UNDERSTANDING HEALTH CARE CHALLENGES IN ZAMBIA

Written By: Gloria Rinomhota, Third-Year Student Pharmacist


During the summer, I participated in a three-week interprofessional global health project in Lusaka, Zambia through the UMB Center for Global Education Initiatives. Joining me for this experience were fourth-year student pharmacist Dana Valentine, nursing student Katie Doyle, and medical student Alexandra Laps. We worked under the leadership of two faculty members from the School of Pharmacy — Emily Heil, PharmD, BCPS AQ-ID, AAHIVP, assistant professor of pharmacy practice and science (PPS), and Neha S. Pandit, PharmD, BCPS, AAHIVP, associate professor in PPS — to evaluate antibiotic administration at the University Teaching Hospital (UTH) in Lusaka.

Upon arrival at UTH, I could not wait to get started. Throughout my three weeks there, I participated in hospital ward rounds, afternoon lectures, presentations, and adult and pediatric HIV clinics. My most enjoyable moments came from the afternoon lectures. Although I was familiar with most of the topics presented, it was intriguing to think about those topics in different clinical settings. What drugs are currently available? What interventions should or should not be used in different clinical situations?

The Human Touch

As different scenarios presented themselves, I came to understand what “resource-limited” truly meant.  During one of the adult clinics, a patient showed signs of non-compliance to her HIV medications and was reluctant to accept her medication regimen due to the number of pills. After the patient left, I asked the doctor about her behavior and what interventions might be best for her and if her preference as a patient was prioritized. The doctor explained, “We treat patients based on what’s available.” The more time I spent in the clinics, the more evident that statement became.

Another patient I vividly remember was a 21-year-old, vibrant young man who was diagnosed with aplastic anemia. I saw him a couple of times during our morning rounds with the infectious diseases team. The last time I saw him, he was sitting in a chair in his private hospital room listening to music, talking, and looking much better than he had at his previous appointment. His care team had tried administering blood with little to no improvement. There were limited options for him, with the exception of a bone marrow transplant, though I came to learn there was no bone marrow transplant service in Zambia. When one of our professors asked what could be done, the doctor raised his eyebrows in a way that said, “We just wait.” Although another doctor wanted to prescribe a special medication that might temporarily prolong his life — his body had turned against him and was sucking all the blood he had — we discovered that it would take a week or two for the hospital to have it delivered. He did not make it.

One of the Best

While we encountered a number of patients for which few interventions were available, I was highly impressed by how organized the hospital was and how different departments operated. UTH is one of the best health care systems I have experienced in Africa. Before traveling to Zambia, I spent time in several pharmacies at the teaching hospital in Zimbabwe and attended a pediatric clinic at another hospital in Nigeria. Comparing my previous experiences to my time at UTH, the progress that I saw in Zambia was inspiring. I was also very happy to learn that the government covered most, if not all, patient medical expenses, with the exception of imaging and laboratory tests. In some instances, the government even covered expenses for citizens to obtain treatment in India if it was not available in Zambia.

A New Appreciation

As part of an interprofessional team, I highly appreciated and valued the expertise of my peers. From our student nurse, I learned the importance of preventing pressure ulcers in hospitalized patients. I also learned that pressure ulcers take time to heal, which can cause excruciating pain. To prevent pressure ulcers, nurses will occasionally manually turn patients. Before this experience, I would never have considered this important issue.

I was also able to gain a lot of exposure to direct patient care in a hospital setting, where I saw and learned about different disease states, including some rare diseases. Although there are still challenges that must be overcome in terms of resources and training, I think Zambia is heading in the right direction and making remarkable progress in the field of patient care.

This experience truly offered me a different perspective on how health care is delivered in an area with limited resources. As I finish my last two years of pharmacy school, I have started to think more about our local community, especially the residents who don’t have access to the health care that many of us take for granted. This trip, combined with my experiences at home, have influenced me to leverage what I have learned as a student pharmacist to become more involved in my community and volunteer to serve those who are underserved in the local area.

14 Comments

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  • Wow, What an inspiring experience! So sad though about the young man and the many others that have lost their lives due to lack of resources that are easily accessible in other parts of the world 🙁 Thanks for sharing and keep up the good work!

    • Thank you so much Joy! Yes, many lives are lost due to limited resources, I hope policy changes and advocacy will help improve health access in different parts of the world.

  • This a truly insightful article into health issues faced by medical professionals in developing countries. You are on the right path to making a difference based on your experiences and expertise!

  • Wow! “We treat patients based on what’s available.” This is true poverty. With that said, I am encouraged with the India arrangements that the government makes. I hope they continue to make strides.

    • I hope so too. It was good to know that there is an option for those who may not be able to get treatment in the country.

  • Thanks for sharing the expirience. I think it’s very important that, as you learn from societies with advanced meds and health systems, you also sensitize yourself to those societies that aren’t so fortunate and work on how that problem can be aliviated — after all it affects at least 80% of the world population. I hope you young pharmacists can get together and share these experiences.

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