From Perth to Zambia OPH Registrar's volunteer stint

In January this year, Joshua Thomas Obstetrics and Gynaecology Registrar at OPH travelled to Livingston in Zambia to volunteer at a hospital in need of obstetric work. He shared his experience...

Late last year, I received a phone call from a friend who knew of a volunteer district hospital/clinic in Livingstone, Zambia, that was needing obstetric volunteer work for their maternity department. It was based in Maramba district in Livingstone, Zambia, and was predominantly run by midwives with the very occasional volunteer obstetric doctor. Given my previous background of working in high volume obstetrics in Malaysia and having three years of rural experience (in both Australia and Malaysia), I felt it would be very worthwhile to stretch out a helping hand. I got in contact with the volunteer team in Zambia, and after reviewing my credentials and CV, I got offered the volunteer post at Maramba health district clinic, Zambia. I discussed this with my team of consultants and HR at Osborne Park Hospital under SCGOPHCG, who were ever more supportive in me pursuing my first international medical volunteer stint. I was very grateful for their support.

A little bit of background on Zambia’s perinatal mortality rates, WHO currently quotes a neonatal mortality rate of 23.5/1000 births in 2018, an improvement in comparison to its previous rates of 36.9/1000 births in 1969. In 2017, maternal mortality ratio for Zambia was 213 deaths per 100,000 live births. Between 1998 and 2017, maternal mortality ratio of Zambia was declining at a moderate rate to shrink from 596 deaths per 100,000 live births in 1998 to 213 deaths per 100,000 live births in 2017.

The efforts placed by the current ministry of health in Zambia in reducing the rates as per above are to be applauded given the lack of resources and manpower. With that, I hoped my contribution would hopefully make a small difference at least clinically in the local setting.

I left for Livingstone Zambia in January 2020, unknowing of what to expect, leaving behind my very supportive and capable wife and two sons in Perth as I embarked on this journey. At this current point, news of COVID-19 was starting to surface and showed its fangs in China however, international travel restrictions had not been implemented yet. I arrived at Harry Mwanga Nkumbula international airport at Livingstone, Zambia after transiting through O.R. Tambo international airport in Johannesburg South Africa. The whole journey took 10 hours of flight time and a total duration of 20 hours including layovers.

I was based in a district called highlands, in a volunteer base camp called Sunbird guest house. It was a whole new experience for me. I was informed that there would only be 4 hours of electricity a day and the occasional water cuts. There, I met 15 other volunteers from all different parts of the world being America, Spain, UK, Hong Kong, Denmark, and Holland. We all had our own roles be it medical, teaching, community building, construction and more. I was placed in Maramba district health clinic alongside Anne, a midwife volunteer from Missouri, USA and we were stationed at the clinic for three weeks in total.

On our first day at the clinic, we were shown around the clinic which comprised of a HIV and medical outpatient clinic/department, an inpatient ward consisting of 10 beds, and finally the maternity department, manned by four amazing and well skilled midwives from Zambia. Two midwives were stationed in the four bed labour and birth suite and one midwife each were in charge of the assessment unit and the antenatal clinic. My role was to oversee policies and guidelines and present suggestions for new and updated guidelines. I also helped oversee complicated obstetric births given that there was no operating theatre on site and there was a lack of instruments and occasional shortage of medications.

During my stint there, I introduced new fetal surveillance guidelines in keeping with RCOG, held antenatal teaching classes for groups of mothers and explained the importance of fetal movement perception and the need to escalate to the clinic if concerned. I also noticed that there was an ultrasound machine donated by a previous obstetrician from America, however it was under utilised given the lack of upskilling or qualified personnel to use it. I ran a tutorial for the midwives teaching them the basics of antenatal ultrasound, confirming fetal viability, presentation, lie, and mean vertical pool (MVP) of which they were exceptionally enthusiastic about and received well. I also introduced the kiwi cup, and taught the midwives the theoretical understanding of vacuum extractions and how to perform basic outlet extractions to shorten second stage of labour. Over my volunteer course of three weeks, I noticed a lack of medications for intrapartum care as well as equipment such as fetal hand held dopplers (pinnards were used) and a CTG machine. I then contacted the tertiary hospital in Livingstone and spoke to the maternity unit head of department. I enquired if they could run an upskilling course of intrapartum fetal surveillance, if I could provide the necessary equipment for Maramba clinic maternity unit. They agreed, and with that Anne, and I managed to raise a sum of 1500 dollars to purchase four hand held dopplers, a CTG machine, and months worth of medication supply such as lignocaine, Paracetamol, ibuprofen, Tramadol etc.

From working in a developing country such as Malaysia, and then to Australia, and now in Zambia, I was critically aware of the deficits that were present. However, I was very impressed by the capabilities of the medical personnel in their efforts to improvise whenever there was a shortage or lack of necessary equipment. They taught me how to work with very limited resources as well as the art of digging deep when facing an obstacle that may be threatening in many ways or form. Their sense of camaraderie and team playing capacity coupled with their resilience, was the pinnacle of my learning experience in Zambia.

At the end of my three week stint, I had mixed emotions on leaving as I had developed such a good relationship with many Zambians be it in the clinic or outside, that I call family now, however I had missed my wife and sons dearly and was looking forward to seeing them. I left Zambia, handing over to the next volunteer, now understanding how important the role of a volunteer is in areas of dire need, and forged a new appreciation of volunteerism (be it medical or other fields). I came home to Perth at the beginning of March and felt a need to continue my volunteer work as I felt it was the best ‘food for my soul’, and with that commenced my active volunteer work with international refugees via the Red Cross Society of Australia under the humanitarian settlement program and I also do soup patrol runs for the less fortunate twice a week.

I would strongly recommend those that have not embarked on the journey of volunteerism to consider this very noble act as it is truly an eye opener and places all aspects of life into perspective. To end, I would like to quote William Shakespeare who wrote “The meaning of life is to find your gift. The purpose of life is to give it away.”

I would like to congratulate all volunteers on a job well done and to thank you all for your amazing work rendered across societies and nations. We as humans are only as strong as our weakest link and in every way and form, we should strive to collectively propagate us as humans forward, leaving no one behind.

“The journey of a thousand miles, begins with a single step.”