My Brother-in-law is marrying Bronya at the end of 2010. She is currently volunteering as a Doctor at a hospital in Zambia until June. Below is her diary of her first couple of weeks I felt compelled to publish.

If you wish to donate anything, Bronya is working through the Hospital itself at www.saintfrancishospital.net

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“I’ve now been in Zambia just 12 days, but wow, what a week  or two .. it’s been a real baptism of fire with good, bad, ugly.. and truly tragic parts to it.

I arrived at St Francis Hospital last Monday with another new doc (Al) after traveling for 25 hours non-stop to be told that they were so desperate for Dr’s that we were to start work AN HOUR LATER… aghh…

What a welcome! Part of me balked at the prospect of not being able to simply collapse into bed, but I was also glad that I really had arrived at a place where I might be of some use.

Hospital life here is mad, and grim.
Really and truly grim.

They are in urgent need of more drugs, more re-agents to run tests with, more staff, more equipment…more everything.

They are also in urgent need of patients who come to hospital while they’re still well enough to treat.

I’ve seen babies and children die here EVERY DAY of diseases that are 100% preventable or treatable.

I see children every day who are so malnourished that their skin is falling off them, forming terrible open painful sores, and whose whole bodies are swollen from lack of sufficient good food.

An Hb (haemoglobin) level of 2-3 here is routine; (normal is >12 for the non medics among you); I saw a child with an Hb of 1.7, his blood was as runny as water,  I had no idea you could still be alive with these kind of figures.

There is a SCBU here (special care baby unit for premature babies) but it simply consists of wooden boxes with a light bulb for heat and a bowl of water to humidify the air… and cockroaches crawling through them (they like the heat) and these poor scrawny scraps of babies desperately fighting to stay alive against the odds… if they lose weight, there isn’t even enough formula milk to feed the prem’s – so if mum’s milk doesn’t come through they simply lose weight day by day until the milk eventually (hopefully…) does.

People come to hospital so incredibly sick. It’s unreal.

For some reason I’ve been put on the paediatric ward – which is chaotic – kids are brought in unconscious every day. All day, every day. More kids who are floppy, lethargic or just plain old unconscious. One was even brought in dead. (that was a shock.. .and then to have to tell the parents).

The intensive care section (the 8 cots nearest the nurses station…with 2-3 children per bed) is filled with kids who would be intubated and ventilated at home.

These are the kind of sick kids you rarely see at home but were they to have been lucky enough to have been unwell in London, they would have had several consultants standing next to them, and no one leaving their side. They would be having minute by minute observations, hourly blood tests and their own nurse.

Here they get max. 10 minutes from a Dr (twice a day, although I am up-ing the ante by trying to review them in between too). If you try and spend longer, well – I have about 100 kids I need to see each morning (with the aid of a medical student on elective, thank goodness – I’d be lost without her extra hands!) and I need to be in clinic by the afternoon. So if I spend too long with one, then others down the line lose out.

But what these kids really need is regular reviews, regular checks to ensure they’re going in the right direction- and if they’re not then for something else to be done for them… But this just isn’t possible.

And as for nursing care… The nurses are their mum’s (or worse their grandmas) who have very different ideas about what their children need. They hate oxygen and nasogastric tubes because they associate them with the sick children who they see die, so they think that the oxygen kills the babies.

So you’ll have a severely dehydrated child- who is too lethargic to drink. But when the parents refuse an ng tube, the nurses don’t tell you so they end up even sicker – you see them 6 hrs later, even more unwell.
It’s painful.

When their child is sick and they’re refusing oxygen or pulling it off their child… it’s so frustrating.
And even if you try to sit down and explore these ideas with them and try to persuade them otherwise – well, to do that you need an interpreter = a nurse, who is often way too busy (and demotivated) to spend much time trying to change these mothers’ minds.

Children dying here is an accepted part of life.
Way too accepted.
It kills me.
The suffering is just terrible.

The adult wards are a bit better – not least because I feel far more confident dealing with adults – and they have more reserve anyway.

But still the crazy severity of disease – and COMPLEXITY too! These patients tend to be HIV +ve, often with really severe infections… but we don’t have the resources to easily figure out what is going on.
(medics among you – I don’t even have access to a K+ ! or a bili/ LDH/ ALP!! Forget about reliable microscopy. No cultures. And Ct scans exist on another planet altogether).

