Medical Training for Media Production Companies

 

Life In Luangwa , Zambia

“Doctor Emergency”! I had seen the blood spattered wheelbarrow parked on the veranda that served as the waiting room and now the sign of the shuffling flip flops told me I was about to meet its occupant. He entered the room uncertainly, supported between his two inebriated friends. The blood soaked tea towel adorning his head giving a big clue as to his presenting complaint. Removal revealed a 7inch gash across his forehead down to the skull. His helpful friends informed me it had been inflicted by an axe, two nights ago, in a fight and they excitedly asked me to examine his leg which had been stabbed by a spear.

Welcome to life in Luangwa or more accurately the Kakumbi Rural Health Centre. I have just returned from my second three month stint as the South Luangwa Safaris Association Medical Fund doctor. The post provides the unique opportunity for doctors to practice in a developing country whilst enjoying some Western style comforts. South Luangwa is a place where two worlds collide. It is situated in the Eastern province of Zambia, one of the countries poorest provinces in one of the world’s poorest countries. It hosts some of the worlds most exclusive safari holidays and draws tourists from around the globe. The medical fund was formed by the safari lodges as a way of importing expatriate doctors to provide medical services for the staff and guests of the lodges whilst securing access to a doctor for the local population. Kakumbi Rural Health Centre is the only clinic in Zambia to have a doctor working in it.

Work at the clinic is challenging. There is a language barrier, a cultural gulf and very basic facilities. There is no access to investigations and so most diagnosis are made on clinical grounds. A limited number of drugs and dressings are available but supply is often interrupted. The local hospital is over an hours drive away along a very poor quality, heavily potholed road. It is manned by two doctors and has microbiology, some blood testing facilities, an x ray machine and an ultra sound scanner. There is no ambulance service and patients are responsible for finding and paying for their own transport.

The health needs of the local population are huge. HIV/Aids is rife and both it and its complications often present during surgery. Diseases now confined to the history books of the Western world make not uncommon appearances. I saw cases of Tuberculosis, Syphilis and Rheumatic Fever during my three months visit. Other more unusual cases include snake bites, crocodile attack and foot trauma due to entanglement in a bicycle wheel. Trauma is a frequent occurrence in the community: children fall in open fires; builders fall off roofs; fishermen get hooks in their eyes and people assault each other. My stay spanned the wet season and in early March the number of confirmed cases of malaria started to rise. By month end it became evident that a full blown epidemic was likely and by mid April we ran out of malaria rapid diagnostic test kits and Co-Artem, the first line drug treatment. A week later supplies of quinine were down to less than 10 adult doses. On most days the clinic resembled a hospital and resources and staff were stretched to the limit. Sadly deaths started to occur as more severe complications such as cerebral malaria started to appear in young children.

The doctor is constantly on-call for the safari lodges but the workload is carefully managed and fitted around work at the clinic. After hours call outs are minimal and luckily I did not have to deal with any major emergencies on this trip. Zambia lacks medical facilities of a standard suitable for most tourists and therefore any problems arising either have to be dealt with by the doctor or medivacced to South Africa. Thankfully most visits to the lodges for guests are for minor problems; diarrhoea, lost tablets etc but serious medical problems and major trauma have occurred in the past. There aren’t however many places in the world where when returning from a “ home visit” you can come across a sleepy pride of lions snoozing on the road or giraffe gracefully grazing in the bushes.

Life in Luangwa is far from all doom and gloom. The valley is stunningly beautiful and the National Park is alive with wildlife both big and small. The doctor has very graciously been granted free access to the park and after a testing day at work there is nothing better than spending a few hours unwinding with a cold beer watching elephants frolic in a mud bath or a spectacular African sunset across a Hippo filled lagoon. There is plenty of opportunity to really get to know and understand the wildlife of the area and local guides and residents are more than happy to help you make the most of the experience.

I have thoroughly enjoyed both of my visits to the South Luangwa valley. I have immensely enjoyed working alongside the local staff and have learned a lot from the nurses. I have re-honed my clinical skills and revelled in the freedom of the autonomy of working in a very different health system. “Life in Luangwa” gives you a fascinating insight into the challenges that face rural Sub Saharan Africa in the 21st Centaury and I would highly recommend the experience to any doctor who is looking for a clinical challenge: who is willing to adapt to an unfamiliar environment and who has the relevant skills and experience to be able to feel comfortable in such a remote but awesomely beautiful place.

Dr Rhona Whiston May 2009

Desert Medicine Traininng Course in Namibia

Expedition and Wilderness Medical Training Courses for medical professionals

Namibia Medical volunteer
This challenging programme offers you a unique opportunity to work at a small, rural Bushman clinic in Africa and make a difference to the lives of those in most need.
N/a’an ku sê is a unique and special place in the heart of Namibia which is committed to conserving wildlife and improving the lives of the Bushman community. Live your African dream and help make a difference by volunteering at our Lifeline Clinic.

