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Understanding HIV in Harare: My Internal Medicine Elective at University of Zimbabwe

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By Polibu Amos, a final year medical student of the Kwame Nkrumah University of Science and Technology (KNUST), Ghana. 

The period between 5th year and final year is always a time every medical student in my school looks forward to, as it the time for medical electives. So, I was excited when my school allowed me to apply for an elective through the GEMx program. With the help of my school coordinator Madam Charlotte, Ms. Faith (GEMx African representative), The applications for an elective in internal medicine at the University of Zimbabwe for me and my colleague went on smoothly. Once our applications were accepted Mrs. Gandara (electives coordinator, UZ) facilitated the rest of the process for us.

We left Ghana on Tuesday, 3rd of September 2019 at 9 pm, we had 2 stops at Nairobi and Lusaka and by 11 am the following day, we arrived at Harare. The weather was sunny but with a harmattan-like breeze. Thanks to Mrs. Gandara, a driver was already waiting for us at the airport. The driver Mr. Gift Tsikirayi, helped us a lot by taking us to our accommodation and all the places we needed to do our registration. It took us several days to get used to the cold weather in Harare, especially at night. We registered with the Medical and Dental Practitioners’ Council of Zimbabwe (MDPCZ) on Thursday and started the clinical work on Friday at the Parirenyatwa hospital.

CLINICAL EXPERIENCE

My colleague and I were assigned to different wards and joined the medical students there. I noticed a couple of differences in the hospital and medical school system in Zimbabwe and Ghana. In Zimbabwe, a team is assigned to a ward and they see all kinds of medical cases as opposed to Ghana where the doctors are in teams but not assigned to a ward. I was introduced to the doctors and medical students in the ward and they all warmly received me and made me feel included. We had wards rounds every day, where we get to present cases and we used to have a tutorial session with the residents (registrars as they are called in Zimbabwe) after rounds. I made a lot of friends who made my rotation interesting, they also helped in translating what patients said in Shona (the local dialect) for me.

As a student who is yet to do my senior clerkship rotation in medicine, this elective gave an overview of everything I will be doing and more. On the daily ward rounds, I saw cases I hadn’t seen before. This elective has also sparked my interest in internal medicine especially HIV and its associated opportunistic infections. As we saw patients with HIV only a daily basis, I read so much about HIV and also had several discussions on the topic.

Our clinical rotation came to a halt after our second as all the doctors declared a nationwide strike after the leader of junior doctors got abducted . Unfortunately, for us the strike wasn’t called off even after he was found, hence we did no clinical work for the rest of our stay in Zimbabwe. Some of the doctors, however, organized a few tutorial sessions for us. I learned about their health system, their culture and the country in general from the students.

 

SOCIAL

Socially, I made a lot of new friends from Zimbabwe, Uganda, Lesotho, and Sweden. We had a lot of fun together with other elective students from different countries. We visited the national art gallery where we saw a lot of great artwork. We were educated on who the artistes were and what inspired the paintings and artwork. We also attended monthly socializing event dubbed “hustlers’ market” where people display indigenous products for sale coupled with live performances. We visited the Mukuvisi woodlands where we had an amazing experience. We went on a horse safari and it was so exciting. I also ate the local dish sadza which is the staple food in Zimbabwe.

CHALLENGES

The major challenge we had in Harare is was getting cash from the banks and ATMs, other than that and the strike, we had a great experience in Harare. Don’t forget to get in touch with your embassy as Ms. Bernice from Ghana embassy made our stay wonderful, we left for Ghana on the 28th of September 2019.

In conclusion, I would like to thank GEMx for allowing me to have this experience. Special thanks to Ms. Faith (GEMx Africa), Mrs. Rachel Gandara, Madam Charlotte, doctors of ward C4 at the Parirenyatwa hospital and Ms. Bernice (Ghana embassy).

Group Reflections on a GEMx Family Medicine Exchange from University of Zimbabwe to University of Kwazulu-Natal

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Nyasha Manyeruke, Leslie Mashayahanya, and Talent Munjombi, medical students at University of Zimbabwe College of Health Sciences who completed a elective exchange at University of Kwazulu-Natal School of Nursing and Public Health (South Africa) through the GEMx-AFREHealth Regional Exchange Partnership.

