‘Hi dad!’ said my doctor daughter, who is doing A&E work in New Zealand. ‘I have a job idea for you.’
I didn’t exactly prick up my ears at this. As a GP partner in a five-doctor practice, I felt I had plenty to be getting on with, including mastering the new computer system, new doctors joining the practice and a tougher QOF looming.
But when she explained that the job involved three months working in a beautiful wildlife area in Zambia, a famously friendly, non-threatening country, I began to consider it more seriously.
At the age of 58, with the children having flown the nest and after 26 years in the same practice, I had been thinking about how to spend the remaining years of my medical career.
I have a pleasant working life, with loyal patients, nice staff and one or two special interests. But I was unhappy about NHS box-ticking and chasing QOF points.
I have always been keen to do my bit to help those who have not been as lucky as me, and I believe GPs have an ethical duty to do this.
My opportunity to put this into practice came about because the Luangwa Safari Association has, for several years, arranged for doctors to visit Zambia for a few months at a time, paying flights and expenses.
These doctors undertake two roles, providing medical care to tourists and ex-pats on a private basis, and voluntary work at the local Zambian Health Department clinic.
I worked in Zambia for three months. The role treating tourists was not busy, but it was the rainy season. I worked like an out-of-hours GP, going around to safari lodges with a big drug bag, but sometimes I had no calls for days at a time.
The difference in Zambia was that my only back-up was to arrange an air evacuation, which generally took about 12 hours. I worked solo and had to collect fees, issue medication and order replacement drugs.
My other role, working with local people, was rather like NHS GP work would have been in the 1950s: no appointment system, illegible handwritten notes, very few effective medicines and hardly any useful laboratory tests. On the other hand, there were no annoying computer prompts, either.
English is the official language of Zambia, but only a few people speak it well, so patient histories – even with an interpreter – were often a recital of a few basic phrases.
Consultation skills are highly relevant, but I often felt I hadn’t understood the patient’s perspective.
Explaining a diagnosis and treatment plan with no patient leaflets, poor literacy and some strange folk myths about health is not easy. However, patients and staff were always polite, friendly and good-humoured.
The clinic has two consulting rooms, a dispensary/reception, a small lab which can do rapid malaria tests, HIV tests and an Hb but not a lot else, and 10 beds, including two in the labour ward. It is open 8am-12pm and 2pm-4pm on weekdays, and weekend mornings, and there is a nurse/midwife on call at other times.
Treating malaria and HIV
Two diseases dominated – we saw malaria daily, although it was not usually very severe in this partially immune population.
Artemether-based treatment was usually effective. The difficulty came with patients who seemed, clinically, to have malaria, but had a negative rapid test. The lab tech could do a blood smear, but only if she was on duty and the power was on.
HIV is also common, with significant numbers in a stable condition on retrovirals, which are distributed by a mobile outreach unit from the local hospital an hour away. Patients would never volunteer their HIV status, but had to be asked.
The sickest patients tended to be children with pneumonia and people with dysentery. Many responded well to IV fluids and antibiotics.
There was also the occasional emergency, such as a woman who came in with shock from a ruptured ectopic. I managed to set up a drip, and with surgery at the local hospital, she pulled through.
If you want a challenge, to help people and to broaden your mind, consider volunteering – or in this case, you could call it ‘voluntouring’.
- Dr Willis is a GP in Lincolnshire. Read more on his blog at: keitflyerzambia.blogspot.co.uk