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My Elective - Blog 2

By Anna Phillips

My Elective - Blog 2

I absolutely loved doing my paediatric elective in Lusaka! Here are the three main differences that I noticed between my experiences in a Zambian city hospital vs the NHS.

Paying for Care - Although care at the hospital is subsidised by the government, patients are required to pay for certain investigations and treatment so test results weren't as readily available as they might be back home.

This gave me a newfound appreciation for the skill of clinical diagnosis, without a heavy reliance on lab results. It made me wonder how much money is wasted on unnecessary investigations in the NHS. However, I also felt grateful that my practice in the UK will not be restricted to what a patient may be able to afford.

Doctor-Patient Relationships - I have noticed that doctors here adopt more of a paternalistic model to patient care, where decisions are made to benefit the patient or wider population. This might be because of the patients' health education, perception of control in their health and trust in healthcare professionals.

In the UK we are taught to adopt a more mutualistic relationship model. There are pros and cons of each - e.g. it can be difficult to accept when patients make a decision against a treatment or investigation that you have advised. However, the act of sharing the responsibility of decision making and facilitating patients to act autonomously can help to build a strong rapport and reduces the challenge of attempting to act on behalf of someone's best interests.

Patient perception of health and the cause of illness - The first patient I saw was a 6 month old girl with severe hydrocephalus. Her mother brought her over to me, bundled up in thick blankets and together we peeled them away, layer by layer, to reveal her fragile little frame.

Her mother had been covering her like this for months due to the social stigma of having an unwell child. She had eventually sought help from a traditional healer when she noticed her baby's sunsetting eyes, as she wondered whether the illness was caused by something supernatural.

By the time she presented to the hospital, her baby was so malnourished and her hydrocephalus was so advanced that we couldn't offer surgical treatment. Although this was sad, learning about and respecting deep-rooted cultural beliefs about health was an important learning curve on this placement.

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