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

Our Week at Save A Life

Hailey and I spent the week working at Save A Life Centre here in Mongu. Our first day was spent doing home visits, which are a part of the feeding program that is run through the centre. This was an eye opening experience for the both of us. It gave us a better understanding of how these families live  and how resourceful they are. They all welcomed us warm heartedly into their homes, and we enjoyed getting to know them as much as we could. We found the women often lived with their mothers, had multiple children, and some still trying to complete school.

The following day we had a chance to interact with the women and children when they came for their weekly visit. The morning started off with a short biblical teaching, after which a beautiful song broke out and soon the whole room was singing. You could feel it resonate through your body as everyone sang. My attention was drawn to a quiet and stoic woman in the front. After a couple minutes of singing, tears began to stream down her face. It was a powerful moment that definitely moved me. We ended the day with some teaching on fever and hanging out with the kids.

I (Hayley) was able to spend a day working in the Village of Hope Clinic. I spent the day screening patients, then assessing, diagnosing and prescribing alongside the doctor. I was able to see some interesting cases and it gave me another perspective of health and nursing.

Overall, it was a great week and was ended off with a trip to Livingstone for Easter weekend. We saw Victoria falls, went on a safari and rode some elephants. We're half way done and the time is flying by. We're looking forward to the upcoming weeks and some exciting things to come!

~Hayley & Hailey

Fostering Fun

This past week we were placed on the pediatric ward at Lewanika General Hospital in Mongu.
(Jackie) Following graduation, I wish to further my career in the field of Pediatric Oncology. And hopefully become a nurse practitioner within this specialty field. Within my past placement in the OR and PAR in had already become familiar with the hospitals resources and staff ingenuity.

The pediatric floor itself is much like the rest of the hospital. It is divided based on condition and event of stay; whether it be surgical, medical, or malnutrition. We had the opportunity to see a variety of patients and conditions during our rotation on the pediatric ward. After doing rounds with various physicians on the floor we realized some of the children had been hospitalized for weeks even months. Those are weeks and months that these children are not in school. In Canada our educational system is a privilege, one in which many children take for granted or are unaware of how fortunate they are.

Children here do WANT to go to school and get an education. With all the fancy things the children know we have, all they ask for are pencils, crayons, and paper. Well, and stickers! Stickers here are pretty much the coolest thing ever and kids put them on their foreheads for everyone to see! In hospital same hold true, kids ask for crayons, books, paper, and stickers!

We tried our best to work along side staff and students on the floor. At times it did prove difficult as our nursing practice in Canada differs slightly from practice here at Lewanika. We modeled our Canadian nursing practices for the students and staff in hopes we could share our knowledge with them. Similarly, we observed the students and staff on the ward to learn from them and about their nursing practice. At UBC we were taught to check in on each patient in the morning followed by a thorough assessment, prioritizing patients reason of stay in hospital. At Lewanika, nurses go around and see each patient while damp dusting (a method of cleaning) but do not perform assessments on them. The practice here is to allow the physicians to see the children as they do their rounds, and that is where  the child is assessed. As we encouraged charting and assessments as a priority is was challenging finding a way to model best practice when the nurses were used to their own nursing cultural practices.

Priya and Jackie with one of our favorite nurses Anette.

As previously mentioned, many of these children are missing a lot of schooling. As we had some time to spare on the floor than many of the staff, we were able to spend the quieter moments with the kids to initiate play therapy. The time that we spent initiating play therapy with the kids was crucial because it allowed the kids to interact with one another which is a very important part of their development and growth. It also allows them to use the play therapy to practice skills such as reading and writing, which is something we would often do with the kids. It was amazing to see how some of the kids really started wanting to be with us in play therapy. Many children were shy around us initially but began to ask us to read books or to draw with the . Also, a lot of the kids did not have things to do during the afternoon periods so having play therapy would allow  them to get their minds off being in the hospital and play as kids! Seeing them smile and watching their faces light up when we would do paintings or play with bubbles was a great feeling.

Priya painting with some children on the Pediatric Ward. 

