Until next time...

Hello all!

Rachel's Week in the Outpatient Department at LGH 

Spending 3 days in the OPD allowed me the opportunity to see many patient presentations- an experience similar to the Canadian ER though vastly different in terms of triage, treatment, and resources. It felt as though I saw anything and everything in a day, though each shift seemed to bring new lessons of trauma, abuse, violence, and suffering. Of course, there was positive change as well; a couple wishing to receive reproductive counselling, a mother with her sick child, or seeing granddaughters with their grandmothers. The simple shift from one patient to another was astounding and taught me a most certain sense of adaptability. In working with the Medical Officers, I saw it- they are there to do their jobs and to treat each patient as best as they can, though that adaptability is much easier said than done. Thirty minutes spent identifying a passed mother and her baby is intertwined with the concerns and questions of the other patients around you. There is never enough time, nor will there ever be. That's what we see at home and it's what we see here in Zambia. How can we best serve patients under such strict time constraints, completely outnumbered and short staffed? It's a question to be answered in both health systems. In realizing this, I was able to enjoy my time spent with the knowledgeable Medical Officers in order to treat each opportunity as a valuable experience, whether it be devastating or surprising. Being in Zambia, I feel that I have experienced so much yet have barely scratched the surface of what it means to be a nurse here. In contrasting my experience in the OPD with our Malnutrition Screening event, there were times of sadness in seeing patients who had little hope of surviving. There was also a feeling of positivity and hope after finding out that one of the patients that we referred from the screening clinic went to the Save A Life Centre to receive help the very next day. To me, knowing that our initiative made a difference for one patient was more than enough to make it worth it.

It's a genuine pleasure, working as a nurse. To find fulfilment in each day that I spent caring for patients is an absolute blessing that I wouldn't trade for the world. How awesome is it that I can say that? I have certainly found my passion and carry such pride in knowing that my fellow students represent the same. I will surely miss all those whom I have come to know throughout this trip though will carry the many lessons learned in Zambia for years to come.

Thank you for joining us on our amazing adventure! I miss you all!

Jackie and I will be continuing our travels through to Cape Town and to London before travelling throughout Europe for a few weeks. I can't wait to see you all upon my return to Canada!

Cheers,

Rachel

Ending is just another word for new beginning

This was our final week at Lewanika General hospital on the labor and delivery ward. We are together yet again, and had the most wonderful week to conclude this final practicum as student nurses. 

(Priya) I want to pursue a career in maternity in the future so, being on the labor and delivery ward was very exciting and something I really looked forward too. This week I got to experience some very beautiful moments with nurses, families and of course lots of babies!! One our first day on the ward we were able to take part in a c-section delivery for surprise triplets! When we walked on the ward the understanding was that the mother in question was pregnant with one child and was going to give birth soon. We had the pleasure of working with the Czech Doctors and upon their arrival they assessed this mom. They were able to distinguish two separate fetal heart beats. After hearing the news, the mom was not as enthused as the staff and students were and it became apparent that the mom was not ready for two let alone one child. We found out that the second baby was in a different position than the other making a natural delivery difficult/impossible. The mom required an emergency c-section to be performed when the OR room was prepared. 

Since the patient was quite young, the patients mother provided consent for the surgery and I (Priya) performed a pre-operative checklist! Very quickly the patient was in the operating room and we were watching the doctors perform the c-section. After the first baby came out I got to perform assessments and care to the baby which was amazing and very interesting. With Priya attending to the first baby I (Jackie) was able to assess and take care of the second child. At one point I was tending to both children as Priya moved to check in on the mom in surgery. While I was busy with the babes at the baby warmer I hear Priya yell, "Jackie! There is a third baby!". It was very crazy, nobody expected this and everyone was surprised. 

(Jackie) Upon hearing that there was yet another baby I was of course very excited. However, a feeling of sadness also came along side my happiness. This mother was not prepared for a single child, let alone three. I could not help but feel for her and the situation she was now in. Over this, I felt sadness and could not help but feel empathy for her. The new mother's sister at only 2 months, had just become an aunt to three new babies. It was a bitter sweet moment for me and I could not help but cry out of joy as well as out of heartache.

We had to leave soon after the birth as the room we were in could not accommodate the needs of the three new babies. We carried the children over to the Post Natal ward where there was a bed waiting for them. Everyone along the way was surprised by the triplets and asking if they were all one birth. Many families were overjoyed by the three new faces on the ward, but in some you could see the struggle. The struggle of mixed emotions that I (Jackie) felt when they were born. 

(Priya) It was bittersweet though, imagining how difficult it was going to be for this young mother and 3 children especially when she did not know of the 2nd let alone the 3rd child she gave birth to.Knowing of this and the difficulty this mother may have for resources we provided her with extra baby packs with clothing, socks, hats and blankets she could use for the babies. All in all, it was an amazing, once in a lifetime experience!

