Dear Mongu

Dear Mongu,

           What can I say about these last six weeks? I will never forget them.

            I am writing this to thank you. Thank you for welcoming us with open arms and warm smiles. Thank you for your sunsets, your flood plains, and your lightning storms. The rawness of your beauty and the wholeness of your people are my favourite parts about you. I feel like I was just getting to know you and now I have to leave! Maybe I'll see you again one day...after all, I have yet to try your cashews.

             Thank you for allowing us into your hospital and trying our best to help even when our language and culture of care is so different. Your nurses and doctors were so ready to work with us; to help make us better and accept help where we were able. I will never forget the generosity they bestowed upon me - whether it was with kindness, knowledge, or time. 

           I appreciate the hardships you experience are every day realities for you and only short clips in our life stories for us. That isn't lost on me. Your rawness wasn't always welcome for me though...I struggled to see my patients endure things that probably wouldn't exist back home. I got angry at the injustice of it all. Why is it that just because I was born in Canada I have all these advantages that propel me forward in life? Advantages I didn't earn by working hard or being a good person. And then the hard part was moving forward and accepting the way things are. Should this be something that we accept? Maybe that's the only way to progress; not looking back and questioning, but looking forward and helping. I hope I was able to achieve this even in the smallest way.

         Thank you also for showing me the wholeness of your people - people who have such great senses of humour, kindness, and openness. It was amazing to see people so whole when their lives seem, to me, so difficult. This life has brought them together, not apart, and that is a great lesson to witness. And although I'm pretty sure they were laughing AT me most of the time, I loved spending time with them.

          It goes without saying I have learned so much from my time with you. I will be forever indebted to you for allowing this experience for me. To your people, I will never forget you!

Sincerely yours,

Johanna

That Escalated Quickly

Originally, when Jessica came to us with the idea to host blood pressure clinics within the community, we were excited to begin this small, yet important project. What we didn't know was that the small clinics we envisioned would turn in to two large clinics and a even larger event. 

This project started as a result of research Jessica and Fay had participated in in Mongu District between 2011 and 2013. Coming here then she had noticed the same trend we noticed this year - that there was an alarmingly high amount of people that had high blood pressure. We knew from school that the prevalence was higher in Africans, but Jessica and her team aimed to gain qualitative and quantitative data in our specific area.

This study, taking place in Sefula, Limulunga, and Mongu (all Mongu District at the time) found that about 33% of people here had high blood pressure. These results are shocking - it means that 3 in 10 people here are at risk of developing complications such as a stroke, a heart attack, kidney disease, or even death.

The study also looked for causes of the high blood pressures. The main things they found were that the diets contained a lot of salt, people were cooking with a lot of cooking oil, and people were not active enough. They also found that medication adherence was a problem either due to lack of education or poor availability of drugs, and that almost half the people here had never had their blood pressure taken before. This made us realize that high BP (or hypertension) was not getting the attention in this community it deserved.

Knowing these study results, we wanted to create a way to not only disseminate the information back to the communities from which it came, but to deliver it back to them in a meaningful way. The way we decided to do this was by hosting these blood pressure clinics. We felt that taking a health promotion approach to this was very important. We also knew that these events would provide us the opportunity to provide individualized patient education as well as gain new data to compare to our past research.

To put on these events, we recruited the help of not only our fellow UBCO Students, but the Zambian Enrolled Nursing (ZEN) Students here as well. This was a total of 64 students! And though the Zambian students had just started their education in the new year, we knew that their cultural insight and ability to translate would be huge in both planning and hosting these events (and, in the end, it turns out that they had pathophisiology knowledge to rival our own!).  

Working with the ZEN students was very rewarding. With the help our our student leader from ZEN school, Nyambe, we were able to watch the students grow and build confidence over these events. Also, knowing that hypertension is under appreciated here, we felt that we were able to hopefully make future change by helping to teach the health care providers of tomorrow of the importance of BP, today.

We formed great relationships with the ZEN students, and by the end of the experience were able to call them our friends. This was not only great for us, but will help when future Canadian nursing students come to their hospital in the next years. Hopefully, the collaboration between these two groups can continue to develop. 

Armed with Canadian and ZEN students at our side, we started planning the events. We knew we wanted to keep Sefula and Limulunga smaller events, but the more people we talked to, the more our Mongu event grew. Specifically, in our meetings with the District Health Office, the Provincial Medical Officer, and with our colleagues at Lewanika General Hospital, the excitement around our event grew so much that we felt that our event planning capabilities were really about to be put to the test.

Suddenly, in a span of three meetings, our Mongu event grew from a table under a Mango tree on the main street of town to an advertised event hosted at Community Hall. We were now planning to have six stations, three Clinical Officer Areas and a mobile pharmacy (for on site treatment), and a guest of honor - no other than Mayor Tombi himself. 

Though we were feeling overwhelmed, and though time was stacked against us (we only had three weeks to plan!) we knew hosting this event was the right thing to do. Over the years, our Zambian colleagues have been so welcoming and so accepting of us coming to practice nursing here. They have given us so much of their time to teach us, inspire us, and show us medicine in Africa. Therefore, we knew it was time to rise to the challenge that they set before us. We knew it was time to give back.

