Reaching out

Janeva, Jeevan, Mark and Steph went on an outreach together with South African Doctor Nilene and two Zambian translators, Banks and Nesilele.

Our adventure started with a 3 hour 'speedboat' ride across the Zambezi floodplains to the Western side of the Zambezi River where we arrived in Kama Village. Upon arrival we were greeted by a mob of local children eager to see the mukuwas (white people) and help carry our stuff to camp. All week, they enjoyed watching us set up camp, make lunch, eat lunch, clean up, sit by the fire, etc.
After a night of fitful sleep on yoga mats in our tents (the 3 girls in one, Mark in his own with all the food) we woke up in anticipation of seeing the locals who were already lined up outside of the little clinic building in the village. It was odd to be sitting and eating our breakfast while people simply waited patiently for us.

Throughout our 3 days of seeing patients, we played many different roles. We worked as nursing assistants, nurses, doctors and pharmacists. One of us would screen the patients by taking vital signs and a brief history. After being screened, patients had anywhere between 30 and 90 minutes to wait to be seen. During this wait, they used the time by seemingly just enjoying watching the mukuwa's work.

After their wait, they moved to diagnostics. There were two rooms set up where two students were waiting with a translator to assess, diagnose, prescribe medications and refer under the guidance of Dr. Nilene.

They then took their booklets to the next building where the 'pharmacy' was. Here they patiently waited again. Then they received their medications and education about said medication.
Over the course of 3 days, we saw 388 patients, often working long into the evening. Our first night, most of us were crammed into the pharmacy with our headlamps on finishing orders for the day. There was no electricity in this building and we shared it with a colony of bats. But everyone got their meds and were on there merry way.
There was a back room in the pharmacy that was used for IV initiation, draining abscesses, debriding wounds, giving injections and more.

On Wednesday, Janeva and Mark left the clinic in the capable hands of Jeevan and Steph to go the school and teach about sexual health and hygiene. Banks was incredibly helpful in translating and engaging the learners. We were so blessed to have him with us. Here we distributed the Days for Girls kits which were a huge hit. These kits are for girls to assist with hygiene while they are menstruating, and last for 3 years if taken care of properly. The kits were really well received and many girls came to our campsite later to ask for more kits. It was really heart breaking when we ran out of kits and had to turn girls away. For more information and to find out how to support Days for Girls please follow this link:
http://www.daysforgirls.org/

Some of the experiences that stood out to us were:
- the amount of malaria and how sick patients can suddenly become
- the number of STIs in a small, rural village showing us the lack of sexual education and knowledge
- how HIV is so much a part of life here. Whether we were saying "you have HIV", or "hakuna HIV" (no HIV) it didn't seem to phase the patient.
- seeing what a borehole with clean water can do for a village (everyone walked to it every day)
- giving out referrals and not knowing whether they could actually make it all the way across the floodplains on a longboat to Mongu

Together we would like to thank our translators Banks and Nesilele for keeping us entertained and helping so much in the clinic. There is no way we could have done this without them. We would also like to thank Dr. Nilene and Village of Hope for organizing everything and helping guide our clinical decision making. We will always remember sitting around the fire cooking dinner and laughing about escalators and policemen.

Encha.

Janeva, Jeevan, Mark and Steph

Week One in Mongu!

Wow- what a first week in Mongu!

