I’ve reached around the halfway point now of my 3 months in Zambia and time is really flying. It continues to be an amazing experience; I’m constantly learning a lot, and really excited about the projects that we’re working on. The main ventures over the last few weeks have been progressing with the stock management initiative and getting involved with a nationwide polio vaccination campaign for under-5s.
WEEK 4: Livingstone & Chobe
After returning from my first visit to each of the rural health posts, I had meetings back at base with OCA staff and discussed my ideas for projects, particularly related to digital training. Rachel the Head of Programmes told me that they were willing to donate a tablet device to each post (which were previously used by volunteer doctors on mobile clinics), provided they would be used appropriately for healthcare delivery. I began digitising records I had photographed from Kanyanga and Chalimongela of stocktakes of medications and supplies, and summaries of patient consultations. I found there to be quite severe inventory shortages in both facilities. The records also revealed that in many cases patients were being prescribed incorrect treatments, likely related to both chronic stockouts and lack of training of staff. I began researching digital options to keep track of stock and discovered an excellent free inventory app called Sortly. I downloaded it to the tablets and began planning how we could use it at the facilities. I also created a poster which summarised the Zambian Standard Treatment Guidelines, in the hope that it would improve prescribing compliance. I started designing a register on Excel for patients with chronic diseases and downloaded some free validated mental health screening questionnaires which could be of use at the health posts. During the long Easter weekend I visited Chobe National Park with a few friends, just across the border into Northern Botswana, for an unforgettable day of safari – elephants, lions, hippos, crocs, warthogs, giraffes and more!
WEEK 5: Zimba & Kanyanga
On Tuesday I travelled to the District Health Office (DHO) in Zimba for a meeting with the pharmacist and lab technician about my plans for digital stock management. They liked the idea and agreed that more consistent reporting could improve supply to the health posts, within the limitations of national and district shortages. The Sortly app also has the advantage that when the tablet gets network, it syncs so that the DHO and OCA can get up to date information on stock levels and consumption rates. The next day I headed down early to Kanyanga with Victor in the Land Cruiser for my second visit. I participated in the under-5s clinic and helped with newborn baby checks which was really enjoyable as paediatrics is what I specialise in at home. I gave the health post staff my Standard Treatment Guidelines poster and mental health screening questionnaires which they appreciated.
During the clinic an adult lady presented with severe abdominal pain, and history of seizure that morning according to her husband. It was another reminder of the stark differences in healthcare available here compared to what I would be used to, as of course we had no access to imaging or even blood tests. She got IV antibiotics, paracetamol and would be observed, with transfer to Zimba hospital (> 100km away with no reliable form of transport) if she deteriorated.
In response to a new case of polio found in Malawi in March 2022, the Zambian Ministry of Health set out to immunize all under-5s nationwide with a booster dose of the oral polio vaccine (OPV) in a supplementary immunization activity (SIA) campaign. The first round was to take place the following week, so the day I arrived to Kanyanga I had the opportunity to attend a training session in Simwatachela for representatives from the 11 facilities in Zimba District. This was a fascinating event, where the facilitators explained the logistics and planning for carrying out the ambitious campaign, in which the aim was to vaccinate all under-5s in the country across just four days. We also collected all the required vaccines and equipment to bring back to Kanyanga the following week.
On Thursday we spent all day at outreach clinics in two zones (N’kungwa and Safari), where we did nutritional assessment and growth monitoring of children, health education to adolescents about sexual health and family planning, COVID vaccinations and routine under-5 immunizations. One teenage girl had quite had a painful traumatic left foot injury following a fall; we brought her back to Kanyanga, wrapped the foot, applied ice, and gave pain relief. Clinical officer Christone told me he is planning a sexual and reproductive health campaign for adolescents next month, and I said I would research some educational resources for him to use.
I showed all the staff the tablet and Sortly app and chronic disease register during the visit and explained my idea for digitizing records to improve clinic performance and drug supply. They were in support of the ideas, and we all agreed that sufficient training and ongoing monitoring would be essential to ensure the new technology is used effectively. We returned to Livingstone on Friday, bringing the injured teenage girl to Zimba Hospital Emergency Department en route. The lady with abdominal pain and seizure had stabilised and didn’t require hospital transfer.
