Doctor needed for 3-6 months in Zambia

Company:  Luangwa Safaris Association
Location: Zambia

Luangwa Safaris Association (made up of people from the safari camps / lodges and affiliated businesses in South Luangwa National Park) funds a doctor in the Luangwa Valley to care for their staff and clients. They are a long way from a major hospital in case of emergency for members of staff or guests and so formed the medical fund to pay for doctors to come and work in the Luangwa Valley. The doctors not only look after the medical needs of guests and staff but also work at the local rural health centre.

Full deails of the position and what to expect can be seen in the text below provided by the Luangwa Safaris Association.
Most of the doctor's time is donated to the Kakumbi Rural Health Centre in Mfuwe near the main entrance to the national park. At the clinic the doctor works alongside the clinical officer and staff nurses seeing patients with a wide variety of health problems ranging from the usual coughs and colds to malaria, HIV, trauma and STIs.

When a client or camp staff requires attention the doctor is informed of the details and priorotises the call, often fitting in these visits around work at the clinic except in cases of acute emergencies which require immediate attention. In some instances consultations can be dealt with over the telephone or by e-mail.

The doctor is on call 24 hours a day for the lodges, but the lodges are careful only to call outside working hours for true emergencies. The doctor is NOT on call for the local clinic (otherwise they would never get any sleep!), but inevitably the doctors do occasionally go into the clinic after hours for life threatening illnesses or injuries the nurses can’t manage alone.
The Dr is expected to deal with the routine cases of lodges staff and guests. Serious cases have to be medivaced by air out of the valley, usually to South Africa. This is arranged by the insurance company of the patient and there may be a significant time delay whilst these arrangements are made (at least 4 hrs). As a result the Doctor must be comfortable with initial management of acute medical emergencies and trauma.

The ideal doctor for this position is a GP/family physician or emergency medicine physician with broad clinical training and experience in caring for patients of all ages. Knowledge of tropical medicine is essential so a course in tropical medicine is encouraged and prior medical work in the tropics is a definite advantage. To enjoy the work here, the doctor should be comfortable practicing alone in a remote environment and revel in a challenge of practicing medicine with extremely limited recourses in a very different culture.

The LSA Medical Fund requires a minimum 3 month commitment for doctors who don’t already have a Zambian medical license because of the great expense involved in obtaining the temporary Zambian medical license and in paying for transportation from overseas. The maximum commitment is 6 months since work visas for longer terms are difficult to obtain.
The LSA doctor works with the full permission of the local health board and has to apply for a temporary medical licence from the Medical Council of Zambia, a very time consuming and rigorous process which the medical fund help the Doctor negotiate. The temporary licence is granted on the condition that the doctor donates his or her time to helping at the Kakumbi clinic. This arrangement suits everyone as the main motivation for most of our volunteer doctors is to work in tropical medicine in a developing country. The Dr is required to arrange their own indemnity cover.

Kakumbi Rural Health Center (KRHC) is a very basic first line government clinic which is currently staffed by a clinical officer, (similar to a nurse practitioner) 3 nurses; 1 of whom is a midwife and a public health nurse. There is a pharmacy technician/translator and a lab assistant. The clinic can be extremely busy at times. There are 3 wards at the clinic; Paeds with 2 beds and male and female with 3 beds each (although currently the male ward has been converted to a lab but another lab is now under construction). Patients sometimes stay overnight for basic treatment or observation but complicated or chronic cases are transferred to the local hospital at Kamoto (1 hour by car). There is a dedicated delivery suite with post natal bed. The clinic runs an out- patient clinic twice a day 5 days of the week and on Saturday morning. There is also a weekly family planning clinic, weekly obstetric booking clinic, weekly obstetric follow-up clinic and a monthly under 5 clinic with childhood vaccination and general health monitoring. The local staff regularly travel into the community to do “outreach clinics” The local staff also over see TB treatment initiated at Kamoto and supervise community support workers who help with care in the community of patient with TB and HIV. The local hospital oversees Anti-Retroviral Therapy and reviews patients at the clinic on alternate Thursdays.

The clinic’s monthly government supply of medications is quite limited and supply is often interrupted. The government supplies each health centre with a monthly kit of basic drugs based on the WHO Essential drug list for first line health centers in Zambia and the clinic is able to order supplementary drugs from an allocated budget.

In order not to deplete the clinic’s supply further, the LSAMF buys a separate, broader set of drugs and supplies for the doctor’s medical kit for emergencies and guest/staff consultations.
Basic equipment is available at the clinic. There are several digital thermometers and 1 tympanic thermometer. Batteries are an issue and it is wise to check what is working and what batteries are needed prior to your arrival. There is a nebuliser but nebules cannot be accessed locally and again have to be brought in by the Dr if they wish to utilize it. There are several sphygmomanometers and stethoscopes. Scissors tend to be blunt and it is wise to have your own pair of bandage scissors. There is no diagnostic set at the clinic so it is useful to bring your own. Both exam gloves and surgical gloves are supplied but usually only in 1 size at a time , if you wish to conduct procedures and have big/small hands it is best to bring a small supply of your own surgical gloves.