There is so much to see, learn, and do here that I find myself often thinking about what is to come next before thinking about what has passed. Here in Mongu, my week taught me that adaptability, hope, and humility can help one to be successful in a new environment, even in moments when frustration, fatigue, and impatience can seem overwhelming. It can be emotionally and psychologically exhausting, seeing new things every day. I guess you could say it's what we're taught about 'culture shift'. While many facets of life and daily living are similar here, there is also much that is very different. Whether I am out in town with the locals, chatting up the taxi driver, or collaborating with the nursing students on the ward, each interaction has been a learning experience for me- good or bad. This past week has brought moments of sincere thanks for the kindness, openness, and genuine friendliness of the Zambian people. Other moments have made me scared and upset, even frustrated at times because I see so much that is new and feel like an outsider in my environment. I feel frustrated in the sense that I am a visitor here, not considered a part of this community in a permanent sense. Of course, how could I? I've been here for a week. Moving forward into this practicum, I want to continue to learn; learn as a person and learn as a student. I am keen to see all that I can in the little time that we have here. I came here wanting to work and to be involved and to help. I can't help but see some of that through a post-colonial lens as well, though I don't want to. Being the 'makuwa' ('white person' in Silozi) here, things are new for us while also being new for the local community. It's a lens that reflects from both directions, it seems. My passion for global health at home makes me all the more motivated to learn and do my best while I am here. How can I learn so that I may choose to begin seeing issues, particularly those related to health and health disparity, in a way that is useful to our patients here in Zambia? How can I truly help? As nurses, I think we often find ourselves wanting to 'help': How can I help? Do you need help? Do you have enough help? That sense of wanting to be a part of something collaborative to create change looks very different here, as I have learned.

-Rachel Ollivier

Michelle and Rachel in the Post-Natal and Neonatal Care Units at LGH: 

(After a long day of resuscitating neonates, we finally got a chance to have a break and enjoy the hot Zambian sun!)

We spent our first week on the Post-Natal and Neonatal Care Unit at Lewanika General Hospital....an exciting experience to say the least! Our first day began with learning what 'dumb dusting' is- a new nursing skill! This involved cleaning the patient areas with soap and water, the first thing we do in the morning each day! It's another way of checking in on each patient to see how they are doing, I suppose, just in a different way! Our first day brought many opportunities for collaboration and teaching with some of the student midwives and speciality nursing students. They were so open to teaching us how they perform assessments in the maternal setting while also encouraging us to share ideas and techniques about how nursing assessment may be different in Canada. I certainly learned a bit and saw how certain health issues are much more prevalent here. Assessment components such as checking the head for lice and bugs, palpating the axillary lymph nodes for infection, or checking the eyelid for anemia were integral components of the nursing assessment here that may have been missed or disregarded in Canada. Needless to say, it became quite immediately apparent that health issues and health disparity are a new reality for us working here as student nurses. It's not what we know it to be in Canada, therefore requiring a different approach and the openness to adjust, tailor nursing care and assessments, and learn! I felt so comfortable asking questions with the staff on the unit and found that to be so helpful in making our first day a positive one. We certainly felt welcome! Our second day brought us many more surprises and, in relation, learning opportunities. We began our day on the post-natal unit before heading to the NICU after morning care and assessments. In what many of us Canadian "makuwa" would call a 'sauna of a NICU', we were subsequently presented the opportunity to resuscitate 3 different infants on 5 separate occasions over a period of 3 hours (without relief) in the 38C