Chifkuwa?

‘We did it because we were with a missionary society’ Shelagh Parkinson St Francis Medical director tells me. As my time in St Francis comes an end I am beginning to think about what it was that motivated me to come here in the first place and indeed what it is that motivates others to spend some of their lives volunteering their skills in developing countries like Zambia.

On the most basic level I came back here because as a medical student in 2003 I had been impressed by the work the hospital was doing in difficult conditions for people that had much less access to health care than those in Ireland yet greater needs. I decided that after I graduated I would come back as a doctor to help in that work. But really there are a whole stream of other motivating factors like uncertainty about my future career, dissatisfaction with my life, some kind of Christian desire to do ‘good’ and really not having anything better I could think of doing. This is only seven months of my life and while it’s been hard work and a huge financial sacrifice I can go home soon and should be able to earn a comfortable living.

Ian and Shelagh Parkinson have been working at St Francis hospital for twelve years. Some of their six children have been born here, four are still in school in Zambia while their youngest Josh is yet to start school. Whilst doing missionary work was their original motivation to come they hadn’t planned to be here long term. ‘I find the work here really rewarding’ explains Shelagh while Ian who is the hospitals administrator responsible for managing the budget and staff adds ‘Shelagh was born in Kenya so there was always that kind of pull back to Africa. My job is less day to day rewarding but it is still rewarding at times’.

In the UK they would earn big salaries as a consultant Paediatrician and a hospital manager and I ask if this financial sacrifice has been difficult, ‘Money is just money, we have been really happy here and we wouldn’t have been able to stay if we didn’t have savings from before’ Shelagh outlines, ‘We’re talking number one on the ARV (HIV medicine) register still alive, to have that feeling you have contributed to making a difference’. Ian also feels that and individuals skills and work can have a greater impact here than back home where ‘you are just a big fish in a pond’.

While they have found raising children here difficult especially having to send them to boarding school they also benefits in having a family here. ‘We have given up a lot whilst the lifestyle is more simple here the kids have not benefited from that they have avoided the negatives’ Shelagh explains.

I have noticed a lot of changes and improvements in St Francis in the seven years since I came here as a student. There is much greater availability of treatment such as HIV drugs and chemotherapy. Recently though he hospital ran out of frusemide a really important drug used in cardiac failure and other conditions. Ian comments on this ‘how can you run out of frusemide, sometimes you do ask what have we achieved have we achieved anything at all?’ Overall the hospital saw a steady improvement in funding from both donations and the government up to two years ago. Ian explains that there have been recent allegations of fraud in the Ministry of Health and international donors pulled out. Last year the hospital got 10% less than two years previous from the ministry. Ian was then told last month that December’s grant wouldn’t be arriving and to make do with what they got in November!

He also points out that Chipata general hospital gets double the budget. I have never been to that hospital and I am sure there are many people there working hard but I find it strange that they have a higher budget when they refer patients here and indeed many people from there travel to Katete for treatment of their own choice. Ian says the ARV (HIV treatment) programme has cushioned the blow. This is funded from the US thanks to former president Bush ‘George Bush whatever other things he has done wrong, the AIDS relief programme people are alive and working’.

Shelagh adds that the availability of meds has had a d dramatic impact ‘We used to have quarterly board meetings and there were always three deaths per quarter among staff. ARVs changed that. Some staff even transferred here in the beginning to be close to ARVs’. I ask Shelagh a little more of the difficulties of dealing with staff health. There is obviously no occupational health department here so member of staff who need medical care simply approach one of the doctors (usually Shelagh) in the corridor. ‘The staff I really don’t mind it’s the VIPs, but that’s just expected but that’s just expected, its not a priority to change it just the VIPs will always be there but if your not going to deal with them you just won’t do well’.

Having worked in the Irish health care system I am well used to VIPs, consultants private patients getting extra attention in the public hospital. At home not looking after them well could lead to less income for that consultant. Here not taking extra care of a chief’s wife or a politicians nephew could lead to loss of goodwill among the establishment or worse still negatively impact on government funding vital to treat all patients.

Overall things have improved greatly in the past few years which I have found really encouraging. Shelagh explains ‘in most areas it has got bigger, peoples expectations have increased and their access to health care has improved. That can make it more difficult with people living longer with HIV there are incredibly complex cases on the wards’. Ian adds that staff numbers have improved there are more government employees, more nurses and nurses with higher training.

Another thing I have noted is that there are more foreign doctors to compliment the few Zambian doctors working in the hospital. I tell Ian and Shelagh that I have assumed this a deliberate strategy to improve standards of care. Ian agrees there have been more in recent years. I enquire as to what they think of all the different doctors coming and going most for only six months or so. One of the interesting things I have found here is seeing the different medical students from different countries, they must feel the same about the doctors. Shelagh adds ‘the vast majority come with a great attitude open wanting to learn. I have found them really good, very hard working, low maintenance. A few come with slightly over ambitious ideas of saving the world and slightly over critical but the majority have been very good’.

Whilst these are volunteers it does cost the hospital money to accommodate them and give them some food, I ask their thoughts on this. ‘Its cheap for what they do, we wouldn’t be getting anywhere without the volunteers. Sometimes you wish we got longer term locals, it’s a vicious circle they (the government) don’t post doctors as they know we can get them from outside. Before, we had clinical officers on the ward, me overseeing and trying to race around. In the early years it was really hard going.’
Ian adds that ‘a good number of staff stay long term, you need freshness, which is another thing the ex-pats bring. Being here a while there is a danger you start to accept things you shouldn’t accept’. Ian adds that includes the countless students who come for 6-12 weeks each giving particular mention to the students hat come form Galway every year ‘the Irish students bring such enthusiasm, I think it is because they spend a long time planning the visit and raising so much money’

So what things do they think could be improved in St Francis. They identify stock control (departments including pharmacy not reordering items until they have actually run out) and nursing standards. There is a low staffing level in nursing here, only one nurse per ward at night, but often that nurse is sleeping. Ian puts it ‘there is not many nurses so they can’t do much so they don’t’. I point out a few things I feel could be really improved on including palliative care and staff training.

St Francis wouldn’t be anywhere close to what it is now were it not for Ian and Shelagh and before them James and Faith Cairns who spent 35 years here. In many ways its easy to find motivation to come here for six months or so but to dedicate a huge part of one’s life takes a special kind of commitment to trying to make the life’s of those less fortunate just a little bit better.