Birthday Wishes from Mongu!

Hello everyone! Nikki here, and I just wanted to share some fond experiences I had over the past few days. My birthday happened during my time here, and it was certainly a birthday I will never forget. The celebrations began a few days before on Saturday night, when a few of the girls and I headed down to Mongu's Harbour to catch the sunset over the beautiful flood plains. The views were absolutely breathtaking, and it gave me the same goosebumps like when I drive through Canada's Rocky Mountains. Later that night we all made our way to a local nightclub and we absolutely danced our hearts out! It was interesting to observe how the locals danced compared to us, and I think it is safe to say they know how to shake it on the dance floor! We all tried to get some lessons on how to drop it low like them, and was probably the hardest workout I've done during this trip. Needless to say we all had a lot of fun, and my gluteus maximus was quite sore the next day.
On my actual birthday it was filled with many surprises. I woke up to my bathroom mirror covered with decorations and our living room had a sweet birthday banner and balloons. Alana spoiled me with making banana pancakes in the morning which left my belly and heart very full. The good vibes continued when I went to the Save A Life clinic where I had the opportunity to observe the feeding clinic and got to play and cuddle with some babies. The staff and mothers were very inviting and became even more friendly when they found out it was my birthday. They sang and danced a birthday song for me and shared that they take birthday celebrations very seriously. I noticed this same notion continued during my time spent with the Lewanika nursing students when we travelled back to Mongu's harbour. Everyone wished me a happy birthday, and we had a lovely day driving through the bridges along the flood plains and had a chance to explore the sights along the mighty Zambezi river. Apparently the Zambezi is home to Nile crocodiles, which happens to be the second largest crocodiles in the world! I really wanted to see some crocs, but I guess I should count my lucky stars that we didn't come face to face with these creatures.
My birthday wishes came true when we went to the Giraffe restaurant for a shawarma wrap and a chicken mushroom pizza. I have had my fair share of shawarmas back home, but never have I experienced one so rich an delicious like the ones here. Despite fulfilling my shawarma needs and all of the great events of the day, I have to admit I was feeling a little blue once we got home from dinner. I don't know if it was finally catching up to me that I halfway across the world away from my family and friends, or there was a lack of cake, but I was feeling a little down. I had found some peace and quiet in the courtyard to make some FaceTime calls, when Kristen came out to say that our house manager requested we clear the courtyard for an event. I looked around me and noticed no one in the yard and in a bit of a huff I retreated to my bedroom to continue the call. Within 5 minutes of getting comfortable in bed, Alana came into my room saying that our teachers wanted to talk to us immediately regarding our Save A Life placements. My heart began to race and my hands began to sweat as I began to replay the events of the day to try to think about what I could of done wrong. I turned the corner and came out of the kitchen and saw everyone underneath the gazebo with two birthday cakes. It was the first surprise party I had ever had, and oh boy was I ever surprised. Apparently it was a bit of a fiasco with the cakes as Emma, Alana and Rylee tried to organize one big birthday cake with writing on it and left Fay in charge with picking up the cake. Poor Fay eventually figured out that the cake was never done and thus had to settle with two smaller cakes. All in all everyone got a piece, and I was so grateful to have all of these women in my life. Even though it was different being a world away from my life at home, I am very appreciative to have gained such incredible women that made my whole world on that day; and that takes the cake!

-Nikki

Ilukui

Hello everyone, Ali here!  This past week I got the opportunity to work in the labour and delivery department.  Although I have learned and studied the theory behind labour and delivery, I have had only one day of practical experience before this week.  During my one day of practical experience in Canada, I saw one c-section and no vaginal births so the morning before my first Zambian shift, I was eager to help with as many births as possible.  Altogether, I saw one c-section (or "Ceasar" as the Zambians call it) and twelve vaginal births - a very busy and exciting week!

I found it interesting that although the biology of pregnancy and the birthing process is the same, the social factors vary widely between Canada and Zambia.  For instance, mothers in Zambia are entitled to only one ultrasound during their pregnancy, prenatal care is not readily available to most mothers, and no visitors are allowed on the ward.  Another obvious difference between the Canadian system and the Zambian is that in Zambia, mothers must provide all of their own supplies (bed sheets, food, water, cleaning supplies).  It made me wonder that if a mother does not have any of her own supplies, she may choose to give birth at home instead of being embarrassed in the hospital.    It was evident through my practice that the combination of these social factors play a huge role in infant and maternal health outcomes when any sort of abnormalities occur during pregnancy.