It’s all quite “blue peter” – there isn’t the right equipment so I’ve been taught how to make do with what there is.

I was putting chest drains into babies this week: the chest “drain” consisted of a green cannula attached to an iv giving set, whose top end has been  chopped off with my pen knife – REALLY! no sterile scissors round here! (no non sterile scissors either.) this end is then stuck through a needle cap (yes. take the needle out and use the plastic cap as a tube! .. that is after you’ve sawn off the end of the cap.. again, with the invaluable penknife. which is then pushed through a rubber bung  into a jar of water for the seal).

Luckily there is an amazing Dr called Shelagh who’s been here for 10-12 years. She’s a paediatrican (but great all round) and when there are no other Dr’s here she ploughs on alone. Alone! On call every night!
She is warm and lovely and a true font of knowledge.

Less luckily for me, once I’d turned up she (quite understandably!) finally had the chance to take some time off work (her 1st days off since November) to spend time with her kids. So I didn’t even have her guidance the 1st week. It was hairy . now she’s back but has unfortunately caught malaria..  so on my own again!

I have to say this is definitely the toughest thing I’ve ever done and I feel utterly inadequate at practicing medicine without the resources I’m used to having at my fingertips..

It’s mad that the people here are so much more severely unwell than those at home and yet I have so much less help to look after them in terms of tests or nursing support.

So whats the rest of my time here like?

Well I have my own bedsit here – my heart sank a little when I first saw it but then I told myself to pull myself together as its probably palatial by most of my patients’ standards..

Now that I have scrubbed it with bleach and put up some photos its starting to look more homely.
There is an ongoing battle between me (& my broom!) and all the African wildlife that wants to invade my room. I’m hoping the gecko I spotted on my wall 3 days ago will come back as they’re wonderful for getting rid of these blasted cockroaches, bugs, ants and all the other wonderful insects that are keen to get to know me!

And once outside of my room.. eek! There are snakes.. seriously. Aarggh. Have to be really careful at night.
Have seen lots of patients with snake bites (and even a kid bitten by a crocodile just up the road!) and several people struck by lightening… even more killed by lightening..
(the thunder storms here are INTENSE!)

The redeeming feature of my time here has been the other Dr’s here.. although when I arrived there were only 2 Dr’s here already, another 2 have started since. So there are now 6 of us incl. Sheila who lives here with her husband and 6 children. (all these gorgeously blonded tanned cuties wandering around barefoot! So gorgeous!)

The other doc’s are lovely and on the ball and are great to work with. There’s also medical students here who are all really great too. (gosh – Without them it would be impossible to get through all the work!) and 2 fab midwives… so quite a strong ex-pat network who all help each other through what is truly a tough time.

In the evenings when I (finally!) finish work, if I’m not on call,  we all sit and chat or watch a DVD and it makes this whole place bearable.

Or I’ll put some music on and dance round my room (nothing changes!) and try to put some of this madness behind me..

So its been a hard first week.. it feels like I’ve been utterly cut off from everything and everyone I’ve ever known and dropped into a totally new existence.

The mad thing is that it’s my “old” life that feels unreal- all shiny and clean and soft and easy – and it’s THIS harsh existence that feels like the REAL version of Life.

(& in all honesty, it IS. This is how the majority of the world still lives. And how humanity as a whole experienced life until 100 years ago).

It kind of feels like I’ve been living in the Truman show and have only now seen outside the saccharin sweet world I’ve been in until now.

(& yet I’ve worked out in the developing world before… I guess never before with this much responsibility .. and I guess never having to live rurally for a long time before either).

I’m hoping it will get easier as I start to get to grips with what we CAN offer people here, and get a better sense of how to work effectively in such a resource poor setting..

(tho apparently – and I was aghast to hear this – this is supposed to be one of the best hospitals in Zambia!)

I think it will also get easier once I’ve settled in and seen “normal” Zambian life – we only see the dark side on the wards. The people here are so charming and friendly that I’m sure I’ll love exploring the area once I get a chance to!

Anyway, if you’ve made it to here then I’m impressed you’ve tolerated my ramblings… but it’s been quite cathartic writing this!

Bronya xx”