By Bridget Hartman, MD
I traveled to Zambia in 2004 when an interest in international medicine led me to accept a fellowship with the Centre for Infectious Disease Research in Zambia (CIDRZ). I had just finished a post-baccalaureate year and was in the process of applying to medical school at the time. I recall the anxiousness that comes with a new life experience like this one, and my time in Zambia certainly delivered the adventure and eye-opening experience I hoped it would.
CIDRZ is a nonprofit, non-governmental organization established in Zambia with a three-pronged approach comprised of clinical care for patients, research, and training of local medical professionals and expatriates in the fight against HIV and AIDS, as well as cervical cancer, tuberculosis, and malaria. Zambia is a landlocked country in the heart of sub-Saharan Africa with prevalence of HIV among adults estimated at more than 10 percent.
My time in Zambia created an incalculable change in me. I returned to the United States with a great appreciation for our health care system and the abundance of care to which we have access.
I've always loved to travel. Despite some early reservations about spending eight months in a new place, it seemed like the perfect time for a move like this. Why not apply for this fellowship that would provide the opportunity to live in Zambia for eight months and to learn about challenges faced by a developing country in sub-Saharan Africa with a high rate of HIV infection? There were about 10 of us fellows, and we each split our time between CIDRZ headquarters, in the capital of Lusaka, and regional rural medical centers.
A clinic outsite Kaoma, Zambia.
My regional assignment was in Kaoma, a rural town of about 14,000 people in the nation's Western Province. Kaoma has a small government-run hospital, one of the few dedicated medical facilities in the region, servicing a wide catchment area with its small prenatal clinic.
It was here that I, another American fellow, and a Zambian medical student began to lay the groundwork for the establishment of prevention of mother-to-child transmission (PMTCT) of HIV programs. Such programs are designed to teach local medical professionals to avert the infection of newborns by their mothers.
We gathered data about the number of admittances and deliveries, managed a local acting troupe that performed skits to educate locals about HIV testing and the importance of knowing their HIV status, and worked to organize education programs for local rural health care professionals, many of whom traveled days on foot to reach the hospital for training meetings.
Because we fellows had yet to receive any formal medical training, we had limited interactions with patients. Our contact with local hospital administrators, nurses, and local health care workers was much more extensive than it was with patients directly.
The most immediately striking impression of Zambia was one of incredible poverty. Nearly 70 percent of Zambians live below the poverty line, with rural poverty rates approaching 80 percent. As a newcomer, I was shocked by the pervasive lack of resources and profound limits on access to health care.
A woman waits outside an antenatal clinic in Zambia.
Looking beyond Zambia's poverty, I was overwhelmed by the positivity and warmth of the Zambian people. The medical workers and staff were impressively caring and motivated, and there was great optimism shared by both the health care providers and the patients. My lingering impression of the Zambian people was and remains one of amazing hopefulness and generosity, which helped significantly to offset the frustration of working with such limited resources.
My time in Zambia created an incalculable change in me. I returned to the United States with a great appreciation for our health care system and the abundance of care to which we have access. I also learned a great deal about the role that non-governmental organizations can play in improving conditions in developing countries. My experiences led me to initially consider a career in obstetrics and gynecology or infectious disease, but I ultimately fell in love with dermatology.
CIDRZ as an organization has grown a great deal since my time there, and I strongly recommend a CIDRZ fellowship for students with an interest in international medicine. I will be returning to Africa this January to spend a month practicing dermatology in Botswana on an AAD Resident International Grant.
I'm excited to return to sub-Saharan Africa with a new set of skills that will enable me to focus on patient care this time around, and I hope to learn how I might incorporate future opportunities in international medicine into my career in dermatology in a way that is productive and sustainable.
Dr. Hartman is a fourth-year resident in the Department of Dermatology at Oregon Health and Sciences University in Portland, Ore. She completed her medical degree at David Geffen School of Medicine at UCLA and her Bachelor of Arts in political science at Duke University.
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