In Sefula and Limulunga, we saw a combined total of 241 people in a span of two hours. And to support our past research, the high BP prevalence rates in these areas was still an astonishing 33.8%! Though these two events were important, we knew they were smaller events that were helping us prepare for Mongu. Through them, we were given a taste of the communities desire to not only learn about high BP, but to become empowered to take their health in to their own hands. This inspired us, and motivated us for our upcoming Mongu event.

 

Then, after weeks of planning, our main event finally arrived. And we were thrilled with our end result! Throughout our day in Mongu, we saw 242 people in two and half hours. Here, we found a prevalence rate of 37.2%. And with our onsite treatment area, we felt we were able to help people on a whole new level.

As mentioned, one of the main purpose of these events was to disseminate our research back to the communities. So often with research, it is conducted, but the results are never appropriately communicated to the people that matter. In this case, this was the community members. We wanted everyone to know that we knew high BP was prevalent in their town, and that we were just concerned as they were. We wanted them to know that we understood it was hard to access health care and medications, which is why we had on site treatment at our event. And most of all, we wanted the people here to know both through our research and these events that we cared about them, and that we were hoping to make a positive change in their community. That is why through our events, our goal was to disseminate our research through action.

Another goal of ours was to raise awareness. We had the research to prove high BP was a problem, and we wanted it well known so the policy makers could start to make change. That why we were so thrilled that at our event, radio stations, television stations, healthcare professionals, and government officials were present. The Mayor of Mongu called upon the government to take a stand on the issue of high BP, and said that non communicable diseases are not getting the attention they deserve. We even found out later that our event was broadcast on the national news. Hearing this was so rewarding.

We were even more excited when we learned that a radio station we had been working with, called Oblate Radio Liseli, was so excited with our work in Mongu that they wanted to help promote health here. Through this, we were able to start a "Health Corner" segment that will run regularly, and even get the ZEN students on the radio singing a song they wrote about high BP. It is amazing how things snowball!

This was such a great experience. Karen and I had both planned events in Canada in the past for nursing (she planned the Global Gala and I planned a blood drive), and this really made us realize how different it was to plan events in Zambia. So many obstacles arose that we didn't anticipate. Printing took twice as long, communication was hard due to language barries and tricky cellphones, and entertainment became a nightmare when we watched our ZEN friends jam a live wire used as an extension cord in to a power outlet using a pen lid. TIA!

However, this experience made us realize how far we had come and how much we could accomplish. In first year, we started off our nursing education with a blood pressure clinic. Now, four years later, we were helping to create one, while teaching new first year nurses all that we had learned. And for the first time, we felt like we weren't students, but professionals giving back to the community while working in partnership with our Zambian colleagues. And instead of an instructor, Jessica became a mentor to us. As this project and practicum marked the end of our nursing degrees, she became a fellow colleague. 

- Danielle and Karen

Thanks for the memories

Currently, we are sitting at Lusaka International Airport, waiting to leave Zambia. And there is something about sitting in an Airport to leave that always makes me feel nostalgic. 

Before I left, I knew there were moments of this experience that were going to be hard. I knew there were moments that were going to break my heart. And as much as I expected them in my nursing practice, I didn't expect that leaving would be one of these moments.

Never in my life have I stayed long enough in a foreign place to not only have it feel like a home, but to make friendships there as well. And I think out of this whole experience, that was the thing that surprised me the most - the quality and quantity of friends I made here.

And though the experience itself was life changing, so were the people I met. And I realized when I was going through some hard times that that is how the people here get through it - that is how they survive the heartache. They support each other to the best of their abilities, and in the end, everything they go through just strengthens their bond.

So though I am excited to begin the next part of my travels, today is really bittersweet. I miss Mongu so much already. I miss my friends every second. And I know it will become easier with time. But in the end, I know I will miss these people for the rest of my life.

The only quote that keeps popping in to my head right now is the super cheesy one that says "Don't cry because it's over, smile because it happened." And though so cliche, it is also very applicable to this situation.

So, today even though we leave Mongu and I am sad, I am smiling. What a great experience. What a great part of my life. And I will always look back on it with fond memories, and continue to smile.

Thanks for the memories Mongu!!

- Danielle

TIA

This Is Africa 

I song I wrote dedicated to some of the girls who were having a rough time 

Sitting under this mango tree

Thoughts of you keep coming to me

Your pretty smile and eyes that shine so blue

We know it's hard 

Thoughts racing fast

The should've and could've but we can't change the past

Oh what I'd give to hear your laugh

Smile a little smile one step at a time

You're surrounded by love oh how it shines 

We've got your back 

And that's a matter of fact

Quitting seems like a way to flee

When all you want to be set free 

Wish we could take these feelings away 

We know your guard

Has taken a blast

The rights and the wrongs a flashback and you crash

Oh what i'd give to hear your laugh 

Smile a little smile one step at a time

You're surrounded by love oh how it shines 

We've got your back 

And that's a matter of fact

The whole world sits inside of your palm 

Your futures bright try not to worry about home 

We've got your back

And that's a matter of fact 

Nicole

"Butata Kibufi?" Outreach in Lukona

We (Sue, Nicole, Marissa) spent last week doing an outreach in a rural village on the flood plains called Lukona. We apologize for the delay in posting this blog, upon return to Mongu Sue and Marissa both got very ill. Don't worry, after some antibiotics, IV fluids and TLC we are all healthy now - and very excited to share our story! 