(Jackie) The following day on my birthday I was able to deliver a baby boy! Priya and I were both very excited and still on an emotional high after delivering the triplets the day before. We worked with a midwife named Regina and she was phenomenal to work alongside. We fanned the mother and held her hand as she started to push. We really wanted to tend to the mothers needs during childbirth as understandably, so much attention is put on the babe during delivery. It was her first born and she was very nervous. At times she felt she was "going to die" and could not continue. However, despite her struggle she was able to deliver a baby boy. When she was ready the midwife turned to me and asked if I wanted to deliver the baby. I got right in there and started supporting the head as it emerged. I was able to check for the chord which was thankfully not of any danger to the baby. Once I delivered the head, I was able to assist in rotating the baby to deliver the first shoulder, followed by the second until the entire baby was out! I placed the babe on mom to promote skin to skin and keep the baby warm. When that baby let out its first cry it was like music to my ears. We warmed him with a towel and took him to the warmer to put on a cute little outfit and surprise mom after she had been tended to by the midwife. My heart was very full, and it was so wonderful to see a mother who felt truly blessed by the birth of her first child.
(Priya) My next highlight of the week was helping in the delivery of a baby boy! We had come on the ward in the morning and during rounds learnt there was a patient who was quite dilated in far into her labor so we followed this case into the delivery room. There was a nurse, nursing student and Jackie and I. We waited for a while before the mother was fully dilated and pushing. During the birth I (Priya) got to catch the babe and give it to mom for immediate skin to skin, as it was crying and healthy! I was so happy I was able to promote and get the mom and babe doing skin to skin as it is not seen much here. Mom was very happy and did so well during the birth, it was such an heart warming experience; watching a new life enter this world. After the delivery we got to assess and dress the baby, we had brought some baby packs and were very excited to dress up the little boy! When mom saw the baby she was very happy and so so thankful for our help, she was very sweet. These 2 experiences were definitely highlights of mine for this entire practicum! I learnt a lot from the midwives and nurses this week and am very thankful I got to be apart of these experiences!

We were able to work with wonderful nurses and midwives on the labour and delivery ward which truly enriched our experience there. There was so much leaning that took place, and we both left with a greater understanding of both labour and delivery but also, working hands on in a limited resource setting and making due with what was available to us. Labour and delivery was such a beautiful was of ending off this practicum. It is hard to believe it is already time to leave and know that this was our final practicum of our Bachelor of Science in Nursing degree. As we step forward into our future we will carry with us all that we have learned here in Zambia, and will continue to reflect on all that we have seen and experienced throughout our careers. This is not an ending for us, it is the start of a new beginning.

To everyone who has supported us throughout this journey, thank you.

Sincerely,

Priya and Jackie

Kyle's Last Blog Post

      In this last week I feel like everything really came together. There's a certain sense of accomplishment in distributing supplies to different wards and taking part in the nutrition event. I think I'll always think about how Lewanika hospital is doing and how far they are progressing. I guess I'll always be able to get a small glimpse through this blog in future years. However, I don't think they'll be able to grasp how far the health care system has come. Just like I wasn't able to recognize progress when I first arrived.

    The medical ward was quite nice to see. It was refreshing to see nurses who charted on the data-action-response forms that we're so gung ho about. They also generally seemed very well trained,  professionally strict and disciplined.

The nutrition event was fun if slightly chaotic. The target population of children didn't seem to have any respect at all for our insistent pleas to return to class. The fact that we had the headmaster's consent to shoo them back to class didn't seem to give us any more validity either. It was interesting speaking with Sister Kathy (who runs our accommodation at Liseli lodge) about the education system here. She told me how dubious she is about the quality of the education system here. I wish I had more time to investigate this aspect of Zambian society more.

It's a weird feeling leaving Mongu. I'm happy to be finished my degree but it's daunting to think about working as a full time RN now.

All in all the trip was about a 9/10. Would do again.
Cheers,
Kyle

Goodbye Mongu, Hello New Adventures

After 4 short weeks the Lumbe house became our (Robin, Taylor, Hayley, Montana, Hailey and Steph) second home. We spent our last week in Mongu on the Peds ward hanging mosquito nets above every child's bed, out in various rural clinics seeing patients who didn't have the means to get to LGH, in the OR theater watching various successful procedures and in the NICU with our fellow Zambian nurses and Czech Republic doctors.

The Lumbe house fostered a place for us to laugh until we cried, practice our dance moves and eat copious amounts of pickles. We are all sad to say goodbye to our new found Zam Fam, but excited at the same time to start our new journeys as part of the 2016 UBCO BSN graduating class.

Sincerely with love
The Lumbe House

This is not goodbye.

What a whirlwind adventure I have been on the past month. I vividly remember the day before I was about to hop on the plane; sitting in the living room, strategically packing my suitcase. Here I am today, one month later, thousands of miles away, doing the same thing. I never truly realized how much I love Africa until I pack to leave; the people, the culture, our surroundings- and yes, I have learnt to make those gigantic spiders my acquaintances.

The experiences I have been lucky enough to have over the weeks have certainly been ones I will never forget. The mornings full of instant coffee, the conversations we laugh at till our cheeks hurt, the continuous sweat dripping down our face and the exhausting hot clinical days. I can't believe our time has come to an end, it truly saddens me to leave this beautiful community and the people in it. So many life changing moments in such a little time. I came into this practicum expecting to change lives; not knowing how much they would actually change mine.  

With love from Mongu,
Rayane

Reaching the Untouched Side of Zambia

This week our time was originally scheduled for Limalunga Clinic. Limalunga is the village where the King lives and is famous for the Koamboka ceremony that takes place annually.  Instead of staying at the clinic, we were fortunate enough to accompany two medical officers (Kuwabo, and Lucia) and a pharmacist (Henry) on excursions to rural villages. We were to bring supplies to the villages and to introduce a new TB charting protocol. We would drop off Henry at Mwanawina Rural Health Centre (named after King Lewanika) to distribute ART medications, and then return the next day to pick him up.