Although each birth was exciting, two births really stood out to me during the week.  The first was a mother who was pregnant with twins.  One twin was a spontaneous vaginal delivery with no complications while the other did not seem ready or able to come out.  After some tme waiting for the second twin, it was determined this mother would need a C-setion.  Ideally, this mother would have had a C-section soon after determining that one was needed, but instead we had to wait three hours before an operating room was ready.  The operating room was ill-equipped with only one anesthetist for two simultaneous surgeries and a very limited supply of blood and IV fluids.  The combination of unfortunate factors led to poor health outcomes for both the mother and the baby.  During the surgery, the mother's blood pressure dropped so low that she began losing consciousness and needed a blood transfusion.  Although there was very little available blood, the healthcare workers were resourceful and used hydrocolloid solution as a fluid expander which was able to raise her blood pressure a little. The mother left the surgery alive but with a very low level of consciousness.   The baby was not as lucky and came out with a very hard time breathing which led to its passing.  I was surprised to see a lack of urgency in the resuscitation efforts with the baby, but with further reflection, I am thinking that this lack of urgency has a strong correlation with the lack of resources available.  It felt to me that even if this baby was able to be intubated, there would be subsequent breathing issues with this child and I wonder if there would even be resources to deal with these subsequent problems.

The second birth that really stood out to me was a vaginal delivery.  The mother who spoke fluent english and loved to chat.  It was easy to build a good rapport with her and feel connected.  When it came time for her birth, I was amazed how little she complained about pain even without any pain medications.  After the delivery of her healthy baby boy and when Alana, the other student, and I had some down time, we went back to check in on the mother and baby.  When we asked what the baby's name was, the mother told us she wanted us to name him!  It felt like such an honour and compliment.  Alana and I chose a traditional Lozi name, Ilukui which means fierce one in English.  We thought that was a very fitting name because even with no prenatal care, this baby came out healthy and kicking!