About N/a’an ku sê’s Lifeline Clinic
• Bushman are treated as third class citizens and live in extreme poverty
• Adult onset diabetes, cardiovascular disease and cancer are sharply increasing in Bushmen and alcoholism has become prevalent
• Many Bushman children suffer from malnutrition, disease, discrimination and abuse

The N/a’an ku sê Lifeline Clinic was set up in 2003 to address the needs of the rural indigenous communities in Epukiro, a remote part of Namibia. The demand for a basic but comprehensive health service became apparent to medical professionals working in the area when they witnessed the tragic and unnecessary death of a young child due to the failure of ambulance service and hospital staff, largely due to the fact that the child was a Bushman.   This vital service relies upon the time and dedication of volunteers and donations from supporters to continue to run and serve the communities in need.

About the role
• Improving Health: The clinic is dedicated to the health and welfare of the Bushman community.
• Making a real difference: The clinic has treated nearly 3000 patients over the past year.
• Free treatments: Over 2200 (72%) of the patients were Bushman who were treated for free.

The clinic aims to help marginalized local people and provide accessible affordable primary healthcare to those living in the area. By joining this project you will experience the harsh realities faced by Africa’s Bushmen communities and have the chance to make a difference to their lives. You will be immersed in the health and development programme while providing care to patients living in extreme poverty.

During your time at the Lifeline Clinic you will work with Sister Anna and assistant Natalia seeing and treating patients from the local Bushman and Herero community. Your daily schedule will be varied and you will carry out duties such as making and recording medical observations, keeping medical records, monitoring the progress of pregnant women, helping with wound dressings and working in the pharmacy. You will also visit an outer community or farm to do general health check ups and any treatments as required.
As part of your time at the clinic you will undertake an assignment such as looking into drivers of disease such as alcoholism to find out more about the health needs of this marginalized society.

You will also assist with community projects such as planting and cultivating vegetable gardens to help encourage good nutrition. You will spend time with the local Bushman community to understand how they live as well as going on a walk with them to look for bush food or medical plants.

You can also choose to experience the rare and exciting opportunity to work and care for the animals of Africa, assisting in their rehabilitation as part of our wildlife volunteering program.

Take part now! To take part in this project or find out more please email bookingsnaankuse@iway.na or visit www.ecotourism-namibia.com.

Make a donation –We rely on voluntary donations and the time and support of volunteers such as you to continue to help the Bushman people in need. If you are interested in supporting the clinic and the patients who need our help please email donationsnaankuse@iway.na to find out how you can help. We urgently need funding to continue to run this service, buy medicines and pay for our one full time Nurse who runs the clinic.

Experience your African dream at N/a’an ku sê
N/a’an ku sê is a unique and special place in the heart of Namibia which is committed to conserving wildlife and improving the lives of the Bushman community. Live your African dream and help make a difference by taking part on one of our exciting and rewarding volunteer programmes:

Volunteer at our Lifeline Clinic – located in a remote part of Namibia, this vital clinic is dedicated to the health & welfare of the Bushman community. By volunteering at the clinic, you will be immersed in the health and development programme while providing care to patients living in extreme poverty.
Contact: bookingsnaankuse@iway.na

Volunteer with wildlife – you can choose to combine your time at the clinic with the rare and exciting opportunity to work and care for the animals of Africa, assisting in their rehabilitation as part of our wildlife volunteering program.
Contact: bookingsnaankuse@iway.na

Experience our Lodge – start or finish your trip to Namibia with a stay at our beautiful lodge in the heart of Namibia’s bush land. Here, you can enjoy sumptuous meals, take a dip in our beautiful pool, experience unforgettable carnivore feeding tours and enjoy magnificent African sunsets.
Contact: naankuselodge@iway.na

Make a donation – sadly N/a’an ku sê does not receive any government funding and we rely solely on voluntary donations and the time of our volunteers to keep our vital projects running. By adopting an animal, sponsoring a child or treating a patient you can ensure we can continue to make a difference in the lives of the people and animals who need it most.
Contact: donationsnaankuse@iway.na

Making a difference
By visiting our unique lodge, volunteering at one of our projects or making a donation you can make a real difference to the animals and people we strive to help. All profits from our Lodge and volunteering activities go directly to benefit our work with wildlife conservation, our Lifeline Clinic for Bushman in Epukiro and the people from the Bushman community we employ.

Take part now by emailing bookingsnaankuse@iway.na or visit www.ecotourism-nambia.com to find out more about the work of N/a’an ku sê.

