My Medical Mission to Zambia

This opportunity was realized after a conversation with my wife’s primary physician, Jorge, prompted me to step way outside of my comfort zone to use my knowledge and skills to accompany him and help those in need half way around the world. The trip began with an unusually long trip from Port Charlotte to Orlando clocking in at four hours and change, a trip that usually takes about two and a half. That was followed by the 6761 mi flight from Orlando International to London/Heathrow airport overnight from 6/17 @ 1840 (EST) - 6/18 0236 (EST)/0736 GMT. 

Luckily, one of us was able to get a couple winks on the plane. Another happy landing…

The arrival in Londontown brought with it an almost eleven-hour layover of which, we decided to make the most- always up for adventure. This lead to our first international Uber to Big Ben, the London Eye and Buckingham Palace.

Good thing we speak the language of the locals, no protocol droids needed. 

We somehow got swept up in a protest demonstration through the main streets of London where marchers chanted for fair wages, affordable rent, kicking out Boris Johnson as well as equal rights for minorities and sexual orientations.

As well as representation for just about every other socio-political cause we could think of. I guess the protesters vote of no confidence in Boris Johnson was effective 🤷‍♂️.

The peaceful protest was easily 2+ miles of marchers taking up the entire streets with music, drum corps, marching bands, balloons and bullhorns. In addition to that experience, we logged over 5.6mi walking through London looking at architecture and monuments. We stopped in to a local British Pub for some fish and chips and a local London Lager. 

Then it was back to Heathrow airport for the trip to South Africa. I’d forgotten how much I hate space travel. 

What followed was a 5651 mile flight from London to Johannesburg, South Africa, which ran slightly late (we were assured that Uh, everything is under control. Situation normal. Everything's perfectly all right now. We're fine. We're all fine here, now, thank you. How are you?), and with an hour layover, that delay tightened things up quite a bit- after not having a gate assigned and sprinting across three terminals to find the flight, we made it to the plane with less than minutes to spare. Off to Zambia. 

We embarked on the 90-minute flight to Livingstone in a small jet that seemed to be no bigger than a womprat. The flight itself was uneventful, and we finished off the last airborne leg of our journey to Africa. 

From the small Livingstone airport, we were shuttled to the volunteer house by the program director, Rabecca, who gave us a mini town tour on the way. We arrived at the Sunbird House just in time for the home-cooked lunch where we met 8 other volunteers from various states and countries fulfilling various roles of volunteering from teaching and construction to fund raising initiatives and medical professionals. New friends. We were then shown our better-than-anticipated lodging accommodations and settled in to get the lay of the land gather our bearings in this foreign land. Throughout our short week at Sunbird Guest House, we totaled 16 volunteers.

The following morning was our Orientation day- one of the volunteer organizers, Kennedy, filled us in on the culture as well as the state of healthcare in Zambia and Livingstone. It is all government run and they lack basic supplies- what they do have tends to be antiquated, worn out or just turns up missing. The clinics serve the surrounding residents, so if you live in this part of town, you’re assigned to go to this clinic. The town has several clinics to service the basic needs of the people, but if they are too critically ill, the towns single ambulance (more of a multi-patient SUV) transports them to the hospital- but the clinic is really the place people go; they don’t go straight to the hospital with illness. The clinics act as a triage or Emergency Department where residents go to either have their issues managed or be stabilized for transport to the hospital. We also learned that when a local child points at us and yells out “Mazungo! Mazungo!” That they are just excited at seeing a white person. And that if we wave back, it warms their hearts.

The Mahatma Gandhi clinic has a Maternal wing, a pediatric area, a general medical wing and an Urgent/emergency department.I think there’s 1 auto blood pressure cuff in the whole clinic, and they claimed to have a manual cuff, but they never seemed to know where it was, nor did the majority of them have stethoscopes. There seem to be a few knee-jerk diagnoses where if a patient comes through, for example, with a cough or fever, its likely “flu”, and many sore throats are simply termed infections. This leads to many prescriptions for antibiotics that are likely unnecessary, and lead to superbugs and a lack of resources for the future, in patients that will truly need their limited supply of antibiotics. The patients seem to feel they didn’t get treatment if they didn’t receive something tangible in their visit- they want a medicine to fix everything, when most times, education is way more valuable. 

Day 1 in clinic- this is where the fun begins. 

I was responsible for a 5-bed clinic room wherein several patients came for my assistance. Jorge was taken to the other side of the clinic where more doctor-y things were taking place (or so I assumed). A mother brought in an unresponsive baby who was barely older than six months, and very clearly lifeless. “BID”, they called it- brought in dead. It’s rather telling that they have a name for these occurrences, but in an infant this young, the doctor on the case said they only see this about once in a hundred. Travesties such as this are, sadly, a part of life in this culture.

I provided wound care and stabilization for an unresponsive man who had stab and abrasion wounds as well as bruising and tenderness on his face, abdomen and legs. He required further diagnostics and scans, so once he was stabilized, he was taken to the hospital. 