On our final day on the ward we got to paint eggs with the kids and their families for Easter! The eggs were hard boiled so it was a great way to add nutrition for the kids and some  protein  as well. The kids and parents had so much fun painting the eggs and decorating them even though for most, it was their first time. It was nice that mom's were getting involved as well with the children. It was an interesting experience for us to explain to the parents that the kids could eat the eggs after decorating them so they could get the protein too! Because who really wants to eat a green egg? (Besides Dr. Seuss, who was also a favorite among the children at reading time!).

And finally, this past weekend we all went to Livingstone! After a 10 hour bus ride we arrived at our hostel, JollyBoys. We visited Victoria Falls which was amazing and breathtaking as well as went on safari in Botswana (neighboring country with Zambia). On separate days,we both went zip lining over a Victoria Falls Gorge, it was crazy. We jumped off the cliff with the harness attached to the line at the back. We literally jumped off the cliff like superwoman! 

Giraffe at Chobe National Park, Botswana

To all our family and friends we miss you and love you!

-Priya and Jackie 

New Life in Lewanika General Hospital

This week, we experienced what it is like to care for new moms and babies here in Mongu. We were privileged to learn alongside Zambian student nurses and glean knowledge from the more experienced student midwives.

During our month-long maternity practicum in Canada, we were taught the importance of time efficiency and thorough maternal and child assessments. The average hospital stay in Canada is 24-48 hours for a new mom after a typical healthy delivery, whereas in Zambia, it is only 8 hours. Because of the quick turnover, we got to do many newborn assessments to ensure the babies had proper reflexes and were healthy enough to go home. However, it was a challenge for us the learn that Zambian clinical prioritization is different from what we are used to in Canada. Instead of doing assessments and checking in with moms and babies first thing in the morning, the staff here "damp dust" or wipe down the window sills and beds before starting vitals signs at 09:30.  The pace was much slower than the maternity ward at home; however, it left us with many opportunities to ask questions of the student midwives. We learned more about breastfeeding and preterm baby development and care. We valued these learning opportunities as they helped us deepen our understanding of maternity care both at home and globally.

On our last shift in the post natal ward, we walked in after lunch to a newborn baby having a seizure.  It was a tricky process for the staff to figure out what was going on with the baby, as many of the diagnostic tools that we would use in Canada are not available here. For example, when an infant has a seizure, one of the first questions we would ask is: do they have low blood sugar? We then would perform a simple test using a glucometer to see if we need to treat for hypoglycemia. At Lewanika General Hospital there is no access to glucometers, so the way to test for hypoglycemia is simply by giving the baby an IV sugar compound and observing how the baby responds. We watched as the healthcare team relied on critical thinking to stop the seizure and determine the cause of the baby's "fit."

After three weeks of travel, practicum, and adaptation to new surroundings, we were able to travel as a larger group to Livingstone, a city in Southern Province and home of the famous Victoria Falls. We spent four days enjoying the sights and activities that the area provided. Highlights for us included spending time taking in the sheer size and grandeur of the falls, getting soaked by its spray, and being taken by a guide into the water above the falls mere meters from the edge. It was wonderful to enjoy some of the incredible natural beauty unique to this country.

We are now exhausted from wonderful travel and are gearing up for another week of clinical. We look forward to many more learning experiences as our time comes to a close.

Until next time,
Julianne and Laura

Our Week at Limulunga: Jamie and Rachel

This week we were placed at the Limulunga Rural Health Clinic about 20 minutes away from our lodge in Mongu, near the Lozi king's palace. With the clinic serving such a broad population, the care needs of patients is quite varied there, therefore allowing us the opportunity to take part in several areas of the clinic, including HIV treatment (ARV), antenatal assessments, and the Outpatient Department (walk-in).

 The Women's and Children's Clinic area.

 Us with our lovely maternity nurse, Lilian, and one of the clinic Medical Officers.

 We used our creativity to hang IV fluids for a septic patient in the OPD- an old nail will do the trick!

Not a bad view from the OPD office!

