Aileen and Darien teaching the kids how to wash your HANDS!

Maternity Week 3 :)

       This week Shawnel and I were paired together again on the Maternity + Post-Natal units. The week was a good learning experience, especially in preparation for our upcoming CRNE (the BIG exam). Though the week was not as eventful as a couple of the other girls who have done maternity, we were still able to get the full experience of maternity nursing in Zambia. 

       A challenging and different thing we noticed from Canada to Zambia is the length of time and overall nature of the labour and delivery process. It was very different for us to see that sometimes multiple women will be giving birth at the same time, in the same room. Then, not  30min-1hr later (sometimes sooner if more women need to give birth), they will be moved back out to the ward and then transfered to the post-natal unit. In Canada, women have an entire delivery room to themselves and after birth, are able to relax in that room for a longer period of time before having to be moved. Obviously, it is of no use to make comparisons between Canada and Zambia due to a variety of different factors influencing circumstances, however, the “having a baby” process here seems much less special than it’s made to be in Canada. Again, this is likely due to the increased number of births here, less resources, less manpower etc. etc. etc. Its just such a different culture here, a different mentality, and a different lifestyle. 

       One situation that really was particularly shocking surrounded one of the post-natal patients on the ward with a severely infected c-section incision. This woman’s infection caused her incision to dehisce (open all the way up) and then she developed a fistula (hole) between her bladder and the bottom of the incision causing her urine to leak through her incision, as well as a vaginal fistula. In Canada this would call for an IMMEDIATE surgery! Here in Zambia, she is on the top of the list to go in for surgery, but the constraint to this was the hospital had no blood bags that matched the patient. Therefore, no surgery until there is blood for the patient which can take days to come, and it took more than a week. Luckily the patient was generally stable, except having a unnervingly low blood pressure on average of 80/60 (normal is 120/80). The patient is still on the ward and has not received surgery. There is question as to whether they will be sending her to the capital, Lusaka, to fix both her fistulas, or if they will do one here and then another there because they do not have a ObGYN here to fix the vaginal fistula. 

This has been a common theme and difficult one to see that some patients are delayed necessary treatment because of the lack of resources and staff. It just makes us feel so thankful and grateful to live in Canada where we have any and almost every possible technology and medical device at out disposal if needed. It just blows my mind, no words can describe it. I can honestly say, I don’t think I will be complaining about a lab result taking to long at home anymore, or having to prep my patient for a CT during a busy shift because at least we have them and my patients will be getting the care they need, when they need it!

        Overall, maternity was a great learning experience and a chance to really step back and see the bigger picture. I learned to truly appreciate the life I live and the health care I have available. As frustrating as it can be here when there is such inequity and resources lacking, my biggest lesson from this week has been to always do everything I can with what I have here in Zambia. This is the key to really absorbing this experience and making the most out of it for us and our patients :) 

Until next week!! :)

- Caitlan S.

Some Extras from this week!

• We got to go into the OR and watch a c-section of TWINS :) 
• Shawnel got to see an abnormally great vaginal delivery!
• Working with the 3 Quintuplets from Caitlin, Leah, and Savannah’s week on maternity! They are doing better and slowly growing and getting stronger! 
• Recognizing that a baby’s nasogastric was not placed correctly and likely in the baby’s lungs. With a pH strip test confirming this, we inserted a new nasogastric tube and confirmed correct placement with another pH strip! 
• Teaching a mother who had a premature baby about proper feeding as we noticed she was not feeding the baby as frequently as should be for a premature baby.

Sefula - Primarily Caring

Last week I had the pleasure of working with Aryn again and we headed to the Sefula Health Center. We had a great week and were really shown how successfully a rural clinic can be run to best suit the needs of the community. One half of the clinic is run as an out patient department and HIV clinic. They are equipped with a pharmacy, a waiting room, screening room, treatment room, adherence room, and HIV/malaria testing room. Patients flow through the clinic - starting in the waiting room, then seeing a clinical officer or nurse - getting appropriate treatment, then off to the pharmacy to collect whatever medications they have been prescribed. Considering that it acts as both an OPD and an HIV clinic it runs very smoothly. I was very impressed with the level of care that the clients living with HIV received. They are scheduled for routine visits to review their medications, any side effects, and how they are coping. There are counsellors available - especially for those who have been newly diagnosed.

