Our first week in Zambia has come to a conclusion and an interesting one it has been! The University of Zambia and the University Teaching Hospital of Zambia have graciously welcomed us into their country. The hospital itself spans a fairly large area of land and has multiple "blocks" that consist of the main focuses of the hospital -pediatrics, ob/gyn, internal med, and surgery. There are also numerous clinics connected to the hospital as well as a fairly new cancer disease hospital.
This week we worked in the OB/GYN wards with Jimmy, one of the clinical pharmacists at UTH. Jimmy is an extremely smart, funny guy. He caught me off guard because whenever he asks a question and you answer, he gives you absolutely no sense of affirmation. I was never sure if I was right or wrong and then I would start questioning myself and then he'd start laughing at me and say I was right all along. Needless to say, I think he had a fun time worrying me. Jimmy wrote this fantastic book of ob/gyn focused cases that he loaned us; it was a great resource to have as our wifi access was very limited.
Mornings consisted of ward rounds where we visited patients with a team of health professionals -the consultant (the equivalent of an attending in the United States), medical residents, medical students, pharmacy interns and the pharmacist. The team size averaged around 15 health professionals per day but Jimmy told us that these teams can get as large as 30 when all the students are back in session. With multiple patients in a room plus the entire rounding team, things could get a little squishy at times. We encountered numerous disease states including anemia, pre-eclampsia, placenta previa, pre-term membrane rupture, HIV, malaria, steroid use in pregnancy, and Rhesus disease. The biggest difference between these rounds and those that I have experienced in the United States was simply technology. UTH utilizes handwritten medical charts whereas I, and I'm sure all of my classmates, am used to using an electronic medical record. It really humbled me to be brought back to paper charts, trying to decipher what the doctor had written in the drug chart and having to share the one version of the medical chart between the whole team. And, honestly, it really tested my knowledge because I had no means of looking up drug information or pathophysiology while on rounds. I solely had to depend on what was in my head. It's challenging because I feel that I've become so reliant on all the amazing drug resources I normally use: UpToDate, Micromedex, Pubmed, etc. It's all gone and now I have to step up and show some confidence of what I've been putting into my brain these past three years.
Afternoons were fun because we had many topic and case discussions. Jimmy taught us a lot about the protocols here at UTH. Sometimes, there were pharmacy interns that would join us. In Zambia, once a student finishes their Bachelor's of Pharmacy degree (takes 5 years and includes undergrad), they are required to complete an intern year, where they rotate through the different sites of the hospital and sometimes community. I equate this to our final year in the PharmD program because it is on site training.
Today, our last day of the week, we had the opportunity to hang out in the delivery ward and watch the miracle of life happen in front of us. It was my first time watching a baby be delivered and I don't think I'll ever forget it. I found it interesting that there were absolutely no men (except the doctors) in the ward, no husbands, no family members. It may be because the ward is already so busy, any extra bodies would just be in the way. As soon as a mother has delivered, they are cleaned up and sent to wait out in the hall until the baby is good to go. I have never seen a live birth in America but that is not how I pictured it going. The nurses and doctors were extremely skillful and able to handle multiple mothers in labor at once.
If this first week is any indication of how much I'm going to learn in the next month, I absolutely cannot wait. The people here have been so kind to us and truly go out of their way to ensure that we are having the best learning experience possible. Up next on the agenda, internal med next week!
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