Macha Mission Hospital – Zambia
This 208-bed acute care hospital includes a comprehensive community health program, outpatient clinic system, and nurse’s training school. Macha Mission Hospital is a moderately equipped rural hospital, setting a high standard for medical care in low-resource settings. Associated with the hospital is the Macha Research Trust, one of three research facilities in Zambia mainly focusing on malaria, HIV and TB.
Since 1980, medical students and residents from the USA, Canada, England and the Netherlands, as well as Zambia’s own medical school, have been studying at Macha. This site is recognized by the MAP International/Reader’s Digest program and the Mennonite Medical Association, among others. Selection of the students and resident physicians is competitive, and thus early applications are encouraged.
Location & Community
Macha Hospital rests in a rural area, 40 miles from the nearest town of Choma, in southern Zambia. Choma is populated with about 30,000 people and is found on the main North – South road that runs through Zambia. This rural area contains some commercial farming (tobacco), as well as other cash crops, including cotton, maize, and paprika. The climate is similar to that experienced in the southern United States with one major exception: the schedule is reversed. June to August is quite cool, October to November can be quite hot, and the rainy season lasts from December to March.
People of the Tonga-tribe populate the area, living in small homesteads. Maize is the main crop grown and the staple diet supplemented with peanut, sweet potatoes and other leafy green vegetables as relish. Most farmers in the area own, cattle, which are sold for cash and provide milk to their diet. Cattle also provide drawing power on the farms. There are several schools in the area, which have raised the level of education to grade 12 for 60% of the population.
Become familiar with Zambia’s culture, history and economy by reviewing the Wikipedia Zambia Profile. Rich resources for Zambia health information include the Institute for Health Metrics and Evaluation IHME Zambia Country Profile and the World Health Organization Global Health Observatory Zambia Data.
Visitors should arrive at either Lusaka, the capital city, or at Livingstone, near Victoria Falls. Arriving visitors usually over night in the city, and the following day travel to the hospital by bus, taxi, or by air charter airfield located at the hospital. To reduce costs, visitors are encouraged to coordinate transportation together.
For current information, please visit the Zambian Embassy website appropriate for your country. United States citizens can visit the Zambian Embassy in Washington, DC. Immigration has recently required students to obtain a business visa that is good for 30 days. A temporary employment permit, additional documentation, is required for a stay longer than 30 days.
Traveler’s Health & Safety
Malaria prophylaxis is usually recommended for visitors to Zambia. HIV prevalence in Zambia is an estimated 16 percent, and HIV prophylactic medication is usually available. Yellow fever vaccinations are not normally necessary for a visitor to Zambia. However, it may be required if the traveler plans subsequent travel to Asian countries after visiting sub-Saharan Africa. Vaccination against hepatitis is recommended. One should consult with their personal physician before traveling, and refer to the CDC Travel Website for the most up-to-date health information.
Infectious disease predominate the health concerns in this region, and include malaria, tuberculosis, pneumonia, gastroenteritis, and HIV/AIDS (estimates of prevalence in Zambia range from 16-18%). Chronic illnesses are on the rise. Rheumatic heart disease and diabetes mellitus type 2 are both very common. Obstetrical emergencies, including obstructed labor and septic abortion, are commonly encountered. In Zambia, cancer of the cervix is the most common neoplastic disease, causing extensive morbidity and mortality.
English is the official language of Zambia and is routinely spoken in the hospital. Staff can interpret for local persons who may not know English. The locally spoken language is Chitonga.
Medical Care Services
Macha Mission Hospital serves a local population of about 150,000 in its catchment area, which in some directions can extend well over 100 km to the next closest medical facility. The Zambian Brethren in Christ (BIC) Church operates the Hospital. It opened in 1957 and has grown to a 208-bed facility with a full range of services. Separate inpatient wards are available for male, female, maternity, pediatrics, and TB/leprosy. Each inpatient ward houses 40-50 patients. Inpatients services include non-contrast radiology, ultrasound, and a clinical laboratory providing basic studies. The hospital has an excellent reputation throughout Southern Zambia, with many patients coming from afar for treatment at the Hospital.