I am excited to see what my last week holds,
Ali

The Face of HIV in Zambia

BLOG POST #2

This week I had the opportunity to work for a few days in the ART clinic (Antiretroviral Therapy Clinic) with the multifaceted team there and individuals with HIV. Before departing on this journey to Zambia I thought I was aware of what it meant when we were told that Zambia's HIV rates are endemic. I don't think that until I was actually staring HIV in the face and experiencing a piece of the reality of HIV in Zambia that I was able to really understand what this meant for Zambians and our journey here.
For some context, at the end of 2014, Canada had approx. 75,000 individuals living with HIV and at the end of 2016 Zambian is reported to have 980,000 individuals living with HIV (ZAMPHIA, 2016). Canadian prevalence of HIV is approx. 1 in every 500 or 0.22% of Canada's population and the Zambian prevalence is approx. 1 in every 8 people or 12.5% of Zambia's population (ZAMPHIA, 2016; Government of Canada, 2014). Of the Canadians with HIV 76.8% are males, whereas in Zambia approx. 58% of people with HIV are women (Avert, 2017; Government of Canada, 2014). In Canada, HIV infections are driven primarily by MSM (men having sex with men) and in Zambia the endemic rates are driven by unprotected heterosexual sex. These numbers can be disheartening in either county so it is important to point out that UNAIDS is working towards an ambitious but achievable goal they have termed the 90-90-90 initiative (UNAIDS, 2014). By 2020, the aim is to have "90% of all people living with HIV know their HIV status, 90% of all people with diagnosed HIV receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy to have viral suppression" (UNAIDS, 2014). This is a goal that is applied to the entire world population and is an aggressive and much needed guide to decrease these statistics and improve the lives of people living with HIV regardless of if we are in Zambia or Canada.
The picture of HIV could not differ more between these two countries, but the goals are all the same; increase life expectancy and improve quality of life. Another similarity is the stigma that surrounds an HIV diagnosis. Steph, another nursing student in ART with me this week, and I were able to go with a nurse in a counsellor role to the wards to do HIV testing. We completed rapid HIV tests on all the individuals in the wards who had never been tested as part of an initiative of the Zambian government to increase the amount of people who know their HIV status; part of the 90-90-90 initiative. We tested 16 patients that morning and of those 16 we gave out 2 HIV positive diagnoses. That not only hits the prevalence rate of 1 in 8 right on the head but experiencing these positive diagnoses highlighted that there is undoubtedly a crippling stigma here in Zambia. I have never had an HIV positive patient in my practice as a nursing student and certainly have not been a part of the counselling of a patient with this new diagnosis. There is stigma in Canada surrounding HIV as well, but largely for different reasons than what we see here in Zambia.
One of the patients we tested was a women in her 40's and the look in her eyes while we were testing and while we were counselling her on her positive diagnosis seemed to tell the entire story of HIV in Zambia. Her eyes were full of fear, confusion, sadness, and so was I! I found myself suddenly very out of my comfort zone and running through my head the transmission of HIV. This moment for me was when I realized that there is still a part of me that associates HIV with a death sentence and lost hope. You could see that there was a part of her that thought this too. I was sitting next to her as the nurse was getting ready to discharge her home, she turned to me and asked with sad eyes if she was going to be okay. All I could muster up was to look straight back at her, put a hand on her shoulder and tell her that she was absolutely going to be okay. I told her that she will go on medication for the rest of her life but that this doesn't mean that the rest of her life has to stop. That was what I needed to hear too. I think once I had time to digest and think about what this day meant, I was able to understand why I still felt this fear. This is not a thing that happens in Canada. A married woman in her 40's who lives a very normal and non risky lifestyle should not get HIV; she should not even be at risk of getting HIV. But here she was, another human being whose life was realistically changed that morning and a statistic in an uphill battle being bravely fought.
Knowing that the Zambian prevalence of HIV is higher in females I couldn't help but be curious of how she could have contracted HIV (ZAMPHIA, 2016). When we consider social determinants of health and their relationship to infection and specifically HIV, we really need to consider the majority of the determinants. Get ready for a list of rhetorical questions. In my opinion the determinants that underline vulnerability jump to the surface. Was this women vulnerable? Was she educated? Did she have access to employment? Has she been a victim of sexual abuse? What does she do to put food on the table? Is her partner faithful? Does she feel safe? Will she be able to have consistent access to antiretroviral therapy? How long has she had HIV for and not known it? Could her partner have it? What about her kids? What does this mean for them as a family? As community members? There are so many questions and while many of them have answers almost every answer will lead you to more questions and considerations. But for now, all that seemed to matter was that she understands that her life will go on and if she adheres to ART, then the rest of her life will be almost just how she pictured it.
A few fellow students had the opportunity to teach sexual education to a group of secondary school girls this past week (make sure you check out their blog!) and the response to and success of their teaching session gave me so much hope for the future of women in Zambia. As I mentioned previously, most cases of HIV in Zambia are due to unprotected heterosexual sex, with more women contracting HIV than men. There is an oppressive notion here of women not being able to say no to sex without a condom or no to sex at all. When considering all of the questions that were racing through my head I kept coming back to how important it is to empower the young women in this country, and honestly everywhere else in the world to be their own champions. A young women who is empowered to say no when she needs to or to stand up for herself and her health is a women who will create change and a healthier and more positive world for everyone in it.
My experiences with HIV in Zambia have given me hope. Hope was not the feeling I was initially expecting but I am so glad that it is the feeling I have now. Seeing the resilience and endurance in the people living with HIV at the ART clinic was reassuring that HIV in Zambia can be fought and is certainly being fought valiantly.




https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/zambia
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-proportion-undiagnosed-canada-2014.html#a3
http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf
ZAMPHIA (2016). Summary sheet: preliminary findings. Zambia population-based HIV impact assessment. 

