12 May 2020
Intelligent Charity? A year in the life of Friends of Mufulira
Simon Jenkins, writing in The Guardian newspaper [‘Billionaires are not the ones to save the world’, 22.02.2020], cited the commonly held business view when it comes to the subject of charity…
‘Charities are notoriously wasteful and inefficient, relying on their perceived goodness to avoid supervision’.
The MMTAs charity, Friends of Mufulira, hopes it is not. We have no paid staff, and everyone gives of their time for free. This means we can spend almost all donor money on objectives – in this case, to promote positive medical and educational outcomes in the copper belt town of Mufulira in Zambia.
Without doubt, the funding of electives has underpinned what we have so far achieved as a charity. An elective is a student in their last year of University training, maybe five years into their course, about to take final exams before qualification.
As part of their course in the UK, all students are required to travel overseas in order to see health care as it is provided in another culture or country. That is what is called an elective. Some opt for the developed world and learn about the extraordinary advances in medicine brought about by tech. But a large minority see the elective as a chance to practice doctoring in a more challenging environment.
But this is not a one way street. Zambia may have far less technology than in the UK, but the hospitals there have huge knowledge about diseases that are not often seen over here. So far, the MMTA has successfully funded 10 electives – and, had Covid 19 not intervened, that would have been 12, plus another young qualified doctor who was due to travel for 4 months.
All this is now on hold but the purposes of the charity remain undimmed.
Aside from the direct experience of the young doctors, another aspect of the charity is the intelligence passed via the student doctors about the real issues on the ground. Through this FOM is basically doing its best not to fall into the trap of imposing solutions, or purchasing equipment with the best of intentions, but not what is really required.
Examples of mismatched donations in developing countries are plentiful. FOM has found by contrast that often it is not only the big ticket item that will change lives for the better but provision of training and supply of small budget items such as medical apparel, cannulas, diagnostic kits, stethoscopes, sphygmomanometers (blood pressure kit) and the like.
Larger items are definitely on the menu but are not the sole solution. When I was there in March 2019 the superintendent of Ronald Ross told us his anaesthetic machine was limping, and that his ultrasound had macular degeneration (its imaging was restricted to the fringes). The need is great and what we can do is limited, but we hope what we can do will be without waste, and in person.
Amongst all this, the conditions in Mufulira can make just trying to assist quite difficult. One our electives wrote in his report.
"We had our first experience of ‘load shedding’. As we were sitting down at table in the living room, all the lights suddenly went out."
Power cuts anywhere in our electricity-dependent world have a huge effect. In Mufulira, this year outages of up to 18 hours a day were a regular feature – thanks to low levels of water in the Kariba dam but also years of under investment in infrastructure and mismanagement by the government-owned power company.
In these circumstances caring for patients comes against a backdrop of food shortages caused by fridges not working, shops unable to keep food fresh and the like. Mufulira, as an urban mining town, suffers as we would in the same circumstances but from a lower base. Imagine then too the consequences in a hospital of cancelled operations.
Let me now allow an elective to speak for himself about part of an ordinary day at Ronald Ross General Hospital.
‘….I also spent some time at the outpatients department...equivalent to the emergency department in the UK…run by staff called clinical officers…trained for three years on common clinical cases in Zambia. They were proficient at managing the common problems, but were lacking in knowledge in some key areas of medicine. I did learn a great deal from them especially in the diagnosis and management of malaria, which was especially common in Zambia, but a disease which I had not encountered in England.’
"They threw us straight into the placement, and we joined the surgical ward round…. What struck me most…was the vast difference as to what constituted a surgical priority in Mufulira compared to the UK. The most striking example was when I encountered a patient who had a fractured neck of femur confirmed on X-ray. In the United Kingdom, due to where the fracture was, this would warrant surgery to have either a total or partial hip replacement. This is because of the risk of avascular necrosis in this area, which if it occurs could potentially lead to an emergency amputation of the whole leg. However, at Ronald Ross General Hospital, since a total or partial hip replacement was too expensive, they opted for conservative management. This conservative management would however render the man unable to walk ever again without significant support. Since this was my first experience of surgery in Zambia I was quite saddened to learn that this was a common way of practice due to the scarcity of resources."
So perhaps I could finally share with you just a fraction of the work that my colleagues at FoM have been doing in the past year, thanks to you - fellow members of the MMTA.
Four NHS electives (UK student doctors in the last months of their training) funded to attend Ronald Ross General Hospital (RRGH) and Kamuchanga District Hospitals in July 2019
Purchase of an Electro Cardiogram (ECG) machine for RRGH – delivered, tested and installed in the presence of fellow trustee, Dr Robin Gleek
Sonography training funded to increase the effective use of an Ultrasound machine bought and delivered by Steve Curtis of the Cary Mufulira Community Partnership Trust (CMCPT)
Diagnostic sets ( to enable examination of eyes and ears )and Littmann Classic stethoscopes handed over to staff at RRGH
Blood pressure machines vital for identifying and treating patients with hypertension and blood glucose testing machines to enable safe and life-saving management of Diabetes emergencies.
Over 100 pairs of orthopaedic shoes for children and young adults, sourced in UK, handed over to Arthur Davidson Children’s Hospital in Ndola
And here is what should have happened in 2020 but which is now postponed.
Two more electives already funded for July 2020 (now postponed)
A young qualified doctor, following completion of her Tropical Medicine Diploma, funded for four months to attend RRGH from March 2020. Her aim was for Mufulira Clinicians (who generally work in isolation) to be able to share her up to date evidence-based medical knowledge. In return it was intended that she would gain hugely from the practical knowledge of diseases she has never personally witnessed. This joint working was further intended to be a further morale boost for RRGH who already gain from the Elective student placements.
What are our Plans for the near future?
Aside from the elective we have identified two key priorities which have emerged from close discussions and meetings with the senior staff at Ronald Ross:-
RRGH has only one remaining anaesthetic machine, which frequently breaks down. We are urgently trying to identify a suitable replacement.
A baby incubator. Low birth weight babies due to maternal ill health of prematurity have a low chance of survival. An incubator would help prevent many unnecessary neonatal deaths.
I would like to thank all our many friends and supporters within and without the metal trade who have supported us to make friends, and show solidarity with those upon whom many of us also rely at the start of the metals supply chain.
Now, with the onslaught of Covid 19, we hope even more to maintain our links with Mufulira and see how we can continue to grow our relationship to the betterment of this community.
At the time of writing, our colleague, Dr Robin Gleek, has come out of retirement after six years and has gone back to his former practice in Cheshire, while Dr Catherine Verity who was due to go to Mufulira in March for 4 months is on an A&E ward in Liverpool. To them both and all the electives who have passed through FOM, we salute you. And I hope you can hear us clapping!
Anthony Lipmann 17.04.20