Canadian-Zambian Nursing students

Little Catching up to do! - Caitlan S.

Well, it has been two weeks since my last blog post! So I (Caitlan S.) have a little catching up to do! 

This past week I was fortunate enough to be at Save a Life Centre in Village of Hope with Lauren (which we will post about soon) and the week before I was on the pediatrics ward at Lewanika with Aileen. So I will inform all who are reading about my week on peds and then you can keep an eye out for myself and Laurens post later ;)

We were told before we embarked on this journey to Africa that it would be filled with some very high highs and extremely low lows. I had not understood this meaning until my week on pediatrics. It was THE hardest and most physically, emotionally, and mentally challenging week I have had throughout this practicum. However, it was also a week where I had some of the most inspiring and happiest moments of this trip. 

The very first day was the day that I felt like I couldn’t go on with this practicum anymore. Within the first hour of the first day on the ward, myself and Aileen witnessed a situation with a young boy that I don’t think either of us could ever have imagined would happen, especially to a child. The boy had a severely infected thigh with osteomylitis (a very painful infection of the bone) and a small incision used for drainage of the leg of pus and fluids that build up. The very first day I was with him, without analgesic or local anaesthetic, the doctor attempted to drain the boys leg by squeezing the leg on either side of the incsion and was unsuccessful. The doctor then proceeded to stick his entire pinky finger into the boy’s incision in attempt to drain the fluid from it, which was also unsuccessful. Meanwhile, I am holding this boy, listening to his piercing scream of pain, and watching him in otherworldly pain.  Eventually the doctor gave the boy local anaesthetic but then immediately (without letting the anaesthetic kick in) put his finger in again and then ended up creating a second incision to allow the leg to drain. This final incision was thankfully successful, the boy’s leg was drained, and then bandaged. Thank goodness Aileen was with me during this experience because she had a certain strength that I didn’t at that moment. I needed a shoulder and she was there. 

This situation was just entirely shocking to me to the point that I felt like I could not comprehend what was going on. There were just so many things about it that just seemed completely wrong to me in every way especially with the involvement of a child. I do understand and recognize that there are many inequities in underdeveloped countries and with a lack of resources, staff, and supplies, certain situations we just have to let be what is. However, what I learned through this experience is that there is ALWAYS room for patient advocacy and comfort. The rest of the days I spent on the ward, I made it my mission to be with and comfort that boy through every dressing and drainage and to advocate strongly to the doctor for analgesia for him. I feel as though our voice was heard during our time on the unit but the hardest thing for me to accept is that boy will likely experience that pain many times over without analgesia or comfort. This is that feeling of extreme lows. 

On the upside... :) By the end of the week, it was fantastic! Aileen and I made it our business to ensure that everyone on that ward, including parents, had some fun! So, we did some colouring, story times, and bubble blowing! It was so beautiful seeing smiles, hearing laughs, and seeing a community bonding together in less than happy times! One of the high highs during my pediatric experience was the day when Lauren, Aileen, Darien, and I taught two groups of 5yr olds at Limalunga school how to wash their hands and brush their teeth! It was a amazing day, especially when we did the hand washing activity and the kids saw glitter for first time :) The day was just filled with giggles, smiles, games, reading, and generally awesome times! I almost think we had more fun playing with the kids than they did with us, but we all had lots of fun! :P 

The week I experienced on pediatrics was one of incredible personal and professional growth. I feel as though I learned more than can be put into words and so much of which can be brought back to Canada with me into my personal life and nursing practice. It truly shaped my entire Africa experience and even though it was quite the week of roller coaster emotions, I’m so happy it happened especially with the group of ladies I am surrounded by. Special shout out to Mama Aileen :) 

- Caitlan S. 

Short and Sweet in Sefula

     Working at the Sefula Health Center was a great way to end our clinical experience. Unfortunately we only had three short days at the clinic due to a house illness (we will spare you the details), but our impression was that this clinic was clean, well run, and progressive. We had the opportunity to sit in on antinatal assessments, assist in the outpatient department as well as inpatient wards. Although this rural clinic was lacking in tangible resources such as running water, functioning blood pressure machines, and other things we take for granted, they did have educational and decision making tools posted on every available wall. We also found the staff to be the greatest asset to this facility with their diligent work ethic and effective communication. In particular, they were caring, and attentive to their patients, and focused on health promotion as well as acute care. One of the clinics largest services is its Maternal Child Health Department (MCH), each day a different public health topic was covered by an MCH educated staff member. We thought this was an important area of focus as maternal- child illness is so prevalent in this area of the world. By educating the mothers, Sefula is helping to build a stronger, healthier community. We really appreciated this experience as our final rotation and we are hopeful that this clinic can be a role model to others.

-Darien and Caitlin

A Matter of Life, Death, and Sparkles

     I apologize for posting so late!  Our internet has been shotty at best and I’ve been sick for most of the week.  This post is in regards to my fourth clinical week, where I was placed in the Out Patient Department (OPD).  I must warn you it was not an easy start to the week.