Week 6: Mukuni & Livingstone
Kazungula District requested from OCA if they could borrow one of our vehicles for the polio vaccinations, so Victor and I travelled to Mukuni on Monday morning for the campaign launch. The ceremony involved a march through the town, the Zambian national anthem, prayers, a poem about polio, dancers, drummers and many speeches. It was a fantastic event and clearly showed the passion the community has for preventing the return of this deadly illness. The organisers thanked us for providing transport, which would be of enormous help for accessing hard-to-reach areas in the district. I gave a brief speech to the crowd on behalf of OCA, highlighting the work we do and expressing our enthusiasm for helping with this important project. After the ceremony concluded, I assisted with oral polio vaccines at Mukuni Health Centre for the afternoon.
On Day 2, we arrived in Mukuni and picked up our team members. Our team would be travelling in the Cruiser to the more remote villages in the region. Machenje, Sirichobe and Ng’andu communities to vaccinate the under-5s. At our first stop of Machenje, it was clear that the social mobilizers had done an excellent job over the preceding days, as 113 children were brought to the meeting point to receive their polio vaccines over one hour – a brilliant start to the day. We vaccinated all of them, marked each child’s thumb and made records in the tally sheets. We then travelled to various houses where there were more eligible children and vaccinated them. Next stops were Sirichobe, where we assembled at the meeting point, and our mobilizer ventured into the community to inform families of our arrival, and Ng’andu where we were able to vaccinate under-5s as they were brought away from a community member’s funeral. Throughout our journey back, we came across 10 mothers with under-5s and opportunistically vaccinated these children. This brought our team’s total for the day to 230 vaccinations, comfortably exceeding the daily target of 100. We dropped the staff back to the health centre, where they would return the vaccines to the freezer, and finalise and report the tally sheets to the DHO. It was a super experience for me to be part of such an exciting and impactful health intervention and I was very grateful for the opportunity.
The remainder of that week I spent in Livingstone, working on creating training manuals and videos for Sortly and Excel, which I would use to train the staff on the new tablet devices. Lizzy (public health volunteer) sent me a selection of sexual and reproductive health resources, which I then forwarded to Christone to see which he would find useful for the educational campaign. I spent some time writing reports and working on a presentation on my activities so far on the placement.
That weekend I went to one of the local churches, where Mike (our driver and logistician) plays electric guitar in the band. The church ceremony was awesome, with loads of passionate signing, music and dancing, and way more energy than what I would have ever seen in Ireland!
WEEK 7: Livingstone & (almost) Chalimongela
Monday was a public holiday so a few of us took the plunge and bungee jumped off the Victoria Falls bridge, an experience of a lifetime that I highly recommend to anyone who gets the chance! On Tuesday I completed the tablet training resources and sent them via WhatsApp to the health post staff and the district pharmacist. We also had our monthly community health meeting, which was an opportunity for me to present to the wider OCA team what I had been working on and my objectives for the remainder of the placement.
The plan was to spend the rest of the week in Chalimongela, with the priority of training staff with the tablets, and enquiring about Child Health Week (which will be held in June 2022) and how I could help with that campaign. Mike and I set off at lunchtime and made it 4.5 hours into the 6-hour trip and deep into the bush when the Cruiser broke down. It became impossible to engage the gears and Mike reasoned that the clutch plate had gone. So we walked to the nearest village, got phone network and called our colleagues back in Livingstone to ask for help in bailing us out of the predicament. They very kindly arranged a tow truck and spent the night travelling out to meet us, helping us to attach the vehicle to the truck, and then driving all the way back. We initially broke down at 16:30, they arrived at 02:00 and we made it back to camp at around 10:00. Chansa, one of the lads who rescued us, then had to attend a job interview at 11:30. Travelling all night in the tow truck with the Cruiser behind us, over the unpaved and crazy pothole-filled roads was one of the bleaker journeys I’ve experienced, but certainly one I’ll remember for a long time! Thursday I pretty much slept all day after the ordeal of the previous 24 hours and then Friday had meetings in the office and finished up work on some projects before the weekend. Mike and Victor brought the vehicle to the garage where hopefully it has a speedy recovery.
Next week is my mid-placement week off. My parents will be visiting Zambia from Ireland and I’m looking forward to showing them around this beautiful place I’ve called home for the past 7 weeks.