It’s been a week since we (my fellow UVM resident, Dave, and I) arrived via a bumpy landing at Harare International Airport to start a month-long obstetrics rotation at one of Zimbabwe’s tertiary medical centers. At times cautiously navigating a foreign system and at others readily integrating into seemingly universal medical practices (daily rounds, admissions, systematic gathering of patient data), we are learning that being a doctor in Zimbabwe is in some ways unrecognizably distinct and in others comfortable, familiar.
Before I go further, I want to clarify something: throughout my preparations for this trip, I received a lot of undue praise from friends, family, and patients about how great it is that I would travel to Zimbabwe for a "medical trip," with the assumption being that I am somehow going to accomplish something great or to "save" people from death or illness. While I would love to be able to end vertical HIV transmission or to vaccinate everyone against HPV, to claim the title of humanitarian or rescuer of orphan children, the purpose of my trip is comparatively self-serving. I am here to gain perspective—to observe, to experience, and to learn what little I can in this short time about medicine and childbirth in a setting where healthcare resources are scarce, complications are frequent, and the only reasonable birth plan is for both mother and baby to survive. (According to a study published by the Zimbabwe Ministry of Health and Child Welfare, in 2007 there was one maternal death for every 138 live births and one perinatal death for every 35 births.)
Prior to departure, we were encouraged to read this interesting article, which discusses the and arrogance of privileged westerners who imagine that we can swoop in for a month or two—or even a year or two—and solve what we presume to be the readily solvable problems facing developing nations. Although I wish I had the power and ingenuity to solve the health systems problems here in Zimbabwe (and at home in the States), the more I experience I have in healthcare, the more I understand that each seemingly simple problem is a confluence of social, financial, political, historical, environmental, and religious factors. To make meaningful change in any one area requires more than just money or equipment or a new perspective from an outsider (here's an unfortunate example). Of course, I hope never to become jaded or to lose hope for a healthier, more just world…but I continue to learn that nothing is as simple as it seems.
We've been in Harare for a week now, and it has been jarring and heart-wrenching at times, humbling and heart-warming at others. With few exceptions, the Zimbabweans we've met have been warm and smiling, eager to extend a warm welcome to “Zim.” I’ll share a couple of stories from the past week here.
One morning on antepartum rounds we encountered a woman who had been admitted for management of a miscarriage at 34 weeks. The patient was sitting up in bed, distraught, with tears rolling down her cheeks. My heart ached for her as the doctor presenting her story told us that this was her second third trimester miscarriage. I couldn't have imagined the next thing he was about to say: "And early this morning we learned that her husband has died after being attacked by a group of thieves in South Africa." Dave and I looked at each other, shocked, as the rest of the team continued discussing the patient's care. While they of course found the woman's story to be terribly sad, it was as unsurprising to the rest of the group as it was incomprehensible to us.
While there are many more sad and shocking examples of delayed medical care and severe complications of pregnancy, it has also been fun to join the excellent team of doctors and midwives working in the "labour ward" where 40-50 babies are born every day! There are no epidurals, no birthing tubs, no electronic fetal monitoring--just a lot of amazingly strong women birthing a lot of adorable babies. Below is a picture of 7 babies that were born within 15 minutes of one another--and shortly after this was taken, 4 more were added to the crowd.
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