     Monday morning… 8:30am…  I had just finished my initial tour of the unit when the first dead body came in.  Carried in by the arms and legs by four men who may or may not have worked for the hospital or even known the victim.  In the emergency part of OPD, there are no doctors on staff.  Long story short, I participated in declaring the patient dead – not something I was ready to process at 8:30 Monday morning.  I can still hear the heart-wrenching, wailing songs of his mourning relatives.  Then the second patient came in.  She was alive, but just barely.  A case of end stage HIV/AIDS; she was so skinny, the blood pressure cuff couldn’t get a reading.  The sound of each breath made me wince, and she was going downhill fast.  I ran to get an IV bag of saline from another department while someone else started an IV.  By the time I came back with the saline, they were doing CPR.  A clinical officer and I kept up the CPR and ventilations for a while, but to no avail.  She was gone.  As we put the resuscitation equipment away, I got to thinking: why had we been thumping on her fragile chest and inflating her sick lungs in the first place?  If we had managed to restart her heart or her lungs – would she was been “saved”?  No.  A beating heart or inflating lungs alone would not rid her of the virus which had overtaken her body.  In her case, even ARVs were useless. By the time she was brought through the OPD doors, her body was shutting down.   So why did I feel so obligated to do CPR on this dying woman?  Simple: I am trained to keep people alive.  In medical culture, prolonging life is often the ultimate goal.  However, experiences like this remind me that death is also a part of health care.   

     Anticipating and planning for death seems like a morbid concept at first, but it also seems unfair to take control away from patients in their last moments of life. By assuming that this woman would have wanted air pumped into her failing lungs, I was putting my needs above hers. In my defense, I had no way of knowing her wishes, and airing on the side of caution seemed to be the obvious choice.  Even in Canada, end-of-life care conversations are often overlooked or avoided altogether. I suppose palliative care might be perceived as a low priority in a low resource country, but this woman suffered for the last few moments of her life because we didn’t know what else to do but try and bring her back.  It’s obviously not a comfortable conversation, but as I finally took the bag-valve mask off of the woman’s face, I really wished I knew that I had done the right thing for her.

     On a MUCH lighter note, Caitlan, Lauren, Aileen and I spent Thursday of last week at a school teaching 5 year olds about health!  After such a tough start to my week, teaching little kids to wash their hands and brush their teeth was like a breath of fresh air!  Health promotion is something I am very passionate about, and kids are especially fun because you can make it a game!  Check out the picture of Aileen and I with our group of kids; we’re all showing off our sparkly, “germy” hands! 

     

Can you imagine?

Can you imagine.....

Worrying that you may have been exposed to the HIV virus, and then...

Getting enough courage to go to the clinic to get tested, and then....

Arriving at the clinic after traveling from afar only to wait in a long line up, and then...

Feeling anxious, scared and alone while waiting to enter the testing room and then....

Entering the hot and cramped 50 square foot counseling office, where you would meet 2 counselors and 3 counseling students waiting to possibly give you life changing news...

Your session begins with a quick assessment of how much you know about HIV,

You’re asked “What will you do if you’re positive?”....“ Who will you tell if you are positive?”... “How will this change your life?”...

All the while with a bounding heart and sweaty hands.

Counseling concludes and now it’s now time for the test.

Your blood is drawn from a finger prick and dropped onto the rapid test.

You now have to wait for 2-5 minutes to know your status....

Flashes of every poor decision you’ve ever made cross your mind

Every time that you could have been exposed comes back in full force

You begin to imagine your sore throat is the beginning of the virus taking over your system...

Is the scab on your knee taking longer to heal than it normally would?

Has your husband been acting different than usual? Has he been coming home later?...

The test is now being read...someone at the desk is filling out a form with results that determine how you will live the rest of your life...

Will it ever be safe for me to conceive a child?

Will my partner be positive too? Will my partner leave me?

Will this affect my job?

How long do I have left?

The counselor turns to you and asks if you’re ready to hear your results

They show you a blank sheet of paper and explain how to read them

R means reactive, you are now HIV positive

NR means non-reactive, you are not HIV positive

The counselor turns to their colleague and collects your sheet of paper...your results.

They hand you the folded up paper and await your reaction.

You open it up......

This is the reality for many Zambian people every day. Can you imagine it? 

We know how this feels, because we did it. 