Over the course of the time we spent with Henry, Lucia, and  Kuwabo, we were able to experience a side of Zambia we had not yet seen. It was amazing to see how many people live out in these rural villages. Although they don't have much, they manage to function and live happy and healthy lives. However we quickly saw how this can change when they get sick. They most eye opening thing we saw was how far people need and are willing to travel to reach a clinic and gain medical attention. For example, we drove one patient from the clinic back to her village after she'd walked all that distance to get there, and it took us 45 minutes driving. We can't even imagine how many hours it would have taken her to walk. On our second day, we reached the clinic, and this time conducted some assessments on patients that were staying on the ward. We assessed one lady who was severely dehydrated and suffering from cryptococcal meningitis which is an opportunistic infection that is commonly seen alongside HIV. We ended up transporting her back to Mongu to admit her to Lewanika General Hospital. Normally, these patients travel by oxcart which can take many hours. Our drive back was about two hours. This just shows how long it can take to receive health care, even simple things such as blood work can take weeks, as there are no labs out in the rural areas.

We had a great week out on the road with our team. We learned so much from Lucia and Kuwabo while travelling to the clinics about rural life in Zambia. Henry also educated us about the different medications used to treat HIV. We are so thankful for their insight and guidance when assessing patients. They welcomed us with open arms and encouraged us to fully engage in their work. The most important lesson we learned was to take time to have fun, to take a break from the medical work in order to enjoy our opportunities and surroundings.

With any great road trip comes good music, and we had a fun time singing along to country, top 40 hits, and African gospel music.

https://www.youtube.com/watch?v=8ybqqVHoiwo

- Hayley & Janeva

Nutrition Screening Event!

Well that was an adventure! The three of us planned a nutrition education and screening event for the community of Mongu. Event planning in Zambia is very different than it is in Canada. Every errand takes extra steps. For example, when you need to get things laminated or printed it takes about eight different stops. Luckily the taxi drivers in Mongu are amazing, especially Mike! He took us on all of our errands and would barter, translate, laminate, navigate, and even chop wood! We could not have done all these necessary tasks without Mike by our side. The house moms at Liseli Lodge were another huge help for this event! All the posters we made had to be translated into the local language, Silozi, and the house moms were more than willing to help out.

The day of the event was very exciting. There were six stations that community members would visit. Up first was the screening station which looked for malnutrition based on measuring arm circumferences and body weights. Based on what we found, we would refer patients to the Save a Life clinic if they were moderately malnourished or Lewanika General Hospital if they were severely malnourished. After being screened, next up were the education stations on infant care, childhood nutrition, obesity, and hygiene. Once properly educated, people could visit the nutrition station, where we displayed examples of healthy and unhealthy food, as well as the cost to show that it could be purchased on a budget. We also served maize meal porridge with groundnuts (a common high protein nut found in Mongu) with the help of the lovely Save A Life clinic staff. In addition to all the other stations, we also a blood pressure station where we screened for hypertension and would refer based on WHO guidelines.

The day of the event was the windiest day we have had in Mongu and the posters and tablecloths were flying everywhere! Within an hour we had children swarming and long lines forming along at the screening station. We were so excited to see this! It was awesome to see that moms and their babies were present and would sit at the education stations for 20 minutes because they really wanted to learn what we had to teach. People were really interested in the information as this type of event does not often happen in Mongu. We had the Zambian nursing students, public health students, and nutrition students helping at the event. This was a great help at all the stations as well as for translating and crowd control. At the end of the event the malnutrition screening station had screened over 500 people and the blood pressure station over 90. We were so proud of these numbers and the community response to the event.

We were able to donate a lot of the supplies and posters to the wards at the hospital after the event. The next day, we learned that a mom had already taken her baby to the Save A Life clinic based on our referral! What a proud moment for us.

This event was a once in a life time opportunity and we were so grateful to be able to take part in it. We learned so much working along side Zambian healthcare workers and were very excited to make a difference in the community that has welcomed us with open arms. It is a bittersweet moment getting ready to leave Mongu but we are all excited to start our careers as Registered Nurses!

With love from Mongu,

Jasmine, Michelle, and Dana

(Jasmine, Michelle, and Dana)

(A big thank you to all of the wonderful Save a Life staff!)

(Everyone is excited about the activity station!)

(Canadian and Zambian nursing students working together at the education station)

(Making groundnut porridge)

(In line waiting to be screened for malnutrition)

(Food Station)

Ituku Village Outreach

Our last week in Zambia was certainly a highlight for the 3 of us. With a fantastic team of people: Dr. Nilene, and our translators, Banks and Gift, we set out with a jam-packed truck off into the unknown.  We drove 2 hours out of Mongu, down a sand road, through 6 foot tall grass to rural Ituku village. Our camp for the week was a collection of tents underneath a tree near the chief's home. 

This particular village had no established clinic, so we set up some handmade reed mats underneath a large, shady mango tree. We didn't even have tables or chairs.  Our "pharmacy" was a group boxes on a blanket, and our "exam room" was a camping stretcher behind a reed mat screen for privacy. At any given time, one of us was screening patients for their names and ages, two of us, with the help of our translators, assessed, diagnosed and prescribed medications to our patients as Dr. Nilene oversaw the whole thing and stepped in to help as needed.  By the end of the 3 days of clinic, we had seen 483 patients. 

Given our lack of physical clinic building we had a constant audience of villagers, patients waiting to be seen and local children, who got great entertainment out of saying "encha" to the makuwas over and over again. 