I also gave more injections than I could count including antibiotics such as Penicillin and Rocephin, the occasional inoculation or vaccine and I gathered some routine lab work for a few patients following up for various health concerns. Jorge rejoined me after other doctor-y stuff (I assume) as we cared for a young girl who had stepped barefoot on a fish one, which lodged and broke off in her foot. 

I assisted him in the minor procedure of retrieving the foreign body and cleaning and stitching the wound. These were a few of the memorable patients we saw in our first volunteer day at the clinic.

All of the volunteering had workdays that seemed to end by 3 or 4 pm, at which time, we all returned to the volunteer house. Seemingly out of the brush, would come a dozen young children to jump and climb on us, and challenge us to lively games of soccer, or football as the locals prefer to call it. They would sing and dance and take photos with our phones, but once the beautiful sunsets start to fade, we had to convince them to return home, wherever that was, for the night.

We boarded bench seats that were bolted into the bed of a pickup truck for a safari-type drive through Mosi-oa-Tunya National Reserve. Mosi-oa-Tunya translates to “Smoke that Thunders” (we’ll get to that later) 

During the drive we saw many different animals from baboons, impala, zebra and wildebeest to warthogs monkeys, giraffes and various birds. At a certain point, we got out and began our walk to see a pair of White Rhinos- a mother and her one-month-old baby. White Rhinos are a protected species as there are a total of ten in Zambia, including these two. We were less than ten yards from these gorgeously powerful beasts, but very closely monitored by the heavily armed military guards who protect these creatures. What followed was a 50-minute drive back to our guest house that featured many more of the aforementioned wildlife including a couple Monitor lizards and a 2-foot crocodile. 

Day 2 in clinic featured several more injections and some patients with generalized abdominal pain & vomiting. A particular woman slowly stumbled in with dizziness and vomiting, unable to keep anything down for several days. With the clinics automatic cuff her blood pressure seemed profoundly low- and she presented as such. The first response by staff was to test the cuff… on themselves! The doctors systolic blood pressure was 190s! When he refuted those results, I half-jokingly asked if he needed the next bed. Then I followed that up by going to get my manual cuff to get a concrete reading. She was low- as i had suspected, but this gave me the physicians blessing to begin an IV and start her on fluids and give her some anti-nausea medicine through the IV. (In the States, we start IVs on nearly every patient that comes through the doors, but the clinics in Zambia are incredibly short on resources, including IV supplies, so they have to be selective on who gets what. This woman’s vital signs and general condition warranted an IV. 

She perked up after the Liter of fluids and nausea med kicked in and she was able to walk out looking and feeling much better than upon arrival. In some downtime between and after these patients we conversed with the staff nurses and med students about assessments and diagnostics to better serve their population. 

After our time in the clinic, Jorge and I headed back to the guest house to change and head to our next adventure. We were driven to a wildlife sanctuary in a large bus, then we bonded and walked with 6 lions through the preserve. They were three-year-old sisters from two families, and we walked between, behind and alongside these powerful cats while holding their tails and patting them on the back.

As if that weren’t enough of an adventure, we then had the opportunity to meet and walk with a cheetah. She was brought into a fenced area where handlers put a harness and leash on her. (The harness is a cue to her not to run, as if me- with a leash- could hold back the fastest animal on land) we stroked her fur as she purred and then we trekked through the plains with her by our side.

Being this close to these animals was truly a humbling experience wherein we could literally feel their strength and speed under our fingers as we bonded with them. It was truly surreal to engage these massive felines.

There are a few volunteer organizations serving the town of Livingstone, and one of them hosts a bi-weekly Trivia Night at a pizza place in town, inviting the other volunteer groups to join. Our entire volunteer group walked the two miles into town to test our trivia chops. The less than $2 cover charge went for donations to their volunteer efforts as well as supplies. The sixteen volunteers who participated from our house were divided into two teams- Old vs New members. Team New didn’t win, but we also didn’t know it was buy-one-get-one pizza night, so we walked away with 3 extra pizzas, so that’s a “W” in my book.

Day 3 - Angels Pool over Victoria Falls. Victoria Falls is one of the largest waterfalls in the world and we were fortunate enough to be a thirty-minute drive from its roaring waters. Mosi-oa-Tunya - Smoke that Thunders- these falls were given the name by the locals because as the mist rises from the falls it looks like smoke and the roaring waters diving from its edge create the sound of thunder, so this literally becomes the smoke that thunders. Once our van arrived at the riverbank, we took a boat from the mainland to a small island above the falls where we were greeted with a local drink- they weren’t specific about what was in it, but it was an acquired taste to be sure. After that, we walked clasped hand-in-hand in a sort of human chain to the side of the falls. At times we were stepping inches into the waters, at one point, we had to traverse a waist- to chest-deep 12-foot path in the waters to arrive at the edge of Vic Falls. The distance across the falls is rather narrow- we could see people touring the falls on the Zimbabwe side, we waved as we gazed upon this wonder. As we neared the edge, we could see the enormity of the falls flanking us. We first gingerly walked right where we were brought, one-by-one, within inches of the edge of the falls.