We had been looking forward to this week for a very long time. While we all loved our experiences in Mongu, we knew that this outreach was going to be something special, and we were right. The week we spent in Lukona was hands down the most valuable and incredible experience of our time here in Zambia. 

Our outreach was put together by the Zambia project, which is the organization that runs the Save a Life Centre where a number of us girls worked while in Mongu. There was one doctor (Lisette from the Netherlands), us three nurses, two translators (Gift and Muselo) and our team leader (Lloyd, our translators father). 

Marissa, Lloyd, Lisette, Gift, Nicole, Sue and Muselo

Our journey began by boat. We thought it was a boat that could seat 50 people so we imagined a decent sized ship that would carry us out through the flood plains. We were quite shocked to see a small, narrow wooden vessel with people packed like sardines in every crevice. The weight was distributed unevenly so we were tilted to one side for the entirety of the three hour journey. Despite being uncomfortably crammed and slightly concerned about tipping, this boat ride was an enjoyable experience because it was one of the most beautiful things we had ever done. The boat sat low on the water and we felt almost eye level as we sluiced through the water. We passed tiny villages in the plains, Zambians standing in dug out canoes, and watched apprehensively as rain clouds stormed in areas we hoped we didn't have to go. 

After 3 hours by boat we arrived on the shores of a small village. We were greeted by an interesting mix of drunks and children and could immediately see the differences of the urbanized residents of Mongu and the rural inhabitants of this village. Not only was the poverty noticeable, but we could already see physical signs of their lack of access to health care. It was a chaotic period of time spent on this beach and we were thankful when our next mode of transportation came plodding down the beach: an ox cart! We loaded our bags into the cart and started the 3 hour walk across the floodplain into Lukona. The walk was an extremely sandy one and we trekked along on foot for an hour or so until dark, when we decided the ox cart was a better bet. Our ox behaved for the most part - a few accidents and run ins with trees, but we survived! For this part of the journey we kept laughing and pinching ourselves to see if this was real. This was a major "TIA" (this is Africa) moment and we couldn't believe we were riding ox out into a village to provide health care. We were already having an incredible experience and we continued to feel this way for the next 5 days. 

Lukona in itself is beautiful. It is set on a hill with one side is overlooking the floodplain, the other side backed by jungle. Small villages and homes dot the floodplain and we took a walk each day to explore new aspects of the village. Lukona is special because there are 2 boarding schools here. Students from even more remote areas are sent to study here. Because of these schools it is known as a village of children. The schools were on break so many of these kids were not around, but there still was no shortage of young ones around. Interacting with the kids was one of our favorite things about our outreach. 

A view of the plains as we left Lukona

Some of the kids we came to love so much. We gave them these Canada stickers and afterwards could hear them throughout the village yelling "Canada! Canada!"

We brought these little masks for the kids. They loved them so much and wore them all week. 

These guys were our little buds all week. We lined them up for what we said was one last picture, and then Marissa whipped out a can of silly string and sprayed them all. They ran and laughed so hard! 

Lucky for us (and the people of Lukona) there was already a clinic building in the village. We were very pleasantly surprised at the state of the clinic - it has a few observation rooms, an area for an ART clinic, and an entire maternity annex. We at first wondered why our help was so greatly needed but very quickly realized that the clinic building appears nice but is chronically understaffed and low on resources. The staff consists of a few nurses, one midwife who was on his first week there, and a security guard who also sometimes (to our amazement) acted as a medical professional as well. The midwife's name was Sunboy and he was fantastic. We formed a great relationship with him and worked well together all week. Between him and our group of 4 we would see patients until 1 or 2 pm. Now that we are gone he is the only one who will run the clinic, and we are concerned about how overworked he will get. He kept asking us to stay and we felt guilty that we were leaving him with such a big task at hand. 

Sunboy!

During the day it was our turn to really put our four years of nursing skills to the test. We would go to the clinic equipped with stethoscope, thermometer, and the oldest blood pressure machine we had ever seen to see hundreds of patients. Our job was to investigate their complaints, via our amazing translators, come to an "impression" - like a diagnosis -and decide what medications if any would be appropriate for these people. The autonomy of it was amazing. Every patient was a puzzle. We had our wonderful doctor Lisette there for the times when we were stumped. We learned some basic Silozi terms to try communicate with the patient and would start every interaction with "Butata Kibufi?" Which means what is the problem? A lot of patients would start their complaints with a "toho" which was a headache, and the rest would eventually be uncovered from there. 

Standing in front of Lukona Rural Health Clinic

Marissa taking a BP with the old school equipment. 