It was a challenging and eye-opening experience to realize that all of these people have very little access to health care.  Many of them have chronic health issues like extremely high blood pressure that could be very well managed with diet education and medication. Some individuals had even had strokes from their high blood pressure and still it wasn't treated.  However, treatment is difficult with the closest clinic located about 10 kilometres away (a 4 hour walk one way, in the sand!). It simply isn't practical for them to walk all that way on a monthly basis to receive the care that they need.  

Even in the short time we were there we saw the fruits of labour. The very first morning we arrived we saw a little girl whose eye was clearly infected. We prescribed her eye drops and by the time we left, her eye looked significantly less swollen and red.  

It was remarkable to realize the impact that a simple 3-day clinic can have, but it is also frustrating to realize that they only receive care like this once or twice a year.  Each night, we held campfires for the villagers and we hope that it was not only a fun evening activity, but a reminder to them that there are people out there who really value them and see their health as a priority.

We were so grateful to be so well supported by Nilene, Gift, and Banks, and will never forget this memorable week.  

Remember, Toho Mutokoko, 

Laura, Sydney, and Montana

Last week as student nurses at Save a Life Centre.

For our final week of practicum, we were placed at the Save a Life centre. This facility runs a feeding program for malnourished children as well as a community clinic. The compound also holds the Village of Hope, which includes a school and orphanage.

The first day we accompanied Community Health Workers on home visits. Jamie visited homes along the harbour and Julianne visited homes further inland.  During these visits we checked up on children who were enrolled in the feeding program to assess hygiene, living conditions, and the physical health of the child. We were both thankful for the opportunity to see and better understand the way of life for families in Mongu.

Jamie providing teaching on STIs

The last two days we alternated working in the malnutrition centre and the community clinic. At the malnutrition centre we assisted the staff in weighing children and babies, distributing nutritious food, and teaching caregivers about STIs. Each week the caregivers are offered education on different health topics. We were pleased to see that the majority of children who came in were slowly and steadily putting on weight. We could see what a great resource the centre was to the community and what a difference it has made to many families.

Village of Hope community clinic

In the clinic, we spent the majority of the day testing, diagnosing and prescribing medications for patients (mostly children) who came in with malaria. We saw a wide variety of symptoms, from patients appearing almost healthy to looking feverish and nearly unable to stand. We also worked closely with the doctor on site to assess and treat patients with other complaints. Although the clinic had limited resources, it was well organized and provided effective care.

Julianne in the screening room where we cared for patients with malaria

Staff members from Save a Life Centre

 It's hard to believe that this was our last clinical placement ever. It was eye-opening, enjoyable, and offered us unique learning opportunities. We had an amazing experience in Mongu and are now looking forward to beginning our careers as Registered Nurses.

Jamie and Julianne

Similarities Despite Differences

For my last week of clinical (ever!) I was on the medical ward at Lewanika General Hospital. I was excited and nervous for this placement, as I had heard from my fellow nursing students that it was a very different experience than the medical wards in Canada. I've spent a lot of time working on medical wards in Canada, and hope to work on one when I graduate. So while I was eager to experience medical nursing in Zambia, I was nervous about what the day would look like and what the patient's diagnoses would be.

When I walked onto the ward, I saw clean, bright spaces and friendly, knowledgeable staff. I instantly felt at home. As we were doing rounds with the doctors and discussing patient diagnoses, I found that a lot of cases were familiar to me, but one patient particularly stood out to me. She was a young woman who was in the hospital with liver failure and ascites. She brought to mind a patient who I cared for in Canada, who also had liver failure and ascites. But while his liver failure was caused by hepatitis (a common cause of liver failure in Canada), her liver failure was caused by bilharzia. Bilharzia is a fluke that lives in freshwater snails, and it can infect people swimming or bathing in infested water by entering the body through the skin or urinary tract. Bilharzia can then infect any organ; for this patient it was her liver. Although it is easily treatable this patient showed signs of major liver damage. I don't know her entire story or how she got to this stage, only that she was now in the hospital.

While the treatment for liver failure and ascites is the same in Canada and Zambia, the resources available in the two countries are very different. This means that these two patients, in their respective countries, will likely have different outcomes.

It really hit me this week how much of a difference resources make, and the options that were available in this situation made it difficult for me to care for this patient. I found that I kept wishing we were in Canada so I could do more - something that I've thought more than once during this practicum. But the healthcare team here continually surprise me with their ingenuity and resilience. They daily care for their patients, in a difficult setting, and they do it with joy. I know that I have a lot to learn from them. Throughout this practicum I have been learning, not just about different diseases and their processes, but also how to keep working in difficult situations and how to solve a problem when it seems like there are no answers. Thinking outside the box has been given a whole new meaning to me.

I don't know what will happen to the young woman I saw at Lewanika. I also don't know what happened to the man in Canada. I do know that all we can do is our best, despite the resources we have in our our hands. Zambia has given me many lessons, but I believe that one of the most important ones is that we are all similar. The details might be different, we might have different accents and nationalities, but at the end of the day we are all just people, living our lives.

I'm so grateful I applied for and was accepted into this international practicum. I have been given a different perspective, and I believe that this experience will shape the rest of my nursing career.

With love,
Cass

Loving L&D!

This week in clinical was what I was most excited for, labour and delivery! I was joined by Zambian nursing students and midwifery students and the births I was able to assist with were absolutely thrilling. While in labour, most of the Zambian women remain very quiet and stoic, compared to Canadian women who are encouraged to express their emotions. I was told by one of the midwifery students that this is because Zambian women are told that if they scream it is not good for the baby. I did many newborn and mama assessments, and on my last day I was able to assist the midwife even more during the birthing process. I have incredible respect for the strength of the women here, especially those who are my age giving birth! 