Overall, our first two days spent in the OPD presented us with many opportunities for learning as there were many cases and/or tropical diseases that we hadn't seen before, such as new malaria diagnoses, fungal skin infections, and tuberculosis testing. In the OPD, you never know what you're going to see or who will walk in next! The Medical Officers are very knowledgeable about the common diseases seen in this area while also demonstrating useful diagnostic skills using clinical basis, assessment, and questioning only. With few resources (we ran out of malaria testing kits on the second day), they often have to 'trust their gut' in being able to diagnose an issue and choose proper treatment for the patient. Also, diagnosis seemed to be very based on what issue or how the issue could be treated. They see many patients in a day, anywhere from 60-100 per Medical Officer, therefore they must make quick decisions using critical thinking and problem-solving based on what they are able to treat. In other words, many of the treatments are based on alleviating symptoms alone rather than creating a true clinical diagnosis based on objective fact, as we perform often in the Canadian ER. Some issues are easier to solve than others, though the specific knowledge base catered to common issues in this area seems to be a very useful advantage for them. For example, a patient presenting with abdominal pain could mean many different issues and is very difficult to diagnose at times, even in Canada. Without ultrasound, blood laboratory testing, CT, x-ray, or many of the often relied-upon diagnostic testing that we use in Canada, the clinical presentation of the patient is all they have to work with in most cases. The plan of care for the patient? It's often narrowed down to one or two possible diagnoses, with the first line treatment being that that is more common, such as intestinal worms or peptic ulcers. We were very impressed by the Medical Officer's ability to differentiate between diagnoses with such little information. They know what they've seen and are therefore prepared to make clinical judgments based on experience and knowledge- even with so little. The MO's were keen to have us participate in problem solving to try and diagnose patients, even teaching us important words to look out for when patients are explaining their symptoms (often in Lozi) so that we could catch on to the assessment before the MO provided us with full translation. It was a great learning experience for sure- very interesting to see what they see in a day!

On our third day, we spent our time assisting with antenatal assessments. For Rachel, it was the first time palpating the babies in the abdomen! Our nurse, Lilian, was very kind in sharing her knowledge and demonstrating to us assessment skills and common issues. She even taught us about breast exams in screening for cancer during the pregnancy check-ups! Our nurse also gathered all of the patients to be seen that day in a teaching room to discuss health information important for a healthy pregnancy. Unfortunately we couldn't understand much of it as many of the patients speak only Lozi, though we tried our hand at a few lines during our assessment visits! It was nice to see a more specific area of the clinic in addition to visiting the HIV department later on in the day. It was so great to see so many patients coming to receive counselling and medication for HIV, though the numbers were many, showing just how common it is here. The clinic was quite efficient for the many patients that they had to serve for ARV treatment and teaching in one day, encompassing 4 stations in their office that involved counselling, medication administration, filing (online national system) for regional accessibility, and follow-up arrangements.

On the first day at Limulunga, Jamie spent the beginning of her day with Lilian in the WCH (Womens and Childrens Health center). Mondays in the clinics were extremely busy, upon arrival there were already many mums and babies waiting outside the clinic. Here they did postpartum assessments on the mothers in one room then sent them to another to have them all together to complete teaching and give the babies their immunizations. Jamie was able to help with many of the tasks involved in organizing the mothers, however many of them only spoke Lozi so Lilian did the majority of the teaching. Lilian was able to teach and give adequate health care to these women with very little resources, the entire facility shared two blood pressure cuffs and had no stethoscopes.  The experience at Limulunga was amazing!

- Jamie and Rachel


Rachel's Weekend in Livingstone!

....was AMAZING!

After a long bus ride, we finally arrived at the Jollyboys hostel! I spent my first day exploring Victoria Falls, as anyone should! Hayley, Hailey, Stephanie, Montana, Laura, Julienne, and I waded at the edge of Victoria Falls in the Angel's Pool, only to find out that we were the last group to visit the area before it was closed until further notice due to strong currents. And I thought, "Oh, it's supposed to be like this....it's Victoria Falls!". I later spent the afternoon exploring, hiking, and seeing all of the views around the falls with Laura and Julienne! Incredible to knock another natural world wonder off of my list!

I spent my second day on a safari in Chobe National Park in Botswana and parts of Namibia for the morning land game tour and the afternoon river safari. We had a memorable encounter with a herd of elephants, getting our truck right in the middle of the action when about 25 elephants were crossing the road. An amazing sight for sure! We also saw tons of kudu, impala, shale antelope, elephants, baboons, giraffes, zebras, iguana, and hippopotamus. A great day overall, though crossing the border took some time!

Jackie, Hayley M., Hailey P., and I on our safari truck!

