I traveled to Lusaka, Zambia as a part of an all-volunteer surgical team in September 2017. We worked alongside the local medical staff at CURE International Hospital on the outskirts of the city, offering free and low-cost pediatric orthopedic and plastic surgery. The vast majority of our cases were burn scar releases, delayed/chronic fracture management and surgical reconstruction of congenital conditions such as syndactyly or amniotic band syndrome. My role as the team’s only hand therapist was to provide post-operative orthotic fabrication, often right in the operating room, rushing to finish before the child woke up from anesthesia in order to ensure the surgery was properly protected. I was also responsible for providing rehabilitation education to caregivers and parents using a local translator, a task that often felt like troubleshooting six months of formal therapy into a lesson or two. Many families we worked with had traveled several days on foot or by bus from their rural homes for the chance to have their child selected for surgery and it would be nearly impossible to expect therapeutic follow-up once they left the hospital. This was by far the most challenging aspect of my time there and it forced me to question my own expectations about what was possible and what was necessary.
The sprawling city of Lusaka is the capital of Zambia, a land- locked country in southern Africa, rich in minerals and the second-largest copper producer (Worldbank). “As of 2015, 58% of Zambians earned less than the international poverty line of $1.90 per day (compared to 41% across Sub-Saharan Africa) and three quarters of the poor lived in rural areas (Worldbank)”. Zambia has universal healthcare supported by the federally funded Ministry of Health. However, it is very poorly funded leading to a lack of high level providers and high staff turnover due to low pay, poor conditions and a high workload. In reality, there is little to no care outside of the major cities. Private healthcare is available in major cities but it is financially out of reach for the majority of citizens. In fact, most upper class and ex-pats are often evacuated to neighboring South Africa when a higher level of care is needed. “In Zambia, health services are largely financed from public tax, donor community grants and direct payments by households and are provided by the government, private not-for-profit and private for-profit providers [15]. The delivery of government services is organized at three broad levels of care: tertiary level, comprising tertiary teaching hospitals; secondary level, comprising provincial/general hospitals and district hospitals; and the primary level, consisting of health centers and health posts [16].”page 2
Access to adequate local healthcare, i.e. physicians and specialists, remain a major barrier to getting timely and appropriate treatment following trauma such as burns or complex fractures.
Serious burns are common in Zambia due to the prevalence of open cooking fires as well as the use of fire pits to dispose of trash as there are no public sanitation services. These pits pose a serious danger to children and adults with mobility issues and should they fall into one of these pits, can become trapped leading to far more serious injuries. Mosquito netting in the home is a necessary luxury in order to protect against malaria infection. However, when netting is used in close proximity to indoor cooking fires, very serious burns can occur. Due to transportation challenges and poor access to medical care in the rural areas, 2nd and 3rd degree burns are often managed at home leading to horrific contractures.
Global Healthcare Workforce Alliance. WHO.
https://www.who.int/workforcealliance/countries/zmb/en/
Phiri, J., & Ataguba, J. E. (2014). Inequalities in public health care delivery in Zambia. International journal for equity in health, 13, 24. https://doi.org/10.1186/1475-9276-13-24
https://www.worldbank.org/en/country/zambia/overview