Desert Medicine training course – Namibia

Expedition and Wilderness Medicine training courses

by Lucy Dickinson

I have just returned from a ten week trip providing medical support to a BSES (British Schools Exploring Society) Expedition to Svalbard. BSES is a youth development charity that aims to provide young people with inspirational, challenging scientific expeditions to remote, wild environments and so develop their confidence, teamwork, leadership and spirit of adventure and exploration. It was founded in 1932 by George Murray Levick who was a member of Captain Scott’s last expedition. The name, “BSES”, is a bit of a misnomer as they don’t just work with school children. There were 15 young people aged 18 to 23 on this trip from varying backgrounds. Most had worked for many months to raise the funds necessary for the trip and a few received charitable grants. As well as the 15 young people there were 7 leaders including myself. Most of the leader team worked on a voluntary basis and paid a small amount towards their expenses. The aims of the expedition were to learn how to survive in the extreme cold, to complete scientific research in the fields of Geography and Biology, to develop mountaineering skills and to simply adventure in this beautiful wilderness.

Svalbard is an Archipelago in the Arctic Ocean around midway between mainland Norway and the North Pole. We arrived there at the beginning of April to find a pristeen white wilderness with temperatures around –20 C. The sun dipped down a little in the first few weeks but for most of our time there we had bright sunshine right through the night. Our first task on arrival was to learn how to shoot a rifle in order to protect ourselves from possible attack by one of the three thousand polar bears living on these islands. We also learned how to construct a flare fence around our tents to ward off bears while we slept. And then, after careful packing, we set off from civilisation not to see a toilet, shower or bed, amongst other creature comforts, for the next 10 weeks. We travelled on skis pulling sledges called pulks that were to carry all our gear and, in my case, a comprehensive medical kit. Some of the young people had barely slept in a tent before let alone put one up and survive in it at –25 C so the first few days were a real challenge. There was a high risk of cold injuries at this time but, despite a few cases of frost nip, we managed to avoid any frostbite.

So after learning to survive in the arctic environment we went on to complete some scientific research in the fields of glaciology and biology and to do some mountaineering and adventuring. Highlights for me included ice climbing, building an igloo, sleeping in a snow hole, exploring an ice cave, summiting arctic peaks, crossing the frozen sea and then watching it break up as the temperature rose, visiting the impressive cliffs of a carving glacier and learning some winter mountaineering skills. Unfortunately I wasn’t able to fulfil one of my lifetime ambitions to see a polar bear in the wild but we were regularly reminded of their presence by their huge footprints. In the early stages of the trip the only wildlife we saw were reindeer and ptarmigan but as the winter turned to spring it was a treat to see huge numbers of birds returning to this rich feeding ground as well as seals, walrus, Beluga whales and arctic foxes.

I was fortunate not to have to deal with any major medical problems on this trip. The majority of expedition members experienced chilblains to varying degrees. Some had a large number of ulcerated sores that required regular dressings. Other medical problems consisted mainly of musculoskeletal injuries and simple infections. It was interesting to learn more about prevention and management of cold injuries as well as the difficulties of keeping the medical kit functioning in the extreme cold.

BSES run expeditions of varying lengths and with different age groups to the Arctic, the Amazon and the Himalayas and are always looking for staff who can offer their time and skills to provide young people with the opportunity for personal development as well as a fantastic experience and adventure. As a leader it is also a great opportunity to visit an exciting location, learn new skills, practice medicine in a challenging environment and have the rewarding experience of working with young people.

To find out more about BSES visit their website www.bses.org.uk

Find out more about the Polar Medicine Course in northern Norway

Expedition and Wilderness Medicine

Visit to Deusa Healthpost, Solukhumbu (March 2009) 

My name is Alina, and I am a medical student from the UK.  In February, with my boyfriend Euan, a nurse in A&E, we walked to the village of Deusa in the Everest region of Nepal.  We were away for just over 6 weeks. Having walked for 4 days from the nearest road, 4 incredible but very long days of going up mountains, then down to rivers, then up and down again, the village we stayed in was extremely remote.  Although most homes have a radio and a few have one light at night powered by a solar battery, there is practically no infrastructure as we know it, and life is very different to back home.  It was an amazing experience, both culturally and medically. We went to this village, Deusa, to help out at the health post.  There is already a midwife there, whose wages are paid for by a doctor in the UK.  As we found out, Deusa is very lucky to have a nurse that is qualified and actually turns up each day.  She works there 6 days a week, and is the nearest port of call for 6000 people.  The nearest hospital is a 6 hour walk away.

THE LODGE
The family we stayed with were lovely, cooked great food, and kept their house really clean.  Our daily routine fitted into theirs.  We had tea when we woke at around 6am, breakfast at 9.30am, then we went to work at the health post from 10am till at least 2pm, and then an evening meal at 8pm.  Meals are essentially referred to as ‘khana’, or food, as they are usually always rice and vegetables.  Dal Bhat is the epitome of Nepali cuisine; rice, curry, dal, and a little pickle.  The ones in Deusa are the best I’ve eaten, and I’ve eaten a fair few!!