An Insider's View

I spent this week at the Save A Life Center, a non-governmental organization ran by The Zambia Project. This Center focuses on malnourished children. Parents/guardians come once a week to pick up food for their child in order to facilitate a full recovery from malnutrition. The children are also weighed and their progress is closely monitored. Parents/guardians are also supported and taught how to successfully run a business and make earnings to ensure that they solve the root problem as to why the child was malnourished from the beginning. Aside from this, they also send team members out to the child's home to asses their living environment and ensure the food is being used appropriately. They also provide homes for orphaned children with 8 children to one mother and aunt. In addition, they run a school with 500 children attending! And last but not least, they have a clinic used for regular checkups of the children and walk in appointments.

I was very grateful to be able to spend some time in such a wonderful center and be a part of something life changing. As much as I enjoyed my time at the hospital, it was a good break and felt more like home (well maybe just a little). I spent my first day going on home visits to check up on the children in the program. Seeing the insides of these homes was an experience like no other. Most families live in small huts made of straw with a tin roof. The insides were tight but often had a mattress to sleep on, couches or chairs and one even had a tv and a deep freeze. A large part of the home visits was making sure these spaces were clean and safe for a child. Most of these homes were, and the children appeared to doing well. Although I noticed a lot of broken glass in the sand and can't imagine how many children cut their feet as many of them do no have shoes. On a separate note, I have to commend these workers that walk through the deep sand in direct sunlight daily, navigating the town without any street names or signs.

After this, most of my time was spent in the clinic as I lucked out because I happened to be there the week that they were doing checkups with all 500 school children. I was lucky enough to be paired with one of the two amazing doctors on site and assessed the children's ears for blockages and perforations, their heads for ringworm (a whole lot more common than I had imagined) and doing HIV tests on new students, including the baby class (kindergarten). I found out pretty quickly that our scope of practice is a little different here as the doctors had us assessing and prescribing treatments for these children fairly independently. Aside from the school house checkups, we did assess some walk in patients and I was always paired with a doctor for this. I was so amazed to see how the doctor was able to diagnose a patient based off of Q&A alone. I was especially amazed to see a patient come in complaining of heart palpitations leave being sent to the hospital to confirm a diagnosis of an ectopic pregnancy. These doctors work with so little and are able to do so much. It really made me realize how much we rely on diagnostics in Canada and made me wonder how many Canadian healthcare workers would be able to do what I was witnessing these doctors do daily.

Although I am sad to leave The Save A Life Center, I am excited for my next placement in the labour and delivery ward at LGH, wish me luck!

-Kristen Monz

http://zam.co.za/projects/save-a-life-centre/

Hope Art

A Hallway Highlighting The Children's Recoveries

In a Little Town in Western Province

In a little town in Western Province
Far from the home we know
I looked behind not once
To find a country aglow
From the humble mud huts
To the storming and flashing sky
To the long roads with many ruts
And the people walking by
Every soul here trusts
That life might go awry
And if it does, they carry on
In a way that takes great strength
We might notice a lot is gone
But to them, they may not know the lengths
That we take back home, where our
Resources they would treasure here
While we complain what we've got
To anyone that will lend an ear
Here the gloves are sparse and the staff is worn thin
They had to cancel a day of surgeries because there was no IV fluid in
Here we come with our equipment clean
The money, supplies, and white skin
And struggle to find an in between
From what we know and understand in
This place where our learning
Is turned upside down
Our 'help' is only temporary
But hope can be found
In the local nurses and doctors who work with the sick an ill
Day in and day out, in conditions that might put them in peril
Yet there they stay, as if duty demands it
Because when we leave, they are the ones who commit
In a week we pack our bags and go home to our washing machines
This little town in Western Province will go on as it did before
Save for our hopeful, lasting impact
An invisible footprint of where we have been

-Brishen

Knowledge is Power!

This week we (Alexa, Carolyn, Katie, Kristen Merkley, and Avneet) had the opportunity to teach teenage girls at the Limulunga Day Secondary School about sexual health and hygiene. Finding out the afternoon before we were going to teach this topic, we scrambled to get our materials together. Luckily Kristen and Alexa had already created some posters on sexual health as part of a previous school project. Thank goodness!

