"Recently, I had the opportunity to visit Monrovia, Liberia while they were preparing for their first democratic elections of their post-war era.  I traveled there with the intent of learning about Liberia, gaining insight to their current healthcare crisis, and seeing where I might be able to make a difference in a return trip during residency.  My experience was both heartbreaking and motivating.  Two years after the war is over, Liberia has no running water or sewer systems.  Orphanages are stealing children to get the meager stipend given from the government.  The tertiary hospital center (JFK) was looted and only recently is able to obtain the most simple of laboratory tests while there is still no ability to culture due to the lack of agar in the whole country. The hospital is operating on only two floors because the other two are badly damaged from the war and there is no money to fix them.  Children are abandoned at the hospital because parents can't take care of them.

During my short stay there, I found an ultrasound machine, which was donated, but there was no one who knew how to use it.  The Bridgeport ED attending with whom I traveled and I were able to perform 20 to 30 ultrasounds on patients hoping to give their primary physicians a better idea of their pathology since there is no CT scanner in the whole country.  I was able to perform a lifesaving ultrasound-guided pericardiocentesis on a young female who possibly had HIV and TB.  The local physicians were gracious, thankful and awe-inspired making my decision to return to Liberia a very easy one. 

I owe many thanks to my residency program directors as well as the attendings who helped me rearrange my schedule to be able to gain this experience as an intern.  The flexibility and understanding of these attendings along with the opportunity to return during my six months of elective time is why I chose Yale Emergency Medicine."

The elective is based at Livingstone General Hospital, a 200 bed referral hospital for the Southern Province of Zambia. I had a positive experience and would recommend this site for residents looking to gain experience with tropical medicine and the triple plague of Africa: HIV, TB, and malaria.

The hospital is currently undergoing some staffing changes, so it is a little difficult to predict how this might affect future rotators. During my stay, there were on average three J&J fellows working at the hospital, which currently has a staff of six doctors and then a number of clinical officers (the equivalent of P.A.’s). My primary responsibilities were attending in the pediatric ward and working shifts in the OPD (essentially the emergency department).

The hospital sees a lot of malaria, sepsis, diarrhea and HIV/AIDS. Among the children, I saw a lot of severe malnutrition. The hospital has very limited supplies and laboratory testing. There is an x-ray machine and an ultrasound machine. Lab tests are limited to CBC, ESR, malaria smears (as well as HIV/TB testing), although they should be gaining capacity for some electrolyte and LFT testing. There are three surgeons at the hospital, including an orthopod, but they seem to do few interventions. While there were occasional success stories amongst our patients, the experience was frustrating and depressing at times.

The Zambian people are lovely, and I felt very safe and at home in Livingstone. Livingstone gets a fair amount of tourist traffic due to Victoria Falls, and for the white-water rafting on the Zambezi river."