Investigations at the clinic are limited to Rapid Diagnostic Antigen Tests for malaria (which often run out), urine BHCG for pregnancy, HIV testing and Syphilis testing. There are sometimes urine dip sticks but these either result from a donation or are brought in by the Drs. There is a glucometer but it is wise to check if test strips and batteries are available before your arrival. The clinic has a microscope and slides and stains for malaria slides; it is also able to carry out AAFB sputum smears (but currently without adequate safety equipment). A fetoscope has been donated to the clinic (it takes a rectangular 9v battery), but no ultrasound or other imaging is available.

The local Hospital is at Kamoto approx 60mins journey away. It currently has a Dr and a Clinical Officer. It is able to provide basic In- Patient facilities but refers more difficult case on. It has X-ray facilities (often not working), an Ultra Sound Scanner and basic microscopy. It is able to do FBC, urea and createnine and CD4 counts. It has 3 wards and an obstetric unit. It has a dental unit run by a technician who is able to extract teeth. There are no formal transport arrangements to Kamoto. Patients are required to find and pay for their own transport which can be problematic at times. Some provision is made for urgent maternity cases.

The clinic covers a local population growing rapidly due to the increasing employment associated with tourism in the area. There are no official figures that reflect this reality, but we guess that we are covering a population of around 20,000 now. Clinic patient volume has increased as the word is out that there is a doctor and drugs at the clinic which seems to draw people from far and wide! Before the doctors started to work at Kakumbi RHC, the clinic was seeing around 500 patients a month. The number is now around 1500 and rising. At busy periods the doctor can expect to average 30 patients a day and at times of very high demand can see anything up to 70 patients in a day. The usual arrangement is for the Dr to see the patients who speak English whilst a nurse sees the non-English speakers. The nurses use protocol driven treatment schedules. The nurse will refer difficult cases for review by the doctor. The doctor may also see non- English speaker with the help of the pharmacy assistant who provides excellent translations (and insight). The Dr is expected to review all in-patients during working hours. There is a very high prevalence of HIV within the community. The true figure has not been established but has been estimated to be in the realm of 1:4 to 1:8. It is up to the Dr what procedures they are happy to perform. Obstetrics is not compulsory and is mainly dealt with by the nursing staff.

The work at the clinic can be challenging and frustrating at times. However, most of the LSA doctors say they find the clinic work the most rewarding aspect of the job. The clinic is open Monday through Friday and Saturday morning, but since the doctors are volunteers, the schedule is flexible and the Dr can take short breaks from the clinic when needed.
The LSA Medical Fund offers a unique opportunity to be involved in front line medicine in a rural part of Africa - something many doctors find very stimulating- while at the same time providing a reasonable level of accommodation and support. The presence of the staff and guests of the safari lodges even gives an "instant" social life.

Most doctors are also delighted with such easy access to one of the most beautiful national parks in Africa and with living surrounded by the park’s fascinating wild animals. The doctor can feel free to jump on a game drive when he/she needs a break, and many of the safari camps offer the chance for a night or two stay when they have openings. (As long as the Doctor understands he/she is on call for emergencies and needs to be within a maximum of 1 hour distance of the main gate).

This project has been running for over 16 years and continues to evolve. We have managed to find donations to have a borehole put in at the clinic so the nurses have fresh running tap water. We help sponsor a drama group to supplement the TB, malaria and HIV/AIDS education programmes already in place, and we have built extra housing for the clinic staff to improve their standard of living. In 2007, the clinic was completely remodelled and refurbished by Dr Johnny and Grant with money they raised themselves and also with help for the Zambia National AIDS Network.

Since the project funding comes from donations by the lodges to keep the scheme running, we are not able to pay a salary, but the stipend should cover expenses. Most doctors have found that the environment and the experience make it more than worthwhile.

The financial details for the position are as follows:
• USD 1200 for travel expenses for doctors based overseas - if this can be covered by the doctor – that is much appreciated
• USD 500 per month pay – the fund is always grateful to those docs who are able to forego this.
• Fees for temporary Zambian medical license paid
• Entry visa and temporary work permit fees paid
• Accommodation at a small self catering cottage. Accommodation is simple and very modest but includes double bed with mosquito net, small living and kitchen with appliances, flush toilet and shower. Maid service, she can do daily laundry, house cleaning and help with prepping of food (not in weekends)
• Food allowance of USD 300 on a monthly basis
• Vehicle and fuel provided for working trips. 

Please contact us if you are interested at per attention of Nathalie
Thank You
Jess, Priya, Amy and Nathalie