 To add to our challenge of producing a presentation on such short notice, we did not know the students baseline knowledge. With Katie as our amazing group leader, Kristen and Alexa, as the Days for girls guru's, and Carolyn and Avneet as teaching assistants, it was a group effort to get this lesson plan together . Kristen and Alexa collaborated with the Okanagan Days for Girls chapter to make kits for women and girls to manage their mestruation. These kits contain washable pads, underwear, washcloths, and soap, to help women manage their menstruation. After applying hard work to preparing the kits for this practicum, we were excited to hand them out.


Upon arrival at the school, we made sure to ask the headmasters permission to teach about female anatomy, puberty, hygiene, menstruation, contraception, and consent. We eagerly entered the school hall, posters of uteruses in hand...what a sight.

We set up our teaching plan by introducing ourselves to the room.  The ages range of these young women from 13-18. We stressed that this was a safe environment in which the girls could ask questions freely. After our brief introductions we broke off into 5 small groups.  Each group had about 10 girls where we taught our topics in 5-7 minute intervals. We were impressed by how respectful and attentive they were during our lectures. What a spirited group of individuals.

In our contraception teaching we stressed that abstinence is the MOST EFFECTIVE way to prevent pregnancy and STI transmission. However, if they choose to be intimate with a partner, we explained other methods of contraception and ways to further PROTECT themselves, affirming that their health and safety is priority.

During our time here we have been informend of common myths/beliefs, which we believe place Zambian women at risk. These include:

-Having sex with a virgin will cure HIV
-Women are not able to say no to sex
-Access to birth control recieves little support

Unfortunately child marriage, HIV, and gender based violence is common in Zambia. Many young girls become pregnant and as result drop out of school to care for their children. Some might have the added burden of managing a lifelong illness such as HIV. With this in mind, our goal was to provide them with knowledge and empower to make informed choices. KNOWLEDGE IS POWER!

To conclude our presentation, we came together as a group for an anonymous question and answer session. We received a question on a slip of paper from almost every student. As we read out their questions, we began collecting a better understanding of their knowledge base. The anonymous questions recieved varied widely.

Common questions included:

-Can condoms cause cancer?
-What are the side effects of condoms?
-Is it better to use 2 condoms instead of 1?
-How is HIV spread?
-How would I know that I am pregnant?
-Can I get pregnant while menstruating?
-How would I know I have HIV?
-Why is one breast bigger than the other?

Our question period was incomplete when we had reached our time limit. Thankfully, we were able to continue and finish with the support of their teacher. Her flexibility made us feel liberated as we believe knowledge is power.  Lastly, we handed out the Days for Girls kits. It was very rewarding to see their excited faces as they each recieved a kit. The session ended with us all chanting our take-home messages:

We are women!

We are strong!

It's okay to say no!

And [protect yourselves]!


This moment gave us all chills, as the room thundered in unison with the young Zambian students chanting about their strength as women.

Katie shared a video of this moment on Facebook (with permission from the students) which has received an abundance of attention. THANK YOU for your continued love and support from both Canada and Zambia. For some of us, having the opportunity to empower these women was a major highlight of our nursing careers.

We are women and we are strong.

-Katie, Alexa, Aveneet, Carolyn, and Kristen Merkely

It's the little things

Hello everyone! Since my last blog I have continued to explore Mongu, have become a better cook, stopped screaming at the sight of spiders, but have unfortunately found a new fear for lizards! Over the past couple of weeks I have adjusted well to Mongu and am enjoying my time here.  It's hard to believe our trip is half over!

This week I was placed in the Sefula clinic with Erin. Sefula is about a 35 minute drive from the compound we are staying at. Although this may not seem like a far drive many of the locals walk up to 40km to get here. Walking this distance in the heat might sound hard, but on top of that many of the locals that come to this clinic are very sick or have to carry babies on their back to get here. I had the pleasure of working with a lovely nurse named Precious. She was very experienced, caring, and passionate about her work. I was able to work along side her in the outpatient department (similar to an emergency department back home), do malaria testing, and participate in a family planning clinic where we gave depo shots. I learned that many women hide these shots from their partners as birth control is frowned upon in many places in Zambia. However, I was happy to hear that birth control is free throughout Zambia.

