HIPAA and US medical records regulations would say about that! If no available book can be found, the patient must walk 100 yards to the little Twiza store to buy a new one for 300 kwacha (about 10 cents).
My other role is to oversee all the “inpatients”, those patients too sick to send home, who stay in the men’s ward or the women’s and children’s ward, each with three thinly padded wooden cots with a blanket and a mosquito net. If we have more than three patients for a room, the “overflow” is put on pads on the floor. During the heat of the day, the rooms become unbearably hot and stuffy, so the patients retreat to bamboo mats under the mango tree outside. As with most places in the developing world, the nurses provide injections or IVs if needed, but family members are expected to stay with the patients, to bring in food and water and to give the oral medicine. Mothers sleep on the cot with their little children or on the concrete floor beside the bed. Believe it or not, this set-up is better than some I’ve seen! If patients seem sick enough to need to stay for more than a couple of days, we send them to the "proper" hospital at Kamoto one hour away.
Transferring sick patients is another difficult task. The clinic was given an ambulance several years ago by the then President of Zambia. The saga of the ambulance is a classic lesson in corruption and developing world bureaucracy. When the ambulance broke down shortly after its arrival, one of the safari lodges generously donated the $500 part and their workshop’s expertise to repair it. When the district administrator heard of this generosity, he accused the lodge of “tampering with government property” and ordered the part removed. The ambulance was then loaded onto a truck and driven the 300 miles to Lusaka, the capitol, where it sat for six months. When it was finally repaired and returned, one of the less benevolent local chiefs co-opted the ambulance for his own private transportation. The clinic had finally managed to wrestle the ambulance back from the chief when the district administrator decided that a “rural health center shouldn’t have an ambulance.” The ambulance was taken to district headquarters where it remains to this day being used to carry the bureaucrats to lunch!! It’s a sordid tale of greed and clear disregard for the best interest of the patients in Mfuwe, but such can be the nature of “administration” in Zambia. Hardly anyone has their own vehicle, and most people don’t have the 10,000 kwacha (about $2.50) fare for public transport to Kamoto. So when we have a very ill patient, the patient’s family must scramble to find a way to get there. If we’re lucky, the patient has a relative (the large, close-knit extended families are a godsend) who works for a safari lodge which will often provide money or a vehicle. Sometimes a vehicle is already going to the district headquarters, and the patient can hitch a ride, often in the open bed of a truck or crammed into an already full car. Obviously none of these means are ideal for someone who is so sick or injured.
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This page was last updated 01/07/06
