Friday, April 24, 2015

"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. 

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! 

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