The last day was a relaxing start, sleeping in and having a good breakfast to start off the day. Jackie and I went on the Gorge Zipline "superwoman" style in the afternoon- a ton of fun! It was an amazing view to look down the centre of the gorge with a 'bird's eye' view, with the zipline spanning 150 metres across. We ended the day on a Sunset Cruise down the Zambezi river with Rayane, Cassandra, Taylor, and Jasmine while enjoying some wine and a braii BBQ. It was a fantastic trip! We spent about 11 hours getting home on the bus, leaving at 3:00am from the Livingstone bus station. The road was very bumpy for the first couple of hours and the bridge was closed so we spent a few hours crossing the river via "ferry" (I'm reluctant to compare it to a Canadian ferry), though it was definitely all part of the experience!

Until next week! Wishing the best to all of my friends and family back home....miss you all!

-Rachel

Our day in L&D

 This week we were in labour and delivery and there really are no words to describe what we experienced in comparison to what we have seen in Canada during our practice. It's crazy how the differences in practices can vary so much between different individuals both in the same country and abroad.

 Although we can't specify, during one of our days in labour and delivery all three of us had to leave the room as we were so uncomfortable with what we were witnessing. The situation lead to the baby not breathing and requiring resuscitation. We went back in the room and jumped into action and after the longest 4 minutes of our lives baby started crying. So did we. 

This situation really made us reflect on the standards we hold back home and how we react as a nurse and the boundaries that we are comfortable with in Canada. In Canada we are trained so much to advocate for our patients however, in this situation we experienced the biggest difficulty was to advocate for the patient.

At the end of the day we had all been in tears and had broken down, debriefed with our professor and supported each other throughout.  Although this day was not one we had hoped to witness we all noted it will greatly impact our nursing practices as we progress through our careers. This experience was not ideal however we returned to the ward the next day and ended up having an opposite experience involving incredible midwifery care.

By Jasmine, Rayane, and Taylor

Kyle in OPD

As always, times have been interesting in Zambia. I was able to experience the healthcare here both as a nurse and as a friend to a patient.

I began this week working in the OPD. For any North Americans this is equivalent to the emergency room. Monday was tough. To my understanding the hospital accepts urgent cases on the weekends but does not accept non urgent patients until Monday morning. Therefore there was a huge crowd as I entered. It was incredible the amount of patients that were seen. The diagnosis was fast paced and often had to rely on intuition rather than the advanced diagnostics that I've become accustomed to in Canada. I remember several patients were admitted with the presenting symptoms of upper abdominal or lower chest pain. In Canada these cases are all treated as severe and there is an immediate rush to rule out heart attack or other cardiac problems. However, in Mongu, cardiac marker blood tests are not done and chest xray is the only thing that the clinicians can rely on for cardiac diagnoses. Most of these cases were treated as gastrointestinal based on intuition by the clinical officers present. It is amazing how much these healthcare workers know and and how much experience they are able to gain in a short time. Several of the clinical officers that I worked with had 6 months of experience and were already incredibly knowledgeable. They are kind and patient teachers who I admire for their intelligence. It is frustrating to witness how hampered their diagnoses are by the lack of resources here. I remember my jaw dropping when i learned that blood culture and sensitivities were not performed routinely at lewanika. This test diagnoses blood infections like sepsis and the best antibiotics to treat them.

I saw many patients who I would have immediately expected to be place at a level 2 CTAS triage score in Canada. They would have been seen by a physician within 15 minutes of arrival, but in Mongu even though they are rushed to the front of the line they have to still wait in line for their turn to be seen.

In terms of witnessing the healthcare system from a patient's perspective I was able to accompany one of my peers to the hospital to get stitches after we went white water rafting on the Zambezi river in Livingstone. The clinical officer did an amazing job of stitching up Mark's forehead but it was shocking to see that services are charged for immediately after completion. I will have to investigate whether Zambian healthcare is universally provided or not in this next week while at Lilimunga health clinic.

