In 1973 I spent my student elective at Chikankata Hospital in Zambia. The hospital was founded in 1947 by the Salvation Army and has been caring for local people ever since. Being there was the greatest adventure of my life and had a significant influence on my subsequent medical career. It was there that I performed my first minor surgical procedures, including a wedge tarsectomy for entropion due to trachoma. Little did I know then that a surgical career lay ahead, though in otolaryngology, not ophthalmology.

This year, fifty years later, I was finally able to return and found the hospital much changed. In 1973 the medical staff consisted of a Canadian acting medical director and three young Englishmen, including me, the medical student. Today there are five African doctors and a dentist, including a fully trained paediatrician. There is still a nursing school on the site and its former students work in other parts of Zambia, as well as at the hospital. The sister in charge of the Chilanga Clinic, which I visited the day before going to Chikankata is one of them.

In 1973 there were two wards full of patients with tuberculosis but now the TB unit mainly treats outpatients and only had a handful of inpatients. This is partly due to the reorganisation of TB management, with treatment being initiated in provincial hospitals, and a move towards ambulatory care thereafter. The leper colony (leprosarium), which was located well away from the main hospital, is no longer there. Leprosy appears to be less common in Zambia now and the reorganisation of health services that took place in 1995 resulted in the closure of leprosaria all over the country and their conversion into general hospitals.

In fact there were far fewer inpatients of all kinds than in 1973. This undoubtedly reflects progress in the management of diseases in Zambia, but may also be related to improvements in services at the nearest government hospital in Mazabuka (there were only 2 doctors there in 1973 but now there are 6, including an orthopaedic surgeon), and changes in administrative districts. When I was in Chikankata the hospital had an out-lying clinic in the Gwembe Valley. During my visit there we met a woman who had walked to Chikankata Hospital while in labour, a distance of about 60 kilometres. There she gave birth to a live infant and we were introduced to the child in question, by then a healthy preteen. In 2012 Chikankata District was created, so that Chikankata is no longer part of Gwembe District. In 2015 a brand new hospital opened in Gwembe, in addition to the existing level 1 hospital in another part of that district.

Another challenge is the isolated location of the hospital. It is approached along a seemingly never-ending (actually 30 Km) dirt road, which is in worse condition than it was in 1973. The hospital’s ageing Land Cruiser, which makes regular trips down the road to the nearest highway, is battle-scarred and has a large crack in its windscreen. The government has promised to upgrade the road, but there is no indication as to when this will actually happen.

As we toured the hospital I spotted a building called the Art Clinic. Remembering the art therapy I witnessed as a medical student at Claybury Hospital in Essex, I asked if this was part of their psychiatric programme. ART actually stands for anti-retroviral therapy. HIV infection is a significant problem in Zambia nowadays but did not exist, or at any rate was not recognised, in 1973.

Since I was there, a biomedical sciences college has been opened on the site, offering training towards a diploma in biomedical science. Graduates are able to find work in clinical and research laboratories all over the country.

The hospital has acquired some modern medical technology. Their ultrasound machine seems to be working but the impressive-looking X-ray machine is not. One of the challenges they face is an unreliable electricity supply and this may be contributing to the problem of keeping their equipment in working order.

Like other mission hospitals, they are now integrated into the government health care system and their fixed costs are met from public funds. There is, however, still a need for additional funding for other aspects of their work. The hospital is classified as a level 2 (general) hospital, has 200 beds and serves a population of about 100,000.