The other half of the clinic operates in my eyes as their Public Health sector. They run clinics each day - antenatal care, child health, family planning etc. I was lucky enough to be a part of the family planning clinic and learned a lot. Many women of child bearing age come to the clinic to hear about safe sex practices, how to protect themselves from sexually transmitted infections/HIV, how to correctly apply condoms, and birth control options. The women all ranged in age - from 16 to late 30s. After the education seminar they are offered birth control as well as condoms. Many women chose to receive the Depo injection which lasts for 3 months. I aided the wonderful nurse in taking the clients vital signs, weight, and then administering the injections. These women also frequently get tested for HIV. One thing that made me so happy was the amount of women who were HIV negative - especially after spending so much time in the OPD department where the majority of care provided is to HIV positive clients. It was uplifting to see that their public health initiatives are working to prevent HIV in these young women. They are receiving correct information and are offered protective means. These women are also extremely independent and responsible for their own health. Many keep “exercise books” that document their health history and previous methods of birth control and the next time they should come to the clinic to update their birth control. 

One thing that I was the most impressed with is how well Sefula has been able to carry out Primary Health Care. I feel like in Canada that is an area that we have lost focus on as our main focus has become acute care. The clinic has definitely adapted their services based on the needs of the community. I also felt a complete lack of stigmatization towards any of our clients. The nurses were extremely accepting of everyone that walked through the doors of the clinic. I never once heard them refer to anyone as a “frequqent flyer” - a term many nurses use back home in Canada for clients who frequent the hospital. There was also never any reprimanding of clients for their diagnosis - another practice that I have witnessed back home. I think the thing that I was most impressed with at Sefula was the Family Planning clinic. Many people in Zambia are religious - which would make me think that services like these might not be available. I also thought that perhaps abstinence would be preached before offering other means of protection and it wasn’t. It was wonderful to see how many women showed up to learn and take control of their health.

- Robyn

This week Robyn and I were placed at the Sefula Health Center. Specific to Sefula, as of recently, is the idea of ART clients and OPD clients coming to the same place and waiting in the same line to see the clinical officer. As opposed to the hospital, where ART patients are in a separate area of the hospital. The clinic is trying to decrease the stigma that has been associated with HIV clients in the past. So far this has been working great for them and I’m curious to know how this effects stigma of HIV patients in the future. 

Something that stood out to me this week was the passionate and caring attitude that the health care workers (nurses, clinical officers, etc.) had towards the patients and their needs. The nurse Barbara was passionate with the staff and making sure that everyone was on the same page. She expressed to the staff how important it was that they attended staff meetings where they would be receiving important information. One specific nurse that stood out for me was nurse Precious. This lady was also a midwife who had done quite a bit of school but had not finished her Bachelors degree because it was too hard for her to be away from her family. In a few short days, I saw Precious show warmth and love to patients that I have been seeking to find in Zambia. Granted, Precious is in a different situation than nurses at the hospital. Nurses in the hospital typically have a ward full of 30+ patients to one or two nurses. During the day Precious can either be found running ante-natal or post-natal clinics, on the ward with new mothers or delivering babies! Minimal room for down time or boredom in her day! Kindness as a nurse is a pivotal characteristic and one that will never go unnoticed. Thanks for being so great!

One cute little tid-bit from our time at Sefula was on our last day. We were just about to finish up with our day when a lady walked into the clinic in labour. Precious left our ‘Under Five’ clinic to go and see how far the mother was dilated. She ran back to us and told us that the mother was just about to deliver! As we walked back to the clinic Precious turned around and says to us “I prayed for you two last night that today on your last day you would get to see a birth”. And a birth we saw! Robyn’s first magical vaginal delivery! The woman basically coughed and the baby came out! Precious at the bedside with her words of encouragement and us there to snuggle the baby afterwards, it was the perfect end to a wonderful week at Sefula! 

- Aryn

Nursing-Zambia style!

