General Surgery, Mutare Provincial Hospital, Zimbabwe

Mutare Provincial Hospital is a referral hospital servicing the eastern province of Manicaland. The hospital refers on to Harare Central Hospital and Parireyantwa Hospital as required.

My elective was in the discipline of general surgery. During my stay there was one consultant surgeon present, who as assisted by a hospital medical officer.

I participated by assisting in theatre, attending outpatient clinics, and undertaking ward rounds. There were two scheduled operating lists each week, with additional emergency theatre time as required.

Outpatient clinics were held weekly, and ward rounds were undertaken on a daily basis.

There was also a small procedural theatre attached to the emergency department where simple procedures such as closed fracture reductions, wound debridement, and incision and drainage were performed.

The operative case-mix was quite varied, involving paediatric patients (largely burns), acute abdominal presentation, and some elective procedures.

The delayed nature of presentations was notable, and seemingly due to a constellation of factors including isolated communities, lack of transport, unfamiliarity/distrust of western medicine, the availability of traditional healers, and cost barriers.

Unfortunately, there was no orthopaedic consultant at the hospital, and even through the consultant general surgeon was able to perform some orthopaedic procedures such as simple ORIFs, there was a lack of hardware available or such procedures.

While in Zimbabwe there was a strike involving the majority of junior doctors in the country. Among the concerns of junior doctors was a lack of medicines, and simple supplies such as IV fluid lines and sterile gloves, along with pay-related grievances.

This did not affect my hospital directly, as the junior staff are concentrated in hospitals in the capital Harare, and second city, Bulawayo.

However, we were ultimately unable to transfer patients to these larger hospitals as they stopped accepting new patients. This particularly affected spinal trauma presentations which were depressingly common due to accidents acquired through illicit mining activities in the surrounding region.

In general, the healthcare system in Zimbabwe is in a poor state, reflecting the nation’s economy and the corruption that erodes what money remains in the system.

This was highlighted by patients often being expected to purchase their own medications from private pharmacies, who would only accept USD due to the fact they need to source the medicines externally.

However, the vast majority of Zimbabweans have no access  to USD as the government continues to persist with their bond note “currency”.

Further, junior doctors and medical students appear to be suffering from the deteriorating system.

Doctors in the public system are paid poorly, and wages are often in arrears. Senior staff are often focussed on completing their public commitments in a timely fashion so that they can work privately, to the detriment of teaching and mentoring their juniors  and students.

The rudimentary nature of the equipment and facility was unfamiliar, but it was heartening to see that good, even great, results could be achieved with the basics.

I was able to assist in a large number of varied cases and perform components of some procedures under the guidance and supervision of the consultant surgeon.

Rounds and outpatient clinics were a great opportunity to hone clinical acumen, as many of the tests that we have in Australia are not available.

Another take-home was the importance of public health measures, and community health literacy.

It was encouraging to that the younger generation of Zimbabweans were better informed about their health, and seemingly more enthusiastic to engage with the healthcare system despite its shortcomings.

My elective proved valuable across clinical, public health, and personal domains.

I would encourage all future students to experience how medicine is practiced and administered in developing countries. The perspective gained will make you a better person, a better student, and hopefully a better doctor.