Born under a tree – Mr Zayson Maambo

Reflections on life from Chitokoloki's Medical Licentiate

 

Mr Zayson Maambo is Chitokoloki’s Medical Licentiate – a ‘non-physician clinician’ role in which he fulfils the duties of a doctor. We have been consistently grateful for Mr Maambo’s skill, experience, dedication and friendship. He particularly enjoys obstetrics and gynaecology although is well able to cover all areas of hospital activity.

 

 

He sat down with us for an extended interview some days back and we found it really interesting to hear more of his fascinating life story and his experiences of working at Chitokoloki. We hope you do too! An edited version of our conversation follows. Hopefully we can feature more of our colleagues in future blog posts.

 

S&J:  Let’s start at the beginning.  Can you tell us more about your childhood experiences? 

M:  I was born in Southern Province, Zambia, in a rural area about 15km outside of a small town called Choma. I was born on the day that my father divorced my mother, and she had to leave home. As she left him to stay with her sister, she went into labour, and eventually had to stop by the side of the road. I was born under a tree!  My father thought I was born in 1981, but my mother insisted that I was born in 1982.  On balance, I decided that I was probably born in January 1982, and liked the number 15, so when I required official documentation of my birthday, I decided to make it 15^th January [NB: many Zambians do not know their exact date of birth]. We were not a wealthy family and I wasn’t able to start school until I was 9 years old. My father was not involved in my upbringing and my mother died when I was 15 years old. This created some challenges in completing my education.

S&J:  You have come a long journey from starting school at age 9, and then completing the extensive training required of a medical licentiate. What challenges have you faced on the way?

M:  There have been many challenges. School attendance and exams were not free while I was growing up in Zambia. At various points in my school education, my progress was in doubt because of difficulty in meeting these costs. When I started 8^th grade at school, I was unable to pay fees upfront.  The parent-teacher’s association allowed a certain ‘grace period’ to allow time for saving money, after which a child’s name would be called out in class and they would need to leave if the amount had not been paid. Although I never was able to pay, my name was never called out and I was able to complete the year.

There have been many miracles in my life.

When my mum died, I needed to work in multiple jobs to try and make ends meet and collect the money for exams. For some time, I worked for my older brother in re-selling fuel but was unhappy with the ethics involved. He was resistant to me finishing school, and even got into a fight with me the night before an exam, when I had spent my evening using the electricity at school to continue my studying, rather than joining him selling goods at market. I had to leave the house for my exams without eating anything, and had a pain in my chest – I felt so aggrieved and upset at what had happened. I blacked out in the middle of my geography exam, but still went on to achieve distinction.

One of the hardest times in my life was when I was 17-18 years old. At the time I was living in Mazabuka (Southern Province). I had tried hard in my exams, but didn’t even go back to check results, as I had no sponsors to help me complete secondary school. I was inspired by one of my best friends at church, who told me that he was going to return to school and finish his education. I was able to find work as a garden boy, and my employer agreed to let me work in the mornings, and support my school attendance in the afternoons. Following five visits to the headmaster of the best school in Mazabuka, he said, “I can see you really want to go to school!” I was praying that the headmaster would look at my [very good] previous exam results, which he did and I was able to raise part of the money required to start 10^th grade there. During that time, I took on a new job of buying and selling fish to help finance me. I was only able to afford one school uniform, but washed and ironed it every single night, so I was always one of the smartest in class - people had no idea what low support I was surviving on.

As fees continued to mount, I received support from my school’s deputy headmaster, who wrote a letter of commendation to the Zambian Sugar company, a big employer in the Mazabuka area. With this support, I was able to get a good, well-paying job which financed me through school and on to university.

S&J:  What influenced your decision to pursue a career as a Clinical Officer? [N.B. a Clinical Officer is a non-physician clinician and a cadre which forms the backbone of Zambia’s health provision in rural areas.]

M:  Since 4^th grade, I had dreamed of becoming a doctor. There were a few competing opportunities in this field. In the end, I accepted an offer in 2005 to study at Chainama College of Health Sciences for a diploma in Clinical Medicine which allowed me to become a Clinical Officer. The offer came with a 90% bursary, free accommodation and book allowance. An offer to study for a MBChB (to be a doctor) came to me after I had already paid the whole first year of diploma tuition fees, so I was unable to accept. I had no sponsorship going forward, but knew that God was going to find a way. The Zambian Sugar company were happy to have their ‘school boy’ back during holidays… I helped at health clinics for their workers. Another provision was through a government bursary. The Zambian government were looking for clinical officers to work in some of the rural districts where recruitment was difficult. They offered financial support through the clinical officer programme in return for a 3 year obligation to serve rurally. I also received support from an NGO that wanted to help orphans through undergraduate studies. My friends thought I came from a wealthy family, but when I went to college in 2005, it was the first time I had ever slept on a proper mattress – and from that moment definitely wanted the biggest one!  When sleeping on a traditional mattress, you always wake up with your whole body aching. I think a lot of people don’t know the definition of suffering.

As soon as I finished my final exam, a Land Cruiser was waiting outside to take me straight to my first clinical officer job in Western Province.

S&J:  What did you think about working in a rural area?

M:  I grew up in a rural area, so I knew about village life. I liked the fact that there was more autonomy in a smaller setting.

