A medical school in Zambia.

Abstract

The Medical School in Zambia was founded in 1968, some four years after independence. The first graduates qualified in 1973, and over the intervening 23 years there have been some 700 medical graduates, 600 of them Zambian.These doctors are now working all over the world, and the standard of their training compares favourably with that at medical schools of North America and Europe. This story of success, against a worsening financial situation and with deteriorating amenities, has to be tempered by the fact that only 100 Zambian graduates are today working in the country and 50 of those are in private practice. Thus the idea of training Zambian doctors in Zambia for the Zambian health care system has been found unworkable. How many doctors and what sorts of doctor does Zambia need now? These are crucial questions. WHO estimates for this type of country and at this stage of development would suggest one doctor per 5000-10000 people, and with a population of 9 million this argues for some 1000-1500 doctors for the country, with the necessary support of clinical officers, nurses and other health professionals. There are some 800 doctors working in Zambia today and registered with the Zambian Medical Council. Thus there is a considerable shortfall. Many of the doctors working are non-Zambian and are on short-term contracts. It has been very difficult to retain Zambian graduates within the country, largely owing to poor conditions of service, lack of career structure and an unsatisfactor y professional experience. The Medical School in Lusaka is in the process of examining its own contribution to redressing this balance. It is reviewing the suitability of the teaching and learning provided, and its emphasis upon primary care and community based education. It is even asking the hard question - do we need a medical school? Assuming the answer is yes, then what sort of school and what sort of curriculum will be most effective in providing the Zambian doctors for the twenty-first century? Does the sort and style of medical school make a difference? Ten years after qualifying, is it possible to tell the difference between the doctor educated at McMaster and the one in Lusaka? The essential