Out of Africa — Experiences of a Canadian Doctor in Zimbabwe

Countries in Africa are among the poorest in the world. As a result, they often do not have resources for basic health care. The most common medical problems are related to a variety of infectious diseases, and African countries have the highest incidence rates in the world of life-threatening infections such as tuberculosis, meningitis, malaria, and acquired immunodeficiency syndrome (AIDS). In November 2000 I went to Zimbabwe as a medical volunteer with a Canadian–Jewish humanitarian organization called Veahavta. I worked at a rural Salvation Army hospital, the Howard Hospital, in a small farming community called Gweshe, about 90 km north of Harare, the capital city. The area is primarily agricultural, with numerous small subsistence farms. The hospital has 150 inpatient beds, a very busy outpatient facility, and a regional obstetrical service with more than 3000 deliveries per year. There is one full-time physician, an obstetrician born and trained in Canada. I spent nearly 3 weeks at the Howard Hospital, where I was responsible for medical care for both inpatients and outpatients, assisted at surgical procedures, supervised a clinical research study, and provided educational sessions for nurses and nursing students. As might have been expected, the major medical problems encountered were a variety of infectious diseases, including AIDS, tuberculosis, pneumonia, gastroenteritis, and schistosomiasis. We also treated patients with rheumatic fever, malaria, hepatitis, meningitis, sexually transmitted diseases, pelvic inflammatory disease, mucocutaneous candidiasis, burns, and traumatic wound infections. The only laboratory tests available were hemoglobin level, white blood cell count, blood glucose level, pregnancy testing, Gram staining, acid-fast staining, malaria prep, direct smears for ova and parasites, and VDRL (Venereal Disease Research Laboratory). Microbial cultures were not available. It was possible to perform plain radiography and abdominal ultrasonography, but no other imaging studies. As a result, most of our diagnoses and treatment were empiric. A restricted group of anti-infective agents were available — penicillin, cloxacillin, ampicillin, erythromycin, tetracycline, clindamycin, cotrimoxazole, nalidixic acid, metronidazole, kanamycin, chloroquine, continued on page 7 In November 2000, Andrew Simor, the Head of Microbiology at Sunnybrook and Women’s College Health Sciences Centre, travelled to Zimbabwe as a medical volunteer. He took this issue’s cover picture during his stay. It shows at least 14 people who were undergoing active investigation for tuberculosis (TB) on one day in the TB clinic at Howard Hospital. Out of Africa — Experiences of a Canadian Doctor in Zimbabwe

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