I’m originally from Nigeria, so I wanted to go somewhere in Africa that was new to me. I went onto the Work the World website, scrolled through and chose Zambia. It was one of those decisions where I just went for it.
The Work the World house was incredible. The rooms were huge and there was so much space for us. There was a pool outside for when we were hot, and a terrace upstairs where I spent time reading.
The house was somewhere we all looked forward to coming home to after a long day at the hospital. It was also nice that we all sat down together as housemates for dinner each night. The atmosphere was relaxed, open, and the Work the World Zambia team were there if we needed them.
Speaking about the Work the World team, they were even more involved than I thought they would be. They really made the effort to check in with each of us to see how things were going each day. Even the housekeeper was lovely—we got to know her well during the weekly BBQ nights.
The catering team made ridiculously good food.
The catering team went all out with the food on BBQ nights, a dance troupe and traditional drummers came to each one. There was a dancer in the dance troupe who was a famous Zambian dancer. She was accompanied by at least three drummers who played drums, and one or two others who did traditional Zambian dances dressed as elephants or lions. There were always stories behind the dances they performed. We got involved in the dancing ourselves whether we wanted to or not!
On normal evenings the catering team made ridiculously good food. One night we had a full Zambian meal and tried different kinds of fish, nshima (a local dish) and other Zambian cuisines.
I was actually the only medic in the house, living with physiotherapy students and nursing students while I was there.
We got together at lunchtimes and in the evenings to chat to each other about what it was like where we were in our part of the hospital. We exchanged a lot of knowledge.
As soon as patients started coming in, it wasn’t about me anymore—it was about them. I quickly got into the swing of things.
With regards to the hospital experience, honestly, I was overwhelmed at first. I didn’t think I was going to be, but when I got in and the Work the World team introduced me to all the doctors I was just very aware that I was by myself. The other students had at least one other person with them, whereas I was on my own in the department.
I overcame it by taking a deep breath and walking straight in. The Work the World team took me to the clinic where I was supposed to be and I met the doctors I would be spending time with. As soon as patients started coming in, it wasn’t about me anymore—it was about them. I quickly got into the swing of things. I was accustomed to how it all worked within the first day.
A lot of patients came in with no real understanding of just how sick they were.
We saw a lot of patients at the extremes of their presentations. But for me, the HIV cases stood out the most. One woman came in whose husband had tested positive for HIV 5 years prior, but she chose not to get tested despite getting increasingly sick and becoming weaker. She came in with a CD4 count of about 15, which is as good as non-existent.
She was so unwell and the HIV had transformed into AIDS. I was shocked that she went so long knowing that she probably have the disease, but chose not to do anything about it. She had children in that time, so they might have had HIV without knowing about it.
Actually, a lot of patients came in with no real understanding of just how sick they were.
The local doctors told the woman off for not coming in sooner. They tried to get across how irresponsible they thought it was. They told her which clinics she needed to go to and sent her on her way with referrals.
We drained six litres of fluid from the patient's abdomen.
One other case sticks in my mind. A lady came in with loads of fluid in her abdomen—more than I’d ever seen. She didn’t know what was wrong, and the local doctors didn’t know what was wrong. Using the most basic equipment we drained six litres of fluid from the patient's abdomen.
It turned out that the woman had chronic liver disease. We weren’t sure why, but it didn’t seem like it was alcohol. She probably had hepatitis—one of the most common infections in the hospital.
There were two prominent differences between the Zambian healthcare system and the NHS. One was a lack of funds and resources. Take cannulas as an example of something we have an abundance of in our storerooms in the UK; Zambian staff were running around struggling to find a spare to able to give fluids to a patient when they were really sick.
Where in the NHS we have secure sharps bins with lids on them, in Zambia they were cardboard boxes. It was the small things like that.
There was also a dearth of drugs. Doctors would prescribe things that the pharmacy just didn’t have. That was totally different to the UK where we have an abundance of medication.
In Zambia, the Doctors have all the knowledge and the patients do what they say.
In these instances either the patients would go home—many had travelled nine hours or more to get in—which was a problem in and of itself. Or, if they had the money, they could try to find a private pharmacy that stocked what they needed. Of course, they had to pay for the latter option.
The second major difference was the relationship between doctors and patients. In Zambia, the Doctors have all the knowledge and the patients do what they say. Whereas in the UK, the patient has most of the power. They can google what they’ve got, they can say what they want and basically determine how the doctor ends up treating them.
To a large extent, healthcare is free at the point of access in Zambia. There were, however, certain investigations that patients did have to pay for, CT scans for example.
There were also options to skip queues. Fee-paying patients were prioritised, as were patients who knew the doctors. Hospital staff also jumped to the front of the queue if they needed to be seen.
If you’re undertaking a placement you should make sure you fully involve yourself in what’s going on and ask questions. The doctors want to teach you, they just need to know that you’re present and ready to learn.
When local staff found out I was a medical student, I was immediately called ‘doctor’.
The dynamic between the hospital staff and I was great. In terms of the hospital hierarchy, the doctors sit at the top. Being a medical student made it so that I was thought of that way, whether or not I wanted it!
When local staff found out I was a medical student, I was immediately called ‘doctor’. People were lovely to me—one of them even paid for my lunch one day because we were doing a full day of clinic together.
The local nursing students were happy to chat and they were really interested to know about the UK when I told them that was where I was from.
We exchanged clinical knowledge too. One consultant called me in as they didn’t have many skin problems in Zambia. He had a patient with a case of psoriasis, which I was able to identify. It was nice to be able to have that moment where my knowledge was put to use in that way.
My time in Zambia outside of the hospital was great. On weekday afternoons we’d take lunch at the house and spend some time chilling together after placement. We were really close to two of the main shopping malls where there was plenty to do, and in the evenings we went to local bars. There was a market nearby, so we went there to haggle for the best prices on things.
We saw hippos, elephants and giraffes… things I’ll probably never see again in my life.
At the weekends we went to some amazing places like Victoria Falls, on safari, on sunset cruises, and canoeing down the Zambezi (with Zimbabwe on one side and Zambia on the other). We saw hippos, elephants and giraffes… things I’ll probably never see again in my life. It was incredible.
We also went to an elephant orphanage and a crocodile farm, and we went to a place called Tiffany’s Canyon—a man-made beach that overlooked a beautiful body of water.
I was only in Zambia for a month, but I feel like I changed as a person. When you’re in that environment there are things you note in yourself that you wouldn’t have noted before.
I think that a lot of the things that changed in me, I won’t realise for a little while. But it’ll be fascinating to see how the experience will help my approach to becoming a fully-fledged doctor after I graduate this summer.