I also had the opportunity this week to spend a day at the Save A Life centre, another placement I was very excited for. The day was spent doing home visits and checking up on the children. I was fortunate enough to be invited into a family's home and really see how the people of Mongu live. The staff at Save A Life were so welcoming, and I was able to sit in with a doctor and diagnose and treat some patients! It was an amazing learning experience. 

Much love from Mongu,

Dana

Exploring Psychiatric Care in Zambia

Throughout my time in Africa I had the opportunity to work in female, male, and OPD psychiatric wards. I am very passionate about working in psychiatry and have experience working as an Employed Student Nurse in the Vernon Psychiatry ward last summer. In Zambia the psychiatric patients are split up into female and male wards as many other wards at Lewanika General Hospital. To become admitted, the patients see a psychiatric clinical officer in the Psych OPD. A psychiatric clinical officer acts as a psychiatrist in Canada - prescribing, diagnosing, admitting, and discharging patients. As seen in other parts of the hospital, the patients family are required to supply food, clean clothes, and hygiene products. This is also the same case for both psychiatric wards. Often the family is unable to supply food, clothing, and soap since there is a large stigma associated with mental illness in Zambia. I was able to bring t-shirts and hygiene products that were generously donated for our practicum and they were very well received on the wards. The staff were very grateful and stated that these donations would make a huge difference for the patients. When I went back to the ward at at a later time the patients were already wearing the shirts! It is very interesting see what we often take for granted in Canada can make such a difference here. I am so grateful that I was able to work with the very knowledgable staff on the psychiatric wards. It was an eye-opening experience to see the difference in conditions of psychiatric hospitals compared to Canada, but it was encouraging to see that the staff were very passionate about decreasing the stigma that is often associated with mental illness.

Sending love to all my family and friends back home!

-Michelle Nurkowski

(Staff room with hotplate)

(Yearly diagnosis chart in male psychiatry) 

Where there is love, there is life.

We would first like to thank the amazing staff members from the Czech Republic for their time and patience. They are always keen in including us in rounds, using our critical thinking and overall increasing our confidence in postnatal and neonatal care.
Throughout the course of the week we were able to revise some informative materials throughout the ward, and put resources to use throughout the hospital. We hope the information we shared with the students and staff on the ward will continue to strengthen their practice and be sustainable for the years to come. 

We would also like to add that after long hard hours we all spent fundraising, it was amazing to see the money put to good use in practice. Brand new curtains on the postnatal ward were installed, so the mothers could have some privacy. We were informed due to these curtains, it has been noticed that the health professionals on the ward have more "pep in their step," carry more pride, and keep the ward cleaner on a daily basis. 

Finally, it was truly amazing to see the resilient mothers who delivered healthy babies, in and out of the post natal ward within 6 hours or less. 

Flight to Zambia- $2,400
Bus from Lusaka to Mongu- $15
Taxi to Lewanika General Hospital- $3
Scrubs- $40
The look a mother gives her newborn child- Priceless 

-Steph, Taylor & Rayane

Liyoyelo: reaching the community

For just two short days this week, we were placed at Liyoyelo Urban Clinic. Instead of spending the days assisting with the various clinics in the buildings, we decided to take an opportunity to go on a mini-outreach with a nurse midwife each day. Here, we did well-baby check-ups, weighing each child and giving essential vaccinations and medications as needed. We spent a lot of our time doing the paperwork for the midwife. Although it doesn't seem like much, we know we were able to help her complete her job more efficiently and see more people that day then she would have otherwise. 

Our office

It was very cool to nurse outdoors, with the scale hanging from a tree and little stools of goat hide for us to sit on. In the end, sometimes that is where the best nursing can happen. When you nurse in the hospital or a clinic, the patient has come to you and is in an unfamiliar environment. But when you go to their community and work in a common space, it's being present and allowing the community members to be comfortable. At one point on our second day, the nurse had the whole crowd in stitches as she addressed them all. These pieces of community involvement and allowing people to be comfortable with their nurse only helps the profession and leads to better follow-up care and adherence to physiological and pharmaceutical regime. 

Julianne and Mark

Kaande

This week brought our much-awaited teaching session with some of the students at Kaande Basic School.

As we wrote a few weeks ago, we met with the headmaster and a few teachers and were very excited to carry out some basic hygiene teaching with the students. We also had school supplies that Aberdeen Hall Preparatory School collected and donated to the teachers at Kaande.

When we arrived at the school, we wrestled a 60-plus pound suitcase containing the assorted classroom items from the road to the school through deep sand. A small entourage of primary school children accompanied us and encouraged us to "push, push, push" the massive bag.  When we finally arrived at the classrooms, some of the younger school kids were crowding around the door and hanging in the windows to see what we were doing!

Among the supplies brought by our nursing team was a collection of posters that had various images and facts about Canada, so we shared a little bit about our country with the students. We pointed out Kelowna on a Canadian map, we showed them pictures of beavers and geese and hockey, and we sang them our national anthem. In return they shared some of the sports that they played, some of their local animals, and sang us the Zambian national anthem.

Cass drew a poster of the 5 steps to hand washing:

We brainstormed with the kids about why it is important to wash our hands, times to wash our hands, and adaptations on hand washing based on available supplies. For example, someone suggested that when soap was unavailable, the grit in ashes from a fire offered a good alternative.

