“When I first arrived, I saw the fragility of this medical system,” Koltai said. “The lack of supplies, questionable water and electricity, the marginal cleanliness outside of critical areas in the hospital. There were no fiber-optic capabilities — that is, medical equipment used for internal examination of the body — and no record-keeping for patients. But I also saw the dedication of these doctors, who were working under conditions we would find almost intolerable at Stanford.”
The types of ENT problems Chidziva routinely treated — and that Koltai would eventually assist with during his repeated visits to Harare over the years — were far more serious than the general population understands, Chidziva said. There’s a common misperception in Zimbabwe that ENT problems in children are trivial. Parents think that continually running noses in their children, constant snoring and painful ear infections are just a way of life.
But, in fact, the list of serious problems is long: untreated ear infections that lead to perforated eardrums and often deafness; HIV infections that cause repeated ear and throat disorders; congenital neck masses; ingested button-cell batteries lodged in airways; leeches that crawl into the ears of babies left to play in the grass, causing uncontrollable bleeding.
When I first arrived, I saw the fragility of this medical system.
“Many of these things are no longer problems in the modern world, but big problems in the developing world,” Dzongodzasaid. He is now on a fellowship in Melbourne, Australia, where he is training to become certified as a pediatric otolaryngologist. He will be the first physician with the certification in Zimbabwe when he returns to lead the clinic in July.
One of the most serious and common medical problems treated by the Zimbabwean physicians is called recurrent respiratory papillomatosis. It’s a disease caused by the human papilloma virus, or HPV, that causes growths in the upper respiratory tract. The growths can cause difficulty breathing, damage the vocal cords and become life-threatening. The conditionoften gets misdiagnosed as asthma, delaying treatment. Children first lose their voices and then struggle to breath until, as in the case of Anoona, the growths threaten to block respiration completely.
“By the time they get to us, they can’t sleep, they’re not growing, their breath is raspy and they are struggling to get in air,” Dzongodza said. “Usually they’re about 3 years old when they first show up, then they return maybe three to five times for surgery as the warts keep growing back. It’s a challenge for us, especially when much of the equipment we had been using was quite archaic.”
This was the case for 8-year-old Anoona, who was rushed into emergency surgery when she arrived on that spring evening struggling to breathe. It would be her eighth surgery to remove the viral warts from her larynx. As a toddler, she had been misdiagnosed with asthma and appeared at the hospital for the first time when she was 3 years old, gasping for breath. This time, though, she would be initially seen at the new clinic, with staff better trained to treat children, and operated on at the adult hospital with new equipment and advanced new imaging technology designed for use with children.
“All the surgeons on the unit had met her one way or the other over the years,” Dzongodza said. “Often the senior colleagues would dig into their pockets to get her bus fare for the next journey back to the hospital.”
To make his vision a reality, Chidziva started by raising funds for construction of the clinic from the Christian Blind Mission International, a charity committed to improving conditions of those living in some of the poorest communities in the world. Next, he invited Koltai to join his team. Koltai’s prior experience in helping to set up several pediatric ENT clinics in the United States and working for 10 years as the director of the pediatric otolaryngology program at Stanford, would prove invaluable, Chidziva said.
“Clemence had a vision, and I bought into it,” Koltai said. “This project resonated with my goals of seeing the footprint of pediatric otolaryngology spread far and wide. I would supply some of the experience, and Clemence supplied the leadership.”