The baby Nicole helped birth 

Another major complaint we ran into frequently was muscle ache due to hard work in the fields. To us the answer was simple: rest and ibuprofen. When we suggested this, people told us there was no way they could take a day off work and soon the minimal supply of Brufen we had brought with us had run out. This brought us to a standstill. Some of our other non pharmacological methods, like ice, aren't possible either and sometimes the only answer we could give them was that it just may not get better. H

Malaria tests were done daily, as well as H.I.V. testing. There was one instance where we feared a woman with severe weight loss and a cough for over a month had a large chance of being HIV positive. Marissa took on the challenge of administering this test. While we waited the long 15 minutes for the lines to show up on the test (slightly like a pregnancy test) Marissa's heart was pounding. She could only imagine how the patient was feeling. The results came back positive as we feared and we were caught in a position where we had been a few times throughout the outreach. We needed to let the patient know, in an environment where she felt safe, as well as in a caring manner involving trust meaning: relational practice. All of this had to be relayed through a perfectly healthy male translator of the young age of 17 or 21 whom is a complete stranger to these patients and we found it difficult to provide compassionate care because of this. Marissa did a great job despite the circumstances and the woman accepted the outcome and was referred to the clinic to be on medication for the rest of her life.

If we would see patients whom we felt needed a higher level of care such as symptomatic patients with extremely high blood pressure, or some abdominal masses that needed an ultrasound to be sure of what we were dealing with, we would write a referral for them to go to Lewanika or another district hospital. The fact that we had completed the ox cart, and boat journey ourselves really brought a perspective to each referral we wrote. A lot of times we may have mentioned the hospital, but had a very strong feeling that unfortunately these people did not feel they were sick enough to make that journey. Having worked at Lewanika and seen what limited resources they had there we also knew that the care they would receive still may not be adequate.

The clinic opened at 830. We would arrive at 800 where our friend Lloyd would lead a devotion for all the people lined up outside all ready. We went home "when there were no more patients". Patients would bring their scribbler notebook and place them in a pile in order of when they arrived. We would take this pile, flip it (very important!)  and divide it between three teams. One for the midwife Sunboy and two for the "makuwas" or white doctors. Our translators let us know later on in the week the patients were sad if their books ended up in Sunboy's pile, as they felt the makuwas were better and could heal everything, even though Sunboy was providing the same level of care as we were. We were told after a physical assessment or an ear flush the patients would go out to the waiting patients and tell them what the whites had done and how wonderful we were. This was nice to hear, although we were just providing care exactly how we would in Canada.

One of 3 stacks of books for the day. 

Patients sat here all day waiting to be seen. 

Most days we were lucky enough to finish around 1 or 2 pm with the patients. There was one day where we stayed until 4pm. But as we were  the ones with the most medical training our nurse and doctor hats were on 24/7. Multiple times in the week we were called in after 10pm. For either a birthing mother (Nicole got to assist on her first delivery), a severely dehydrated woman carried in by 4 men as she was too weak to walk, or even a bad ox cart accident that involved the doctor suturing the top of a badly lacerated foot in what we can only imagine were the most extreme conditions she ever has.

The incident with the ox cart was one of the experiences that had the biggest impact on us. We had just wrapped up our nightly bonfire with the villagers when a man came to tell us his friend was hurt. We found the man on the edge of his ox cart bleeding quite profusely. As he jumped in his cart he caught his foot on a jagged piece of metal and sliced the top of his foot deeply - even his tendons were exposed. Caring for him was a sharp realization of how few resources we had. The suture needle was dull and Lisette couldn't get it through his tough skin. The security guard/sometimes medical personnel gave it a shot (apparently he had sutured before) and couldn't get it either. We eventually found another suture set that worked but it was a long and laborious process.  While one of us held the flash light, the other swatted away moths and mosquitoes, the third provided comfort to the poor mute man the ox cart had fallen on! We had lidocaine for pain but it was not really doing the trick. We could tell he was in pain but there was nothing else we could do. We were told it was going to have to be analgesic by cooperation, which of course shocked us and goes against what we believe in for provision of care. As a side note the dedication the doctor showed that night was truly inspiring. She went straight from the sutures to a second labouring mother and didn't end up sleeping at all that night.

Marissa concerned about using these rusty clamps. We made sure to give him a tetanus shot 

We could go on and on about our week in Lukona, but hopefully we have communicated a bit of the amazement we had every single day we were there. We are so thankful we had that opportunity. It was amazing to work in such a remote and low resourced clinic. More than that, we felt welcomed into the arms of the people of Lukona and immersed ourselves in the culture. Our hearts are full and happy and it was a week we will never forget. 

Pictures are worth a thousand words, so here are a few more snapshots of our week! 

She Was Only 6

This week I was caring for a girl, six years of age, suffering from meningitis. She had been transferred from a nearby hospital and her condition was so advanced by the time she reached us, it was not likely she would live through the night. We didn't even get a proper chance to save her and yet we tried so hard.

As nurses, some cases hit you harder than others and the reasons are not always explainable, or clear. This was one such case for me. 

So I wrote this piece to help me find closure with her passing.


She was only 6,
And she had already endured so much,
A disease ravage her mind and body.

She was only 6,
And her siblings will never hear her laugh again,
Cry again.

She was only 6,
And her mom will have to go on surviving,
Go home and take care of her four other children.