Outpatient facilities include a primary health center, a general outpatient clinic, dental clinic, an eye clinic, and an HIV/AIDS clinic that provides antiretroviral therapy. Macha Mission Hospital conducts mobile maternal/child health programs at 17 area sites. In addition, the hospital operates a nurse’s training school.
In the early 1990s, Macha Mission Hospital expanded its vision to include establishment of the Malaria Research Institute at Macha (MIAM). The Institute is now a field research site affiliated with the Johns Hopkins Bloomberg School of Public Health. Those wishing to primarily participate in or carry out a research project at Macha should communicate early with the research institute staff about possible projects. More recently, the institute has changed its name to the Macha Research Trust, and is branching out in TB and HIV/AIDS research as well.
HIV Care Services
The HIV/AIDS epidemic is a major challenge both to public health and socio-economic development of Zambia. In response Macha Mission Hospital has undertaken a strategic approach to mitigate the devastation caused by this disease. In 2005 the hospital opened an antiretroviral therapy (ART) clinic that today manages therapy for over 6000 HIV patients. INMED students may participate in health education efforts, management of ART, treating HIV complications, prevention of mother to child transmission (PMTCT), and end of life care. Research support is provided through the Macha Research Trust.
Healthcare Profession Staff
Medical staff includes three Zambian national doctors. Philip Thuma, MD, is a Johns Hopkins Hospital trained, Board-certified pediatrician who also heads the Macha Research Trust. John Spurrier, MD, is an American physician, Advisor to the Medical director, and ART coordinator. Ken Johnson, MD, a Board-certified American surgeon is available for consultations.
Medical students and resident physicians at Macha are expected to make regular rounds on the assigned ward with the staff doctors, see outpatients in the clinics both mornings and afternoons, and assist in the operating theatre twice weekly. Usual hours in the hospital are from 8 a.m. until 5 or 6 p.m. While direct supervision is available at all times from the staff doctors, students and residents are encouraged to take responsibility for patient care as assigned. They are placed on the on-call schedule, including nights and weekends, with a staff doctor on duty and always available. Weekly lectures are given on appropriate topics, and students are expected to participate. Previous INMED Learners who served at this training site include these Graduates.
Student Lodging & Meals
Students and residents are accommodated in either a hospital guesthouses or at the research facility dormitory. If accommodated in the guesthouse, the visitors are expected to prepare their own meals. They should also bring some means of water purification, such as a water filter. Accommodation in the dormitory does not include cooking facilities, but meals are available in a dining room at a nominal cost. Two simple restaurants are also located in the area.
Individuals should be aware that running water is often only available in the hospital guesthouses for a few hours in the morning and evening. Houses are constructed of brick with screens on most windows, have electricity and appliances such as electric refrigerators and stoves. Check with the hospital before traveling as to whether a mosquito net is already in the house, or whether one should bring their own net.
Visitors are advised to bring their own portable computers along to Macha. Wireless Internet access is available through the Malaria research institute for a fee. Most people use the local phone providers for Internet access, which requires purchase of a modem (about $30) and of data, which is sold by the gigabyte.
INMED invites all participants to consider raising extra funds to financially support this facility. While such efforts are not required, they provide opportunity for INMED personnel to become involved in this important aspect of international healthcare.
Behavior & Dress
Volunteers should be aware that Macha Mission Hospital is administered by the Brethren in Christ Church in Zambia with all local housing owned by the church. People living and working at the hospital are expected to respect the church’s beliefs, even if they themselves do not adhere to the same beliefs. Use of alcoholic beverages, tobacco or any addictive drugs is prohibited, and unmarried adults of the opposite sex may not live in the same house together. Because Macha is a culturally conservative area, women are expected to wear dresses/skirts and are usually not seen in public with short skirts or shorts. Women can wear slacks in the evenings. Shorts are worn by men only for sports, outdoor work and sightseeing at tourist locations, not for hospital work.
What To Pack
Visitors should bring copies of all healthcare profession licenses, diplomas, or certifications. It is also recommended to pack a carry-on bag that has essentials items just in case one’s luggage becomes lost. Bring clothes appropriate for the weather.