In Country Post 1

Despite having been here for two weeks I find myself learning new and exciting things every day. Twelve days into my time in Zambia, we had our first full day shadowing at UTH. I walked into firm B of the obstetrics and gynecology ward which contained 12 beds allowing for no personal privacy for the patients. We spent the morning following the doctors around on their grand rounds which turned out to be a lot of standing around trying to overhear as much as we could of what the doctors were discussing. The first patient they discussed was a school girl probably only 15-17. She was off getting scans but they proceeded to discuss her case in her absence. Her primary care doctor presented her current case and subtly mentioned that this pregnancy resulted from a sexual assault. A majority of the doctors paid no attention to this fact and continued to focus on her current case. As they discussed, I found myself distracted, one because I felt pity for that girl attending school, while pregnant and what if her rapist also attended the same school; and two I was caught up in disbelief of the doctors’ utter disregard for the sexual assault. I found it difficult to reconcile what I was observing with how I personally felt about the situation and how I am used to people treating a situation like sexual assault.

After the doctors had easily passed over the subject the counsellor brought the conversation back to the sexual assault inquiring if she had been treated at the time of the attack. She asked, have we handled this girl from the beginning? Is anything being done about the case? Is it a medical-legal issue? Was she treated at the time of the attack? Was she tested for STDs? The doctors did not have answers and seemed shocked at the myriad of questions just thrown at them. One responded that she probably had been treated but did not know if anything was being done in terms of prosecution of the perpetrator. The Counsellor responded inquiring about what is done for sexual assault cases as these cases are handled by firm C. Doctor C. responded by reciting a protocol for treating sexual assault victims to prevent/treat STDs. The counsellor began grilling Doctor C with questions on how to treat individual infections, with what antibiotic, and what dosage; however, he could not answer her questions. She inquired what else is done besides administering antibiotics and another doctor chimed in saying that they are supposed to have the victim stand over a collection bag and take nail clippings and collect any DNA and evidence remaining on the victim. He followed this by saying that although this is intended to be the standard protocol, it isn’t done in practice. The counsellor, expressing her disappointment said, “it seems as though we have not handled this patient properly, it is not a matter of following protocol to treat patients. You are treating a person and you must treat them first how you know and then consult a protocol.” The counsellor was the voice of my thoughts, asking the doctors the questions I was wondering like why she hadn’t been treated and why no one really cared about her situation. They had become desensitized to that fact and just glanced over it. They were ready to give her treatment and send her on her way which shocked me.

The importance of this experience was the insight into the way in which things operate in the health system in Zambia and also the culture in Zambia in general.  I could tell that the doctors operate on a protocol, a scripted method of treatment for a condition to send them on their way. On the first orientation day at UTH we learned the necessary education and training to become a doctor which is much shorter than that of the U.S. This conversation showed me the differences in practical training; the doctors just followed scripted protocols without inquiring who made them or bringing in their own knowledge and training on proper treatment. It was unsettling to treat this small conversation as just an observational experience without making judgements. I realize that things are done differently here but it was hard to remain unbiased in my thoughts. I kept thinking of how differently the situation would be handled back at home and found myself judging things for not being done the same way or people not expecting that standard.

This experience was the first time this trip I have felt challenged between what I know and believe and what I am experiencing. It was hard for me to reconcile how I think it should be done with what I observed all while not being able to voice my opinion. What got me through it was the fact that at least someone was questioning why her case was handled this way. I was comforted by the fact that the counsellor admitted that this patient hadn’t been handled properly. This challenged how I know these situations are handled administratively, how patients are handled and treated and how people respond to sexual assault culturally. I chose this experience because it I was challenged objectively and emotionally. I struggled to remain objective in treating the whole situation at the time as just an observation. While reflecting on this moment I struggled emotionally with how to settle what I observed being different from what I feel is right.

I’ve spent my first two weeks being really observational trying to learn about Zambia. It’s a completely different place than I’ve ever experienced so everything that’s happen I’ve been able to compartmentalize as something different about Zambia that does not necessarily conflict with my life experiences it’s just different. However, this moment was the first time that what I am experiencing conflicts with my life experiences and I think that’s why this moment stands out most. It was a moment where I couldn’t separate what I’m seeing and what I know and I think that was a point of struggle for me. This experience really showed my inability to remain inherently unbiased and reminded me that I have my values that might not always agree with what I am experiencing.