by Analeta Peterson
University Teaching Hospital
The two weeks I spent on the gynecology service were eye-opening and much less pleasurable than working on the maternity wards. On this service we were mostly giving bad news and taking care of chronically ill patients. Of the urgent cases, the majority presented with complaints of bleeding during the first trimester of pregnancy. At least half of these were spontaneous abortions (miscarriages), an average of 12 per 24 hour shift. These patients needed manual vacuum aspiration to empty the uterus of any retained products of conception. Amazingly, the women accepted the news gracefully and were cooperative with this method of treatment. Only their strength carried them through this painful procedure as analgesia was not given.
Unfortunately, a few of the women lost a significant amount of blood and fainted soon after the procedure. We scrambled to start intravenous fluids and manually monitor vital signs for quick resuscitation. We were always very concerned about blood loss knowing that the entire hospital had a critical shortage of blood available. For weeks most requests for blood transfusions were denied. Blood was only given for surgical cases since these patients were at highest risk for becoming acutely anemic.
I had the pleasure of visiting the Chongwe District Health Center, a rural health center outside of Lusaka. The clinic was very busy and ran as efficiently as possible with 1 physician working day shift, 1 clinical officer, 2 midwives, and 4 or 5 nurses. This center functions as a hospital and clinic, keeping patients who need close monitoring overnight as well as treating any acute cases that come day or night. On site is an antiretroviral clinic used for the care of people with HIV/AIDS, a women's clinic with equipment to perform cervical cancer screening, and men's and women's wards which are usually mixed due to an overflow of patients. Pediatric cases are also treated and kept overnight if necessary. The physician on duty treats a variety of illnesses, from malaria to strokes to burns. Emergent cases or those needing specialized care are stabilized and sent to University Teaching Hospital, some 45 kilometers away. All medical care is free, including medications and laboratory tests. In 2009 this clinic serviced over 17,000 patients.
The medical care in Zambia is adequate. The major shortcoming is manpower, a result of limited resources. I was grateful to be welcomed as member of the medical team, helping patients receive quality care in a timely fashion. The dedication of the medical staff and strength of patients will forever influence my attitude and actions throughout my medical career.