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Central Hospital, Bulawayo, Zimbabwe

Autumn 2000

From Saving Health - Autumn 2000 - Central Hospital, Bulawayo, Zimbabwe

Adesoji Abiona, from London, with Mr Michael Cotton FRCSINTRODUCTION
I spent five weeks in this 600-bed United Bulawayo hospital (UBH). Government care is heavily subsidised. There is one 'private' hospital in Bulawayo run at a standard comparable to hospitals in the developed world.

THE DEPARTMENT OF SURGERY
I was attached to Mr Cotton's team. He is an English consultant general surgeon of British training.

The firm was busy with a 1 in 2 on-call commitment and a rapid turnover of patients. There is a long operating list once a week with 6 - 7 'big' cases (requiring general anaesthesia) and 3 - 4 minor cases in the 8-hour scheduled list time.

A patient could be seen in today's outpatient session and admitted for tomorrow's operating list! A significant proportion of patients on the list travel for hours to get to the hospital.

RESOURCES AND DIAGNOSTICS
Articles often taken for granted in western hospitals were used economically. Some drugs needed in the hospital were often in short supply or were absent from the hospital's formulary. Many operations are carried out under intravenous anaesthetic ketamine.

Most basic blood investigations are available for half the working day. Urgent blood investigations have to be carried by Mpilo, the other UBH hospital.

The hospital has a reasonably well equipped radiology department with facilities for ultrasound as well as x-rays. CT scanning is available in Mpilo.

HOSPITAL IN-PATIENT CARE
Nursing care was generally delivered with great professionalism. At times though, the nurses seemed to just do their jobs and spent very little time talking patients. Doctors "gave orders" and the nurses carried them out, sometimes with little display of initiative. The doctor-patient relationship follows a similar format. Patients were very uncomplaining - they were quite stoical and seemed to accept any negative outcome as fate.

OUTPATIENT DEPARTMENT
The patient walks in carrying his own notes. The whole encounter is usually over in about 5 minutes but much is decided in this time. The surgeon books the patient directly on to his surgical list diary before writing a very brief summary into the patient notes which they carry with them to the junior resident on admission.

Patients present quite late in the natural history of their disease. They often consult their local traditional healer or witchdoctor before approaching conventional medicine as a last resort. Healed scars and tattoos are evidence of such consultations.

THE TRIP TO BEITBRIDGE
Beitbridge is the only border town between Zimbabwe and South Africa. It has a small hospital. Visits by a consultant surgeon were started by Mr Cotton. Through donations (mostly from abroad) and the services of Mission Aviation Fellowship who fly him into this and several other relatively remote areas he is able to fit Beitbridge Hospital into his already busy schedule back in Bulawayo.

Having finished the ward round at UBH by late morning, we headed for the airport whence MAF transported us in a 6-seater Cessna 206 light aircraft to Beitbridge - a journey of 1.5 hours. The landing strip was little more than a clearing in the bushes and we arrived to a waiting hospital minibus that was to take us the ten minute journey to the hospital.

We were met by the senior house officer. He directed us on a quick ward round An operating list for the day was composed - in all 6 patients long, ranging from Z-plasty of burn scars to inguinal herniotomy. Onwards to a busy outpatient clinic with typical cases of hernias, anal fissures, fungating recurrent breast cancers, thyrotoxicosis, and hare-lip and cleft palate - to name but a few who presented for assessment.

Then with no break for lunch, the theatre list began with a deadline of 4.5 hours to finish all the cases on the list if we were to be on time for our flight back to Bulawayo that same day. This was very narrowly achieved by operating non-stop, with only the shortest of breaks in between cases to recuperate and refresh. It was indeed an exhilarating experience as we operated to the last possible minute before having to leave to catch the plane.

IN CONCLUSION.
Being of African origin myself, I have found quite interesting the apparent similarities and differences in our southern- and western-African cultures. I found Zimbabweans to be a peaceful and patient people who generally complain little until conditions were absolutely unbearable.

My experience of Christian service abroad was in the role of observing the admirable manner in which a consultant surgeon applied Christian ethics and principles to difficult management situations that he faced literally everyday. His displays of tireless service and professionalism were very inspiring.

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