degree NICU room. I describe it objectively to begin simply because the experience itself was something of substance, requiring much reflection afterwards. In the moment, we were in there helping out before resuscitating another babe while a full code (CPR) was happening with another baby. The intense heat and dribbles of sweat running down my soaked scrubs seemed to take a backseat in that moment. Michelle and I, as a team, were there with each other to provide guidance through the process- and boy were we thankful! Situations such as the few that we were presented that day certainly illuminate how one reacts as a nurse. Even between ourselves with Alex (Canadian Nurse accompanying our group), I found the responses to an acute situation such as neonatal resuscitation to be a bit different from our Zambian colleagues. After a short, yet very long 3 hours, we came out of the room to find Lisa and Jessica awaiting our reactions. "Was it okay? How are you feeling?". In the heat of the moment (with some certain adrenaline still pumping after 3 hours), we didn't quite know ourselves. Taking time to debrief after was helpful as we had a lot to think about. First, you think, "how did I do?", "what was the outcome for the patient?", "how can we ensure that this patient is well cared for and that follow-up is received?". As we spoke with Lisa and Jessica outside the door, a full code was still running inside, having surpassed approximately 1.75 hours of CPR already. I knew in my heart, it needed to end. We needed to let this small, small child pass peacefully. Michelle and I stepped away for a bit to rest, though the thought of wanting to advocate for the patient was still in our heads. 'I know this isn't protocol where I am from, but I know that we have done our best', I thought as we sat outside in the boiling sun. As Jessica said, we need someone to declare the end of the code, but that decision carries a weight of one thousand bricks when it's in your hands. I understood that, we needed to be patient and to allow things to progress how they would here. Upon our return, Jessica had found the physician and they had decided to stop CPR. It is sad; losing a life that young and innocent is never easy. To bear witness to such a beautiful moment and to know that the mother and the family had time to say goodbye and to love as all humans should be loved, was so very special. That's what is important to me: patient and family centred care. It looks different here as patients tend to be very stoic about pain or difficult issues to sometimes 'show strength', but emotions never leave us. We are human that way. Seeing the nurses work tirelessly through that resuscitation in collaboration with Alex while we worked as a student-based team to care for the other patient who needed resuscitation at that time was amazing to me. For us, it's a big deal. For them, it's very important, though they know and see this so much more than we do. It can be difficult to understand their reactions simply because the cause of patient and staff responses to acute situations is so multi-faceted. Sadness and grief are ever-present when health disparity is such a harsh reality like it is here. During the resuscitations, it was difficult to know that there was so much missing that could have been useful and beneficial for the patients. That's how it is here; you make do with what you have and use it to its fullest potential. To be resourceful is a skill that will never pass as useless. Here, the nurses are so strong and resilient. It's something we can look up to. At the end of the day, I felt so sad in thinking "this is hopeless", "how do patients even survive here?". But they do. That's the thing- they DO. Wow- how could I have ever otherwise known hope to be as powerful as it is here? Seeing hope in others is what makes these long days possible. That day, we saw hope in the nurses, in Alex, and in each other. You keep going because you have to try. No matter what, try. We are a team and we are here to do our best for the patient. That rings true no matter the situation or setting. While the environment, the resources, or the goals of care may change, knowing that we are there to care to the best of our ability is integral to nursing practice. Our worlds and different, yet the underlying similarity is what will carry us through this Zambian practicum. The knowledge built throughout these past four years will grow exponentially while we are here and I absolutely cannot wait to see what's in store.

