“What a challenge!”

General Impression

Overall Rating:    10 / 10

As an internal medicine physician, I was not quite prepared for my reception at Yeta Hospital in Sesheke, Zambia. This is a 100 bed hospital and outpatient clinic that is a regional government hospital. Adults and children are treated without charge. I met an ophthalmologist who was just finishing up her night coverage. Despite her training, she was responsible for total care, including minor surgery, childhood and adult medical problems. With no small amount of anxiety she indicated that she was going home and that I was to be the doctor for the entire hospital! The other physician was away for a month and another had recently resigned. She would help me by making rounds with me this first day.

I started morning rounds and quickly learned that these were the prevalent patient problems: AIDS, malaria, childhood diarrhea, malnutrition, trauma and hepatitis B. The only x-ray machine was over 100 km away in Livingstone, laboratory tests were severely limited except for rapid diagnostic kits for HIV and malaria and pharmaceutics were frequently unavailable. The hospital's infrastructure was deteriorating and the government had not infused any capital for maintenance in several years due to the country's financial constraints.

What a challenge !! Supplementing patient care were the equivalent of nurse practitioners who eagerly sought out information about general medical care. They begged for medical textbooks that would help them and asked that I send them info via the internet.

I did what I could. I performed an abdominal paracentesis in a man with end-stage liver disease, inserted foley catheters, excised a sebacceous cyst, prescribed antibiotics, IV fluids, and diagnosed a man with advanced prostate cancer whose admitting diagnosis was hypertension as an explanation for his weight loss and back pain. In the end, I transferred him to Livingstone for consideration of chemotherapy.

Fortunately, I was initially trained at a time where the use of technology was in it's earliest stages (the 1960's) and one depended on listening, looking and feeling to make a diagnosis. In the outpatient clinic I saw a woman who presented with a rectocoele, a child with cerebral malaria, and a couple with issues of infertility. Again, the nurses helped facilitate each interaction.

In my tour at Yeta Hospital, I felt a sense of both accomplishment and frustration. There was so much need and so little resources allocated to help. I did what I could and would do it again.

Raymon A. Noble MD

Huntingtown, MD, USA