I thought, “if everyone is going to refuse to work in rural areas, who is going to help these people?”

From December 2007 to December 2010, I worked in a remote hospital at Kalabo, until my bonded agreement ended, and I was able to move back to Southern Province, nearer family. At that time, travel to Kalabo meant a slow 7-9 hour boat journey from Mongu. My wife and I got married in December 2008, and when she travelled back with me to Kalabo she had never been on a boat before. She cried for the whole trip!

S&J:  How did you come to train as a Medical Licentiate, and what did this entail? What do you now think about this training?

M:  A Medical Licentiate is also called a Physician Associate in some contexts, and fulfils the role of a doctor, particularly in the rural areas where it is difficult to recruit and retain medically qualified physicians. The Medical Licentiate programme was designed to help Zambia attain the Millennium Development Goals, particularly those pertaining to maternal and neonatal outcomes.  These goals were going to be challenging to achieve due to the acute lack of doctors, particularly in rural districts.  The programme was initially open to Clinical Officers with at least 2 years of work experience, and lasted 3 years, now upgraded to 4 year direct-entry BSc, or 3 years in the case of previous Clinical Officer experience. The finances to take me through this programme were uncertain, but I thought,

“If God has been seeing me through, and didn’t allow me to die by the roadside [at birth], I will have a way through… God has something bigger for me.”

The training programme was very much satisfactory. It was focused on ensuring confidence in key emergencies in obstetrics and gynaecology - such as those requiring Caesarian section and hysterectomy, with training in surgery for other emergencies such as laparotomy [i.e. opening an abdomen] for intestinal obstruction.

The career path for Medical Licentiates is not so good [as doctors]. Some of my friends who trained as Medical Licentiates are now back training at medical school. Some of this is about prestige, and some colleagues have had difficulty in receiving due respect from other doctors. For me, I already have what I need to help a community – that’s what makes me happy and satisfied. I was well trained and finished the programme confident in areas where new doctors struggle.

S&J:  Tell us what it is like for you to work at Chitokoloki?

M:  Health care is so bad in many parts of Zambia – it is hard to be motivated in many locations, and you can feel abandoned to your responsibilities without any unity among the staff.  I think Chitokoloki is one of the most outstanding mission hospitals in the country. It is the first place I have worked where there is good teamwork, and every staff member plays their part. I’ve often been in situations where each member of clinical staff wanted to be the one who knew everything, and didn’t want to listen to each other. Here, Dr McAdam wants to listen to my opinion, and the nurses enjoy working as one, even if there are differences here and there.

At Chitokoloki, I’ve found many resources that I’ve never seen in other hospitals. Many missionaries and their contacts supply us with equipment and I think our support from abroad is key. We get good support from management and our hospital director Mr Hanna is an incredible man. Everyone works hard to keep the patients and the staff happy. The spiritual aspect to our work keeps the unity amongst the staff, and keeps us focused on our task. Christians are supposed to help the poor, and it is good to see things in action. The mission welcomes everyone, regardless of denomination.  I enjoy the freedom to worship as I think right.  I have been a member of the Seventh Day Adventist church since my teenage years, and in some places, it would be a difficulty belonging to another denomination – not here at Chitokoloki.

My family and I also enjoy a good standard of living here. The cost of living is cheap, and the mission provides free accommodation, power and water. I really appreciate what we are given. My wife works as a school teacher in the local primary school and has been able to help our three children access their education.

The only challenges here are that it is a remote area, and there are still many traditional beliefs. When someone is sick, often they will accuse someone of bewitching them. But the mission activity has had an impact, and there is a Christian witness.

S&J:  What does it mean to you to be a Christian?  What do you think about Zambia’s self-proclaimed status as a ‘Christian nation’?

M:  I think many people go to church because they want the help of that community – for example, people want a decent burial and think “at least these people will sing at my funeral!” However, a true Christian is one during the night as well as the day. A true Christian needs to totally accept Christ and die to self. It’s a two-way thing – we are saved by grace, but our works should reflect our salvation. This is my key motivator – to worship God and influence others in doing the right thing. 

For everything that has happened in my life, there is someone behind it.

One of Zambia’s presidents (Chiluba) declared Zambia a Christian nation, but in the majority of people, I do not see evidence of true Christianity. When you look at the life of the nation, there is violence, corruption and no consequences for crime.

S&J:  What are your plans going forward?

M:  In the future I really want to be a farmer!  I’m hoping to buy the rights to a large tract of land, and get family help to cultivate that with the help of a tractor.  I see lots of opportunities for business development and government salaries are not enough to access the opportunities that I’d want for my family. For now though, I’m happy at Chitokoloki and to be serving a rural community.

S&J:  Is there anything else that you’d like to say about your own story?

M:  I really like telling my story!  I have overcome many odds, and the challenges of being an orphan from the age of 15. Sadly, many orphans in Zambia will feel that without the support of parents, they have no resources to succeed. Many end up as school drop-outs and don’t manage to achieve anything in life. As a Christian, I have a heavenly father and he has given me everything I need in life. Being an orphan should not be an excuse for not achieving your dreams in life. All orphans can achieve their dreams if only they believe and follow Christ.

The Maambo family: Top row: Phiness [niece], Lexinah [wife], Zayson; bottow row [children]: Chipo, Maluba, Chileleko