- Sarah & Robyn 

Back to Basics

Last week the three of us (Lauren, Ali, and Robyn) were on the Maternity Ward.  On Monday morning a woman was in labour and we had the opportunity to see the birth of her beautiful baby girl before the end of our shift.  From our experience on the maternity ward we have gained a new appreciation for the obstetric practices back home. One thing that we seemed to value the most was the way we involve family members back home.  We encourage family to be with the patient and comfort them, whereas here family members are not allowed on the Maternity Ward at all. This leaves the patient all alone during such a vulnerable time.  We recognized this while our first laboring mom was in the delivery room and took it upon ourselves to comfort her as best we could. There was a strong language barrier between us, but from her body language we could tell that she appreciated when we rubbed her back and aching legs, and provided her with a cool cloth.  We knew we made a connection when she started to ask us for assistance by addressing us as “madam.”  

It is clear that there is a cultural difference in how we view the birthing process.  At home it is important for a nurse to be with a laboring mom at all times and we felt that it was important to stay with this mom.  Some of the nurses on the ward thought it was strange that we were with this mom for such a long period of time, but we realized this was something that we valued and felt was important.  

Although our first day on the Maternity Ward wasn’t what we were expecting, we feel that we learned the most about ourselves and our values.  At home we can often be too task oriented and we can easily forget how important bedside nursing is and being present with a patient.  This was a good reminder on the difference we can make in a person’s experience; the littlest things can have the biggest impact. 

- Lauren, Ali & Robyn

Sefula: An Extremely "Precious" Clinic

Savannah:

This week Leah & I (Savannah Moody) spent the week at Sefula Clinic. Located about 20 minutes outside of Mongu. It is a small clinic that has expanded through out its years of operation.

With in our first 10 minutes of being in Sefula Clinic we noticed all the encouraging signs and quotes. Reminding the staff about the importance of quality patient care.  We were so thrilled to see these signs of encouragement; during some of our other placements we have noticed a greater need for patient empowerment.

The nurse we primarily worked with was named Precious and that is exactly what she is.  We were privileged to be a part of one of the most beautiful births I have ever witnessed. Precious was calm, patient, and quietly encouraging to the mother as she gently caught her first child.

Once the mother and baby were settled, and the baby was feeding beautifully we had a chance to discuss the challenges and rewards that Precious encounters during her day-to-day shifts. 

In the delivery room that day there were three people, instead of the usual one. Precious expressed to us that our presence offered her a small respite from her usual one-woman job. Normally Precious preforms all deliveries by herself, to put this into perspective… in Canada during a hospital delivery there is usually 2 nurses and one physician, and a home birth generally involves one midwife and a midwife assistant. On top of all that manpower there is a Neonatal Intensive Care Unit (NICU) close by with a fully staffed team ready to intervene if required. At Sefula there is just Precious. Lawinika General Hospital is over a 40-minute ambulance ride away (20 mins for the ambulance to reach Sefula and return to Lawinika).

The nurse on night shift has even more responsibilities. The night nurse is responsible for running the Out Patient Department (OPD) equivalent to the Emergency Department in Canada. He or she will also tend to any deliveries that occur throughout the night and care for the other admitted patients’ needs.

We asked Precious how she felt about this…
Precious diplomatically stated that she found it difficult to work independently so often. She told us how she appreciated our help, even the small things we were able to do for her such as, going to the pharmacist to get her more oxytocin. She discussed how Zambia as a country is experiencing a nursing shortage, she said even with new nurses graduating all the time there is still a chronic nursing shortage. Zambian nurses coming from a low-income country will often relocate to middle or high-income countries such as South Africa or England to earn more money. Precious said that she would appreciate the opportunity for an opportunity to have an increase in pay (lets be real… who wouldn’t?). Precious discussed with us her long working hours, often times without a break and no overtime pay or compensation for a missed break. And each day she comes to work with her head held high as a true Zambian woman does, she laughs with her co-workers, she is kind to her patients, she is patient with the Canadian nursing students.  She does not let the long hours make her jaded, she single handedly preforms beautiful deliveries beneath a sign in the maternity unit that reads, “No Woman Should Die in Childbirth”.

 Leah

This week Savannah and I spent an enjoyable week at the Sefula clinic. Sefula is a lush little village about 20 minutes out of Mongu. There are always an abundance of children lining the road as the village is also the home to some reputable boarding schools, but you are just as likely to encounter a herd of cattle grazing on the roadside. The clinic is small but airy, built around an open courtyard with approximately 16 beds for in-patients, a 2-bed maternity ward, outpatient department, and a large room in the front that facilitates all the public health activities. I liked Sefula immediately, both the staff and patients were so warm and welcoming and I also felt like the clinic was clean and organized (sometimes the larger Leuwanika hospital can feel like anything but.) I also loved that the walls were lined with educational posters, inspirational quotes, and statistical information (a small sample is provided below). Of course, the main reason I enjoyed my time at Sefula so much was due to the wonderful nurse we were paired with – the knowledgeable, kind, and inspiring – Nurse Precious. Precious’ passion in nursing is with maternal and children’s medicine – much like myself, and it is evident in the work that she does. After witnessing a few births on the maternity ward that left something to be desired (to put it lightly), I feel so blessed to have been present for a Precious delivery. She was so quiet, gentle, and encouraging with the patient that I was still putting on my sterile gloves to help out when I was surprised to hear a baby cry – the delivery happened that calmly & smoothly. Throughout the week we were also able to help out with antenatal visits (I am feeling pretty confident in my fetoscope skills now!), a family planning clinic, and child immunizations. Here I would like to give a big kudos to my partner in crime Sav – graciously volunteering to take the needle job! I felt that a big strength of the Sefula public health program was due to the fabulous educational sessions by Miss Tembo. Although we were not able to understand the Lsozi language, Miss Tembo was not afraid to ask questions and use actions (with unabashed imitations of breast feeding and labour) and the ladies appeared to be listening attentively.

