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Neurological letter from Zambia
  1. Omar K Siddiqi1,2,
  2. Masharip Atadzhanov2
  1. 1Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
  2. 2Department of Internal Medicine, University of Zambia School of Medicine (O.K.S, M.A.), Lusaka, Zambia
  1. Correspondence to Dr Omar K Siddiqi; osiddiqi{at}bidmc.harvard.edu

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Tucked away in the heart of sub-Saharan Africa lies Zambia, one of the continent's best kept secrets. Formerly known as Northern Rhodesia, Zambia was a British Protectorate until 1964 when it gained independence. It shares a border with eight other African countries, many with longstanding internal conflicts. Despite this, Zambia enjoys relative peace with a functioning democracy, free elections and status as 2012 African Cup of Nations football champions! The country is landlocked but by no means lacking water with wetlands covering nearly 20% of the terrain. In fact, Zambia derives its name from the mighty Zambezi River which arises in the North-Western Province and empties into the Indian Ocean. As a result, outdoor activities abound including kayaking, tiger fishing and spectacular wildlife viewing. This is the tropics, relatively underpopulated, with vast swaths of fertile land seemingly untouched since the dawn of time.

Zambia unfortunately also lies at the heart of the HIV pandemic. It has an HIV prevalence of 13.5%, among the highest in the world.1 The situation has improved with the availability of highly active antiretroviral therapy but HIV-associated diseases continue to overwhelm the health system across every patient population. Until very recently, the University of Zambia School of Medicine was the only medical school in the country with approximately 80 graduates per year. Of the 1327 healthcare facilities in Zambia, 85% are government-run facilities, while 9% are private sector facilities and 6% are religious affiliated (mission) facilities. The three levels of public health facilities are hospitals, health centres and health posts; the hospitals are divided into primary (district), secondary (provincial) and tertiary (central) facilities.2

There are a number of strains on the Zambian healthcare system. It is estimated that the country has less than half the number of required healthcare workers and only a third …

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