The toilet was at the end of the garden, and the shower was a bucket outside, where we also washed our clothes and cleaned teeth amongst the chickens.  There is no electricity in the lodge apart from a solar powered light in the evenings, so a torch is a must.  There is also no running water so the family have to fill numerous buckets from the nearest water tap and carry it back.  We were therefore extremely conscious of how much we used.  However, they are very hospitable, and we had all we needed. The only thing I would suggest if you are going there is bring a book and pack of cards, as the evenings can get very quiet!!

THE HEALTH POST
The health post was an amazing experience.  We had up to 30 patients one day…perhaps to see the spectacle of two foreigners!  Dev Kumari, the nurse is young and like many Nepali women, extremely shy, but she is also very bright and competent so we shared the work between the three of us, asking eachother what we thought…  (I have come to love ‘Where there is no doctor’, it saved us a lot.)  Her English is better than she lets on, and will understand most things with patience!

It seemed the norm to have all the patients sauntering in to the consultation room, so there were sometimes up to 15 people milling about, gossiping, having a look at the rash, or sore, regardless of where it was on the body.  Euan and I tried to get people waiting outside in order to see one patient at a time.  We’d then see and try to treat the patients. Dev Kumari would translate from Rai, the local language, to Nepali, to English.  Having only been there for a few weeks, and not speaking Rai or Nepali, there is only so much you can understand about the culture and beliefs of the people.  However, through Dev Kumari, and lots of sign language and basic words from phrasebooks, the work is extremely rewarding and the experience definitely a positive one.

We saw a lot of diarrhoea, coughs, eye problems, wounds, epigastric pain and general aches and pains, and lots of babies with fevers.  Although we tried to be thorough, looked at books to make sure we didn’t miss anything, and checked with each other a lot, playing doctor was still pretty scary.  Whenever we weren’t sure, we suggested going to Phaplu, to the nearest hospital.  But even this brought up problems…being six hours away, and with lives taken up with the present day…farming and cooking, would people really go?  And yet after a while, it got easier.  One woman returned after a week with oranges for us.  I didn’t recognise her.  A week before she had the most terrible sounding chest, and could hardly breathe.  A week later, having been given an inhaler, she was transformed.

Despite initial appearances of darkness (again take a torch) and dirt, the store room is surprisingly well stocked, but I don’t think Dev Kumari knows or feels comfortable using some of drugs.  There is plenty of Paracetamol, and we have ordered some Ibuprofen and Diclofenac.  There are also a range of antibiotics, and Euan wrote out a protocol for when to use which ones…this should be stuck on Dev Kumari’s desk.  There are condoms, the pill, depo injections for family planning.  The ‘examination’ room also has a well stocked cupboard with dressings, antiseptics, as well as books including some OHCM, OHCS, and ‘Where There Is No Doctor’ in English and Nepali.

THE SCHOOL
Whilst we were there, the students at the school were busy revising for exams, but Euan and I did go for the afternoon to run a first aid session. We kept it simple and focused on general hygiene and  keeping teeth, hands and wounds clean etc.  We did demonstrations and updated their first aid kit.  This was a worthwhile visit and I would definitely recommend doing something similar.  The children are very sheltered in Deusa and feed off outsiders with enthusiasm.

EVEREST
After a few weeks, we set off for Everest base camp.  We had a two day walk to find the main trail.  That two day walk was interesting….the paths would peter out in front of us, or open out to four paths, and we would have to find someone to ask in our very limited Nepali.  Having been guided the wrong way by an old man we met on the way, we stayed with a family on our first night.  But we found the path the next day and were revelling in the lodges that had menus!, the hot water, and the general comfort that we missed.

The trek to Everest Base Camp was brilliant.  Although extremely cold and barren, it was really beautiful, and the crispy mornings with peaks of mountains over 7000m surrounding you were spectacular.  We met up with an Irish couple whom we went up to base camp with, and luckily none of us suffered too much from the altitude.  We did all feel it though!  Walking got progressively harder and slower.  I felt my heart pounding in my sleep, and sometimes just couldn’t get enough breath.

So, summed up by outside showers, or no showers at all, rice, rice rice, Euan and I going a little mad, resorting to ridiculous games to occupy the quiet evenings, but incredible scenery, a beautiful village with a fascinating culture that we only saw and understood a tiny part of, Deusa has taught me a lot, about culture, health, illness, and life in Nepal, but also to appreciate how lucky we are at home.

We started a visitor’s book in Deusa with similar notes, suggestions and impressions, which we left with Purna’s family at the lodge.

Alina and Euan