Hello from Mongu, Zambia, capital of Western Province!  This week, the majority of us were at Lewanika General Hospital, which is the only second level hospital for Western Province (population of 1.2 million).  This means that smaller district hospitals refer people here from more rural areas.  There are various wards in the hospital, and Lauren and Adia were on the male surgical ward (which also has a one-room, two-bed intensive care unit for all patients), while Matt and Mallory were in the OPD (Out Patient Department), which is similar to an Emergency Department in Canada.  We have learned A LOT this week about working in a low resourced area, where improvisation and critical thinking are impressively demonstrated by the local staff, on a daily basis.

We chose to write this post as a group because we shared an experience that none of us were prepared for, or will ever forget, but that we were able to support each other through.

Lauren and Adia were involved in rounds on the surgical ward when Mallory and Matt rushed through to the ICU with a trauma patient on a stretcher.  A team of physicians, nurses, and nursing students packed into the small ICU room.   The room was cleared by a physician, who instructed all non-essential staff out, but who graciously allowed Matt and Mallory to stay and continue to assist.  Lauren and Adia, looking through the open ICU room door, noticed that Matt and Mallory appeared fatigued, and entered the room to offer their assistance.  From that moment on, we supported each other, communicating our thoughts and actions, and over the next 90 minutes, the four of us worked with our Zambian colleagues to continue and assist with the resuscitation efforts.  Our feelings of frustration were obvious to one another as we struggled to perform the interventions we knew were necessary, but were hampered by the limited resources at hand. Having said that, the ingenuity of our Zambian colleagues and other medical staff from around the world was incredible, using the items available in ways we would never have imagined.  Everyone involved did the very most they could, but in the end, the patient succumbed to their injuries.

This was our first experience being actively involved in a trauma case of this nature. For all of us, the learning was beyond having to use strong clinical judgement and reasoning; we had to adjust within a new context.  Upon reflection, we all voiced our gratitude for the presence and support of one another, and the expertise of the various medical professionals who offered guidance and encouragement.

We give thanks to one another, our fellow students and friends, and our instructors, who continue to help us debrief.  We learned how to do a lot with very little, and decidedly did the very best we could.  We also agree that the trauma suffered, in this particular case, would have been unlikely to have a different outcome regardless of location, resources, and interventions.

Ultimately, through various conversations between all sixteen of us, we have come to realize that much of the learning we experience here will, unfortunately, result from facing some challenging situations and incredibly difficult circumstances, some with happy outcomes, others not.

Matt, Mallory, Adia, and Lauren