Sunday, March 29, 2015

Sefula Part One: The Clinic

This week Danielle and I (Rebecca) worked in a rural clinic in Sefula, about 40 minutes from our home at Liseli Lodge. This clinic is divided into two main sections: an outpatient department combined with an ART clinic (for HIV patients) and a maternal-child health clinic. Almost all of the patients spoke Lozi, making it very difficult. The staff knew English and were able to translate, but it is hard to make connections with the patients. We definitely picked up some words and phrases along the way and the locals, who don't often see Mukuwas like us, loved that we tried to integrate ourselves into their world!

Main Street, Sefula

We were very impressed by how the clinic was run and we can attribute that to Barbara, the charge nurse at Sefula. She was very organized and made sure things were getting done. All of the paperwork was up-to-date and medications were labelled. It may not seem like much, but it was a drastic difference compared to the hospital. There were motivational signs and statistics from their clinic posted as well. One of the most notable was how the rates of HIV have diminished since antiretroviral medications have been in place. One of the counsellors said about 1 in 10 people tested would come back positive before. It is now closer to 1 in 20. With the success of the ART clinic comes challenges too. As the patients live in very rural villages, some of them do not have contact information. When people miss their appointments, the staff try their best to find them and make sure they are staying on track, often by calling the village chief or bicycling over to see them.

Barbara also told us how there are quarterly meetings to get feedback from the communities in their catchment area. This assures that problems are being addressed and they are meeting the needs of their clients. This was something that we don't even really have implemented in Canada. These meetings are also a way to communicate back to the communities, such as by encouraging women to come in to a facility to give birth instead of at home.

Sefula Clinic

In addition to the administrative side, Barbara worked in the clinic. She assessed, came up with impressions and diagnoses, and developed treatment plans. While doing this, she treated the patients with the utmost respect. 

We spent a good part of the week with Precious in the maternal-child clinic. We spent time with her doing antenatal assessments on pregnant women and working in the under-5 clinic doing vaccinations. We learned so many new skills and she was incredibly encouraging. We felt the mothers' bellies for the position of the babies and listened to their hearts using a fetoscope. We felt like she really appreciated our help and was excited for us to be there.

Vaccination Clinic

We have both experienced vaccination clinics in the Okanagan and it is very different here. They are so busy because there are so many children and it seems hectic from an outsider's perspective. Although it might not be as regulated as home, the most important thing is that women are bringing their children in to be protected against illnesses that are more common place here.

Rebecca and one of our Favourite Nurses, Precious

The biggest thing we learned working in a rural clinic is that you have to work with what you have available. This really hit us when we assisted a mother giving birth to her baby. In Canada under her circumstances, she probably would have gone for a c-section, but that was not an option at Sefula. There were limited supplies and limited people available to have a birthing experience like back home. Instead, we helped the mother with support and encouragement, something that is readily available no matter where one is nursing. 

- Rebecca


  1. Dear Rebecca & Danielle,

    Travelling to Sefula via your words also brings back memories from our 2013 trip to Zambia and our brief time with Jess in one of the village clinics. You are so right that wherever one practices nursing, fundamentals do not change - respect, relationship, assessment and problem identification, planning and treatment. Being there and showing up for people the best that you can with what you can.

    Your stories about the HIV incidence charts to help communities see their progress with ART and the community meetings to discuss their needs also point out how vital it is for any of us in healthcare to both give AND get audit and feedback - the road to change and improvement is built through the learning together that happens when we exchange knowledge with each other.

    Lessons learned again that we already know, but too often forget!

    Tricia Marck

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