This was a challenging experience. The teaching that we had previously done was in a Canadian context with access to laptops, powerpoints, and electricity. However, in Zambia, we had to draw our posters and use available supplies. We relied on a translator to communicate our message to the students. And although we know that the school items collected by Aberdeen were helpful, it felt like it was only a drop in the bucket. There is so much need at Kaande, and in many schools in Zambia, that a suitcase of supplies seemed like pittance. But while it may have felt small, we hope that the items will make a difference for the students at Kaande and make learning more enjoyable and rewarding.

For us personally, it was eye-opening to see what school is like in another country. It was also a good opportunity for us to show initiative and make community connections in Zambia. We were able to use the leadership skills we have developed throughout the program (and especially during our fourth and final year of our degree). Reflecting back on our time at Aberdeen Hall and Kaande Basic School, we now realize that we too were learners in this experience, and we will remember this time as a rich and rewarding piece of our international practicum.

With one week left,

Cass, Laura, and Julianne

A Week of Waiting.. For Babies

This week I spent my time working on the labour and delivery ward at Lewanika General Hospital. Seeing as I started my perinatal specialty this past fall, I was excited to get into practice and get some hands on experience of what I'd learned during my course. 

I quickly saw how different the experience of labour and birth is here compared to Canada. The women here are strong and resilient. They come to the hospital alone, rarely make a peep when giving birth, all sans pain control. After the baby is born, the woman gets up, walks back to her bed, and goes home after about 6-8hours. 

I also learned that babies come when they want. On my last day, I took the initiative to ask the midwives if I could deliver a baby (along side them of course). They gave me a patient to look after, a young and single, first time mother. I monitored her throughout the day, providing her with comfort measures and helping where I could. I waited along side her for what felt like forever. Although, the pain of my waiting could not have even compared to the pain of hers. Finally around 1PM, the baby was ready to make her arrival into the world. I coached the mother, held her hand, and with the help of the midwife, delivered the baby into the world. It was the most amazing feeling, bringing new life into the world. The baby ended up having a couple complications after birth and inside, I was quite scared. I stayed strong for the mother, congratulated her and took the baby away for a few moments to deal with the issues. In the end, baby was healthy and happy, and the mother couldn't thank me enough. This made me feel quite good. It was also encouraging because I felt like I'd formed a relationship with the mother which I sometimes find difficult here, especially with the language barrier and different cultural practices. 

Overall it was a great week and I attained my goal of delivering a baby, and experience I will never forget.

~Hayley Muss 

My week in the OPD

This past week I had the privilege of working in the Out Patient Department (OPD) at Lewanika General Hospital. The OPD is equivalent to the Canadian version of the Emergency Room. I am so thankful for the many Medical Officers, Nurses, and Doctors that taught me so much about the journey of a patient from entering the OPD to being admitted on a floor.

The first thing that I noticed about the OPD is that the morning starts slow. However, as I learned Monday morning the "slow start" is really not an accurate picture at all. Once patients are allowed to enter the hospital they must get their medical card, and vitals before waiting to enter the treatment/screening room. First thing in the morning everyone is still getting their vitals done but by about 9:30 -10:00 you get an influx of patients that take over the OPD like a tidal wave.

The majority of patients do not pay the extra cost to be seen faster and therefore it is very challenging to see and treat all patients out of the one small main room. Patients that are severely sick will be rushed to the front of the line after having their vitals taken. In my experiences, patients that had a decreased level of consciousness were rushed to the front of the line. Despite being placed at the front of the line, the health care workers would address their "urgent" patient in an unhurried manner, sometimes waiting to have treatment started or to be reassessed.

But the Medical Officers and Doctors were so knowledgeable about the conditions seen routinely in the OPD. My one colleague taught me how to read and diagnose x-rays as they are one of the staple diagnostic tools available. I learned that symptoms and history are the key to diagnoses in Lewanika. I was given the challenge by one colleague to diagnose a client based on their symptoms alone and it took me most of an hour to finally provide them with my diagnosis. My colleague had diagnosed them in fifteen minutes and had sent the patient home with treatment in that time. The staff there are so gifted at developing differential diagnosis, and the amount of critical thinking involved in that was truly challenging but rewarding to learn.

Despite having limited resources and space the nurses are able to accomplish a variety of tasks such as cannulation, catherization, and giving medications to patients. The teamwork between the Doctors, Medical officers, and Nurses was evident as they worked in such close proximity to each other. I really enjoyed my time in the OPD and look forward to my week at Lilimunga.

Cheers,

Janeva

First Aid at Save a Life/Mutoya Clinic

This past week and a half we (Hailey Parr and Robin) had the opportunity to coordinate a first aid course for 33 staff at the Matoya/Save a Life Clinic and teachers from a local school.

                One challenge was thinking about how well/if first aid interventions that we use at home were would translate here because higher levels of health care are lacking in certain ways. For example, we know that CPR on an adult having a heart attack is very ineffective without the use of a defibrillator (here and at home). Defibrillators are non-existent in the communities here and I am not sure how widely used they are even in the hospital. Other barriers here include the lack of ambulance attendants (there is an ambulance but it is only manned by a nurse if there is someone available, otherwise there is just a driver) and the fact that most of these people will not have access to gloves (we do not want them to risk exposing themselves to bodily fluids). We were pretty stoked when we found out how to make a glove out of a clean plastic bag!