Of course the clinic experiences its share of challenges as well. It can be hard to find qualified staff (the week we were there, the OPD functioned without a clinical officer) and staff must work in other areas where they are not trained. They also experience drug and other shortages, for example one day we were all out of HIV test kits. The limited space can make patient confidentiality challenging, and patients can wait for a long time before being treated.

However, I left this week feeling hopeful for what health care in Zambia can look like with great leadership, the right allocation of resources, an emphasis on education, and qualified, competent, passionate staff like Precious!

Teaching in Limited Resourced Setting

Teaching in Limited Resourced Setting

I have now had the opportunity to teach a few times in Mongu. What an eye-opener! I will try to refrain when I get back to Canada from complaining about classroom sizes, the weather, and AV equipment (but I cannot promise that will happen J). I taught in the following settings: a community health clinic, the ZEN school of nursing and at Lewanika General Hospital.

My second teaching experience was at the ZEN School of Nursing. This school trains ‘Enrolled Nurses’ (ENs). The students will graduate as ENs, which is similar back home to a practical nurse. If an EN would like to become a ‘Registered Nurse’ that nurse will need to take 3 more additional years of schooling, and further, if that same nurse pursues a bachelors degree it is an additional 4 more years of school- think about that timeline!

I taught on the topic of the very sick young infant, using the Integrated Management of Childhood Illnesses (IMCI) material designed and created by the World Health Organization. I covered the assessment, diagnosis and treatment components of caring for the very sick young infant. IMCI material is extremely helpful in countries such as Zambia because the material is designed to help healthcare providers learn to assess children, classify a child’s illnesses, and treat children that are living with complex health challenges (i.e. a young child who presents with pneumonia, malnutrition, and is also HIV positive).  The IMCI material is a valuable tool and the documents are all available on the WHO website

So how did the day go? …Well there were 78 students in one VERY hot room- we started the day as the school always does with singing and a prayer- the signing is fantastic! And then I presented the material to the students. All – in- all the teaching was fine (not good… no one here uses the term ‘good’ you are either fine or not fine); however the AV broke down countless times (and was fixed by a student) and the sound to the video was also an issue. Internally each time I felt that instructor PANIC! As we have said here many times over the last 6 weeks “the program was crashing!” But as the morning went on I stopped and looked around and I noticed that these are just everyday classroom challenges that the students here are all too used to! In fact securing a laptop that could connect to AV was a two-day fiasco in itself! But the students and the nurse tutors work hard to maintain the school as a positive learning environment. 

The resource issues are everywhere; the school needs more space, more tutors and more functional equipment. The tutors and the students are all committed to learning and you can see the hard work that many people put into educating these future nurses. The goal for the ZEN school is to make it a school that graduates RNs, but there are still barriers that have held up the proces

s of this transition.  In the future I hope to get more chances to teach in Mongu, as the healthcare providers, nurse tutors, and students have certainly taught me more than I have been able to give back!