One thing that stuck out to me the most this week was how grateful everyone was over what seemed to be small things to me. Last week some of the other girls and I played soccer with some of the children on our street. They were so welcoming and eager to play and take pictures with us! Many of them posed and were laughing as we showed them their pictures. We take photos so often with our smart phones or cameras that we don't realize how fortunate we are to be able to do this. Many of us have photo albums or cameras that we are able to flip through and see the hundreds of photos of ourselves or loved ones. Many people here in Africa are unable to do this. Another eye opening moment I've been having is when we go to restaurants. Whenever we eat out we usually leave a small tip and the servers often looked shocked when we do this and say we paid them too much. It's refreshing seeing their smiles when we let them know the extra money is a tip for them because they did a good job. Having worked in the restaurant industry for the last four years I know I have expected tips before, but it's been a nice change seeing how grateful people are here. I think this is something we can all take home with us. Africa continues to blow my mind and most importantly reminds me how to appreciate the little things!

Thank you for reading and I hope everyone is doing well back home!
Kristal

A day at the market

World TB Day at The Sefula Clinic

A week in the theatre

Hello friends and family, Steph and Cierra here!

It's hard to believe another week is coming to an end and that we are more than halfway through our Zambian adventure. For us, this week was spent mostly in the OR, which is referred to here as the theatre. This is an area of particular interest for Steph, so we were looking forward to the learning that this experience would bring. 

The theatre turned out to be just as interesting as we had anticipated. We were amazed by the variety of surgeries we were able to see, from general to orthopaedic to gynaecological. We also noticed that the surgeons were from several different countries. Although there are probably language barriers and variances in techniques and approaches, the staff seemed to work very well together. It is inspiring to see people from all different backgrounds coming together for the common purpose of providing the best possible medical care with the resources available.

Another area that we were interested in seeing was the post anesthetic recovery room as we had heard that our fellow UBCO nursing colleagues from last year had helped to organize and create educational posters for this area. We learned that unfortunately there are rarely enough staff on in the theatre to have someone dedicated to monitoring patients post-surgery, meaning that patients often return to the surgical ward almost right away after their procedure. We wondered how this may impact the rate of recovery and the potential for post-surgical complications such as hemorrhage or adverse reactions to the anesthetic. Complications such as those could be especially difficult to manage as we know that the nurses on the surgical wards often have large patient loads and may not always be able to watch each patient as closely as they would like. 

We are thankful for the experiences we have been able to have so far in the beautiful city of Mongu and we look forward to the rest of our journey!

Until next time,

Cierra and Steph

Cierra's own mother could hardly tell us apart in this one.. No pressure to Steph's mom.

Doctor's Orders: Play More

Hello everyone! 

I had the pleasure of continuing my clinical experience at the Lewanika General Hospital's Children Ward. As I mentioned previously in my last blog post, this ward is filled with very sick children ranging from a month up to 16 years of age. I have seen an array of illnesses such as malaria, pneumonia, HIV, severe malnutrition, burns, various surgical patients and the list goes on! Needless to say I have been working with children that I normally would not have the opportunity to work with in Canada; however, nursing them has not been my primary focus. Playing with them has.
Now you may ask yourself, "Why would playing with these sick kids be helpful?" And the answer to that question is very simple: playing helps with healing. At this point you are probably questioning or wondering how playing with toy cars, or bubbles or reading can help a child heal from a nasty illness. And that has been a similar feeling I have noticed when I have tried to implement play therapy on the ward. It is not that the staff have been resistant to this idea, but with the high demands of children, countless procedures and other tasks tends to place play therapy near the bottom of priorities. However, after researching about the benefits of play therapy in hospitalized pediatric patients, the evidence demonstrates the greater need to prioritize play time in hospitals. The hospital is an unfamiliar environment and can be a scary place for anyone especially for kids, because it can cause stress, anxiety or feelings of discomfort. As such, playing is an effective tool to help children overcome stress. Furthermore, due to the uncomfortable and painful procedures that accompany a hospital visit, there are several studies that suggest that playing can decrease pain post operatively, alleviate pain during dressing changes or IV starts. The research can go on and on, but I am pleased to report that my attempts to display the evidence and practice play therapy on the ward has proven to be successful. The nurses have asked me to come with them prior to starting an IV because they know I can help distract the child through play. Over the past week the other nursing students and I have attempted various methods of assisting a little girl during her burn dressing changes through reading, asking her math equations and singing (the same 2 songs over again and over again and very poorly I might add). Even though every procedure may still inflict pain or discomfort causing the children to cry and scream, I have noticed that they do not cry as much or as long compared to not playing with them at all. And not only is playing helpful for a child's overall cognitive growth and development, it also is a way for nurses or other healthcare professionals to help build better relationships with their patients and families. Because I know I would rather have a nurse or doctor blow bubbles with me before they listen to my bowel sounds with a cold, funny looking stethoscope. I feel very honoured to be a part of this project, and I will continue to update about the progress or obstacles that may take place with trying to implement play therapy more on the unit. I also want to highlight how positive and receptive the staff members have been to incorporating play therapy, and to note that they still play with the patients as often as they can. All in all I know there is a lot that still needs to be done in order to incorporate play therapy more heavily on the unit, however, through further education for staff and family members, modelling play during rounds, finding time to schedule more formal play therapy sessions and getting a new toy cabinet will hopefully be the pieces needed to solve the puzzle of play therapy.

