Background

 I will give a brief background on how I found myself at Macha. After leaving Ridgeway Campus in December 1999,I found myself without a job for about 6 months along with my classmates (class of 1999), that in itself set a demoralising tone for many newly qualified doctors. This was due a strike by junior doctors, probably one of the longest in Zambia. By the time we started work in June, for those of us who remained at UTH, a number of the postgraduate students in Surgery were leaving for Botswana. So after internship, I found myself asking the question “What next?” A friend I had known during my high school days had been talking to me about working at Macha Mission Hospital, a rural hospital about 72 kilometres northwest of Choma in Southern Province, Zambia. I decided to visit the place just before the end of 2001. The hospital is run by the Brethren In Christ Church from Pennsylvania in North America. After my initial visit I decided to give myself at least a year to try the place. Eventually one year turned into two and that turned into 3 years. So in March of 2002, I had my few worldly goods transported to Macha.

Macha

 At that time I found 8 physicians at the hospital, two Internal Medicine Residents from the USA and a few months later, an Infectious Diseases Fellow from Pennsylvania, two pediatricians, the three Doctors who were based there as long termers and two Zambian doctors from Ndola undertaking malaria research. Shortly after that I found myself learning how to do bowel resection and how to do a colostomy from a former Pediatric Chief Resident at Johns Hopkins Hospital who was now doing Malaria Research in the area. I thought to myself, uhmmm… this might be an interesting place to work in. The staffing levels fluctuate very much at Macha hospital, there was a time there were just two doctors, Dr John Spurrier and myself, working in a 208 bed hospital for close to a year. That can be stressful especially when you are on call every other night and studying for the USMLE at the same time.

Skills learned

For most of my first year in Macha, I worked in the pediatric ward with Phil Thuma, MD, a pediatrician and malaria researcher. It was wonderful working with this great teacher and astute clinician. His scope of knowledge simply dazzled me.

One of the most fascinating things about working in a rural place in Zambia is ability to perform surgery. For those attracted to surgery, it is a superb opportunity to hone one’s surgical skills, especially if one has good teachers. Fortunately for me at Macha, there were several teachers such as Dr Spurrier with decades of experience in Surgery. Over the three year period, we’ve had several short term (3 months) surgeons visiting and  I learned  a lot from those doctors.

 One of the memorable surgical cases for me occurred sometime in the third quarter of 2004. There were four physicians at Macha at that time, Kelvin Moonga and myself along with two American Family physicians, a married couple that had arrived a few months previously for a 6 month term. Just before going home at 17:00hrs, an 8 year old boy was brought in with a history of having fallen from an oxcart (a common means of transport and source of accidents in this farming community) earlier that morning. He was complaining of abdominal pain and looked rather pale to me. After getting further history and examination I thought the boy had a ruptured spleen. Ultrasound confirmed my suspicion. The only problem was that neither Kelvin nor myself had ever done a splenectomy. The nearest surgeon was 2-3 hours away in Choma. We planned to send him there. In the meantime, the boy who had been conscious and talking on arrival was drifting into unconsciousness and looking even paler with the abdomen getting more distended. It was becoming clear that he would not survive the journey to Choma on our gravel road. We had no choice but to prepare him for surgery. So while blood was being cross matched and patient being transported to theatre, Kelvin and I crammed the surgery books we had on how to do a splenectomy. Holly, one of the American doctors gave the anesthesia and with great trepidation, we opened his abdomen reciting to one another the steps we were supposed to follow as we performed the surgery. Fortunately everything went on smoothly and after ligating the splenic artery we were able remove the macerated spleen without further ado. That boy lived and went home in a little over a week and seemed to be doing well several months later when I last saw him. My obstetric skills were mainly developed during the 8 months I spent doing OBGYN at UTH. In Macha I had an opportunity to put into practice what I had learned. Of course there several challenges with ruptured uteruses, stuck babies and many other obstetric emergencies. Almost everything was within the scope of what we could handle. 

My time at Macha was also an experience for me to be involved in research and to interact with physicians and scientists from such prestigious medical institutions such as Johns Hopkins, Yale and Harvard.

Encouragements and challenges

Over the course of my three years at Macha I have had opportunity to work several months to work in Internal Medicine, Maternity and Children’s ward.

There are several advantages to working in a rural place like Macha. Expenses are also relatively fewer compared to living in the city. One of the amazing things about folk in rural areas is their immense generosity. They do not have much but they are very willing to share the little they have with others. They are very appreciative of what one does for them.  It is also a wonderful opportunity to be involved in research. Most of the research I was involved in still going on and results may not be known until a few years hence. Nevertheless, it has been great participating in research. The time I have spent in Macha has given me time to explore all aspects of medicine before I narrow down as I specialise.

Living in a rural place is not without its constraints. For a place like Macha, lack of communication was one of the greatest problems when I arrived. There were no phones, transport to the nearest town was unreliable and there was boredom over weekends when one was off duty. However some things have changed over a period of 3 years. Through collaboration with Johns Hopkins Malaria Research Institute, we now have Internet via satellite. And so by September of 2004, I could check for emails on my laptop in theatre in between surgical cases or listen to classical music on the Internet while performing a C-section. Instead of spending 6 hours travelling to Lusaka from Macha, it is now possible for me to be in Lusaka in just under 50 minutes because of an airstrip that was opened last year. And the community has an Internet Café in the middle of nowhere.

At the same time, I feel it is time I moved on in my life and try something else. So my time at Macha comes to an end in Mid June 2005. It’s been a great learning experience in my life and in my career.