           (Our last day on the ward! We made educational posters for the staff as thanks for their support and as a way to promote continual education and best practice.) 

(Handwashing tubs in the NICU)

(Patient supplies in the back room, including a wheelchair and many blankets.)

On another note, I was interrupted in writing this post by an amazing procession going on outside along the road. Apparently an important businessman passed away and the funeral was being held near the king's palace today, about 10 minutes down the road from our lodge. It looked like the whole town of Mongu was attending! We saw it as a good time to head into town and have the whole grocery store to ourselves...muahaha!

Here, it's all about celebrating the small things as a group. We had a little patio party on St. Patrick's Day to make things feel a little more like back home. On a completely unrelated note, having normal bowel movements is also something to celebrate here. Woohoo, thank goodness for probiotics!

Cheers to all of our family and friends back home! Until next week!

-Rachel Ollivier and Michelle Nurkowski

Paving Pathways Smile by Smile

Wow did that week ever fly by. Where to start. Pediatrics in Zambia is like nothing I've ever seen before. In Canada I found pediatrics included a lot of mental health and new diagnoses such as diabetes. Here however pediatrics is extremely acute (Jasmine). Each day during rounds we'd see children have complication after complication. For example a HIV positive patient ended up getting TB as a complication of the low immunity he had resulting from his illness and then was diagnosed with a pleural effusion as a complication of the TB. This child, these children were very sick. This was very eye opening to us and really made us take a step back at first and ground ourselves in order to be the best we could be for these children in whatever way we could be. By comforting or advocating. We wore many hats. One of the amazing and rewarding projects we were able to work on during this week was play therapy. The children were very shy at first but we were able to get them to paint and draw the first day. We ended up leaving some of the kids with pencil crayons and paper when we left so that they could keep drawing. We kind of assumed that we probably wouldn't see these pencil crayons again as they are rarely found here. However when I walked in the next morning the little boy was waiting for me. He was holding his pictures up smiling and handed me the pencil crayons (Jasmine). He was so proud and it was such a moving and memorable moment. The next day we made paper bag puppets. The kids loved this and moms, dads and grandmas would make them for the children that were too sick or too young. The last day I (Jasmine) walked into the unit and moms were calling me over saying "sister" "sister" asking if they could get supplies for a puppet for their child. The children slowly warmed up to us (as at the beginning some would scream and cry when they saw us saying ("makuwa") and by the time they got discharged they'd be looking around to give a hug and say goodbye. Those were the warmest and most meaningful hugs. Overall we have learned that the children here are the strongest we have seen. Even when they are so sick and acute and may not make it through the week they still smile and are relatively happy. We will never forget the things we saw, heard and felt this week.

In terms of staff and supplies available at lewanika we were quite shocked. The lack of documentation and general distinction between Canadian and Zambian nursing responsibilities were hard to get used to. I'm used to conversations with doctors in Canada where a diagnosis is reached together. Here the doctor primarily performs assessments and a nurse takes orders. It reminds me of older forms of Canadian nursing. (Kyle)
Also, I (Kyle) became more and more grateful of the abundant supplies available to us on wards in Canada. It was an effort to even obtain printed documents. I know that this is only a reflection of the economic climate of Mongu and will become better over time. It's interesting to hear Jessica's perspective regarding the changes that have occurred over the last 8 years. Things seem to be changing for the better in increments and I'm reminded of a common local saying: "everything happens in Mongu slowly"

By Jasmine and Kyle

Ingenuity in the OPD

This week I was placed in the OPD, similar to the ER in Canada. I was a little daunted because I was the only student there and didn't have a buddy to experience my first placement with. To top it off during our tour of Lewanika General Hospital the OPD was very hectic! Luckily all the nurses and medical officers were very welcoming. I spent most of my time working with a medical officer to help diagnose and prescribe medications.

Although we were all told how prevalent tropical diseases are there is nothing like seeing it first hand. We diagnosed countless patients with TB and malaria. Seeing how diseases that are non existent in Canada or uncommon effect a population so heavily is very eye opening, especially in a low resource setting. The ingenuity and critical thinking that goes in to providing care for patients when items are out of stock or just don't exist here is incredible.

As well as being an emergency room the OPD operates like a doctors office. One interesting aspect of this for me was being able to see the management of patients with chronic diseases and how they are treated in the community. I was able to participate in patient teaching on diabetes management, as well as the importance of sticking to medication regimes in hypertension. Effective patient teaching can go a long way. I definitely take for granted all the handouts, brochures, and booklets we can give patients to refer too in Canada. I am interested in cardiac medicine so seeing the similarities and differences to what I am used to peaked my interests.

I am excited for the learning experiences I will get next week in the ART clinic.

Sydney

A Partnership that Spans the Sea

The highlight of our first clinical week here in Mongu wasn't actually a clinical experience. It was our visit to Kaande Basic School, about a half hour drive from Liseli Lodge.

This might seem like an odd excursion because it was out of the way and not directly linked to a clinical experience. But this particular trip was a continuation of our leadership project from last semester, where we taught students in grades 3 and 6 at Aberdeen Hall Preparatory School in Kelowna about global health. We covered topics such as water and sanitation, education, malaria, and world festivals. Our goal was to create global awareness and to challenge students to become acrive members in their communities and the world.

As part of the project we asked the kids at Aberdeen to collect school supplies to send to schools in Zambia and Ghana (the other option for an international nursing practicum through UBCO). This activity was part of helping them to be aware of the lack of basic school supplies in many countries around the world, and the challenges faced in places where school isn't easily accessible.