She was only 6,
And she wasn't conscious enough to hear my words of comfort,
She wasn't conscious enough to know how much I cared,
How much we all wanted her to live.

She was only 6,
And I wasn't ready to let her go,
I hadn't done enough,
I had just learned how to do this!
She was taken.

She was only 6,
And God thrust this evil upon her little soul.

But,

God also blessed her with a loving mother.

She was only 6,
But I didn't need to speak to her family to know how much my patient was loved.

She was only 6,
But she blessed her siblings with 6 years of her pure spirit,
More than many other families are afforded.

She was only 6,
But I hope she felt the love flowing over her,
The soothing words,
The comforting embraces.

She was only 6,
But she left this world with the most important people right beside her,
Loving her.

She was only 6,
But her little life was not in vain,
I will never let that happen.

She was only 6,
But now her body is at peace,
Her chest no longer grunting with effort to breathe,
Her eyes no longer staring, unfocused,
Her skin no longer burning with fever,
No more struggle.
Just stillness.
Given to us to pick up our pieces, silently, and move on.

She is in good hands.

Expect the Unexpected

In Canada, we have taken away much of the suspense and "unknowns" when having a baby. People in developing counties like Canada have become largely attached to the strict plans they have created, leaving little room for what was once called a natural experience. Couples nowadays are able to: know the gestation of a baby, the gender of the child, visualize the baby on an ultrasound, screen for abnormalities, genetically engineer a child, and/or abort by choice. Presently, couples have "birthing plans" that are developed prior to labor to communicate to midwives, doctors and nurses what one would like to have, happen and avoid. Couples have the opportunity to attend prenatal classes to help them understand the best birthing options and choices available. A birth plan includes: a birthing companion, various birthing positions, pain relief and fetal heart rate monitoring. Basically, couples have taken out the mystery of having a baby. 

During our last clinical week in Mongu we ( Amanda and Trisha) were placed on the maternity ward. Right away we could tell that the atmosphere on the maternity ward here was not like the maternity wards we have practiced on in Canada. Women were not accompanied by their families and as a result often gave birth alone. Women were not given a choice of position, instead they gave birth solely on their backs holding their own legs back (where stirrups would be in Canada). Unfortunately, there was limited supply for a high demand of analgesic so most women were forced to fight through the pain on their own. Another difference we noticed was that the fetal heart rate was assessed with manual auscultation (horn) instead of the advanced fetal heart monitor you would see on maternity wards in Canada.  Due to a lack of accessibility and antenatal care, most woman were unaware of their gestational age which made both maternal and fetal health assessments difficult. Adjusting to the women labouring with little privacy or support was emotionally challenging. Clearly, in Mongu, birthing plans do not exist. 

On Friday morning a mother came to the ward from a clinic in the community. She had delivered her first baby at 2400 hours in community and was awaiting the birth of the twin. She had failed to progress to deliver the second baby which had brought her to Lewanika General Hospital,where we were anxiously waiting. The second twin was delivered breech, crying and healthy. When the midwife went to deliver the placenta he was in for a big surprise!

While assessing the second baby, we turned around and noticed a third baby was delivered. This was not only a surprise for the midwife and us, but the mother as well! We were quickly put to work drying, assessing, weighing and labelling the triplets (with masking tape on foreheads) to avoid confusion. 

This situation enabled us to reflect on the antenatal care and resources that we have back home in Canada. We are privileged to have access to frequent ultrasound visits and health check ups that are largely taken for granted. The element of surprise in Canada is minimal and unknown triplets would rarely happen. 

Despite the lack of resources this strong mother delivered healthy triplets. Two baby girls had entered he world and joined their older brother this morning. This situation shows that the birthing process is part of natures course whether we choose to intervene or not; technology is not always necessary for the birth of healthy babies. The opportunity to be part of the delivery of triplets here in Mongu is something we were so grateful to be apart of and will cherish this memory.  We couldn't be more thrilled to welcome beautiful triplets to the world on our last day here at Lewanika General Hospital!

Trisha and Amanda 

Rebekah and Rebecca visit the Village of Hope and Save-A-Life-Centre

For our final week, Rebekah and Rebecca were paired together again at the Save-a-Life Centre and Village of Hope Clinic. We have been a running joke throughout this whole experience with locals finding it humorous that we share the same name, asking if we are twins. In response, we resorted to our given Lozi names for most of the week.

It was a pleasure to work at the Village of Hope Clinic and see firsthand the incredible health care that is being provided. This clinic is funded by the Zambia Project, a missionary organization that has established the Village of Hope initiative here in Mongu. The goal of the Village of Hope, is to provide healthcare, nutrition, shelter, and education to those children in need. 

These services are provided through the clinic, school, orphanage, and Save-a-Life Centre, with plans for further expansion. 

Children getting excited about brushing their teeth! These tooth brushes were donated from the Kelowna community and where given out at a feeding program. 

The Village of Hope is entirely run and supported through volunteers, employees, sponsors, donors, and money raised from the jewelry sold at the Hope Art store. The Hope Art store, sells jewellery, stuffed animals, and bags that are all handmade by local volunteers. The profit from the store goes directly to supporting the Village of Hope initiatives. In fact, with the purchase of two beaded bracelets, two malnourished children can be adequately fed for 2 months. Both of us enjoyed some shopping, knowing it is for a great cause! 