Treating the Person, Not the Disease

Last week we (Ali, Lauren and Caitlin Robertson) worked between the women and male wards. Our focus was to assess the most acute patients and care for the patients with the resources available to us. The most valuable learning experience for us was recognizing the lack of mental health resources for acute patients on the ward. We worked with three cases in particular where the psychosocial assessment of the individuals was lacking and not as prioritized in the care plan as we thought necessary. 

One situation involved a patient who was transfered from the mental health unit onto the women’s ward.  She was presenting with clinical symptoms of meningitis. Meningitis effects the brain and causes an altered state of mind, which can easily be mistaken as mental illness.  Although this was her diagnosis and was being effectively treated, the staff members were passing these symptoms off as a mental health illness and low priority, rather than as an acute medical condition. There was an obvious stigma present on the ward. 

This was also the case with two other patients we cared for throughout the week; one of which was very similar to the scenario mentioned above. Our most significant situation involved a patient who was brought in to the male ward by our fellow nursing student Sarah Duddle. Sarah was working in the outpatient department that day when he came in after ingesting rat poison. It was mentioned to us that rat poison is a common choice for suicide attempts. 

The attention given to this patient was minimal and lacked a sense of urgency. Without the efforts of Sarah, he most likely would have passed away in the outpatient unit with no interventions. The young man’s condition was brought to our attention just early enough where we could intervene. We fought for medical attention from the charge nurse and the attending physician; it was very frustrating. We didn’t feel that this situation was being treated as an emergency. We pushed to have an NG tube inserted to suction the poison out of his stomach and to administer charcoal which induces vomiting. We were successful in both interventions as well as advocating for the attention and care that he deserved. 

Throughout these situations we were shocked at how the patients were ignored and put to the wayside, and we didn’t understand why. It wasn’t until reflection, that we were able to better understand the actions of the staff. It wasn’t that they didn’t care about this patient, rather that they do not have the same resources available to them that we are used to in Canada. There are minimal interventions and diagnostics available, so much that we were unable to provide something as simple as oxygen. LGH is also understaffed, especially with psychiatric nurses (there are only two in the entire hospital!). Even in Canada, mental health care is lacking and could be improved on.

 There is also a huge stigma around suicide and unfortunately for these patients the nurses and staff members have minimal training. It was hard to hear that the suicide cases are common here, and yet they are not addressed in a manner that we deem appropriate. Ensuring patient’s receive adequate mental health care is even a problem we are fighting as nurses back home in Canada. This experience has helped us recognize the  importance of treating mental illness with the same patient care standards we would any other condition. We are trained to treat everyone with a holistic approach, without passing judgement. This proved to be successful in our practice last week. 

We are so happy to know that our efforts assisted in saving the life of this young man. We were pleased to find out he was discharged today and following up with some counseling services.

- Lauren, Ali, & Caitlin Roberton

Safari weekend!

 What an amazing weekend we had at Mukambi Lodge! 

Highlights of the weekend included:

- Meeting up with Faye and Jenni! So happy to have them join our crew :)

- So much fruits and vegetables! The food at Mukambi was all included for us and amazinggggg! Never did we leave full... ever.

- Waited all weekend to see a lion, only to see him on our last game drive

- Chicken wars in the POOL! (like, the water kind of pool ;) )

- Getting our butts kicked at soccer

- Kicking the locals butts at Net Ball! 

- Big sunburns and tsi-tsi (sp?...) ... Oh wait, definite low light! Ruthless things those flies are

- Having an elephant in our parking lot, and having to be driven home to our lodges

- Listen to Basel (the lodge hippo) burp and groan all night

- Beautifullllll accommodations

- Yoga in the foyer! (in a dress?...)

- The bus breaking down..... TIA!

- Seeing lots of monkeys, puku, impala, birds and elephants! 

- The beautiful skies that we saw at night - so many stars!

- Sunday morning boat cruise with the cutest laughing hippos in all of Zambia!

- And last but not least, getting to spend time our amazing group in such a fun and wonderful setting! 

We can all say that there may have been a bit too much fun had, but the fun was much needed! Who needs sleep when you can wake up at 515am to go on a game drive! Only two more weeks left here in Zambia - what will we all do without our big group!?

Big thanks to Mukambi Lodge for being the greatest hosts! 

Xx Zambia Girls