Cheers,

Kyle

Learning at Sefula Clinic

This week we were placed in the Sefula Clinic which is an rural clinic, about 45 minutes away from our compound. We spent time in the antenatal check up clinic, as well as the Out Patient Department (similar to an emergency centre in Canada). Here we assisted with vital signs, as well as height and weight for the patients. We also spent time working with the clinic's medical officer, Conrad, which was an amazing experience! He was extremely knowledgeable and we learned so much about HIV treatment and transition, as well as treating TB in a low-resource setting. In return, we told him about working in the hospital back in Canada, particularly about wound care and how it is different than in Zambia!

We are also working on developing an Nutrition Education Day that will be held on April 7th for the community. We will be working with Jasmine and our nursing peers, along with the Zambian nursing and midwife students, Save A Life Clinic, Lewanika General Hospital and many more to create a full day event that will include nutritional screening, education, and demonstrations. This week we started to work on some of the many educational posters, and wrote a script for the radio ad to bring awareness to this event. We will be translating all the posters into Silozi with the help of our Zambian colleagues. This event will be very fun and we are hoping for a large turnout!

We are enjoying our time here in Zambia and are very eager to continue learning and working in collaboration with Zambian healthcare team members.

Until next time! Sending love to our family and friends back home.

-Michelle Nurkowski and Dana Dalgleish

A letter to Canada

Dear Canada,

Words can never fully describe how privileged you are to have a healthcare system that is organized, compassionate, resourceful, comprehensive and accessible. Though the healthcare system in Mongu is different and complex it is resilient and determined.

If you were to spend a week in the medical ward at Lewanika General Hospital, you would become familiar with death. Not just any death, you would see younger populations dying instead of what  you are most accustomed to. They die from diseases like HIV, malaria, tuberculosis, and other general medical conditions (heart failure, liver cirrhosis, etc.) that are known to you.

You would see a lack of resources. You would notice no oxygen on the walls - instead just a single machine that doesn't currently work. You would see hospital beds often covered in linens that patients family members bring from home since the hospital can only provide so many. You would notice the empty shelves where some medications should be.

But you would also witness a strong family presence. Most patients have a minimum of one family member at their bedside. The family members do not passively observe care but help to change the patient's position, help them to remain clean, even assist them to walk. On one occasion you would witness family helping with a complete "bay change" as they lifted the bed into the rightful location. You would know how important family is to the Zambian people just by seeing how they help their loved ones through their illness. Illness truly affects the whole family here.


You would witness nurses being creative and inventive in providing their care. They have perfected how to use every piece of equipment that they have as completely as they can. Nurses would collaborate as though they were a single person. They would exchange tasks or provide care seamlessly and without any regard for who was initially assigned what patient. They are inquisitive and willing to answer questions about diseases that you have never experienced.  They courageously enter day after day to combat infectious disease and to care for their patients. You would see how determined they are to make a difference and how hopeful they are in the healing of their patients.

Although it is a different system, hospital, and population, it is continually progressing forward with hope and determination. This Canada is what makes Mongu so strong.


Sincerely,

Janeva

Finding the Similarities Between Cultures

For my placement this week I was in the HIV clinic. I was very excited to start in the clinic because I have an interest in nursing with marginalized populations. I have had slim to none experience with HIV in Canada so being able to work solely with people who are HIV positive was very eye opening.

I started my week in counselling where patients are diagnosed with HIV and given education. Patients are diagnosed by using a finger prick, like a glucometer for reading blood sugar, and are given another test if the first turns out positive to make sure of the results. It was an extremely humbling experience working alongside the counsellors whose job it is to give the patients their results and help them to figure out the next steps and receive education on their diagnoses. It is a very important job to treat the patients with respect and help them to understand how to prevent the spread of disease and be their first line of contact into accepting treatment.

On my last day I spent my time in adherence counselling. This was my first time using an interpreter and I was able to fill out the adherence paper work. Although it was awkward at first I got into the flow of it. It was very interesting to see the cultural differences in why some patients would miss their medications, as well as seeing the similarities to habits in Canada. Learning different methods to help patients adhere to their medication regime and help them figure out what works best for them is definitely something I can take back to Canada.

I found my time in the HIV clinic to be really helpful in understanding the disease and how it truly effects the lives of those it touches. Being able to
to gain knowledge on how the doctors pick the different medications, how to stage HIV, what the common opportunistic infections look like, and being the bearer of life changing news for clients has helped to expand my ability to be an effect nurse in Canada.

