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Medical Zambia

Health Centre Meeting

I arrived first to the meeting room at 6:59am for the 7am weekly Monday meeting. I would have been earlier but the police had barricaded off the muddy track to the clinic and I had to make a detour. Three male health workers turned up in the next few minutes and we began with a prayer at 7:10 when no one else had joined us. At least this time, we did not pray for God to speed the missing nurses to the meeting.

The nurse in charge of outpatients said that he had been seeing many babies with pneumonia. The National Immunisation Programme includes polyvalent pneumococcal vaccine which is given at 2, 3 and 4 months, but babies were getting sick before they had completed the course. The only intravenous antibiotic we have is benzyl penicillin. In other settings, intravenous gentamicin and ampicillin would have provided better treatment.

He also complained that we had no asthma drugs at all, not even salbutamol tablets. He asked if I could help out with salbutamol nebuliser solution. I have some in stock, but it is out of date and waiting to be disposed of. If the situation arises where I judge it to be life threatening, I will use the out of date medication and face any consequences. But we must not have any out of date stock on the shelves at the health centre.

No one turned up to clear the weeds and rubbish from around the health centre last weekend. Not even the health inspector who suggested that we should do it. One volunteer buttonholed me saying that he had done my share of the work and wanted reimbursement. I told him that I was a volunteer, too.

Another volunteer managed to persuade a health worker to lend him the Health Centre motorbike over the weekend for a “family emergency”. He was caught at a police road block and the bike keys were confiscated. The District Health Officer will decide on his punishment.

On the subject of police road blocks (revenue raising activity), I was stopped today because my vehicle was muddy. The policeman asked me why I didn’t clean it. I told him that the road to my house was atrocious and the car would be splattered with mud again as soon as I drove to work. He grunted and accepted this.

The nurse in charge told us to be on the lookout for unhealthy activity around the health centre. Last week he had come across a young mother who was bathing her newborn baby in brown water which looked like it had been collected from a nearby pond. The water was cold and the newborn was shivering. Most young mothers are accompanied by their own mothers or an auntie, who teach them how to look after their new baby. This new mother had no support, unfortunately.

Melvin and Elvis, twin boys less than a week old

On a brighter note, a mother gave birth to twin boys last week, Melvin and Elvis. They are doing very well. However, another set of twins (boy and girl) have not gained any weight since being born six weeks ago. They have both been admitted with pneumonia. The girl was just 1.4kg but instead of making sure she got the first feed, her mother was favouring the boy who was 1.8kg. I told her that girls were just as valuable as boys, that I had three girls myself and she agreed to pay more attention to her daughter.

Zambian health workers are able to deal with cognitive dissonance remarkably well. There is a course to train nurses how to perform medical terminations, when abortion is still illegal under the constitution. Every patient is encouraged to have an HIV test to know their status, but because this approach has a low pickup rate and is expensive, we are being castigated. Instead, we have been told to target those people who are most at risk, even if this is against national policy. We heavily promote condoms to the young while at the same time preach abstinence before marriage. Perhaps if you don’t think about it too hard, you can cope with conflicting policy and advice.

I had been hoping to provide antipsychotic drugs for the dozen or so people with severe enduring mental illness in the area. Unfortunately, the District Medical Officer told me that the psychiatric ward at the provincial hospital were so short of medication that they could not spare any. I was told that there are (at the time of writing) no antipsychotics in the public health system in Zambia. Basic drugs like haloperidol cost just 10 cents a tablet. I have been out with my begging bowl and thanks to an NGO (you know who you are, Karen) we now have enough drugs to treat the most disturbed patients for the next three months. It is not helpful to say that such a situation is intolerable without doing something about it. Seriously unwell patients are forced to tolerate the toxic effects of continued psychosis which will have a permanent, detrimental effect on their future lives. If they have a future. 

By Dr Alfred Prunesquallor

Maverick doctor with 40 years experience, I reduced my NHS commitment in 2013. I am now enjoying being free lance, working where I am needed overseas. Now I am working in the UK helping with the current coronavirus pandemic.

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