Not to worry- we were anchored in place by two men: one holding each ankle. This is when I was glad that we pay for this experience AFTER we return- that seems to prevent the guides from getting a case of the butterfingers. 

David Livingstone, an English missionary, had heard about Mosi-oa-Tunya and went to local tribal leaders to gain their blessing in visiting this sacred place. There is a monument erected where David first saw the Victoria Falls, and the town of Livingstone is named for him. 

Day 4 in clinic Jorge and I were both more comfortable in our environment and we faced the day together, in the general medicine wing where we encountered a series of patients with cough & sore throat- a few mothers and their babies sharing symptoms wherein we assessed and diagnosed these patients with the staff- assisting in expanding their knowledge base. There were also patients complaining of abdominal pains, spotting after depo birth control shots who were educated on those medicines and what to expect and what concerns to look for. Unwanted pregnancies and HIV are massive concerns through much of the population in Zambia and many clinicians focus on education, prevention and treatment of HIV to keep viral loads down which has proven to greatly reduce the spread of the virus. Family planning is also a large part of healthcare in the region, with many women seeking birth control regimens through the clinic. We were in a patient interview when someone from the emergency wing ran over to retrieve us for a patient needing our help.

We entered my old five-bed clinic room to find a poorly responsive teenaged girl with stridor and difficulty breathing who started walking home from school to get medicine because she wasn’t feeling well. She collapsed en route and her teacher brought her to the clinic with an “asthma attack” we didn’t hear evidence of asthma in her lungs and knew something else had to be going on. She was given an inhaler that didn’t seem to help whatsoever. We were gravely concerned for her survival, as her lethargy and poor responsiveness quickly turned unresponsive. We knew steroids MIGHT help and Jorge decided she could use some sugar (despite not having access to a glucose meter). I got an IV in her and we gave her 1/2 Liter of Dextrose (IV sugar), 1/2 Liter of maintenance IV fluids. We were convinced if she didn’t turn around she’d need to be transported to the hospital, but with the steroids and sugar water, she perked right up and within two hours of coming in nearly unresponsive, she thanked us and walked out of the clinic. 

About fifteen people came through to get antibiotic injections, but were stalled when we discovered we had no more needles. The staff didn’t seem to know what to do until the shipment that was set to arrive later that day. We learned that needles could be purchased at the chemist a couple blocks away, so we sent one of our fellow volunteers to buy 70 needles for under $5. That would be enough to meet the clinic’s injection needs until their shipment arrived. We then quickly made our way through the fifteen patients injections to clear out the congestion as we wondered how the acknowledgement of issues didn’t lead the staff to look for viable solutions. Unless a $5 solution isn’t viable, which I think might, sadly, be the case. At the very end of the day, the girl with the fish bone extraction from the first day came back for suture removal and a penicillin and a tetanus shot. She was looking better already. 

Jorge had the seemingly impossible idea to create a human pyramid, including 15 of the volunteers, 5, 4, 3, 2, 1. Throughout our week, we created and strengthened bonds with our fellow volunteers, and on that last night, after dinner (when everyone was slightly heavier- probably a better idea to attempt this BEFORE dinner) we had Ethan, who is an engineering major, draw up the plans and, with several attempts and a little tweaking, we made it work. For nearly two seconds. 

The next morning, as we were preparing to leave, Kennedy and Rabecca approached us, having heard from the evening staff about our human pyramid from the night before. They made sure to tell us that once we arrived, the volunteers seemed to gravitate more toward each other and interact a bit closer and they look forward to engaging future volunteers to form those tight-knit bonds that are so effective in team building. 

Over the course of our time in the clinic we noticed many shortages of things we, in America, take for granted. They had very few supplies and lacked a great many things. Gloves, syringes, cotton and tape are rare commodities and tongue depressors, gauze and scissors seem nonexistent. General supplies and medications are in astoundingly short supply. We were unsure of what we would need in Zambia, so we brought some extra supplies such as stethoscopes, ace wraps, gauze, gloves, bandages and various supplies such as first aid kits and scissors and forceps. On the last day, some of the other medical volunteers were gathering their spare scrubs and random supplies to drop off at the clinic, so we contributed all that which we had brought so that they could have a little more than when we came. And now, they’ll be able to use the manual blood pressure cuff I left- (unless that one mysteriously joins their other missing one..?).

In the country of Zambia, we noticed all the things these people lack, but we also saw, more predominantly, the things they HAVE. The joyful spirit in which they greet the Mazungo and their friends and neighbors. The resourcefulness and resilience, in addition to the sometimes abrasive pushiness of the hustling street vendors trying to vigorously provide for their families selling paintings, carvings and various goods in the town enrich the colorful flavor of the lively town of Livingstone. The beauty in the simplicity here is only matched by the vibrance in the town and its sunsets.