Post #5:  Nothing Clinical This Trip……..Right!

The trip is over.  Our intent, to help out, and scope out the potential for medical work in the future (no clinical work on this trip…).  We helped with a project that Zimbabwe Gecko Society had set up in an elementary school, (sewing program teaching grade 7 girls how to sew washable sanitary pads and setting up a computer lab), which went really well.

We visited and saw first-hand many of the projects that Zimbabwe Gecko has been involved in.  What really impressed me is their track record of building capacity, and being so effective that they work themselves out of a job over time, leaving things better than when they arrived. And Susan’s love for the people in general and children in particular was obvious.

We got to re-visit memories and do the tourist things, like walk with the lions, learning more about the country of our birth. This also provided an opportunity to connect with the founder of African Impact who is interested in moving in the direction supporting more effective medical volunteers.

We had the opportunity to meet with the Minister of Health, Deans of both medical schools, Physicians practicing in both rural and urban areas, members of the medical council.  All were positive about the possibility of building capacity through relationship. Despite my intent regarding clinical medicine there was no option but to be exposed to clinical need, there are a myriad of examples, but here is one just to illustrate my point.

This gentleman arrived at the place we were staying the morning I left for Karanda.  He is in his 20s, and was pushed over 10 km in a wheel barrow, with this painful swollen leg.  He had been told he had cancer and he had gone home to die.  He waited until we returned from Karanda (after nightfall). The diagnosis is Kaposi’s sarcoma and the barrier to treating his HIV was $5 for a registration card and $1 a week for treatment with bus fare $2 a week.  All it took was a time spent communicating and a few dollars.  He was followed up after we left and is improving on treatment. And the need was obvious every day.

What next, we will prepare a business plan for the Minister of Health as requested.  I plan to go back, this time for clinical work in March/April next year, and am open to taking others along (I will open this up to students).  The plan will be to spend 2 weeks at a Hospital like Karanda doing some hands on skills refreshment and trying to help improve the care delivery, and then 2 weeks helping set up a clinic at the Hope centre which feeds and teaches 400 orphans and at risk children a day. The goal is a mutually beneficial Educational trip, some capacity building within the Zimbabwe medical system, and hopefully in the future supporting the use of mobile tech to help support clinical care, even from Canada. What this trip has reinforced is that it takes very little to make a big difference to individuals. I am excited about the doors opening and the potential!

Dr. Ray Markham is a family physician practicing in Valemount, BC.

Post #4:  Pride comes before the fall at Karanda

I decided to take the opportunity to visit Paul Thistle, a Canadian Obstetrician working in Northern Zimbabwe at Karanda Mission Hospital.  He gave us directions, the long way around (around 4 hrs from our base) given the wet season, and off we went.  En route Tafadzwa and I decided that we knew a shorter route, and sure enough we cut 45 min off the journey.  The only problem was the river ford was impassible by vehicle (we later found out a tractor could cross).  Not wanting to face 45 min trip to get around the long way, and given the fact that we could see the hospital on the other side, we decided to wade across, damping our pride in finding a better route. Paul later commented on the crocs inhabiting the river, making the return trip even more interesting!

Paul was very hospitable, taking the time to show us around their 120 bed hospital, with a nursing school.  They have a very active surgical program (Gen Surg, endoscopy, Gynae, Ortho), actually getting referrals from the major hospitals in Harare.  There are 2 surgeons on staff, a general surgeon and Paul who does some gen surg and O&G.  Anaesthetics are done by a nurse. They also run an active obstetrics program, screening programs and HIV/TB programs. There is an elementary school on premises.  We discussed the possibility of students/residents coming over from UBC.  They have very nice self catering accommodation on site. There have apparently been some issues with docs coming over and getting drunk and sleeping around, and so we did have a long discussion around code of conduct and professionalism.  I think this would be an excellent spot for hands on surgical and anaesthetic skills enhancement for residents as well as the potential for infectious disease training. In addition if accompanied by a preceptor I think this would be a great learning environment for medical students ( ER surgical skills, obstetrics and ID).  Paul is in agreement for this to move ahead pending the code of conduct understanding. My hope would be to bring this back to UBC and see where it leads. UNBC is supportive of preceptors taking med students over for an elective, the potential is there for more, time will tell.

