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Medical Zambia

Community Child Clinics

I help the health centre staff with two community clinics each week. These are extremely popular with the mothers who bring their children under the age of five years to be weighed and vaccinated. We are so busy that there is no time to deal with clinical problems, so we arrange for the children to attend the health centre where we can do a proper examination and perform tests.

This morning, we weighed 172 children. About 10% of the children were underweight, but 20% were already obese. The health educator gives advice to the mothers of both these groups, but I don’t think his heart was in it when talking to mums with fat babies as this is seen as an obvious sign of good health. We must have vaccinated over 50 children. Our data is very impressive, much better than children in the UK.

Being weighed
Fast asleep

Most children had “Road to Health” cards which set out their vaccination schedule, a graph of their weights, special blood tests, a record of de-worming and vitamin A supplementation, feeding method (99% breastfed only for the first six months) etc. Sadly, the clinic has run out of cards but an enterprising pharmacy has photocopied a blank card and sells the copies to the mothers for a small fee. Some older children have lost their cards, but if they bring a school exercise book, we can fill in the details from the clinic register. Today, I saw that one child’s exercise book/health record was looking a bit thin and asked what had happened. It transpired that his father often tore out a sheet when he wanted to make roll-up cigarettes.

The mothers queue up to have their babies weighed. One of the community volunteers hangs a basic scale from the lower branches of a shady tree. We use a bag with long handles to weigh the infants. Their legs fit through two holes in the bag and they are suspended from a hook on the scale. The volunteer records the weight and passes the child on to the public health officer for review of the weight and to see if any vaccines are due.

Suspicious

Many of the mothers are very competitive about their child’s health and weight. They are really keen to know the precise weight so they can boast to other mothers. It reflects well on them as excellent parents. When the child’s weight has stalled or failed to gain, they might ask for a second opinion about the value on the scale, especially when a short volunteer is looking up to read it (parallax).

Like mothers everywhere, they like to dress their children in their best clothes to see the health workers. The colours are gloriously outrageous, pink and orange being a favourite combination. Forget the colour wheel, these children are dressed to impress. I especially enjoyed a yellow knitted jump suit with matching cap.

Yellow knitted outfit

 The mothers and children sit in the shade on a mat while they wait their turn. I told the team about a video on the internet where a doctor plays with a baby, singing a song, touching them with the shielded needle until they are distracted and don’t notice the jab. Unfortunately, the children all know what is coming by the look on their faces. Of course, if the first child screams, all the others will too. Some mothers are genuinely concerned when their babies cry in pain, even though they know it is effective prevention against disease. Other mothers think it is funny and laugh. Perhaps that is their way of minimising it.

Fancy having to dress like your sister! Mum must have bought a job lot of material

The immunisation schedule is very similar to the UK, with pentavaccine, inactivated polio, pneumococcal and rotavirus vaccine, which comes in an oral form. Thankfully, it tastes sweet so it may lessen the pain of the jabs. Of course after getting needled in both thighs, most babies are crying so one has to be careful that they don’t choke on the rotavirus. Cunningly, we slip the liquid down the inside of the cheek, so it is easier to swallow between sobs.

And it wouldn’t work without help from our community volunteers

The babies often have biblical names, such as Enoch, Esau or Jehosaphat. Two names stood out for me – Wisdom and Miracle. When I asked Miracle’s mum why she had chosen that name, I was hoping that she would come up with a good story, but she said that she didn’t know what it meant. One of the local chemists is called Honest; his mother wanted to call him Earnest, but it was lost in translation when his birth was registered.