Jackie

Last Week on the Men's Ward

It has been quite a week. Today I am realizing that this my last day as nursing student. This week on the men's ward was challenging because of the number of acute patients and the limited resources . It also was a challenge as nine out of the 12 of us came down with a nasty GI bug that unfortunately has made us feel quite sick the last couple of days. Again, the team pulls through and we care and support each other the best we can. Even on the other side of the world, thanks to Lauren and Ali we had soup for dinner and it is the best thing when you are sick.
The experience on the men's ward really showed me this week the challenge of the number of patients , the shortage of staff and acuity. It would seem like any time we walked by or started to get involved in the patients care , we would find a case that would lead us to advocate for that patient's needs and see some cases as more of a concern than the staff did. I still stand by our concerns, however considering I know I would burnout very quickly if I gave it 100% on this ward everyday. There are images and sounds from this week that I will not be able to forget. I could see how the past weeks have changed me and confidence level. When it came to trying to advocate for patient to receive more medical attention, I went in not hesitating to get a doctor to listen to me and write out an order. At home prior to this practicum it made me
so nervous to make a call for orders from a doctor , and here I am now I am now challenging , offering suggestions and getting into a debate if a patient should be moved to the ICU. I think I might be getting a reputation, but also the respect of some of the doctors , because I hope they see that I advocate for the patients. 
I worked with a few of the student nurses this week learned more of their role. In a lot of ways we have similar frustrations. It was neat though that throughout the morning I was able to show how I do a head to toe assessment and demonstrate documentation. I did notice however the value of building the relationships with the staff because later when more serious case was underway, I had the support of staff and students. We trusted each other. 
We went to an orphanage this week for girls that have had their lives impacted by the HiV virus. We were greeted with songs, the history , and made to feel very welcome. It was nice that after a hard day at the hospital we were able to go and play a game of soccer and other games. It still never gets old , hearing the children sing and is very much part of the culture.
We came home and got ready to have a fantastic dinner and celebrate my birthday. This one is definitely one for the books to remember. To be sitting a group of women that have been so fortunate to learn from and share this experience is what I was reflecting on as looked down the table and read my card. Thank you to everyone for making it birthday never to forget . Although who knew later that night a majority of us would fall ill. Haha so I didn't finish my last few days of clinical like I thought , but TIA and so glad to have great instructors and team members to look after us.
This truly has been an experience of a lifetime, and so glad that it worked out for me to be able to do this . I always dreamed of going to Africa , especially after my grade 6 project , but didn't think I would be doing this. I wouldn't trade this for a regular practicum at home because of the growth and development that I have made and don't think I would have otherwise.  
Thanks for all the love and support! 

Aileen

ART Clinic Week Four

This week we Caitlin R and Aryn were placed in the ART (antiretroviral therapy) Clinic at the hospital. This unit is strictly for HIV infected individuals and those to be tested. We spent the week moving through counseling, adherence, meeting with the clinical officer and all of the other stages a person who comes into the ART Clinic experiences. Up until this week we have seen few cases of infected people, only the positive clients on the hospital wards and a few in the clinics but never really noticed just how many people are living an HIV positive life within Mongu. Coming from Canada, having never seen an HIV patient, to working at the ART Clinic where they reach 18,000 plus individuals is mind blowing. Of all the positive clients only a few that we assessed and met with were in stage three of their disease, for the most part our clients were healthy and just coming to get their medication top up, you would never be able to tell these people were HIV positive by appearance alone. Due to the large number of clients each day, and the limited staff, we noticed conversation with most of the patients was quick and at times lacking in education. 

One of the gaps in the education that we noticed was regarding cervical screening for women. The women who were recently diagnosed had information sessions including cervical cancer screening and were sent to receive testing straight after their HIV status was determined. The cervical screening clinic opened at Lewanika in March of last year and has seen over 3,300 patients since! What an amazing job they have done - we can only imagine the number of women who have been positively impacted by this clinic! On the other end, we did notice that women who were diagnosed with HIV before March of last year were not being encouraged to attend the clinic as well as patients who tested negative for HIV. Women who are HIV positive have a higher chance of contracting HPV than someone who is HIV negative however it is still a very prevalent disease regardless of the HIV status. We thought that in addition to the topics mentioned in adherence, cervical screening could be added as top priority. Upon saying this, we made it our goal to mention this to each patient we met, as well as speak with the staff about the importance of educating women on this topic. The staff was receptive and recognized the need so hopefully enthusiasm will be continued! 

Working in this clinic allowed for us to practice in the cervical screening center where we both screened a number of patients ourselves which was an interesting experience finally being on the other end of this very routine procedure we have had many times back home. We also went through the circumcision clinic in which we supported a 13 year old boy brave enough to go through this procedure since he was educated to the reduced risk of contracting HIV and lessened chance of becoming a carrier for HPV after being circumcised.  It is unfortunate that they do not have the technology to circumcise infants and have to perform this procedure with boys over 5 for safety reasons. 

The highlight of our experience was working the pediatric day where all ages of children living with HIV came in for counseling and medication. We played many games with them and had a lot of fun, reminding them that they are still kids even though they have been dealt such a responsibility at such a young age we wanted them to know that its still important to have fun and live a normal life. The educators were great at empowering these kids as young as 2 and teaching them about their disease. It was tough to see these little ones diagnosed so early on in life but it was really eye opening to the reality here in Zambia.

We really enjoyed working in this clinic and understand just how important it is in Mongu  to screen people and have antiretrovirals available because the sooner the client is diagnosed they can start ART and live a healthy prolonged life.

Donation to the Maternity ward - 2 dopplers so they can better monitor fetal heart rates!