Thanks for reading, and remember to take some time and go play!

-Nikki

The educational poster I created about the research into play therapy

The ART of saying goodbye

After another lovely week in the ART clinic, we are very sad to say our goodbyes. The nursing staff has made us feel so welcome and involved and we are honoured to share the nursing profession with some fantastic men and women. 

We started the week off with paediatric patients on Tuesday which was a very uplifting day, given the circumstances. We were invited by the staff to play with the children and we happily accepted the offer, not really knowing what to expect. All of the children were asked to join us in a circle, where we soon found out that dancing was the first thing on the agenda. We have never felt more like "makuwas" aka white people in our lives. The dancing commonly seen here involves a lot of hip movements, which is especially hard in loose fitting scrub pants. Unsurprisingly, it's a lot harder to "get low" when you're constantly pulling them up. There was a lot of laughter and smiles from the children and parents, and we're still not sure if they were laughing with us or at us. Nevertheless, it was fun to dance and play with the kids even if the laughter was at our expense. 

Another incredible part of our week was when we had the opportunity to work in counselling, where HIV testing is done. This time around, the counsellors let us perform the test that determines whether or not a person has HIV. We got to be apart of some very heartfelt and emotional conversations around HIV status and what that means to a person. The counsellors and nurses alike work very hard to break down barriers and end the stigma around HIV. In all of the conversations we witnessed, you could see how much thought the nurses and counsellors put into the care they provide.

From a Canadian nurses' perspective, we tend to look at healthcare from a very clinical and medical standpoint. Since being in Mongu, we've noticed that the nurses and staff here take a more relational approach to nursing care. It's something that has really resonated with us, and is something we will incorporate into our practice back home. Although we've only spent two weeks in the ART clinic, we have created great relationships and friendships with the staff there. 

On our last day, we asked if we could have a group photo which once again, resulted in laughter at our expense. The doctor who took the photo ended up taking around 80 pictures, which made for an entertaining morning trying to find the best one. Our facial expressions in the photos range from unimpressed to having the time of our lives. We came into ART having no expectations and we are now leaving the clinic with bittersweet feelings. At times the ART clinic was a lot of fun, but this wasn't without some sadness as well. We learned so much from our two weeks there and hope that we made as much as a difference for them as they made for us. 

Laura and Jill :)

"Collect Moments, Not Things" - anonymous

Hello Everyone,

It is hard to believe we are halfway through our Mongu practicum! We are enjoying every minute of it but the time is going by a little quicker than we would like it to.

My (Erin) week provided me with three different experiences. On Monday, I joined Kristen in the Special Care Baby Unit (SCUB). There were 5 babies and (without us) only one nurse. We were fortunate that this week, a doctor from the Czech Republic had returned to Lewanika General Hospital. Between himself, and the nurse on staff, we learned various ways to take care of such teeny tiny humans in low-resource settings, and other dangers we need to be aware of. Those babies though… heart strings were pulled.