With the comforting thought that Paul was joking about the crocs ( I hope…..) we waded back across the river, patting ourselves on the back for being on time, and promptly got stick in the mud…… Tafadzwa suggested I contact Paul to see if we could get help.  I did not want to look like the idiot I was turning out to be insisted on a sweaty, muddy frustrating hour trying to get ourselves out.  I eventually succumbed, ate my humble pie, and called Paul.  He was extremely gracious, and organised for a tractor to come over and pull us out. When I offered to give the maintenance manager some money for his trouble, he declined, saying he just was happy to help.

This day was by far the highlight of the trip.

Dr. Ray Markham is a family physician practicing in Valemount, BC.

Post #3: The Meetings

Friday 7 March was a big day, after a failed attempt, earlier in the week, at a meeting the Minister of Health of Zimbabwe (an extended cabinet meeting and then an evening flight) it finally happened. Why the Minister of Health you may ask? In discussing the options with colleagues and friends I was encouraged to approach the Minister, to get his input on 3 main areas:

1. Their feeling about medical students from Canada coming over to Zim, and where they might interface.
2. What ways capacity building might be best served, and where the areas of most need might be?
3. How they would approach the use of Technology to help improve medical care.

After the first meeting had to be postponed, and I must say that left me feeling disheartened, and wondering if all this effort was worthwhile and of there was actually any benefit in pursuing this course.  However the second date was set.  We were advised to arrive at 9:20 am for a 9:30 meeting, no earlier.

We got up early and drove into town (45 min away) and arrived early. And so began the 3 episodes of rubbing up against authority. Being more than a little “type A”, I suggested we scout out the gate to enter the premises. Good thing we did as the guard tore a strip off us for pulling into the gateway and then me for trying to get out of the car. Strike one!

Suitably repentant we drove away and found the correct gate, still half an hour to go…….  Well Umesh ( a fellow Valemount resident hoping to enter medical school this year who is travelling with us) needed to get a bus ticket it was only a few blocks away, let’s check it out…. Big mistake, unbeknown to our driver (who shall remain nameless), the street configuration had recently changed from 2 way to 1 way……. Police officer……. lots of angst…….. ministerial meeting looming, we were given permission to be dropped off while our driver had his licence held until he returned to pay the fine when they could find the receipt book. Strike 2……

We arrive breathless for the meeting, wait a while and have a good meeting.  It was a very informative and encouraging meeting.  He did not believe us initially that Umesh and I do actually live in a village. I must use that as an icebreaker more often.

His responses to the main points:

1. Very open to students coming over and mutual learnings happening. Quite open to looking at primary care level interactions possibly at the district hospital level.
2. Feels this is best done in a longitudinal manner, and would support selecting an area and then facilitating building relationships and allowing solutions and direction to come from the grassroots level.
3. Very open to the use of technology, initially thought this would need to be based in Harare, but when discussing the options of wireless technology was open to exploring options. Communication was raised as a very important issue ( eg having to send a runner (literally!) to get an ambulance for a patient.

He pointed out that healthcare priorities would include maternal and neonatal health, and he has invited us to submit a firm proposal which we will do on our return.

We (Susan Janetti (the founder of Zimbabwe Gecko Society), Umesh, and myself) left enthusiastic, we even got a photo with the minister! We walked out of the building only to be hauled back in to face a very stern officer. Apparently someone had reported that we were taking photographs in the building! Where were we from??? What was our business?…Awkward moment…. I mentioned that we had indeed taken a photo with the minister, and then had to prove that there were no other photos of the building on his camera, which there were not. Much laughter as we explained that we were probably checking the photo of the minister.  Strike 3…..

We were out at around 11 am, next meeting the Dean on the Medical School at 2 pm, who is supportive of building relationships with Canada, but that is for another day…..

Dr. Ray Markham is a family physician practicing in Valemount, BC. 

Post #2:  Getting There

From snow in Vancouver, to +30 in Dubai.  The long flight (15 hrs from Seattle) was worth it. This was our first trip on Emirates, and thoroughly enjoyed it.  We are now sitting at over 30 000 ft, flying into Zimbabwe, a short hop. I feel as if I am standing on the edge of a precipice, I ask myself, is that feeling in the pit of my stomach anticipation, anxiety, or acid reflux……. A friend suggested probably a combination of all 3.

