Makuwas in Makilipwe: A Tale of Rural Outreach Nursing

This week Karen, Jessica and Courtney headed into the wilderness of Africa on a medical outreach. In this rural remote nursing experience in Makilipwe, we set up tents, cooked over a fire, and built a pop up medical clinic made of reed mats and chintenges (a traditional piece of fabric the women use for everything, from skirts to baby wraps).

Jessica dispensing medications.

The church we held our clinic in.

An average house in the village.

Our bathroom facilities.

Straw huts we strung chintenges across and boiled water over the fire to put in a small basin to wash with.

Makilipwe is a small village 2 hours outside of Mongu in the floodplains of Zambia. Homes are made of mud and straw, and there is no electricity or running water.

On this outreach our role was similar to that of a nurse practitioner in Canada. Under the guidance of Nilene, a South African doctor, we assessed, diagnosed, and dispensed medications to patients. We were also lucky to have our translator, cultural guide and impromptu little brother, Muyunda. During this week we realized just how important it is to work together as a team, all of us quickly becoming a family.

Muyunda, Courtney, Jessica, Karen & Nilene ready to head out to outreach.

Our camp site was set up near the community church, and the villagers welcomed us the first night, inviting us to sing and dance around the fire. As the villagers danced the Milky Way was shining brilliantly above us, and across the floodplain, lightning was flashing. The people danced to the drum, and sang biblical songs in Slozi, and soon we were joining in. It was an experience that we will never truly be able to describe in words, this was the real Africa. This experience was relived for roughly three hours each night of our visit until the last night, when we treated the villagers to a play in Slozi. (That was a first.) 

Our days would start bright and early at 6 am, prayer was at 8, and clinic started soon after. During clinic it became apparent that lack of access to medical care in this village had a great impact on the health of the people. Medical outreaches like ours may only visit them once or twice a year, the nearest medical facility is a four hour walk, and the nearest hospital a two hour drive away!

Jessica working in the clinic.

Courtney and Muyunda attempting to fix a shoulder dislocation with manual traction.

Courtney manning the outdoor clinic. 

Reed mats used for patient privacy.

Social determinants of health, here, and in many other communities in sub-Saharan Africa, have a large impact on the mortality and morbidity rates. Makilipwe faces challenges including extreme poverty, lack of resources, and its community members lacking formal education. Social determinants of health, according to the WHO are described as the "conditions in which people are born, grow, live, work and age, and these conditions are shaped by the distribution of money, power and resources." For example, we encountered many late stage cancers, where it was evident that the patient had been exhibiting symptoms for many years. For these patients to get diagnosed living in a rural village such as Makilipwe, they would first have to get a referral from a clinic, meaning walking several hours to the nearest clinic. After receiving a referral they would then have to figure out how to get to the hospital in Mongu, which is a logistical nightmare. At the hospital in Mongu if it was determined that the patient has cancer, they would have to take a bus to Lusaka for treatment (a nine hour trip, which is too expensive for the average villager). 

A Grandfather talking his granddaughter into trusting us at the clinic. We loved the bear she carried around in her chintenge on her back. 

As we saw more patients we realized that while we could give them medication, in two weeks that medication would be gone and they would be back at square one. Initially we felt like we were putting a small bandaid over a huge problem, each of us struggling with this conflict. We questioned if we were truly making a difference. However, by the end of the practicum we realized that through providing education, being present and forming strong relationships, that we were making a difference in this community. Our presence in the village brought more than medical care, but also hope and a reminder of the importance of unification. Although we couldn't speak Slozi, and they couldn't speak English, we were able to form strong relationships with the community and its members.

The villagers called us makuwa (literally translates to 'white man'), and the difference in privilege between us was apparent, as many of our phones were worth more money than they had ever seen, or would see in their lives. Ultimately the differences between us were pre-determined by where we were born. By making personal connections with villagers and integrating ourselves into their community we felt that we were able to overcome some of those differences, and for the week unify with the common goal of improved community health and health education.

-Courtney (center), Jessica (right) and Karen (left) ❤️