UBCO Nurses in Zambia: 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!