We also had the pleasure of working in the Village of Hope clinic. During our time in the clinic, we were pleasantly surprised by the resources and medical supplies that were available for use. These resources were familiar, and made our work easier in many ways. We worked closely with a couple physicians at the clinic who were very knowledgable and we were able to learn a lot from them. Our time in the clinic was very unique, in that we had the opportunity to step into the role of a nurse practitioner. Within a few hours of our first day, we were triaging, assessing, diagnosing, and prescribing medications to our patients. This is not within the scope of the registered nurse back in Canada, but it was exciting to have the opportunity to practice this skill. We were both surprised by the knowledge and skills we had to offer in the clinic and by the end of week were able to see patients independently. However, it was very difficult  communicating with the locals, and found ourselves frustrated with the language barrier. Many times, we felt that we could have provided better care to our patients if we could speak the native language. Somedays, we relied heavily on a translator to communicate. 

The staff at the Village of Hope and Save-A-Life-Centre have built incredible relationships with the local and surrounding communities. Although newly established, the Village of Hope clinic has seen over 1400 clients. It is evident how greatly needed this clinic is in the community, with locals walking hours to receive the health care they need. We both gained anew appreciation for the locals who walk hours to the clinic, when we had to walk hours to their homes for home visits. We both could not imagine walking hours when feeling unwell to access health care services. 

After long days in the busy clinic, we both welcomed the thought of spending an afternoon with the children at the Village of Hope orphanage. Upon our arrival to the orphanage, we  were greeted by the children with overwhelming excitement and joy. As we learned, many of these children are orphans or are children who are not able to live at home anymore due to their living conditions. Despite some of the difficult circumstances that some of these children had come from, their love and zest for life was infectious. We both found ourselves laughing and playing with the children for hours. Many times, the media can portray orphans as sad and hopeless, but it was evident that these children were some of the happiest children we had ever met. We could also see how the children loved and supported each other and a true feeling of community and family was evident at the orphanage. 

The mission of Village of Hope-Africa "is to bring lasting hope to orphans and vulnerable children by providing them with love and care so they can embrace adulthood as contributing members of society." This was very evident during our time at orphanage and in the clinic. We were continually impressed by the high quality and commitment to care of children and families in the Mongu community. The doctors, nurses, and other staff at the Village of Hope and Save-A-Life-Centre are an essential reason why the programs are so successful. It was an honour to work closely with the staff and with the local people of Mongu who we saw in the clinic. 

For more information about the Village of Hope, please visit this site: 

https://vohafrica.com

Rebekah and Rebecca 

Accomplishing our goals in our wrap up week

This last week Jackie and I were in the post-natal ward. 

Since it was the last week at Lewanika hospital we focused on getting our donations out this week. We gave away make up, nail polish, baby clothing and baby care supplies. When we went to give out the make up, a lot if the women were unsure how to use it, so we showed them how to apply it. They really enjoyed this. It was nice to put a smile on heir face while performing make overs on them. Part of our nursing duty in Canada is to assist and make sure patients are washed and have good hygiene. Here in Mongu, it is left up to the family to assist with hygiene, so we thought it would be nice to do something for them that they normally wouldn't get. We feel that although this isn't a nursing duty, it was nice to take their mind of their illness or post-op complication. We felt that this made the women feel special in their own way. As health care workers it is important to think of the whole person when caring for them. Over the last 6 weeks we have seen a lack of nurse patient relationships, for example; health care workers here only inquire about health status and not the whole individual who has special needs, desires, preferences. Throughout our education, we have focused on patient centred care, and have learned how important it is for health, healing and well-being. When applying eyeshadow, lipstick or mascara on someone, they really enjoyed that. It was really nice to see them happy and not just as a sick patient. 

We also thought it was really important to give our baby donations to the women who really needed it and can't afford these items. We worked with Rhoda, the head nurse to keep track of who we gave gifts to. Rhoda has a log book where she records the mothers with the biggest needs and how much she has given each mother.

This week our goal was to make sure charting was done and to teach about how to chart. It was great to see at the beginning of the week Rhoda teaching on the importance of accurate assessments and charting to the nursing and midwife students. This also encouraged and inspired us more to learn and teach with the students. With the students we were able to demonstrate a head to toe assessment on a mother and child prior to discharge. We felt it was really important for us to exchange knowledge. We were impressed with their assessment skills as well. We also taught the students DAR charting and charting by exception. It was challenging to set up charting due to lack of paperwork and to feel confident that charting would be used however, we did our best to teach them. Overall, we feel like we made an impression on the nursing students and staff about our charting skills and assessments. We feel we have accomplished our goals for the week on teaching and charting.

-Jackie & Gillian

One of the mothers we had a special relationship with

Sister Rhoda - the head nurse

Jackie attempting to clarify orders along with charting

Shining a light on Zambia Nursing

And we're done! Our last week of hospital practicum is completed! The next time we go to a hospital we will be full fledged RNs! We are very excited to be so close to finishing our degrees, but both Natalie and I (Liona) are feeling bittersweet about leaving Mongu. We have made so many amazing connections here that we will miss when we go back home. For our final week we were placed on the Male Ward at Lewanika General Hopsital. We both learned so much, but also had to deal with a lot of frustration and challenges. 