We had a lot of questions which Dr. Nilene and Lehana (of the Matoya/Save a Life Clinic) were able to field. They also helped us select and make our topics relevant to the setting. Something we needed to add that you don’t see in Canada was how to handle if a spitting cobra spat into your eyes (hint: don’t open them, there are crystals in their spit that will scratch your eyeballs!). Another thing we considered was what kind of household materials people could use as resources for splinting, burns, and bleeds. Some of these items included brooms, pieces of chitengues (the traditional skirts worn here), clothes, large wooden spoons, and brooms. It was fun being creative with this.

The topics we covered included Adult/Child and Infant CPR and Choking, Burns, Bleeds, Broken Bones, and Snake and Bug Bites. Priya, Jeevan, Rachael, Jackie, Kyle, Hayley (Muss), Jaime and Sydney taught these topics and then manned 6 different stations where the participants got hands on practice and supervision. Big shout out to Jeevan and Jackie who made it despite being sick, and to our teacher Lisa for taking care of the Adult CPR station! We modified our stations to fit into the time slots, answered some great/funny questions, and ensured that the participants were having a great time while learning. We were happy to see so many people enjoying themselves and learning.

In the end it was a great opportunity to give back to a community which has done a lot for us. We hope that the skills that they have learned will be practical and useful in the future should they need them.

Hailey, Robin, Jeevan, Priya, Kyle, Hayley, Sydney, Jaime, Rachael, and Jackie 

Sexual Health in the Community

I learned a lot about sexual health during my placement at Limulunga from the wonderful medical staff. I was surprised during the family planning day and other visits in the outpatient department (similar to a walk in clinic/emergency department in these settings) how available and widely utilized birth control is for women. Perhaps this was naïve of me. Another sexual health intervention that is encouraged in Zambia for the prevention of HIV and sexually transmitted infections (STI’s) is male circumcision. Because hygiene can be an issue here, infection rates decrease with increasing rates of male circumcision because the infection does not have as many places to take up residence and proliferate, if that makes sense. This is not just for infants but for adult men as well. These circumcisions are conducted not only at the hospital but also at the more rural clinics. I feel like I should also mention that they do not use any anesthetic when they do this. Some medical professionals even go out into the villages to perform them. It is a very effective intervention here!

 I was also surprised to hear about some of the common misconceptions around sexual health. For example some people believe that oral birth control/male circumcision will protect them from STI's (though this is not an uncommon belief at home), and some people are more concerned about preventing pregnancies than they are about preventing STI’s. Another is that gonorrhea is so common in some parts that some people think that symptoms such as purulent discharge and pain when you urinate is normal! Many of these notions are perpetuated as well because sexual health is a stigmatized topic that is not openly discussed.

Sexual health is obviously a complicated subject linked to many things such as education, hygiene, health, and personal and cultural beliefs.

Robin

First Experience At The Lewanika Hospital (March 21-23)

Post by: Montana Zaporzan 

Last week I spent 3 days on the postnatal (postpartum) unit at Lewanika Hospital. This experience was far from comparable to the postpartum units I have had experience in during my years in school. We would start every morning dusting the bugs off the walls which would often fall on patients beds, the beds were made with two blankets... One very fuzzy flannel blanket and a very old stained linen used as a sheet. The pillows were made of a plastic material without pillow cases, but easy to clean. The postnatal unit did not even have curtains between a bed, which made it very awkward and almost impossible to do a proper assessment on the mother without everyone seeing what you were doing. Luckily with our fundraising money this year we were able to hang curtains on the whole ward which included 18 beds, so the week I spent was the last week with no curtains!!! One experience that stood out to me included a newborn who was having seizures. With lack of equipment the doctor had to figure out the cause of these seizures a process that in Canada with endless diagnostic equipment, probably would've looked a lot differently. The Doctor first needed to place an IV in the child's hand, which took 3 attempts and was probably the longest 8 mins of my life! Finally he got it in and he was able to push saline with added dextrose, to rule out if the seizure activity was because of hypoglycemia (which would of been diagnosed in Canada with a test that takes 2 seconds) after giving two boluses of the solution the child was still seizuring which is when a anti seizure medication was given next. The seizure came to a stop and the child was very lethargic. 

This experience put a lot of things into perspective for myself, it was heartbreaking to me while the doctor was struggling to start an IV all I could do was watch and if the child's colour changed give assisted breaths, or start cpr. No neonatal intensive care team, no respiratory therapist, no glucose reading equipment, not even a proper crash cart or resuscitation equipment. However the staff handled the emergency the best they could with what they had. 

Moreover, there must of been at least 20 moms with healthy babies discharged in those 3 days, it was very busy and amazing to see the resiliency of the mothers after child birth, some walking miles to get home just 6 hours after giving birth, which was the minimum requirement from the doctor. With that week behind me I will take with me the experiences I had and learn and grow from them as I continue my time in Zambia. Verdict is: I still cannot speak "silozi" and the midwives and nursing students would not let me forget that as I struggle to pronounce their names. 

 

Reality check: From the tourist's and the patient's side

This weekend, we all went to Livingstone to experience one of the seven natural wonders of the world, the Victoria Falls, or the Mosi-oa-Tunya (the smoke that thunders), as the locals call it.
Ask anyone, and they'll tell you I had a very weird weekend. However, I very much enjoyed it. I went in to the weekend excited to see the Falls, but hoping to spend some time reflecting and talking to other people. I wasn't too keen on spending a ton of money on adrenaline activities and safaris. As much as we all love each other, after almost three weeks of living together, it's nice to have some other folks around.