Tuesday, Wednesday, and Friday I joined Kristal at the Sefula Health Clinic. Sefula is an area outside of Mongu, which had us taking a cab for roughly 35 minutes each way –BUT members of the community can walk upwards of 40km to visit the clinic. All of the staff we encountered are AMAZING! On of the nurses/midwives (named Precious) is such a gift to the clinic! She was very welcoming to both us, and the patients who came to her sessions. My experience had me: doing malaria screening (with many being positive), treating severe malaria cases, initial screening/triage, providing family planning/depo injections, antenatal revisits, and listening to chief complaints/diagnosing/prescribing medications alongside another nurse on staff. I was very impressed with the patient flow and resourcefulness at this clinic (also, every patient gets a malaria and HIV test each visit!) - I must mention, Sefula has been WITHOUT running water for over a YEAR AND A HALF!... Can you imagine??? On Friday, they put on a celebration for World TB Day where many children came from school and danced to music throughout the morning and early afternoon – what a party! Once our antenatal visits were complete we had the opportunity to go out and mingle with the local children – at first they were a little hesitant of us, but we soon we all friends!

However, it was the research data collection on atrial fibrillation that stuck with me this week. On Thursday, the Lewanika School of Nursing students joined us on a busy street in downtown Mongu. Here, members of the community would randomly come up to our tables and go through various screening stations (questionnaire, blood pressure readings, pulse, weight… etc.). Myself, and a couple of the local nursing students were placed at the first table and were responsible for completing the questionnaires. We asked numerous questions, including ones on alcohol and tobacco use. As healthcare professionals in Canada, these are every day questions asked without judgment. However, I was quickly informed that these are HIGHLY cultural sensitive questions and that it was important that the local nursing students asked them. I found this very interesting, and was reminded that through every action, and every conversation in this setting, we must remain cautious and respectful – it is so important to not fall into ways that are considered “the norm” back home…we definitely do not want to break the trust that the UBCO School of Nursing/OkaZHI (okazhi.org) has worked so hard to create the last several years!!

This week I (Maggie) was at Save-A-Life Centre, a Christian based organization that works to combat malnutrition in children who are living in Mongu and surrounding areas. In our Global Health class we learned that malnutrition is responsible for nearly half of all deaths in children under the age of 5. Unfortunately, this has become evident to many of us, as we have seen children with signs of moderate to severe malnutrition both inside and out of our practice placement settings. 

During my week at the Centre, I was able to sit in on their weekly feeding program, where families in need are taught about healthy nutrition and feeding practices then provided enough food to last the rest of the week. I also worked alongside a physician at the Centre's Health Clinic assessing and treating individuals from the surrounding area for various illnesses. Finally, I was given the opportunity to accompany a community health worker on her home visits where we checked in on families who are in the feeding program. Home visits were definitely the most eye opening and educational part of this experience for me. While my few weeks in Mongu have demonstrated how few resources many members of this community live with, seeing their homes and the way they live shed an entirely different light on their situations and ability to access the limited resources that are available. Most homes were made of little more than sticks and clay with a single large piece of tin or grass for a roof. Many people must walk up to an hour to get clean drinking water and then carry it back. To be a part of the feeding program, people must also walk to the Centre to attain their food each week. In some cases this walk is up to 2 hours. There was certainly no lack of strength or resilience in the people I encountered with each visit. 

While we continue to learn of hardships and lived experiences... we must also acknowledge the beauty, kindness, and strength we have witnessed in the people we encounter. Each person we have met has greeted us and asked to hear our stories with genuine interest. During home visits, each family I encountered offered for me to come sit in their house often giving me the only chair they owned. At one of the houses a grandmother offered me some of the afternoon meal. This was after showing me the family’s only food for the next 3 days (part of the check-in during home visits) – one egg, half a bag of rice, and some formula for the baby. This was a humbling experience indeed. 

The upcoming week is sure to come with more great adventures – stay tuned! To our friends and family, we love and miss you so BIG, and are thankful for your support!

- Erin and Maggie

"Piglet noticed that even though he had a very small heart, it could hold a rather large amount of gratitude" - A.A. Milne

A common view during Save a Life home visits 

Celebrating world TB Day with the local Sefula students

Sundowners