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Chitokoloki Mission Hospital, 2006 - Tim Warlow, medical elective

There is so much to say about the spiritual, medical, mental and physical challenges and opportunities on my elective. However, I feel that focusing on the overriding and predominating feature of the importance of focussing on God, is both of most interest and most relevance to other students undertaking such 'out of this world' placements as I did. I visited a small mission hospital called Chitokoloki mission, 3 1/2 hours by chartered mini aircraft from Lusaka, Zambia's capital, close to the Angola border.

In contemplating my elective during my 4th year exams, thoughts of relaxing by the Zambezi river, reading my bible, and seeing some interesting medicine filled my mind. Time to concentrate on my faith which at that point was shaken to shreads with exam stress was a must. I was looking forward to escaping the stress and bustle of western life for a calm, tranquil spot in the bush where I could reflect on life, this past year and the future. Lots of time with God would make up for my neglected quiet times during hectic revision.

Soon upon arrival however, I realised that my plan was to be turned on its head in a rather dramatic way. The first week consisted of 14hr days doing ward rounds with the one resident surgeon and sister, long days of surgery and dealing with every pathology under the sun. Each morning after a devotional meeting with the staff we were faced with a huge queue of largely disgruntled Zambians, waiting to be seen by us, along with a full schedule of surgical patients twice a week, an outpatient clinic with over 100 patients, as well as a TB and Leprosy colonies to be seen to. I was relieved to hear that Sundays were off, however in practice there were always badly times caesarean sections or ectopic pregnancies that needed to be seen to and operated on!

After two weeks I was beyond exhausted and fending off my natural grumpy nature when tired. But this was just the beginning. Soon after, I became the on-call Dr, 24hrs a day, 7 days a week. I was up at all hours assisting breach deliveries, reciting catheters, seeing emergency admissions of cerebral malaria, battery acid ingestion, intestinal obstruction etc. A shock to the system would be the understatement of the year!!

I rapidly realised that this would be a very different elective to the one I had expected, and the time with God I longed for became shouts for help as I inserted pleural drains and diagnosed patients with diseases I had never seen before. A complete dependence on God became nothing less than a necessity.

He got me through situations I could never have dreamt of dealing with. For example, one night at 3am a call from maternity comes in….. 'Dr Tim, breach twins for you to deliver, can you come now, the mother is at 8cm dilated'. So off I go to maternity, a plain room lit by torches held by nurses, or sometimes the patients themselves, with less equipment than a waiting room in the UK! The first twin came out fine, one down, one to go. The second however had its hand caught so I had to go in and bring it down. Then it had the cord around its neck, and its whole body was twisted in the wrong direction. I had to twist the body and release the cord before this blue baby appeared and needed resuscitation for several minutes. I was so scared of twisting its neck or causing a massive tear that I was sweating and praying harder than I have ever done before. Both babies were fine, but having never done obstetrics, or seen a birth in the west- God was the only one who could enable that to happen.

Death was another big obstacle, never having seen it before in the west. Within 4 weeks in Zambia I had seen 2 children die in front of me and an elderly man who I attempted resuscitation on with no-one else around, no airway, no monitoring, and on a soft mattress. After 25mins I was exhausted and wiping sweat and tears from my brow before I got myself together to tell his 20-year-old son his father had died. I was able to pray with him which was such a blessing. I couldn't put together more than a few words the rest of the day.

These challenges and many others like these helped me to realise that with God we can do anything, deal with situations we could not contemplate, in a state of tiredness we can barely fathom, when trusting in God is the only option we have.

Now to him who is able to do immeasurably
more than we ask or imagine, according to his power
that is at work in us, to him be the glory
in the church and in Christ Jesus
throughout all generations,
for ever and ever!

Ephesians 3v20-21

However, in these challenges come the opportunities for such growth and development of character. I saw how unable I was to deal with tiredness by myself, in a situation where loosing focus on God meant breaking down. Learning to live with the injustice in Africa was another aspect which proved challenging. I saw a child seroconvert from a HIV +ve infusion they received at a government hospital. Children also came to hospital malnourished and near death because their mothers had been in hospital for a month, and the children left behind had no food. One such child, 5 years old, died with my stethoscope on his chest after being weighed, an effort that his 8kg body could not cope with.

My plan for a calm, tranquil elective turned out to be the most hectic emotional roller coaster of my life. However I had to trust in God in a new way, and explore the gifts he gave me, both in medicine and preaching in church, as well as trusting him to get me through a bout of malaria in the 5th week of my stay. Although my time did not take the course I expected, God used it to teach me so much, in His way, not mine.

Oh the depth of the riches of the
wisdom and knowledge of God!
How unsearchable His judgements,
And his paths beyond tracing out!
Who has known the mind of the Lord?
Or who has been his counsellor?
Who has ever given to God
That God should repay him?
For from him and through him and to
Him are all things.
To him be the glory for ever! Amen'

Romans 11v33-6

I would encourage all other Christian medics planning electives to go with open arms, available to the Lord and embrace the challenges He gives them.

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