I spent our first full day touring the Zambia side and experiencing the soaking spray of the "smoke that thunders" that puts Niagara Falls to shame. The next day I had to go to Zimbabwe for visa reasons, so walked across the bridge with some teachers from North America who are teaching in Abu Dhabi, and a young woman who has spent almost 2 years traveling the world.

While walking and talking, one of the teachers described the kind of work we do as a reality check. I found that to be the perfect way to put it. It's seeing people in their reality. It's seeing the illnesses that we don't have. It's seeing the way people react to pain.

I had a reality check in a few ways this weekend. Firstly, while hanging out at the hostel, I was approached by a group of kind-looking men asking me to take part in filming a tourism video. They were Zambian men from the northern part of the country. They do a lot of travelling in Europe and wanted to show off their homeland when they are abroad. They figured it would be more effective if they filmed it with a tourist instead of themselves. They offered to take me to do the white water rafting on the Zambezi, bunji jumping from the bridge and a microlight flight over the falls. I was shocked, but obviously said yes. It was interesting to see these gentlemen who wanted to draw people to their beautiful country so much that they were willing to spend their own cash to produce a video. I mean, they were mining engineers, so it's not like they were short on money, but it was a nice to experience the Zambian hospitality.

Kyle and I ready to take on the mighty Zambezi

My next reality check came the next day when we set out to get their footage. They suited Kyle and I up with GoPro cameras to go white water rafting and we had an absolute blast. While on the water, we flipped and I got a paddle to the forehead, leaving a small, but heavily bleeding gash. They patched me up on the boat, but when we returned, they sent me to a clinic to get stitches. It was uneasy for me as I knew that although I was going to experience Zambian healthcare from the patient's side, it wasn't going to be the same as what we have been seeing. We went to a private clinic where I waited with Kyle for about 6 minutes before seeing the doctor. In the doctor's office there was a TV blaring the latest music video from the top Zambian artists. While he pulled on my face trying to get the dull needle through my tough skin, the doctor paused once in a while to look at the screen. It was odd, but he seemed to do a good job. I went back to the front, had no trouble paying the 470 kwacha (about 50USD) bill and walked out in a matter of about 35 minutes.

Getting zipped up

I knew that if the patients we see on outreach or in the hospital were to hurt themselves with a paddle while on their longboats, it would be a stretch for them to: a) get to healthcare at all and b) afford, private health care. They would wait for hours after cleaning their wound with Zambezi water and stopping the bleeding with a t-shirt before probably seeing a nurse who wouldn't have the supplies available to him or her to be able to do what was needed for the patient. So they'd patch it up best they could, send them home and hope it doesn't get infected.

So fitted with 3 stitches to heal my "Zambezi tattoo" Kyle and I went back to where we were meeting our friends again and went to the airstrip to take our microlight flights (it was too late in the day to bunji). We did a little interview for them afterwards and bid our goodbyes. It was an incredible connection to make and we were so pleased about our free day.

My Zambezi Tattoo

My quiet little weekend turned into a bit of a crazy adventure, but it was an amazing experience. I will never forget it and will always have a little reminder of the power of the Zambezi over my right eye.

Now back to reality.

Mark

Opportunities in the Operating Theatre

This week was my first week in Lewanika hospital where I spent my time in the Operating Theatre and Recovery room. My last day was especially eventful. I asked if I could scrub in and I ended up being guided into the nursing role for the first surgery of the day. I had the opportunity to work with healthcare providers visiting from Lusaka, surgeons and nurses from Lewanika hospital, and nursing students. 
Everyone involved in the procedure was excited to share their knowledge with me and help me gain as much experience as possible. I have always been interested in pursuing a specialty to work in the OR, so I was really looking forward to this. It was interesting to compare and contrast practices in the OR in Zambia to Canada.

For example, I noticed surgeons enjoy working to music in both places! I also noticed that each place faces different challenges in trying to provide the best care with the resources available. One afternoon we received a patient in the recovery room whose oxygen saturation remained low, no matter what intervention we tried. She needed supplemental oxygen but there was none available, not even in the ICU. It was frustrating being unable to help, whereas at home, this resource is easily available. This experience challenged me to critically think in a changing situation and reflect on accessibility of resources in the global health setting.

Sincerely,
Jeevan

Stephing in to Lewanika

After an amazing week at Kama, I couldn't wait to get into the hospital. My second week would be spent on the male and female medical wards a Lewanika General Hospital.

Monday morning came with nervous excitement. As I walked onto the female medical word I was overwhelmed with joy to see the nursing staff receiving morning report from the night nurse. I thought to my self "I can do this, it's just like at home." I couldn't have been more wrong.

After receiving report, the nursing staff proceeded to making patients beds. Not just readjusting the sheets around patients and making sure the had fresh water, but literally making sick patients get out of their beds to properly make their beds with the sheets that they had personally brought from home. After all 36 beds were made we continued to dusting the ledges and windowsill (which get done everyday and need it!). At this point in my day I was a bit rattled, but quickly regrouped and was looking forward to rounds with the Physician. I spent the next few hours brain storming with a medical student about various diseases such as liver cirrhosis, HIV, STIs and malaria. I also learn enormous amount about the nurses scope of practice in Zambia. For instance the nurses in Zambia can "tap" a patients stomach with live ascites due to cirrhosis to remove the excess fluid, where as at home this procedure is performed by a physician. On the other hand, nurses in Zambia can not catheterize a married man without his wife being present.

The variations in practice continued to astonish me over the next 3 days. I'm looking forward to learning a great deal more in the weeks to come.

Steph