Categories
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 I have some in stock, but it is out of date and waiting to be disposed of. If the situation arises where I judge it to be life threatening, I will use the out of date medication and face any consequences. But we must not have any out of date stock on the shelves at the health centre.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. 

Categories
Medical Zambia

First day at the Clinic

Kakumbi Rural Health Centre

Baboons. Need I say more? At least a hundred of the little blighters, making mischief. But animals have priority on the roads, so I waited until they had crossed.

The road was badly cut up by trucks driving through the muddy sand. There were lots of pools on the track, but the deepest had been partially filled in with old bricks to provide a better grip for the tyres. The big dirt road had several streams running across it, creating gorges which needed careful negotiation. As I reached the tarmac road, a lorry came into view. The passengers in the back were waving frantically at me. I didn’t realise I was so popular, I thought, until I turned the corner and saw a large bull elephant ripping tasty branches from a roadside tree. So they were trying to warn me.

Good morning and welcome to South Luangwa!

Normally when you see one elephant, you can be sure that there are others nearby. But lone bulls do venture off on their own, so I wasn’t too alarmed. I drove slowly towards him but couldn’t resist a few photographs. Just to prove the veracity of the story, of course.

Further along the road, I saw bushbuck and puku antelopes, as well as another mob of baboons. The village hasn’t changed much. A few new shops here and there, more potholes in the road to the bridge and a new restaurant, which I will have to visit soon.

More churches have been built beside the back road to the clinic. The Obama Bar has closed during the day and its courtyard is a haven for grazing goats. But at night it remains highly active. The clinic road is worse and I passed the rear of a sign saying, “Road Closed Turn Right.” The clinic has a new HIV/AIDS block in shimmering white, built by US aid (PEPFAR). The clinic now deals with 875 patients living with HIV without the fortnightly visits from the district hospital.

New block built with US Aid money for HIV/AIDS support
Maternity Block, now usable as it has an electricity supply
First delivery of my tenure – I had nothing to do with this!
Incinerator and drug pit

The maternity block has finally got an electrical connection so it can function as intended. The consultation rooms look cleaner, water flows from the taps and there is soap. The only towel is the one I donated in 2014, which looked rather grubby. I wiped my hands on the seat of my trousers.

Erina starts the fire with plastic and wood to heat the steriliser

The staff who knew me were delighted to see me again. The new health workers welcomed me back and we chatted about the good old days. “But the drug situation is worse now. We have less medication now than we had when you were last here, doc.”

The clinic water supply tower
The patients’ toilets, with the incinerator in the background

People in the Ministry of Health must be worried about the increase in malaria cases in this district. We are adopting a proactive strategy of testing and treating anyone who lives near all new patients found to be suffering from malaria. Unfortunately, heavy rain has made it almost impossible to get to remote areas to carry this out. It will be an interesting experiment.

The clinic now runs two community clinics a week, in which I will participate, as well as a schools inspection and health education
programmes (sexual health is on the agenda again).

It feels great to be back.