 

Students selfie in Durban

INTRODUCTION

When we signed up for the GEMx Elective experience in South Africa, we hoped to experience and gain better understanding of the clinical setup in a neighbouring African country and improve our overall clinical skills in preparation for our final year of medical school. We happily report, that the experience exceeded our expectation and broadened our knowledge overally.
Under the supervised guidance of Proffessor Mergan Naidoo, we had an opportunity to rotate in different wards at the hospital, that is- High Care Unit, Out Patients Department, HIV clinic and Accident And Emergency Department. We had multiple opportunities throughout our elective to interact with Family Medicine constultants and Registrars for “one on one” tutorials as well as group tutorials. We also interacted with other members of the clinical team including interns, counsellors and nurses, who taught us and encouraged us to perform certain procedures, such as, drawing blood for investigations, inserting urinary catheters, suturing and so forth. Outside clinical activities at the hospital, we also explored Durban –visiting the beach, shopping malls, indulging in local delicacies, and interacting with fellow Zimbabweans living in South Africa, as well as the other locals we encountered in our day to day activities. We gained a greater appreciation of the multicultural and diverse society that makes up South Africa, Durban in particular, and how this correlates to patient management in the hospital setup.
In this report, we have summarized our elective experience into experiential sections and attached pictures accordingly.

Hospital Clinical Experience
1. Out-Patients Department
We each spent a week attached to the outpatients department, participating in local procedures and guidelines. In our logbooks we had clear learning objectives and subjective measures to assess our progress throughout our elective. We enjoyed ourselves thoroughly, and below in Figure 1.1, the picture illustrates Leslie clerking patients seated on the bench waiting to be served at the Out-patients Department.

MD student looking at papers

2. High Care Unit
We each spent a week attached to the high care unit. We mainly learnt ward management of patients and ward conduct as well as protocol. Besides knowledge learnt on commn ailments in our setting, such as, HIV, TB and Myorcadial infarctions, from the various ward rounds and tutorials,we also assisted the interns in performing their daily ward duties, such as, taking blood, performing lumbar punctures, inserting chest drains and so on, as well as interpreting lab results for investigations. Figure 1.2 below illustrates Talent taking blood from a newly admitted patient, with the assistance of one the nurses.

Students taking care of patient

3.HIV clinic
We each were attached to the HIV clinic for one week, and we mainly participated in patient adherence counselling, reviews, as well as initiation of patients on Antiretroviral medication. We learnt about the importance of the multi disciplinary team and we often assisted the nurses at nearby clinic( gateway clinic) in using the referral system tool effectively in ensuring patients receive the best care. Figure 1.3, is a picture showing Nyasha, standing at the entrance for Gateway clinic.
Student in front of hospital sign

4.Accident and Emergency
We each spent one week at this department. This was a very busy department, it was very interesting learning about the triage system at this hospital and the acute management of patients. We learnt about the importance of time and sharing tasks amongst members of the clinical team in order to manage patients adequately. In figure 1.4, the picture below illustrates Leslie, preparing bloods to be sent to the laboratory for investigation.

5. Other Hospital Related Activities

Talent and Leslie reviewing clinical magazines for updates on recent research findings, new additions to clinical guidelines and for Continuing Medical learning(CME) in the doctor’s tea lounge during some of our lunch breaks.

Students Reviewing Journals

Talent(female) and Leslie, standing in front of college of health sciences building for the University of Kwazulu-Natal. We visited the medical school a few times during our stay and we marveled at the architecture

Talent(female) and Leslie, standing infront of college of health sciences building for the University of Kwazulu-Natal. We visited the medical school a few times during our stay and we marvelled at the architecture

A selfie taken after our GEMx end of elective exercise and discussion with us and Professor Ross( one of the consultants at the hospital. We enjoyed our interactions with him during ward rounds and our various tutorial sessions.

A selfie taken after our GEMx end of elective exercise and discussion with us and Proffessor Ross( one of the consultants at the hospital. We enjoyed our interactions with him during ward rounds and our various tutorial sessions.

As we come to the conclusion of our elective experience, we would like to thank all the people who made this elective experience possible, we thank you for impacting our careers in our fruitful and adventure filled manner. We hope you continue your great work.

THANK YOU
Siyabonga

My Elective Exchange at The University of Zimbabwe College of Health Sciences

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Joy Kinya Kimathi

Post by Joy Kinya Kimathi, a 5th-year medical student at Jomo Kenyatta University of Agriculture and Technology in Kenya who has completed an elective exchange at the University of Zimbabwe College of Health Sciences.

I was granted an opportunity to participate in an elective program in the University of Zimbabwe at the Parirenyatwa Group of Hospitals in Zimbabwe, from the 20th of August to 30th September, 2018 by GEMx. I found this as a great opportunity to learn, a stupendous chance to mingle with new people, explore a new culture, food, and new places. It’s worth noting that Zimbabwe is a vibrant country whose occupants mainly speak Shona and Ndebele, and are amazingly hospitable.