Traditional Healing at Save a Life

This week we (Shawnel & Sarah) were placed at Save a Life Clinic.  We had an absolutely amazing experience at the clinic and on home visits and can both say confidently that we were challenged and rewarded by the work we did there along side Lihana, Ivy, Nasilele, and Annie.  We spent time seeing patients in the clinic, got experience diagnosing and prescribing, taught baby gym classes to babies and families being followed by the clinic, and visited the homes of other patients. During our time at the clinic we noticed the influence cultural traditions had on the community we were caring for, as well as how these traditions affected our practice. There were 3 experience in particular that illustrated this theme: 

When teaching the baby gym classes one of the activities we encouraged the parents and babies to do together was about recognizing their self image.  We had the parents hold a mirror in front of their child to allow them to study their reflections and identify their facial features. One of the mothers was hesitant to participate in this activity because she believed that if the child looked into the mirror they would get diarrhea.  At first we didn’t know how to react as we are not familiar with Lozi traditions and this made little sense to us medically.  This comment introduced to us a barrier for nurses working with this population as their cultural traditions or beliefs can often interfere with treatment.  

Another example of traditional healing would be the use of crushed TB medication to treat wounds, which is popular in villages surrounding the clinic.  We came across one young boy who was brought to the clinic by his teacher with a huge infected and bleeding wound on his foot.  Upon closer inspection we realized that the wound appeared to be packed with a hardened muddy substance, and the boy was reluctant to discuss the state of his wound.  When we soaked his wound and debrided some of the embedded material we noticed that the substance seemed to be some type of powder that had adhered to the edges of the wound. After speaking with the teacher who brought the boy to the clinic we discovered that his parents had most likely been treating the wound with something at home.  We did the best we could to irrigate and debride the wound and dress it with an antimicrobial dressing.  Later on after discussing the situation with the team at the clinic we learned that the boy had actually been to the clinic the previous week.  He had a suspected bone infection from this wound which was actually chronic and was supposed to be taking antibiotics and having daily dressing changes at the clinic.  Lihana explained to us that this community has a strong belief in witch craft and often seeks the advice and treatment of traditional healers, which she suspected might be involved in this case.  

The final experience we had with traditional beliefs affecting the delivery of healthcare involved a young HIV + mother and her baby with status unknown.  We went to visit this family on our home visits as the two had not been attending the feeding program for the last month.  The baby appeared very ill and small for its age.  When asked about why the mother had stopped bringing her baby to the program the mother replied that she was too tired as she had to travel all the way to Lewanika Hospital for her ARVs on the same day the feeding program took place (although Annie let us know that she is not currently receiving her medications).  The mother was also still breast feeding the baby at 8 months although she was aware that this puts her baby at risk of contacting the virus. This was the excuse that she used as to why she did not need to attend the feeding program, because the baby was receiving breast milk. After fully explaining the implications for the way the baby was being cared for the mother still refused to come to the clinic for the feeding program.  Both of us were very frustrated by this experience and could not comprehend the mothers reasoning behind her refusal.  After reflecting on this experience though, we agree that this is a great example of how traditions affect the way that people view and access healthcare here in Mongu.  We recognize that there is still a large presence of traditional medicine in the culture, and there is  lack of trust toward modern medicine, especially in the villages.  We assume this mothers refusal to attend the clinic stemmed in her belief that maybe her baby was not actually that sick or even that there were better methods for treating him. 

These experiences opened our eyes to the difficulties that face Lihana and her Save a Life team every day.  This week we noticed the prevalence of traditional medicine and witch craft and how this can make things difficult for health care workers in this setting.  Thank you Save a Life team for the fantastic experience and making us feel so welcome!

Shawnel & Sarah 

Week 3 at Lewanika in the OPD

I spent my 3rd week at Lewanika in the OPD and had a very challenging and very rewarding experience.  I struggled this week with the differences between how I have been trained at home and how the emergency department operates here in Zambia.  There are so many cultural differences here that affect the way nurses and doctors provide care, but the big one that I noticed this week in the OPD was what seemed to me to be a lack of urgency or emergency ... at first anyway.

There was one situation in particular that was very difficult, but really illustrates the theme of this blog.  After spending a somewhat quiet day in the OPD with the clinical officers a patient was carried into the treatment room in an obviously compromised state. He presented with symptoms such as foaming from the mouth, vomiting, seizures, and a decreased LOC.  Needless to say .. I panicked!  I ran around like a chicken with my head cut off collecting vital signs equipment, trying to do an assessment, trying to come up with ideas about what might be causing these symptoms, all the while having no idea what was gong on with the patient because I could not speak any Lozi to their families and the patients were obviously not responsive.  I remember feeling the whole time very embarrassed because all of the other nurses and clinical officers kept such cool heads!   I remember thinking.. This is an EMERGENCY! Why isn't anyone showing a sense of urgency? I realize now when thinking back that although no one may have been panicking or showing outwardly a sense of urgency, they were all still being very effective in their roles, maybe even more effective than I was being!  It reminds me of the saying don’t judge a book by its cover, because at this point I definitely was.  Just because outwardly no one was behaving like they were worried or panicked about the patient did not mean they were not. I ended up running to find a doctor at one point because  didn't know what else to do, and when I returned with the doctor the patient had an IV, was in the recovery position, and the patients' family had given a history which lead to his diagnosis, which was poisoning. Reflecting now on this experience I think it was good that I did react the way id did and get the doctor to call attention to this patient because it was necessary, a doctor needed to be there to order emergency interventions, and I think all of my panic and anxiety sped up the actions of others around me which was positive as well.  I also learned though that people all react to stress in different ways and the Zambian nurses react very different from the way I do.  I have a new found respect for the Zambian nurses and clinical officers who remained so composed during this situation, but I also believe I modeled behavior that is sometimes necessary in practice that they may take into consideration in the future when the time calls for it.  At the end of the day I feel proud that I reacted quickly to a situation I felt needed closer attention and  although I may have looked pretty crazy in the moment,  it resulted in the patent surviving, which is the best outcome I could have hoped for 