Sydney

One does not "Simply" Prepare for Africa

Before I came to Zambia, I had done a fair amount of learning and research on the country and the common health challenges seen here. However, there is no easy, catch-all method of fully preparing you for the realities of life here. So while I knew that there was a larger population of HIV in Zambia compared to Canada, it was still a shock to work at an anti-retroviral therapy (ART) clinic and experience the sheer amount and variety of people who came there. And through I knew intellectually that malnutrition stunts growth, I was still startled to learn that the boy I was talking with was not 10 or 11, but 17. This has happened again and again, where I see a child and, due to their height and appearance, believe that they are many years younger than they are. And even though I knew that there is a larger population of children compared to adults in Zambia, it's still surprising to work at the hospital or in clinics and see children instead of older adults.

These examples are only a few of the many situations which have shown me how much more there is to learn, and how the reality of life can surprise and shock you.

During these past two weeks I have spent time at rural and urban health clinics. I have seen a lot of clients come through, mostly children and new/expecting mothers. With so many clients, there are bound to be ups and downs; things that are familiar and new. I made a child cry because she was afraid of my white skin. I made mothers laugh with my attempts to pronounce their unfamiliar names...and slowly, with help, I became better. I grew more accustomed to making a preliminary diagnosis based on symptoms, without the myriad of tests that are available in Canada. I relearned how to take a blood pressure manually, and I discovered that you don't need to speak the same language to communicate - a simple smile (or elaborate game of charades) can work wonders.

Throughout this practicum I have been learning so much here from the Zambian health professionals and students. I learned about malaria, HIV, ART, and TB. I learned about my Zambian counterparts, the midwife and nursing students. I talked with people, young and old, about everything under the sun. I've seen new babies, new mothers, and children of all ages. I've seen grandmothers, sisters, brothers, and fathers.

Despite all that I've seen and experienced,  I know that there is still so much more to learn. My Silozi is quite rudimentary, and I still have a lot to learn about the common illnesses here. I recognize that I don't even know all that there is yet to learn. I hope that I can continue to have an open mind, and that there is as much (or even more) learning ahead of me.

-Cass

Our Medical Experience at Lewinika General Hospital

This week on the medical wards at Lewanika General Hospital was certainly a whirlwind of emotions. Day one, we began to get familiar with the ward and participated in rounds with the Zambian doctor and nurse team. It is so refreshing that the healthcare team here is so willing to share their knowledge about tropical diseases with us students! We have learned and experienced so much already that we would not have seen back in Canada.

Day three was definitely the hardest. Not long after arriving on the male medical ward, a young man suffering from severe malaria stopped breathing. We helped the doctors and nurses try to resuscitate him, but sadly he passed away. The team worked hard, and did everything they could. It's not easy seeing someone your own age (22/23) pass away from an illness that virtually does not exist in Canada. In Zambia, family mourns the loss of a loved one by wailing to express their grief. It is not a sound that we will ever forget.

One of the nurses we worked with on the female medical ward soon became a good teacher as well as a great friend. Her name is Tina and she is extremely hardworking, caring, and knowledgeable. She took the time out of her day to really explain the process behind HIV/AIDS, as it is not a disease we encounter regularly. We really enjoyed working with her and look forward to seeing her around the hospital in the coming weeks!

-Hayley and Dana

A Week at Save a Life

Charlie, for the purpose of this blog, is a 7 week old babe weighing in at approximately 4 pounds. She's a strong little fighter; battling many severe diseases. I was with Charlie the past few days on my rotation. She had been doing well.

Friday morning I arrived on shift and soon thereafter Charlie began to struggle for a breath. The quick decision was made that she needed to be transported to Lewanika General Hospital for further evaluation. I carried her in my arms down the steps to a taxi, where I then held her steady in my lap down the long pot hole-filled road, until we arrived. Carrying Charlie in my arms down the corridors of the hospital felt like it took forever.

We finally reached the Pediatric ward where I was asked to sit on a bench with her for what felt like an eternity. Many staff and patients would stare, they knew Charlie was critical, but the urgency of attending to babe was not as high as it would have been back home. I have began to realize the different sense of urgency here seems to reside from the fact they truly do not have the resources to help this baby. The same resources we take for granted at home, every single day.

