Greetings from Zimbabwe! Adam and I have been in the city of Harare already for over a month. We thank you for your patience awaiting this first blog post!
We are stationed in Parirenyatwa Hospital, a sprawling complex with over 2000 beds that serves as a community hospital for Harare and a referral center for the entire country. There is hope that it would be a fantastic location for UVM students and residents to rotate in the future. As such, we have been doing our best to serve as forerunners and representatives.
Prior to our arrival, we had almost idea of what to expect. Not too long ago, Zimbabwe was one the more prosperous nations in Africa. However, the country’s many woes have been highly publicized in western media over the past decade. In 2008, Zimbabwe was the source of the world’s worst inflation, with prices doubling daily with currency eventually ballooning by a stunning 22 orders of magnitude. In the midst of the economic collapse and the HIV epidemic, Zimbabwe became the site of the world’s lowest life expectancy in a country not in wartime—37 years old in men and 34 in women. At one time, over a quarter of the country’s population was HIV positive (it is now estimated to be around 15%).
Without a reliable source to tell us how much things had improved, we expected the worse. The Zimbabwean immigration website informed us that visitors were required to bring in sufficient funds to survive the length of their stay—which we guessed meant no functioning ATMs. Visa requirements were Byzantine and Adam spent dozens of hours on the phone with the embassy, trying to get a straight answer. Tourist blogs warned that waving with an open palm—the sign of political opposition—was an imprisonable offence.
What we have found, however, is one of the friendliest and most pleasant countries we could imagine—and one that has made great strides forward from the chaos of the 2000’s. We have been welcomed with a smile everywhere we have gone, and never felt unsafe for a moment. In addition, although the country still has overwhelming medical needs, we’ve been surprised at the comprehensiveness of hospital services and robustness of the medical education system.
Adam is in the surgery department and I am in the pediatric department. For me, the experience has been a thought-provoking juxtaposition between familiar medicine alongside huge differences in pathology, culture, and resources.
For example, every morning our team—made of medical students, residents, and an attending pediatrician—go on patient rounds. The bedside physical exams and teaching are usually superb. I feel right at home with about half of the pathology—bronchiolitis, neonatal sepsis workups, neonatal jaundice, asthma exacerbations, and diabetic ketoacidosis. We get labs and imaging when needed, and usually provide standard-of-care treatments.
Yet it is impossible to ignore the fact that somewhere around half the hospital’s patients are HIV infected. Malaria is on the differential for any febrile illness, and TB for basically any chronic illness. Less than ten years ago, this hospital was the epicenter of one of the largest cholera epidemics in recent history, one of the only nosocomial cholera epidemics ever recorded. Medication shortages, staff shortages, and bed shortages are the norm. And perhaps the only reason things function at all is that it is an up-front, pay-for-service hospital—those who are truly destitute are referred to far more crowded and under-resourced centers.
From my point of view, this mix of familiarity and along with high volume, acuity, and new pathology has served as an ideal transitional learning experience.
It is also an ideal place for additional resources to make an enormous difference. There is a fantastic infrastructure in place here, and the hospital is staffed with dedicated, talented, and experienced medical professionals. Any new medical resource here is immediately utilized to its absolute maximum capacity. For example, when Adam showed up on the surgery wards carrying a copy of a new edition of a surgical question bank he had brought, it attracted the attention of every member of his team. Adam soon decided he had little choice but to donate the text to the department, and within a week dozens of spiral-bound copies of the text had been distributed. One week later, some residents and physicians had already completed the entire book (and pearls from the book quickly were finding their way into clinical practice).
As such, we believe that the University of Zimbabwe and Parirenyatwa Hospital are perfect partner sites for The Microscope Exchange to support and collaborate with. And we are excited report that we have already been able to present a magnificent 5-headed teaching microscope to the University of Zimbabwe College of Health Sciences (UZCHS). We are confident it will get a remarkable new lease on life here that may last for many decades.
UZCHS is the only medical school in Zimbabwe and the source of nearly all of the country’s physicians and nurses—going on to serve a population of almost 15 million. Nearly 200 students matriculate each year at the medical school. The challenges these students undergo on the path to becoming health professionals can be shocking. Students will save every penny they have to purchase new textbook editions—paying sometimes twice the books cost in shipping—just stay abreast of standards of care. From the years of crisis, students tell stories of eating on the 0-0-1 plan (one meal per day), and having no water to wash their hands after dissecting in the anatomy lab. Their educational model is in the strictest British tradition—meaning that what we consider student abuse in the US counts as a complement here. Although we heard Zimbabwe was suffering from enormous brain-drain, we have found that the hospitals are full of residents and new attendings excited to improve their country and grow as physicians.
Most pertinently for our perspective, medical students at UZCHS learn histology and pathology on only a few dozen outdated microscopes. The professors in the UZCHS department are skilled pathologists and microbiologists, but lack the resources to provide the necessary training in diagnostics and pathology for students (even though doctors across the rural areas of the country are expected to perform most microscopy themselves).
We presented the microscope to the Dean of the Medical School, and between all of the hospital’s clinical departments, he chose medical education as the greatest area of need. The microscope will be utilized by multiple departments around the clock. Most excitingly, its top-of-the-line scope mounted camera will allow projected microscopy for entire lecture halls, effectively creating the capabilities of nearly 200 microscopes.
We will be back with some final departing thoughts. We have been having an incredible experience, and want to thank those who have made this trip, and our microscope donation possible, including
the UVM office of medical education, and Dr. Sadigh for transporting the 80lbs scope from the US and through customs.