Another theme I wanted to mention in this blog was teamwork and the importance of feeling supported by the nurses you work with.  Once the doctor had come to see the patient he ordered an NG and activated charcoal before leaving.  Once he left though there were no NG tubes in the OPD (which we had to get from another ward) and I felt like no one agreed with me that this patient really needed the NG at all.  At this point I began to doubt myself and wondered if the tube was he best thing for the patient.  Some of the nurses brought up some valid points like that he was already vomiting, and that we don’t know what kind of poison was consumed so there is the danger of perforation from the NG if the poison had caused burns, and so I began to really question myself at this point.  I recognized I needed to confirm my ideas and feelings with someone who understood where I was coming from I guess so at this point I went to find some support from the group.  I found  Caitlin, Ali, and Lauren in the conference room who all agreed that the NG was necessary and that the possible consequences were outweighed by the benefits and I found the support or confirmation that I was looking for.  This situation reminded me of how important it is, especially for a brand new nurse to seek out help and support when needed.  

That sums up a bit of what I experienced this week in the OPD and I look forward to my next placement t save a life center, 

Until then, 

Sarah: ) 

Sunday on the Zambezi River

African Queens

The Resilient Children of Mongu!

This week on pediatrics was great, but left me asking a lot of questions. I started Monday with feeling nervous about entering the children’s ward because this population is one that I love to work with and care for. I didn’t have much time to think about it as maybe 5 mins into our shift it felt like I was pushed out of my comfort zone and past my limits. A child was receiving treatment to help drain his leg of osteomyelitis was difficult to be a part of.  I am grateful to have Jackie, who came into the room just when we needed her. It wasn’t easy to be there while this was happening, but as I have reflected it was a fight or flight moment and I chose to fight. I kept saying , it will be okay, and to look at the father. The moment was difficult later to reflect on and needed some support, however I could see the growth in myself from the previous weeks and was partly the reason why I was able to continue to work and become involved with the care with the other patients. More importantly from this experience was able to help us connect with the community of the pediatrics floor.

On this floor the community is visible and all the parents help care for each other’s children. If one parent can speak some english, then that parent helps with the translations. On one side of the bay I could see that between three parents that would make sure one parent was there at all times and would comfort, watch over each others children, bring food to the bedside. This floor goes through a lot of highs and lows. I could see in the women’s faces the sadness when a child had passed away on the floor one morning. I wish I could describe it better, but it is something that you feel and can see on the floor.

Caitlan and I would read stories, pull out the coloring books and crayons, bubbles to create some activities. It was a great moment to see the family members coloring with the children, or just coloring themselves. We created a story circle and then going around and read the books to children again. It was moments like this that the language barrier could be set aside and we could still be a part of the community.

I had also struggled with the children dying from what I perceive as not receiving the basic health care, such as oxygen or getting access to ventolin. The staff works very hard to try and treat the children with the limited resources they have access to. I think I found it really hard to see the children that were dying from things such as pneumonia or  malnourishment ( also when the malnourishment  was related to malaria or HIV). It is incredibly difficult to see children who either are not getting treatment or unable to have access to the medications or treatments that would help children extend their live when battling illness such as HIV. It is just hard to be in the room with the parents and the children and know that I come from a place where there are a lot of resources, I know there can be more done, or even how much the basics would make a difference. However, you have to remind yourself as I have learned this week, that we do the best we can with what we have.
Caitlan and I really wanted to be able to administer ventolin to a young child as we could visibly see and hear that the child was having difficulty breathing. With Faye’s support we managed to get our hands on a liquid form of ventolin and then used our resources to create our own chamber to use with the inhaler. We found a mask, a large dropper (turkey baster looking thing) and a little mask  and created this little tool. This was good enough to get some of the medication into the child and what a difference it made to her breathing. It was moments like this where you realize that creativity goes far with limited resources.