I have gone through four years of nursing school learning that I have everything I need at any moment in time, right at the tip of my fingers. Here, I have instead been learning and watching how to be resourceful in times of desperation; which I might add is a lot more mentally and physically draining then it would initially seem.

The resourcefulness of the medical staff on the Pediatric ward was incredible. For example, where we would have a simple tourniquet back home to start an IV, here they snapped off the wrist portion of a rubber glove- something I would not immediately think to do.

I am quickly learning how resilient the people of Mongu are; the things they see and do on a daily basis, the conditions they live in, the minimal resources- it's truly inspiring.

Dr. K. on my left hand side made the quick decision to send Charlie to the hospital. It was an amazing week with some great people.

- Rayane

Hi everyone ! This first week in Mongu I was placed at the Save A Life Malnutrition Center and the Clinic that was on site for children and families in the area. Instantly this experience was eye opening in so many ways. 

First off seeing how long the people here wait to be seen by a doctor is crazy! Women with children on their backs would wait up to 10 hours to be seen by the doctor. I assessed one lady and her baby who actually came the day before but were turned away after she waited ten hours because the clinic had reached it's sensus for the day. So she walked home and returned the next day, not to mention the 2 hour walk home from the clinic. This patients story is similar to so many of the patients at the clinic. 

The doctor I worked with was so amazing and by my second day she offered to just translate for me and I was able to do assessing, diagnosing, intervening and prescribing with her over looking. A very new experience for myself being that prescribing and diagnosing is not part of a RNs scope of practice in Canada. I throughly enjoyed my time in the clinic and I am now even more excited for the rest of my placements over the next few weeks:)

- Montana

Lewanika on PAR with Canada

This week was our first week at Lewanika General hospital. On Sunday we began with a tour led by a wonderful nurse named Anette. She took us around the hospital grounds where we were able to see where we would be placed this coming week!

A map of the Lewanika General Hospital.

On Monday, we both started off on the female surgical unit with a tour by the staff there. They were so welcoming and appreciative of our being there. The hospital is not set up like those in Canada. It is made up of various single story buildings unlike those in Canada with many floors. As we could not both stay on the female surgical unit, I (Jackie) moved to the male surgical ward to offer my assistance there.

Stepping into the male surgical ward I immediately felt as though I was being watched. I think each man and family member had their eyes locked on me as I proceeded to the nursing station. As I searched for a nurse to introduce myself I was being called for by patients and being grabbed at by family. It was difficult to understand them, but the world "help" was one I understood very clearly. In that moment my heart felt heavy for these people and I felt saddened by my inability to assist them. One of the most amazing things we have experienced this past week is the ability of staff to be very resourceful and find multiple uses for everything. 

I began my day with assessments of patients on the ward as I would on the surgical ward back home. I was glad to help in any way I could and learn alongside the nursing staff. My last practicum in Canada was on a surgical floor so I was very eager to jump into surgical nursing here in Mongu. We started our day at 0800 and at around 0900 hours I decided to follow one of the patients I had assessed in the morning to the operating theatre. I assisted where I could on the ward but I thought it best to try something new and get the most if this experience!

I transferred my patient to the OR by wheelchair and introduced both myself and my patient to the OR staff. Looking around I could see old stretchers with OR supplies laid out to dry, as well as other patients waiting on a bench inside for an open theatre. I was able to follow my patient into his surgery and watch the operation alongside the staff. They were all so excited to have me there and watching them at work! The main surgeon kept telling me to get closer and closer! The OR room itself was pretty empty, and dark. It looks as though it had been well used over the years! This week we had the opportunity to watch general and orthopedic surgeries. The orthopedic surgeon is from North Korea and has been working in Mongu for a few years now!

One of three Operating Rooms at Lewanika General Hospital. 

Once the operation was done the patient was wheeled out into the far hallway and left until someone came by to pick him up. I asked one of the Nurses if they had a Post Operative/Anesthesia Recovery Room. She said they did have one in the past but were not practicing that way now. She pointed in its direction and I brought the patient with me to this room. I had no idea the state in which I would find it but I wanted to keep an eye on this patient still recovering from anesthesia. Once I got to the room I realized it had become a sort of catch-all. I removed boxes of supplies, dusted, and sorted through boxes to find what I needed to run this room! I was able to clean the room up and find equipment for assessing and monitoring vital signs. I was also able to find resuscitation equipment if needed. There was now an operational PAR that patients could come to following surgery to recover and be under close monitoring and assessment.

