UBCO Nurses in Zambia

Shawnel and Caitlan S. – Sefula Health Clinic

This week we (Shawnel and I) were placed at Sefula Health Clinic (SHC), which is about a 30 minute taxi outside of Mongu. Sefula Village is literally right on the flood plains, very small, and absolutely gorgeous. There is a walkway out onto the flood plains that goes on for over 200 hectares and it is the main way for all of those people living on the plains, to come to SHC when seeking medical attention.

Sefula Pathway to the Plains

We definitely noticed two themes present in this clinic, one being Family Centered Care and the other being Low Resources & Staffing.

Here in Mongu, and Africa in general, everyone has a someone. Every single patient will have a friend or family member with them for all 24hours of every day during their stay at the hospital, and even when they are just coming for an outpatient visit. It is remarkable the care they show their loved ones, doing all personal care, providing food and water, and even retrieving medications. For example, we had many people come in for HIV adherence and medication renewal for themselves, but also for other family members who couldn’t make it to the clinic that day. This was a strange concept to accept because the adherence counselors and clinical officers would be giving medications to and writing reviews on patients who weren’t even there and just going off of what their family member reported about that patient. This was also prevalent in another case we experienced where an older mother (60-70) walked 4 hours to SHC because her pregnant daughter was very ill. We didn’t really know what to do or how to treat a person who we couldn’t physically see or assess. After learning how far away they lived and from listening to the mothers recount of her daughters symptoms, we diagnosed her daughter with probable severe malaria and prescribed medications accordingly. Through this, we truly gained an understanding of the vastness of this under developed country where distance is a HUGE factor in determining life or death of someone needing medical attention.

A final example we witnessed about the importance of family centered care even presented on our very first day at SHC. A 3 year old child came in with a fever, diareha, and vomiting blood. He was referred to Lewanika Hospital in Mongu but had to wait for the bus which came the next morning. We decided to take the child with us at 1300 that day. In Canada, it would usually only be the child and a parent accompanying during transport. In our one cab, we ended up having the driver, the child, the mother, the grandmother, a sibling, and the two of us! Canada centers and prides its healthcare on patient and family centered care, but we have NOTHING on the African people and the care they show their family members. It is beautiful and inspiring. It may be quite difficult coming back to Canada and seeing so many people in the hospital with little to no family support.

The other common theme we noticed this week was the total lack of resources and staff at these small clinics! The funding is not present to stock and supply even the most basic resources needed at a health center. Some of the things missing were:

- - Fetoscope (what is used to listen to a baby’s heart rate in the mothers belly) – it has gone missing

- - Batteries for the blood pressure machine and NO manual blood pressure cuff for when the batteries die (which they did twice this past week)

- - Cleaning solution for cleaning some commonly used medical instruments such as the thermometer

- - Garbages – there was 2 garbages in the entire clinic for general waste….

- - Sharps containers – needles/lancets are used frequently to test for malaria and HIV and there were only 3 throughout the clinic. These containers were also made of cardboard

- - Pain medication – for the first 3 days there was no pain medication at all… no Tylenol, no aspirin, no ibuprofen, nothing! This is a frequently missed stock at SHC. The patients prescribed with pain medications (or any medications the SHC pharmacy did not have) had to go to the local pharmacy and purchase them, which many patients could not afford

- - Rehydration fluids – there was only 1 of each 1L bags of fluid (Normal saline, Ringers lactate, Dextrose 5% water)

- - Strapping (tape) – absolutely no tape was present in the clinic which means that when someone needs an IV, they couldn’t tape it to hold it on, meaning the IV wouldn’t be started

Where we found this most challenging was when we witnessed a male patient in extreme discomfort. When we enquired about his condition, we were simply told he had lumbago, which means back pain (reminder: no pain medications stocked). Both of us knew instinctively that whatever this man was experiencing was not just back pain because he seemed confused, disoriented, and agitated. Further enquiring into his situation, we were told he had been suffering from severe vomiting and diarrhea for the past 24hrs. Immediately we knew he needed IV fluid ASAP as he was likely severely dehydrated and had electrolyte imbalances. When we asked why he had not had an IV started earlier, the nurse said that they had no strapping (tape) to keep the IV in place so it would have just fallen out because of how agitated he was. Thank goodness we had brought tape from home that day and we got an IV started on the man right away! The next day we brought a giant bag full of tape to the clinic so that another patient will not suffer due to a lack of resources.

In relation to staffing, this issue was most exemplified during the Under 5 Clinic day where over 150 babies and toddlers showed up with their mums for check-ups, weight, and immunizations. ALL of the following duties during this day are normally completed by ONE NURSE for EVERY CHILD.

1. Weigh and record in the child’s card file.

2. Find each child in the registrar (a book with written records of each child by number and year).

3. Enter the weight into the registrar.

4. Analyze every child’s file to determine what vaccinations are needed at that visit, if any. Enter it into the registrar.

5. Write in a separate registrar every child’s number who was seen that day and check off the vaccinations they need if any.

6. Prepare the vaccinations for each child.

7. Administer the vaccinations.

8. Educate the mother on the vaccinations given, proper nutrition, and proper hygiene.

We found this day with the amount of tasks to be done and children seen, to be physically impossible for one nurse. We spent 1.5 hours weighing the children and then 2.5 hours completing steps 2-4 and barely got through half of the children’s files! It was so mind boggling that only one nurse usually does all those tasks.

EXTRAS!!

Nawa, our cab driver, was so great! He was very knowledgeable of the Lozi culture and political and historical aspects of Zambia. We learned so much from him. He even gave us Lozi names! Caitlan is Namakau and Shawnel is Nyambe. Nawa is still searching for the exact meaning of those names in english but is going to let us know very soon :)

At the end of each day we would hit up the small market right infront of the clinic. We got samosas, fritters, and fresh veggies after every clinical day! YUM!

The lovely market ladies :)

Us organizing the file room before accepting people into OPD (equivalent to Emerg).

Buried in files!

The first day at the clinic was also World TB (tuberculosis) Day! We had a great time, sipping on sodas, listening to music, and seeing everyone dance.