Planning your elective - Zimbabwe

Iain McNamara recommends the wealth of medical experience available in a country much in the news

From the grandeur of the Eastern High-lands to the magnificence of Victoria Falls Zimbabwe is an amazing country. It was here that I decided to spend my elective period. The requirements to work in Zimbabwe are very few.

Visas

Visas from the University of Harare are officially required, although different hospitals seem to have different requirements and, as with everything in Africa, there are few hard and fast rules. It is a good idea to check with your hospital contact in Zimbabwe as to whether visas have to be purchased or whether they can be waived. If needed, the cost is US$50 and application has to be made to J Svisviro, Department of Medical Staffing, University of Harare. Applications take about two months to process and must be made before departure.

Once you are at the hospital it may be worth asking about temporary resident passes, as these will enable entry into a whole variety of tourist attractions at local rates rather than at the inflated tourist prices.

Vaccinations

Vaccinations needed are hepatitis A and B, typhoid, tetanus, polio, rabies, and tuberculosis. Yellow fever certificates are not required unless you are entering Zimbabwe from an infected country.

Insurance

The Medical Defence Union and Medical Protection Society cover British medical students for indemnity in Zimbabwe and will extend their services for the price of a phone call. Health insurance is also recommended and one of the best, which will cover any dangerous sports undertaken, is offered by BMA Services.

Personal health

Malaria is the major illness that presents as a problem to a visitor to Zimbabwe, as chloroquine resistant strains are prevalent. Therefore mefloquine should be taken prophylactically (if the side effects are not too undesirable). An alternative, although unlicensed as yet, is doxycyclin, but advice about its use should be sought from a professional. As with many diseases, prevention is better than cure, and the usual precautions of impregnated nets, long sleeves, and insect repellent should be taken.

African sun is phenomenally hot, and therefore a good sunscreen is needed. Tap water is usually safe to drink but it is better to check first and then if in doubt boil it. Take Imodium for those cases of Harare-hurry that you will undoubtedly get. Clean needles and syringes should be taken in case you require a hospital procedure, and try to avoid blood transfusions. Although the blood is screened by ELISA, there is still about a 1 in 100 chance that the donor was in the early stages of HIV seroconversion, and there is no sterilisation procedure. Knowing the blood group of the person with whom you are travelling may therefore be advisable.

HIV

In hospital HIV is the major risk factor, and long, hard consideration should be given to the matter before deciding to work in such an environment. Goggles and gloves (a sufficient supply to enable double gloving for most procedures) should be taken from the United Kingdom, as well as a good supply of waterproof plasters to cover any cuts. The population has an HIV prevalence of 30- 50%, thus there is ample opportunity to come into contact with infected secretions. As yet there are no trials supporting the efficacy of post-exposure prophylaxis, merely anecdotal evidence and extrapolated data from other studies. A course of action will have to be considered if a needle stick injury is received. This is something beyond the scope of this article but should be discussed with an occupational health advisor before leaving for Zimbabwe, and a telephone number in your home country should be made available for 24 hour advice.

Accidents

Motorists drive in a relatively haphazard way, and there is very little regulation of standards, drink-driving, or vehicle maintenance. The main mode of transport is by combivans (commuter taxis), which have a high accident rate due to the aforementioned problems, and it is probably best therefore not to use these at night if they can be avoided.

Contact with home

The phone system in Zimbabwe is unreliable to say the least and foreign calls tend to cost a great deal. Likewise internet connections seem more than usually likely to fail.

An elective in Zimbabwe will provide the opportunity to do more in the way of medical procedures than you could possibly dream of. Just make sure that you record all the experiences in a diary as nobody will believe you have done so much when you get back.

Iain McNamara, final year medical student, Magdalen College, University of Oxford
Email: iain.mcnamara@magdalen.oxford.ac.uk


studentBMJ 2000;08:217-258 July ISSN 0966-6494