A cleaned out PAR room with vitals machine and bed.

On Tuesday we got to work together in the OR and PAR with the wonderful operating room staff at Lewanika and observe several different surgeries. Tuesday was an orthopedic surgery day and sever children were slated for surgery today. In Mongu children receive general anaesthesia so it is very important to have a recovery room where they can be monitored until waking up! Being able to watch surgeries first hand was so incredible! The doctors and nurses are very resourceful with the limited resources they have at their disposal! Our goal for the week was to start making the recovery room more usable for our Zambian colleges. The hope is that is we are able to set it up and model correct use of a post operative room it will make their transition into using it again easier!

One of our favourite OR Anesthesiologists we had the pleasure of working with.

(PRIYA) I was on the female surgical ward for the first day of the week and got to see patients who had gotten surgery and was able to see how nurses do assessments here, seeing some similarities and some interesting differences in assessment technique from back home! I enjoyed my time observing and quickly learnt how the nurses managed without supplies here. I was also able to follow the doctor who was performing his rounds, and was tested on all sorts of information! Something that was difficult for me to watch this week was the doctor performing abortions on patients on the female surgical ward, which were not elective but urgently needed. I had never seen this procedure and did not know what to expect really, so seeing it first hand was hard to watch. The hardest part to watch was the lack of pain medication given to patient prior to the procedure. I was able to see that the patient was in pain, but in Mongu, it is common for the Lozi women to not show or voice their pain and remain stoic. Although it was a difficult experience for me in the moment, I learnt the importance of advocating for your patients and especially pain medications in this situation. After our first day we all shared what we had done, and I realized that my time may be better suited toward establishing and maintaining a PAR room with Jackie. So  on my second day I joined her and went to the recovery room. The room had started looking nice already, there were few supplies but it was a nice room to begin working with!

Priya & Jackie in the main Operating Theatre.

After observing the surgeries we would follow the patients to the recovery room and perform assessments and do charting on our findings. Charting was a nursing intervention that was not completed or prioritized as it was back home. As this was something that was lacking at the hospital,  the push for the recovery room and regular charting was very much needed! Throughout the week we went around the hospital seeking out equipment and more charting forms. On Jackie first day she had to make charting for for post op recovery herself!  We kept our post op routine throughout the week and were able to make some great progress beginning the recovering room and demonstrating post op nursing! As we had never worked in PAR prior to this placement we did research on common operations, anesthesia, intra operative medications, and post operative assessments and observation.

On our last day, we made educational posters on topics such as fluid resuscitation and hypovolemia for the recovery room, as a guide on what to look for after surgery. We also translated pain scales into Silozi to use with our patients.  We are both very excited to see how the first steps we've taken are built upon by other students coming into the surgical setting! We can't wait to see the final result at the end of our practicum here in Mongu!

Priya & Jackie in the refurbished Lewanika Hospital PAR Room.

Lots of love to our family & friends!

Priya & Jackie

A week in Labour and Delivery at Lewanika General Hospital

The women here are the most resilient and strong women we have ever seen. After spending the week in the hot delivery room, it was evident of the strength of these people. On the labour/antenatal ward, you walk in and hardly hear a peep. Labour is done in a stoic silence. After labouring for hours, they give birth with no pain management. The babies are wrapped in the mothers blankets that were brought it by her. Almost immediately after the birth process is complete, the new mother gets up, dresses, and walks herself across the ward. Having had experience in a Canadian maternity ward and seeing all the luxuries and pain control given, it was incredible to witness a different kind of strength. We noticed that the antenatal (prenatal)  care in the community was effective. All the mothers came prepared with all the necessary supplies including clean towels, blankets, baby clothes, birthing sheet, pads, hydration/food, laundry bins and clothes for the mother. The staff on this ward know their stuff and are resourceful to provide adequate and clean care with what they have. It's incredible how many births they conduct in such a short amount of time and in such a hot environment. They were awesome teachers and open to many of the suggestions we had. We thank the ward for their support and commend them on their hard work and commitment. 

Sincerely,

Hailey Parr and Jamie Towert