When I arrived in Zambezi I was confident that I had come without any expectations. I had a busy last semester of college with graduation preparations, medical school finalizations, and a full load of classes, so I had minimal time to envision what my month in Zambezi would entail. I got off the bush plane with an open mind and an open heart, ready for impressions to be made upon me. However, I soon started to discover hidden expectations that had been conditioned within me throughout my American life. Particularly, the healthcare system in Zambia left me with the realization that my preconceptions about basic health care did not match the realities before me. Over the past few weeks I have come to see that what I thought were universal standards of healing were in fact only privileges reserved for those able to pay for them.
I am more or less obsessive-compulsive and have perfectionist tendencies that manifest as habits to clean, organize, and control everything around me. Given these compulsive propensities, certain aspects of hospitals and the health care system in America drew me to study medicine. When I stand in an operating room there is a certain calm that washes over me. The room is spotless and smells so clean that I cannot help but breathe in deeper; the walls are fresh and white while the floor is shining and manicured; the instruments are smooth, undisturbed stainless steel, and the outfits and dressings are crisp and unstained. Perhaps even more attractive, however, is the step-by-step procedural organization and control that exude from the operating room. It is meticulous, where checklists are made and protocols are followed; it is where I undoubtedly belong.
Given my passion for surgery, I have spent a significant amount of time shadowing in operating rooms and am familiar with the associated procedures, rituals, and precautions. When I found myself standing in the Zambezi District Hospital’s “Operating Theatre,” my expectations of what I would encounter in that room were immediately shattered. Instead of fresh white walls I was staring at peeling, yellowed paint. Instead of shining floors I was staring at sandy, cracking, concrete. Instead of shiny instruments and bright lights I was staring at rusting sinks, spider webs, collapsing ceilings, and a corroding operating table. This was not my haven; it was my hell. I commend the doctors and surgeons that work at these hospitals as they try to save lives in conditions that fight them every step of the way.
Healthcare in Zambia is free. My expectations of what free healthcare would look like shifted as I was told that although fees are not a problem, transportation is. Only a few designated hospitals throughout Zambia are equipped with antiretroviral drugs for HIV/AIDS treatment, and thus treatment is inaccessible to a large portion of the population. Some of the district hospitals also deal with corruption, with leaders pocketing money that was intended to purchase vaccinations for the population. I cannot imagine a world in which free health care could be so difficult to take advantage of, where doctors and hospitals were not a comforting commodity around every corner, and where not even those dedicating their lives to healing are trustworthy with honest intentions.
My expectations were further challenged yesterday during our visit to Chitokoloki, one of the most respected and sought-after missionary hospitals in Zambia. The hospital constantly exceeds capacity, having to accommodate excess patients on makeshift mattresses all over the floors, and private rooms for treatment are non-existent. Women and men are separated into their respective wards, which are large open rooms packed with beds to allow for “patient privacy.” Patient protection programs, such as HIPPA, are nonexistent, and the reciprocal doctor protection programs, such as lawyers and impeccable dissertations, are not necessary seeing as Zambian patients do not sue their doctors. Premature babies are left in dysfunctional incubators heated by a warm water bottle, and before recent innovations, x-rays had to be hand-developed in a dark room before they could be read.
Although the operating rooms at Chitokoloki were much improved compared to the Zambezi District Hospital, they still lacked basic necessities such as anesthesiologists. This type of doctor is present in every operating room in American hospitals and yet is nonexistent in the district, thus requiring all surgeries to be performed under local anesthesia. This expectation was one of the most shocking for me to let go of. These people had to go under the knife in a waking fog with no muscle relaxers, speaking to the bravery of both the patients and surgeons. Yet there are no complaints. These people do not whine, they do not cry, and they certainly do not have anything to say about the meager conditions in which they are treated. The resilience of this country astounds me.
The health care students, plus a few others tagging along, were permitted to watch both a bilateral tube ligation and a basic hernia repair. As I prepared to enter the operating room I found myself waiting for the ritualistic instructions, preparations, and sterilizations. None of these expectations were fulfilled. We were told to find some scrubs in the supply closet and put them on, and that shoe covers and masks were not necessary. Our only instructions were to avoid touching anything blue in the room, which signifies sterilized equipment and surfaces. Further, the surgeon allowed seven of us to observe in his operating room. In America most doctors do not allow more than one student observer in the room at any time; my previous experiences have done nothing to prepare me for Zambian medicine. I was prepared to be chilly in the operating room, as they are kept cold to control microbial growth, but actually found myself quite warm standing there. The room felt strangely relaxed to me with the familiar procedural orders seemingly lost in the art of improvisation.
The hospital staff amazed and inspired me. These people literally have dedicated their lives to saving people in hot, smelly, second-hand conditions, and they do their jobs without complaint, without hesitation, without leave, and without letting their limitations stop them from defying impossible situations. They have become self-sufficient and have learned to improvise with unmatched skill. It is inspiring to see what expectations you can rise to and what standards you can set in the face of such obstacles.
Although Zambia is filled with happiness I cannot begin to measure, love I cannot begin to emulate, and hope I cannot begin to harness, it is also filled with unimaginable darkness and cruel hindrances. Medicine was designed to make people feel better, to make them feel secure, and to ensure confidence; yet the medicine here is unlike any I have ever encountered. As Zambezi has dissolved expectation after expectation, I have begun to rediscover the face of medicine. I realize now that doctors and hospitals are more than just checklists, order, and precautionary protocols; they are where innovation is fostered, bravery is expected, and where faith is constantly called upon to make the impossible seemingly palpable. This continent may not be a leader in medical advancements, but I think Africa has a thing or two to teach future doctors like myself on adversity and finding a way to beat the odds; after all, a life might depend on it.
