Day 12: Beit Cure Hospital

Today we spent the day at Beit Cure Hospital. We started our program there and we are ending it there, as we will be there for our last working day tomorrow also.

We assigned students to rotations in Audiology, ENT, the children’s ward and physiotherapy. I was in Audiology and because Alfred, the audiologist at the hospital was ill he ended up leaving us in charge and we tested 17 patients in the morning clinic! It was busy and kept us hopping, but the students did well and it was clear to see that they have learned a lot in terms of basic testing skills over the past 2 weeks! We saw lots of patients (both children and adults) with eardrum perforations after chronic ear infections, some post-op, and one little girl who had lost all her hearing after meningitis about 3 years ago.

Hearing testing – teamwork

Other students enjoyed observing the two ENT nurses Evelyn and Charity: they got to see patients with chronic ear infections, eardrum perforations, and fungal ear infections. Still others checked hearing aids and also took apart some hearing aids, spent time with children in the wards, in physiotherapy and in the kitchen helping with preparations for lunch (nshima, beans and kale).

We stopped for lunch at about 1:00 and had a nice lunch out in the open. Then it was back to the clinics at 2:00. I saw three more patients in the afternoon, and then wandered a little – first to the laundry to see Jessica ironing and Jill folding laundry, and then to the wards where students were playing with children.

Ironing laundry

And folding it….

We wrapped up around 4:00pm and returned to the lodge. Before we left for dinner we decided to take a group picture of all of us wearing our chitenges that we got from our Zambian buddies yesterday…

Group wearing our chitenges

Once again we went to the Arcades for dinner – most of us ate at the Mint Café, which is quite good and has a lot of vegetarian choices. Then it was back to the lodge for the nightly de-briefing in the presidential suite. Today’s discussions:

• They enjoyed spending time in the wards with the kids; one student spent a long time with a child and his grandmother and was given a gift by the grandmother – a chitenge!
• They found the ENT rotation to be really interesting – especially as they were allowed to look in ears and see the disorders
• Two students got to observe an in-office myringotomy and tubes on an adult: this involves putting a local anesthetic in the ear, then making a small incision in the eardrum and inserting a tube in the eardrum. This adult patient had a large unrepaired cleft palate, and has to wait yet another year before specialists will be visiting Beit Cure and he may be finally able to have the cleft repaired!
• They commented on how undergraduate students in the US do not really get any clinical experiences, and it is very different in other countries (as we have discussed here on a couple of other occasions), where they get some experiences and in fact in many other countries the model is to have an undergraduate degree that allows one to do clinical practice. In fact the clinical experiences in Audiology this week have made one student consider the AuD (she came in thinking she was going to do speech pathology)
• Despite the transportation problems that we have heard about, they were impressed at the return rate of patients who kept follow-up appointments
• They were allowed to look at patient files and found it interesting to read the doctor’s notes in the files about each patient some of which were quite personal
• They commented on how patient “comfort” did not appear to be the first priority; rather the focus was more on the treatment with little explanation to the patients, and a very different kind of patient interaction
• They noticed that most of the children sat still and were very cooperative for the procedures
• They noticed that people still use malaria medication is ototoxic (despite the WHO recommendations to use alternate medications)
• They also noticed patient comments that they used their “old” gentamicin drops that had been previously dispensed, rather than getting new medication. We discussed the overuse of these drops to treat ear infections, that then may end up causing hearing loss
• They commented on the use of English words in Nyanja conversations – we have to investigate whether they are interspersing English words or whether Nyanja which is considered a mixture of languages actually includes some English words

Tomorrow will be our last working day – and it is with mixed emotions that I write this. Yes, I am happy to be going home, and yet, these experiences in Zambia will be pulling me back I am sure….