We chose Kaande Basic School because our nursing instructor, Jessica, connected us with Rachael, who runs an organization near Kaande. Through Rachael, we got into contact with the headmaster at Kaande, who enthusiastically agreed to a partnership with Aberdeen.

Rural area surrounding the school. 

Throughout this project, we wanted to make sure that a partnership would be fostered between the two schools. We wanted to avoid a situation where foreigners simply donate resources and leave. With this in mind, the students at Aberdeen created brochures which briefly described themselves and their lives. Our hope was to create a more personal connection to the students who would be receiving the donations from Canada. It was important to us that the students at Aberdeen realize that they can learn from students in different countries and continents, and that one way of life isn't better than another.

We were a little nervous upon going to Kaande. We didn't know quite what to expect or what our plan would be. Upon meeting the headmaster and several teachers, however, our fears were quickly relieved. We were warmly greeted and welcomed to Kaande. We were able to find out a little more about Kaande - it was established in the 1900s, and there are about 400 students. They do not have electricity or computers, and limited classroom space. Despite this, the teachers are passionate and the students eager to learn. We feared that the school supplies we had would not be enough, but the teachers assured us that they would be very helpful. We decided to give the supplies to the school rather than to individual students to ensure their use at school and for school.

Although plain, the school was beautiful and clean. Anywhere from 60-90 student would learn together in a small classroom, and teaching materials consisted of a chalkboard and hand-drawn posters with some shared textbooks. But it was such a joyful experience for us to meet teachers who clearly loved and were proud of their work, and finally getting to see the school that we had anticipated visiting for so long.

This trip was a wonderful experience, and we are so excited to go back to Kaande and give the school the supplies as well as teach the students about hand hygiene. We'd like to thank the many people who have helped us get here, especially our other two group members, Gurpreet and Noella, without whom we'd never have gotten this far.

Main schoolyard at Kaande

- Cass, Laura, and Julianne

A Beginning

This trip has been interesting so far to say the least. I've never had any travel take as much of a toll on me physically before. I'm still quite jet lagged and tired most days. The plane trips themselves were the most extensive that I've ever experienced.

I remember a fellow UBCO student doing an international exchange from Madagascar telling me that it took him 2 days of travel in order to reach home. I nonchalantly told him that 2 days didn't sound so bad. I now understand his hesitation at making the trek home for winter/Christmas break.

It's both intimidating and exciting to be here. I find it amazing that society still thrives here with such obvious environmental challenges. Malaria, the tse tse fly, hippos, and water communicable diseases all seem so foreign to my Canadian sensibilities. This gives me a new perspective on my ability to simply jump into any body of water I see in Canada and call it a vacation. But I also see that it's because life thrives here that there are so many hardships. Competition between living things for all the lush resources here is the reason for so much disease and danger.

Approaching people here is very different from my expectations. I was expecting to experience hostility due to my skin color as well as a sort of white guilt but I've seen exactly the opposite. I find it amazing given Europe's historical exploitation of these lands that the general population will still smile at a white guy. I suppose that I think too much about these things. I should strive to adopt the carefree attitude of the local populace. There's so much singing and dancing. A lot of joy exists here.

In terms of healthcare I can already feel a gratitude for the development of North American health care.The hospital is just not equipped to that standards I'm accustomed to. However, I'm glad to hear from Jessica that the conditions have been slowly improving throughout here years working here.  I thoroughly enjoyed the tour we were given of the save a life center. This religiously founded organization really does seem to be providing excellent orphanage, school and pediatric undernourishment services. It's shocking to meet a 17 year old boy who looks around the age of 13.

I'm nervous for my rotation on the pediatric unit. This field has never been my passion but I'll do my best. I think I'll really enjoy distributing the supplies that were fund raised for play therapy. I can definitely see the need for adqequate play therapy. It's tough to develop emotionally when undernourished or sick. I know for a fact that I'm particularly grumpy when I miss a meal. I can't imagine experiencing this feeling with any frequency during my childhood.

Cheers,
Kyle