 

Reception and Accommodation

On arrival at Zimbabwe, I was treated to a very warm reception by the University of Zimbabwe elective office. We were 2 students from Kenya at the time of my elective. Throughout my stay in Zimbabwe, I was accommodated at the Medical residence elective flat within Parirenyatwa hospital grounds. This was a very convenient spot to access the hospital, and I wish to pass my gratitude to the Accommodation office at the University of Zimbabwe for this consideration.

At the Medical and Dental Practitioners Council of Zimbabwe (MPCZ).

Academics

As a prerequisite to working in any clinical area within Zimbabwe, one needs to register with the Medical and Dental Practitioners Council of Zimbabwe (MPCZ). This was one of the first exercises that I embarked on just after settling down. The elective office was kind enough to offer transport to the Board’s premises to register with them.

Clinical Areas

Being a very adventurous person, I explored various departments within the hospital during my elective. These included: Medical Ward, Hematology Department, Urology Department, Oncology Department. I have to admit that I had an awesome learning experience within the institution. The consultants were very enthusiastic and more than ready to impart their knowledge and skills to me. Special thanks to Dr. Marejela (Consultant Physician), for his well-researched discussions crowned with a special sense of humor. Being in your ward round was something each of us looked forward to every single day.

Special thanks to Dr. Mberi (Hematologist Consultant) together with the whole Hematology team, for your dedication to teaching me. Lots of gratitude Dr. Chikore for teaching me how to administer Chemotherapy.

At the Hematology Laboratory

It was a great honor to work with Mr. Dube (Consultant Urologist). His austereness kept us on our toes bringing out the best in us. A shout out to the Oncology team for being one of the most amazing teams to ever work with. I was able to participate in cancer diagnosis, staging, planning of management, radiotherapy, brachytherapy and chemotherapy sessions. Above all the team got to include me in most of their social events making me feel at home.

The junior doctors (JrMOs) in all the departments I rotated in, occupy a special part in my heart. They were not only colleagues but also mentors and probably the greatest friends I’ll ever make within such a short period of time. They shared with me tips on how to navigate around Zimbabwe and were really great chaperones.

In a nutshell, the academic part of my elective was marked with new amazing and interesting exposures. Of special note is the fact that the whole experience sparked in me, a special interest in oncology, a field that I had never ever considered prior to my elective.

Interacting with local students ZiMSA dinner

Social

Over my stay in Zimbabwe, I got to visit many astounding places. It all began with a tour around the University of Zimbabwe main campus. The institution is located in a vast piece of land, in an exquisitely serene environment at Harare.

Some of my major highlights were: A visit to the agricultural showground, visiting the National Gallery of Zimbabwe, Grabbing lunch and dinner with the Zimbabwe Medical Students Associations (ZiMSA), and visiting the Bally Vaughn Animal Sanctuary

Challenges

Zimbabwe cash crises:

I found myself in the middle of a Zimbabwe Cash crisis right from the time I landed at the airport. The challenge was brought by the fact that I couldn’t withdraw any money from the banks due to acute cash shortage within the country. This was a very unique challenge that I had never anticipated at all. To add insult to injury, some of the swipe machines in the country were not compatible with my visa cards making it almost impossible to pay for accommodation as well as the Board fee. However, I would like to take this chance to thank the UZ elective office for being patient and resourceful in handling any new challenge that came up.

At this juncture, I would also like to pass my heartfelt gratitude to the Kenyan Embassy in Zimbabwe. They went out of their way to enable us to get Hard Cash when all our efforts had hit the wall. God bless you richly.

Photo at the Kenyan Embassy

Lesson Learnt

To any student planning to travel out of their country, make a habit of getting in touch with your embassy on the intended country of travel before leaving your country. Let your embassy advise you accordingly pertaining your travel expectations and expected challenges. This will help with your planning and cushion you from any unanticipated shock.

Conclusion

My trip was amazing. In the beginning, I faced a few strains, but I still got the best out of this elective both academically, socially, and culturally. I greatly appreciate the opportunity afforded to me by GEMx team. I wish to thank everyone who went out of their way to ensure that I had the time of my life. The GEMx initiative is a great one, and I take this opportunity to encourage more and more students to enroll and be part of it.

