Monday, March 28, 2016

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'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!


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