Tara Lane, MD, outside of the University Teaching Hospital in Lusaka, Zambia, where she is completing a global health rotation as part of her med-peds residency training.
I am finishing up my first week rotating at the University Teaching Hospital (UTH) in Lusaka, Zambia. I have been participating on the ID consult service, and it is amazing how much I have learned over the past four days. The ID team has been very welcoming, and I am grateful for their teaching and patience, especially as I learn a new system.
One of my objectives of rotating at an international site is to learn about diseases that are not common in the U.S., with the hope to return home and both teach my colleagues and be more prepared to recognize and manage these diseases should I see them in recent immigrants, refugees, or travelers. My career goal after residency is to work in med-peds primary care, specifically with populations who traditionally have difficulty with resources and access. I also hope to incorporate global health into my long-term career, and even after just one week in Lusaka I know that this experience will help me to better serve my patients in the future.
Already I have seen patients with multiple iterations of tuberculosis (pulmonary TB, TB meningitis, TB arthritis, possible TB pericarditis), which is something I often screen for in the U.S. but have yet to diagnose. I have also seen a much higher prevalence of HIV than I do in the U.S., especially in admitted patients. One doctor quoted to me that up to 90% of patients admitted to UTH are HIV positive (according to the CDC, it is estimated that 12.9% of adults aged 15-49 in Zambia are HIV+, but patients with HIV are overrepresented in the hospital since they are more prone to infections). One patient I saw in HIV clinic was a 19-year-old male who had 3 weeks of knee swelling and difficulty walking. His diagnostic studies are still pending, but based on the available data the leading diagnosis on the differential is tuberculosis monoarthritis. Once the diagnosis is established he will need 9-12 months of anti-tuberculosis therapy.
Last year I completed a two-week rotation on the ID inpatient service at my home residency program, so I have seen opportunistic infections such as cryptococcal meningitis before, but during my first week here I saw and learned even more about cryptococcol meningitis, TB meningitis, Kaposi Sarcoma, and sepsis in an HIV patient. The ID team at UTH has been so helpful with answering my questions and helping me to think through differential diagnoses that are potentially different than if someone presented with the same symptoms in the U.S., as well as develop diagnostic work-up and management plans that make sense in a system that has less resources than my home institution. I am grateful to the Hope Through Healing Hands Foundation, who provided me with funding to help me realize this rotation.