GEMx Elective Reflections – GEMx African Regional Exchange Experience

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Kennedy Omondi Ogutu, BScN Student at Jomo Kenyatta University of Agriculture and Technology (KENYA) in 2nd week of GEMx elective at University of Zimbabwe (ZIMBABWE)

PRE-DEPARTURE

GEMx student steps off plan for exchange

Indeed, I lack words to express my sincere gratitudes to the GEMx committee represented by Carol Noel Russo, the host coordinator at the University of Zimbabwe, Mrs. Hope Chuma Vunganayi and my school GEMx coordinator at Jomo Kenyatta University of Agriculture and Technology, Dr.Monicah Karara.

It is my pleasure to thank you all for your commitment and determination made to ensure my elective at University of Zimbabwe attached at Parirenyatwa Group of Hospitals become a success.

As a medical student, it was always my dream to participate in an exchange program outside my country in order for me to learn and gain skills on how healthcare systems workout in other countries.It was with much joy and happiness when I received an email congratulating me for being elected to participate in GEMx elective at the University of Zimbabwe (MEPI), to me the medical elective was a golden opportunity which only comes once in a lifetime. I was prepared both psychologically and physically to participate in the elective and make it a success.

ACCOMODATION AND ORIENTATION ACCOMODATION.

GEMx Student in housing accomodations

The day I arrived at Harare International Airport, I was received warmly, I felt at home. Later on, I was taken to the place of residence within the University. Indeed it is a well-furnished guest house meant for visitors who come for elective at the University of Zimbabwe. The house is conducive for learning activities and well secured. Indeed it is nice and comfortable.

CULTURE

The main languages spoken in Zimbabwe is Shona and English. I found it quite a challenge adapting the language because most of the places, the commonly used language is Shona. This led to some communication barriers at times but I was able to cope through the interpreters.

ORIENTATION TO PARIRENYATWA HOSPITAL.

In front of Parirenyatwa
My 2nd day in Zimbabwe, I was taken to Parirenyatwa Hospital located near University of Zimbabwe, College of Health Sciences.  It is the largest referral hospital in Zimbabwe, with well-equipped facilities and personnel. I was privileged to be oriented by one of the students at Parirenyatwa School of Nursing. It was a very nice learning exposure while at the hospital. I got the opportunity of visiting almost all the departments in Parirenyatwa Hospital despite the largeness of the hospital. Among the departments I visited were the paediatrics ward, surgical ward, medical ward, the oncology ward, the Intensive Care Unit, the labour and delivery ward, the accident and emergency department among the very many departments in it.

CLINICAL ROTATION AT THE LABOUR AND DELIVERY WARD.

Based on the elective that I chose, majorly dealing with obstetrics and gynaecology, I was attached to the labour and delivery ward for a two week experience

I report to the labour and delivery ward at 7am, where reports from the nightshift duty staff is given to the staff starting of the duty. The reports on the patient was given inform of case presentation.It was a very nice learning session to me during the ward rounds and giving off the patients report. Ward rounds were conducted with the presence of the Obstetrics consultants, the midwives, interns and the students. Different aspects on different patients were discussed based on their condition. The staff were able to teach us the very many obstetrics emergencies and complications and their management. Being a referral hospital, I was able to witness most of the complications related to labour and delivery and their management. Among the complications I came across was post-partum haemorrhage, breech presentation, retained placenta among many others emergencies and complications.

View of Parirenyatwa Hospital

View of Parirenyatwa Hospital

KNOWLEDGE AND SKILLS OBTAINED

For the duration less than 2 weeks that I was attached to the department, I have been able to meet my objectives in the labour and delivery ward.  Among the very many objectives set and which have been achieved include; the assessment of a pregnant woman, prevention of mother to child transmission of HIV/AIDS, management of women with post-partum haemorrhage, eclampsia etc, management of babies with special needs, performing and suturing of an episiotomy, administration of medication used during labour and delivery. Finally, was conducting labour and delivery.

IT IS AN AMAZING EXPERIENCE.

LESSONS LEARNT

GEMx exchange student in hospital
GEMx Exchange Student in front of university sign
I believe in improving and prolonging the lives of human beings through a holistic approach of healthcare services to humanity. It feels good when a patient who was critically ill, bed-ridden and was not be able to do activities of daily living, gets well as a result of good health care service offered to them. I learnt that medical practice is similar globally, and it needs teamwork, sharing of knowledge and empathy to patients in order to ensure holistic approach of care to patients.

From the deeper recess of my heart,/ express my sincere gratitude to GEMx for giving me this wonderful “golden opportunity”

 

GOD BLESS

 

 

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