One question that keeps coming up is why go so far to try to help people in need?  If there is need at home in Canada or even in countries closer to home, why look so far. I do not know what the answer is, I suspect it is different for each of us, for me some of the answer revolves around my roots, some of it is around relative need, the heart of it however for me is people, a impacting lives, and where I feel a calling. It has been a struggle but a conscious choice that I have made on this trip not to be involved in direct medical care. Instead to seek input from the communities and groups that are open to partnerships in improving health care. 

We are doing some work with the Zimbabwe Gecko society , mainly around enhancing opportunities in a local school ( computer lab set up, sewing projects etc). Zimbabwe Gecko has a track record of grass roots development of clean water, food security, education, and income generation opportunities over the course of years in an environment that has not been easy.  They have built capacity and rendered themselves obsolete over time, which I think is a great model to apply to health care provision. I hope to seek the potential for mutually beneficial opportunities of helping with capacity building in health care in Zimbabwe, and skills enhancement for rural health care providers in BC and Canada across all the CANMED roles.

This rumination has led me to conclude that the feeling is probably all 3

Anticipation, because I know the potential that must be there.

Anxiety because I worry about messing up the opportunities

Acid reflux because I have eaten way too many Carbs on this trip so far (that Baklava is so good!)!

What a comfort my faith is in in this journey knowing that I am not in control, I just need to take each step as I am called.

Dr. Ray Markham is a family physician practicing in Valemount, BC. 

Post #1:  From Home to Home

As an international medical graduate, I am always amazed at how blessed I am to be living in this wonderful country. We have such freedoms here, great quality of life and endless opportunities to practice medicine in such a variety of contexts. I am proud and honoured to call Canada my home. But at the same time I cannot deny the influence of the country of my birth, the country I grew up and was educated in. The country in which I fell in love and was married to my wonderful wife. Canada is unquestionably my home but in a sense Zimbabwe is where I am from, also my home.

Over the years I have been wrestling with how to reconcile these two themes, especially in my professional life. I get the impression of a great interest from the medical profession within Canada to see if there is opportunity to share some of the benefits we have in the medical world in Canada with Zimbabwe.  This has been from Students who have worked with us here in Valemount, to other health care providers (Canadian trained or not) throughout the province.

Our family has been involved in a non-profit called Zimbabwe Gecko Society, based in Canada but working with widows and orphans in Zimbabwe.  After 15 years of not setting foot in Zimbabwe, we are about to embark on a trip to Zimbabwe, to do some work with this society, to introduce our children to some of our heritage, also to see if there is opportunity to be involved in some kind of medical work in Zimbabwe in the future.

My hope for this trip is seeking information and guidance from Zimbabweans as to how and where relationships may be developed in a way that will be mutually beneficial to the people in the 2 countries that are closest to my heart.  I am cautious about preconceiving what this might look like without consulting on the ground, in particular I am cautious about parachuting in a service that outsiders think might be helpful. I believe there is great potential for health care providers in Canada to support healthcare delivery in Zimbabwe as well as supporting medical and allied health professional education. I believe this could also provide potential opportunities for health providers in Canada, in clinical skills enhancement, leadership development particularly within the rural context. I see the potential for sharing learning opportunities in both countries.

My hope for this trip is to focus on building relationships and capacity toward ongoing health care improvement in Zimbabwe.  It might be as small as a doc taking medical students to an underserved area and developing hands on skills while teaching providers in that area, or could be as big as hands on trips with teams ( docs nurses NPs students MOA lab etc.) from Canada going over and doing the same in an area, with the added component of team building and leadership development of the physician leads in this, and/or virtual relationships growing out of these experiences, be it video clinics and treatment to shared medical school lectures /CPD events.

I have been encouraged me to share the journey of our family in this.  I guess the word needs to get out some way so I will give it my best shot. We leave next week, and so thought it appropriate to share a photograph of my home and family in Canada as I invite you to share our journey.

This is where we start checking out where we started!

Ray Markham

Dr. Ray Markham is a family physician practicing in Valemount, BC.