Saturday, April 19, 2014

Sefula: An Extremely "Precious" Clinic


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”.


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!

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