I was lucky enough to go with Caitlan, Darien, Lauren, Faye and Jessica to Limulunga school. There I was able to take the letters from the Canadian students and share them with the young students at the school. So glad to have their teachers help translate the letters and was a neat moment to have them connect with each other. We also taught dental care using (thanks to Lauren’s idea) egg cartons jaws with our homemade tooth brushes to demonstrate. We talked about malaria, safe water, physical activity and hand washing. For hand washing we poured sparkles onto their hands and then had them shake hands with each other to try and demonstrate how germs spread. The look on their faces as we poured the sparkles was fantastic. They didn’t know what to do with them first and then they were excited. I think my favourite part was having the children singing twinkle twinkle little star as we washed our hands. The children were so excited just to play and sit with us. It is neat to see these children and be reminded that all children are the same in the end. Special thanks to Sister Peggy and the teachers of our classrooms for inviting us and making us feel so welcome.

Over this practicum I have been reflecting over my experiences and been thinking about how it has changed me and how it will affect me when I am back in Canada. It will be my birthday soon, which I always try to come with goals to achieve over the next year. Because of this experience I find myself thinking about working towards career paths or experiences that I don’t think could have been inspired or that i would be able to do it without this practicum. Thank you to my friends and family at home for their support during my time away and to the Zam crew for making this experience amazing.

looking forward to going and making this last week here in Mongu count :)

Aileen

The Children of the ART clinic

Tuesday is pediatric day at the Anti Retroviral Therapy (ART) Clinic here in Mongu. Although we (Savannah & Leah) enjoyed our week at the ART clinic and learned so much about HIV/AIDS, Tuesday is the day that made the most impact on our experience, as it was one of the saddest, but at the same time, uplifting days of the week.

Just a little background for perspective, currently, according to Unicef.org, there are about 120,000 children under 15 years of age living with HIV in Zambia.  Every year, another 28, 000 babies are born HIV +. Furthermore, 11% of deaths in children under 5 years of age are due to HIV related causes.

This is why Tuesday is sad. Sad because it is children, and mostly sad because there are medications available so that no more children need to be born with HIV, and yet Tuesday continues to be a busy day at ART. The preferred PMTCT (prevention of mother to child transmission) is to start pregnant moms on a triple-action anti-viral medication as soon as possible in pregnancy, and which continues throughout her entire life independent of her CD4 count (this means how low her immune system is). Right now, pregnant moms will only get this preferred therapy if her CD4 count is low enough. If it is too high, both she and the baby will receive medication in labour & delivery. Although this method is effective in many cases, it is not AS effective as the preferred treatment, and some babies will still become infected.

However, there is hope that one day pediatrics will not need to have their own “day” at ART. Zambia is currently undergoing a campaign to eliminate the transmission of HIV from mother-to-child by 2015 (the plan was established in June 2010). So far, the campaign is having positive results – within 2 years, there has been a 55% decline in the number of new HIV pediatric infections (IATT, 2014). Furthermore, 86% of HIV+ pregnant women received ARV medication to prevent transmission in 2011, this is up 36% from 2009! Perhaps most impressive, there has been an 80% increase in HIV testing among pregnant women within 5 years…allowing mothers to know their status, access treatment, and prevent transmission in the future. Zambia has also promised to implement the WHO standard of treatment (remember that one where pregnant moms get the best treatment for their whole lives?) Unfortunately, as we all know too well, there is always a lag between the promises made at the “top”, and the actions that occur on the ground, especially in a country where resources are limited and accessibility to health care can be challenging (anyone up for a 5 hour walk to the doctor?)  

It was sad seeing these children who were HIV+. It was sad that many of them were small for their age, possibly due to bouts of chronic diarrhea or lack of appetite from constant respiratory infections because of their decreased immune defence. It was sad seeing a 12 year old already having to switch to a second-line treatment because he had developed resistance to the first-line treatment and had a CD4 count of 84 (that is really low!)

It was uplifting because these children were smiling, laughing, and trying to catch all the bubbles Savannah was blowing at them (big hit!). They are on ARVs and are growing up living healthy, active lives – like all kids should, independent of the country they were born in or their HIV status.

The ART clinic is very busy any day of the week, and can seem overwhelming with up to 500 clients flowing through each day. The clients show up early in the morning to receive education, and then must make their way through registration (to find their file), then on to see the nurses where they are weighed and measured, and have their vitals taken. After this, they may have their blood drawn depending on when their last CD4 count was, and then back into the que to see the clinical officer (by the way – there was ONE clinical officer the day we were there).  Then they still have to go to Adherence (to ensure the medication is being taken properly), and on to pharmacy to receive a new supply of meds. The whole process can take hours, waiting on hard wooden benches, or standing elbow-to-elbow on the concrete sidewalk in the sun (I will never complain about my 15 min wait to see the doctor again!) As you can imagine, this can be a tedious, frustrating day for the most patient person – imagine if you are 4 years old. 

One of the fabulous student nurses here, Aileen, came up with the idea last week of creating a toy box for the children to utilize while they wait for their treatment. We have talked to the hospital carpenter and he is starting to design the toy box, stay tuned for more updates!! 

Leah & Savannah