Being back on a real medical/surgical ward gave us a new perspective on how nursing here compares with nursing back home. After talking with the nurses on the ward and finding out how their job compares to ours, it's no wonder not many people are inspired to become nurses here. For most of us in the nursing program, and definitely for both of us, connecting with patients and getting to know them in order to provide the best care possible was the motivating force that brought us to nursing.  The same is true for the Zambian nurses we spoke to, but the reality of what we can do in practice is very different. Even as students we have both been thanked by patients and their families for taking care of them, and the wards in our hospitals are constantly getting thank-you cards and boxes of timbits from appreciating families. Here is very different. I have yet to witness a patient thanking a nurse for her care, and that is probably because the nurses have no time to build a connection with any patients, no matter how much they want to. On the Male Ward, there are two nurses in the morning for over forty patients. In the afternoon, that drops down to one nurse. One person, to look after 40. No wonder no one gets any one on one time. There's no daily assessments, no vitals done for every patient, non of the stuff that usually keeps us running while on shift, but the Zambian nurses are just as busy. And they get non of the thanks that we get. While in Canada nurses are among the top 10 most trusted professional (according to a very official poll from Readers Digest), nurses here is Zambia are very undervalued. They receive almost no recognition for their work, and one nurse on the ward told us that a Zambian government official once publicly expressed nurses are no better than the completely untrained cleaning staff. I wish there was a sliver lining here, that the nurses were at least paid well for their hard work, but that's not the case either. They are paid monthly, and do not get compensated for overtime hours. They make a fraction of what a nurse makes in Canada. When we go home to work, we are almost guaranteed to be making enough for a comfortable life.

But the purpose of this blog is not to say how much better nursing in Canada is, or to rant about how terrible it must be to work here in Zambia. It's to highlight that these nurses aren't working for money, or recognition or thanks, their doing it because they still care about their patients. They still want to make those connections, and they try everyday for that to happen. We want to take that incredibly motivating spirit and work ethic back home with us, and do our best to exemplify it. When ever we have a hard shift, or are questioning whether we made the right choice with nursing, we can remember how strong the Zambian nurses are against all odds and know that we can be too. If they can still see nursing for the reason they started, than so can we. Caring is the backbone of nursing, and these nurses showed that. 

References

http://www.readersdigest.ca/magazine/2013-trust-poll/canadas-most-trusted-professions-2012-trust-poll-results/#L5zsShibkEHwbxqo.97

Breaking down barriers with bubbles

This past week, I (Rebecca) spent time on the Child's Ward with Trisha. I had been waiting so long to be placed here and was definitely excited, but nervous because of the hard stories I have heard from the other girls. There were a few things that we learned this week that stood out. The first was just how resilient children are when faced with difficult situations. The strength some of these children display could rival that of their adult counterparts. The second is the power of play.

Some patients on this ward have to endure things that wouldn't occur in Canada.  They come into the hospital with illnesses like malaria, gastroenteritis with dehydration, and osteomyelitis.  The hospital is run-down and a scary place, and their parents don't really get a break because they are responsible for feeding, cleaning up, and all other daily activities that the child needs.  The parents work so hard to care for their children and they don't always have the extra energy to play with their little ones.  You can notice the unease on parents' and children's' faces when we first walk in, as we are the minority, but this slowly changed from uncertainty to relief when we take the time to throw a ball around. 

One of the hardest things to see is when children must undergo a procedure, as it is not commonplace to use analgesic here.  They are lucky if they get some Tylenol, which hardly does anything realistically. Some kids have gone through the same things week after week.  They scream before the doctors even touch them, knowing what is about to happen.  One boy had to undergo a procedure a couple times during the week while we were there. The first time he was so scared, wriggling away from the clinical officers, and inconsolable.  The fear of the unknown is a big thing, especially for little ones, but the second time he was very stoic. He did not wriggle away, and just a squeeze of my hand got him through.

The amazing thing is when they smile and laugh an hour later when they get to play.  Some of the kids have such serious looks on their faces all the time. It is rare to see a smile without prompting.  It was my goal to get some laughter out of some of the kids and the key was bubbles! Going around and simply blowing bubbles brought so much joy to these kids.

The nurses don't have the chance to hand out toys to play with as they would also have to get them back after.  A big part of us being there was having the time to do such things for the children.  Being handed a colouring sheet and some crayons give them something to do, a little distraction from what they are dealing with in the hospital.  The look of pride on their faces when they finish and show it to you is literally a picture worth a thousand words.

Kids are forced to tough it out by the situations they find themselves in, but they are still children at the root of it all. Tiny. Innocent. Dependent on others. A smile can go a long way in making their circumstances a little better.

-Rebecca and Trisha

Sefula: An A+ for Option B+!

Did you know that a pregnant mother, who is HIV positive, can conceive, carry her baby for 9 months, deliver, breastfeed, and that this child can still be HIV negative? Prior to our trip to Zambia, we had honestly never really thought about it since HIV is not as common in Canada. 