God bless and much love,
Kylie Edinger, Class of 2014
P.S. Mom, Dad, Jake, Jason, Jonathan, and the rest of my family: I love you all dearly and miss you all deeply. Zambia is in my veins and I cannot wait to share it and my future plans at Chitokoloki with you. Kisu mwane xoxoxoxo.
Your words brought me to tears and also made me laugh out loud. Your ability to capture the essence of what you see and feel made me feel like I was right there with you. Nothing about Zambezi is easy but I am absolutely confident that these things are going to make you an even better doctor one day. I love you girl!
To the whole group: each day your words serve as a beautiful reminder to my own Zambezi experience and the lessons it taught me. For that I thank you.
I’m so glad you got to experience that! I can see you just being in shock in that operating room after all the perfectly clean ones you’ve seen. I can’t wait to hear all your stories from your trip! I miss you so much!! I am scheduled for my first flight tomorrow morning. I’m not sure if you get to read this but just in case, maybe someone can pass the word. I love you!! Hurry back!!
Alright so Susan’s comment on Shannon’s blog made me realize just how much of my mothers daughter I really am- josh and Conner could attest to this. But truly, I just don’t ever want to say goodbye to Zambezi and your blog posts have been my outlet to keep holding on. So thank you 🙂
Kylie, after reading your post I immediately texted my boyfriend Christian (pre-med) and told him he needed to check it out. He was so interested by your experiences and your newfound outlook on medicine. I’m so happy that you’ve been able to grow in this way and share that growth with other aspiring doctors who may never get the chance. Even though I don’t know you, your writing made me so confident you’re going to make the best surgeon one day. By the way… I’m so curious about your plans in Chitokoloki!!
Conner, it may have missed it in Zambia time but it’s your birthday in Washington TODAY and let me tell you the sun is SHINING! 80 degrees in Tacoma after a week of clouds and rain. It must be because of you 😉 Happy bday Conner I can’t wait to celebrate in Spokane with ya.
Hi Mark, Cecilia, Matt and Josh! Thinking of you and the rest of your Zamily daily…as I’m sure you can tell.
HAPPY 21ST BIRTHDAY CONNER!!! I hope your day is/was full of joy, you deserve it! My phone just started buzzing and I looked and it said “Conner House’s Birthday is today.” And then I remembered you are in Zambia and I remembered you guys have this blog! I have spent the past hour or so reading everyones heart felt, passionate, thought provoking posts. You are all an inspiration! I am honored to go to school alongside such selfless, genuine people. After reading this post Kylie it sounds like anyone would be extremely lucky to have you as their doctor one day. Anyways I hope the rest of your guys’ trip is great, and I can’t wait to hear about it firsthand when you get back! HBD CONNER CAN’T WAIT TO BUY YOU A DRINK WHEN YOU COME BACK! Sending lots of love your way!
Cecilia- I hope Zambia is treating you well! I’m sure everyone is inspired by your kind heart and energetic spirit! Can’t wait to go on adventures with you this summer (none will be as cool as Zambia but we can head to Canada)
Mark- We miss you around here and can’t wait for you to come back! I’m sure all the kids think you are some famous soccer star and that the community is loving you as their computer teacher!
I love your post. I wasn’t a part of the health group when I was in Zambezi, but the one day I got to go with them was by far my favorite day, the most special to me and yet at the same time the most challenging. And although we went to a classroom and not the hospital, so much of what you have been amazed by reminds me exactly of what I felt witnessing the intricacies of healthcare there… keep being amazed!
PS: Hi Josh!
Kylie- your post really resonated with me as I’m in healthcare as well. Such a gift to experience such a “different” side of medicine. It’s difficult for any of us to fathom patients going “under the knife” without general anesthesia or a spinal block….your reflection on rediscovering the face of medicine is a gift you will always treasure and it will no doubt assist you with being one of the best future doctors out there!
God Bless you All!
P.S- Love you, Conner House!
WOW….you all look great in scrubs! So glad you got to see this side of health care. In addition to making us grateful for what we have, it also teaches important lessons about how quality care really can be delivered with limited resources when there is dedication, creativity, and courage.
Kylie, I know how excited you must have been to be able to observe and get a glimpse of the medical facilities while in Zambezi. I know this because of how excited you get at the opportunity to observe ANY medical facilities no matter where you are, let alone on another continent! I feel it is with purpose and not by chance that you ended up in Africa witnessing a completely different realm of medicine both from the patients and the doctors point of view. While the facilities, conditions and protocol may differ, what remains the same is that there are medical professionals who are dedicated to giving their best and patients who trust them to do so. Your keen awareness, deep faith and genuine compassion will serve to make you a great doctor no matter what circumstances or country God places you in.
It looks like you all having fun and making wonderful memories!:)
P.S. We love you Kylie and Jake flew today! No word on LASIK yet.
WOW! Wonderful job depicting this experience. I scrubed in a surgery last year at Chitokoloki and was blown away at how brave, creative and compassionate everyone was. I couldn’t believe the limited resources and how much was accomplished there everyday. I would love to go back and work with Tanis someday as well. Thank you for sharing your experince.