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My Elective - Blog 2

By Alice Gwyn Jones

My Elective - Blog 2

Saying goodbye to Zambia

With our time in Zambia coming to a close, it was time to look back and true medical school style reflect on the experiences we've had.

Having always been taught about triadic interviewing in medical school and the challenges that clinicians face in these situations, I'd never quite believed it. My ignorance maybe of always being presented with simple triadic interviews in GP and A&E, with genuinely concerned relatives.

This particular shift in the surgical casualty department (A&E is split into surgical and medical over in Zambia prior to doctor review), the true difficulties of triadic interviewing raised it's ugly head, to my surprise in the form of a medical student. As my Nyanja still hasn't improved much past how are you and thank you, I needed someone to translate for my 29-year-old patient with multiple swellings in her neck and groin.

The only person available was a 5th year medical student (3rd year UK equivalent). I started by introducing myself and checking the patients name on the form I had with her details on it before asking what had brought her to the hospital.

Immediately stopped by my "translator" who proceeded to question why I hadn't asked what village she was from, who her next of kin was etc etc, I agree those were relevant questions if it wasn't for the fact all this information had already been recorded, but to this day I'm not sure how her being Christian is going to affect her management to the point of me being forced to write it above the presenting complaint.

Anyway, 10 minutes into the consultation I finally got the presenting complaint, something I already knew from the triage sheet. A non-productive cough that the patient had had for a year with some associated pleuritic chest pain and painless lumps that had appeared between 3 to 6 months ago in her neck, groin and arm pits.

No fevers, some pain in the lumps in her groin when she starts her period and some decrease in her appetite. This was all I managed to get out of the 3-way consultation that was going on, until the medical students phone rang. To my shock she then proceeded to answer the phone mid consultation!

A few phone calls later and a little more history from the patient in between, the medical student decided this time to pop outside to take her next chat on the phone, I jumped into examining the patient due to my lack of translator. I frankly didn't want to just stand there in awkward silence with the patient after attempting a hand gestured consultation before the medical student decided to reappear.

I wasn't expecting the ridicule I was met with when she reappeared into the room, it seems that everything is done in a specific order here, clerking isn't a guide on how to construct a history from a patient but more the law. When finally examining the patient, I really did need the extra time to document.

With over 30 lumps on her body, ranging from her neck, armpits, groin and even managed to find a few periumbilical lymph nodes. These lymph nodes were some bigger than I ever imagined a lymph node could be. One in her groin measuring 10cm in length.

Anyway, with the longest consultation I think I've ever had with a patient, my provisional diagnosis of Non-Hodgkins lymphoma (why she had been triaged to the surgical department I was unsure) which meant a short admission to the surgical ward to await biopsy before being admitted to medics.

Watching the medical student squirm under the wrath of the consultant later in the ward round, did put a brief smile on my face, but to give her some credit, I wouldn't have been able to concentrate either with surgeries version of the ward chicken they have in paediatrics, a naked man bum shuffling around the floor.

After what felt like a very long day, it was time for the other side of what elective is all about…

Taking a few long weekends to explore Zambia, we really did manage to cram in some adventures. Firstly we went up to South Luangwa national park after a killer of a 12 (more like 15) hour bus ride, that made a chicken bus look fancy, we made it to our lodge. A quick fully clothed jump in the pool later, we checked into our rooms, well we had to get the bus germs off.

A weekend of safari, beer by the river hippo spotting, not getting in the way if the daily lodge visitor - a 4 metre tall bull elephant and a few embarrassingly bad attempts at African dancing. Although the most expensive part of the entire 4 weeks, the money was worth it, for the most magical experiences of spotting lions sleeping to a leopard coming less than a metre away from our truck. The 12 hour bus ride seemed a million miles away, until we had to get it back!!

But we still weren't done with our bus journeys yet, slightly better 7 hour bus ride brought us to Livingstone. Luckily the adrenaline in our blood kept the agony of the pressure sores and the DVTs developing at bay. It was time to visit Victoria Falls, and what better way to see the falls than to bungee jump it!!

The terrifying feeling of dropping 111m into the valley under the falls was indescribable. Deciding we should probably go see the falls without pure fear in our eyes, we took the tourist path next to the falls, and got absolutely soaked through, the spray getting you before the falls even came into sight, but wow, definitely understand why it's one of the seven wonders of the world.

We couldn't simply go back to Lusaka without a last adrenaline fuelled trip to say goodbye to Livingstone, so we opted for white water rafting in the series of grade 5 rapids that stretch 20km down the Zambezi river. A few close calls but all alive we made our way back to Lusaka, exhausted but raring to go for the next 4 weeks in Cape Town.

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