Jessica running triage.

The term mother-to-child transmission (MTCT) refers to the transmission of HIV from an HIV-positive woman to her child during pregnancy, labor, delivery or breastfeeding. MTCT is by far the most common way that children become infected with HIV, in fact 90 percent of HIV positive children have contracted the virus through MTCT. 

Without treatment, the likelihood of HIV passing from mother-to-child is 15-45 percent. However, antiretroviral drug therapy (also known as ART) and other effective interventions for the prevention of mother-to-child transmission (PMTCT) can reduce this risk to below 5 percent!

In 2013, the World Health Organization

(WHO) issued new guidelines for PMTCT. These new guidelines recommended Option B+, which is lifelong antiretroviral drug therapy (ART) to all pregnant and breastfeeding women living with HIV, regardless of their CD4 cell count or WHO clinical stage in countries whose resources would allow for it. 

If a country was unable to provide for Option B+, then the WHO recommended they follow Option B. Option B is similar to Option B+ with all women starting ART therapy during pregnancy. The difference is in Option B, only women with low CD4 cell counts or those with a clinical stage of 3 or 4 would remain on ART. Those women deemed ineligible for life long ART therapy (women with CD4 cell counts over 500 or clinical stages of 1 or 2) would stop ART after the completion of breast feeding. Both Option B+ and Option B are effective forms of PMTCT. Option B+ is the preferred option only because it helps slow the progression of HIV to AIDS for the mother which will help keep the family healthier as a whole. 

Back in February, we had researched PMTCT in order to prepare for our trip to Zambia and as a result we were aware of the WHO guidelines. In a high resourced country such as Canada, there is no question that Option B+ is and should be implemented but we were curious to see if Option B+ would be possible  in such a resource limited setting like Zambia.

Fast forward to this past week at Sefula Health Clinic, which is located approximately 40 minutes outside of Mongu. 

Jessica walking to Sefula.

When we pictured going to Sefula Health Clinic, we initially expected it to be similar to what a Public Health Center is like in Canada. When we arrived, we were given a tour of the building and quickly realized that Sefula Health Clinic is actually a small rural hospital. 

Sefula Rural Health Clinic.

While in Sefula, we had the opportunity to work with an amazing nurse named Barbara, who introduced us to management of HIV positive mothers in Zambia. We were so excited to see that they are implementing the most current WHO recommendations, and you guessed it, Option B+! All of the HIV positive mothers that we saw in our antenatal appointments had been starting on ARTs regardless of their CD4 cell count, and will remain this way for life. We were amazed that this practice was being implemented, in such a rural, resource limited area. We expressed our thoughts to Barbara, and she explained that there is such a good uptake of services because of the wonderful education these women are receiving from community health volunteers. The

Sefula Heath Clinic serves the roughly 9000 people that live within Sefula itself as well 9 different districts on the outskirts. As you can imagine this is a very large catchment area for such a small clinic so adequate access to health care for everyone is a real challenge. Fortunately, the Sefula Health Clinic is currently working with 25 amazing community health volunteers who are working to improve access to health care. These volunteers are people who live in Sefula and the surrounding area, and have been educated informally by the health practitioners at Sefula Health Clinic.  These people are extremely passionate about the health of their community, and are committed to helping their people. Many of these volunteers are women who are experts on PMTCT. They are trusted and respected members of the community, and the people listen to them. 

Barbara, the nurse who ran Sefula the week we were there.

Sefula catchment area map.

Antiretroviral medication dosing for infants.

Since they officially formed last year, there have been no reported cases of maternal death which is an amazing achievement! We also noticed that during our week at Sefula Health Clinic, not one child of HIV positive mother tested positive for HIV. Their interventions are working and it's absolutely amazing! It gives us chills just writing about it. 

These volunteers and nurses offer an extremely effective PMTCT program, where the women and their infants receive a cascade of interventions including uptake of antenatal services and HIV testing during pregnancy, use of antiretroviral treatment (ART), and they ensure safe childbirth practices by recommending coming into the clinic, or ensuring they have a skilled birth attendant. They also teach appropriate infant feeding, uptake of infant HIV testing and other post-natal healthcare services. 

Mothers in the antenatal education day. They are holding Polaroid photos we took of them and their babes!

Courtney and her buddy. 

Throughout the week we had the opportunity to work in the antenatal clinic. We performed exams, worked with mothers to detect and treat other opportunistic infections as well as STI’s, and we helped educate and counsel around medication, labor and delivery of baby, infant feeding, and safe sex. The clinic ran so smoothly, the women looked so happy and healthy, and we realized that this is what capacity building is all about. 

 

A community health volunteer teaching sexual education and birth spacing to the women.

Without these community health volunteers (and of course Barbara and the wonderful staff at the clinic), the health of the community would be much lower. Together, they are working together with the nurses to facilitate ART retention among and to improve their infant outcomes. Sefula is doing an amazing job of bridging maternal, newborn and child health services with HIV care and treatment at community and facility level.

- Courtney & Jessica

A photo of a woman in the hospital. She was so beautiful and wonderful to visit!