ART clinic

We learned about the pathophysiology and we have heard the stats. HIV numbers are staggering in Africa in comparison to home. We knew this before coming, but nothing could have quite prepared us to see it first hand.

This week we (Shelly and Michaela) were working at The Antiretroviral Therapy Clinic (ART clinic). Each day the clients gather on rows of outdoor benches first thing in the morning and place their patient card into a cardboard box that sits at the front of this courtyard, so that their files can be pulled. The files are pulled from many small filing rooms that to us look impossible, yet our Zambian colleagues seem to know them like the back of their hands. The clinic can see upwards of 500 patients in one day.

All the nurses and staff have a meeting to start their day before the patients pile in. They pray for strength and courage and remind each other to treat each and every patient that walks through the doors with dignity, compassion and respect. This part of their daily routine we found to be humbling, and we reflected on how far these reminders could go at home in our workplaces.

Day one was the pediatric day. We hit the ground running and we had to learn the paper work and routines quickly. Some patients were there for full clinical check ups while others were there to pass through adherence counselling only before picking up their medications from the pharmacy.  Some of these children were born with HIV while others contracted the disease as teens. They were missing school to come to the clinic. Due to shortages of antiretroviral medications (ARV’s), some have to come back each month to collect their medications. The process takes most of the day and includes long wait times in the heat. Despite these challenges and hardships we did not hear a single complaint. The rest of the week passed and we had the opportunity to work alongside the doctors, clinical officers, adherence counsellors and pharmacists. For us the rooms seemed small, hot and crowded; however, our Zambian colleagues championed through their day.

The staff is working hard at implementing a community adherence group (CAG) where people who live near each other, and are doing well on their medications, can send one person to collect the medications for groups of 6. They are facing some barriers related to processes and resources. 

We experienced a day with a counsellor testing people for HIV. We saw fear while they were waiting for the result, relief wash over those with a negative result and despair in the eyes of those who tested positive. The campaign in Zambia states “Know Your Status” and we can not even begin to fully understand the courage that it took to come get tested in the first place.  This week being in the Art clinic we saw that there are many positive strides being made in the fight against HIV. Our Zambian colleagues are working hard and making great progress towards the 90/90/90 goal; Where 90% of people are aware of their status, 90% of those with HIV are on treatment and 90% of those with HIV have a suppressed viral load. Overall this week we were so very struck by the resiliency of the hundreds of faces we had the pleasure of meeting.

Shelly and Michaela

Postnatal Unit

This week Ella and I (Amanda) had the opportunity to work in the Postnatal Unit and SCUB (Special Baby Care Unit) at Lewanika General Hospital. The morning of our first day was filled with excitement and anticipation as we patiently awaited the familiar sight of Santos' blue mini bus to pull into the parking lot and take us to the hospital. Once on the bus, Ella and I briefly reviewed maternal and neonatal assessments with one another, scribbling notes in our notebooks as the bus navigated the many potholes in the road.

When we arrived on the ward, we were warmly welcomed by all of the staff on the Postnatal Unit. Ella and I were very grateful to be working alongside other nursing students, midwives, and doctors on this unit! We also appreciated being able to exchange knowledge and gain insight about each other's health care systems.

One difference that we noticed between our health care systems is the difference in length of stay for postpartum mothers and babies in the hospital after delivery. In Canada, we typically monitor mothers for 24-48 hours on the Postpartum Unit after delivery, whereas at Lewanika, mothers can decide to be discharged in as little as 6 hours. Ella and I (Amanda) were very curious as to why some mothers didn't chose to stay on the postnatal unit after birth so we asked the nurses. What we discovered was something that made me (Amanda) pause and reflect on for the following days after. The reason was this: mothers might choose to leave right after birth to get back home to their families and continue with the tasks of homemaking and/or helping out with small family businesses. As a result of the high turnover on the Postnatal Unit, we learnt a lot about the discharge teaching provided to mothers, which included topics such as newborn care, breast feeding, and family planning.

Another challenging, yet unique experience that Ella and I (Amanda) quickly discovered about nursing in another country, was putting aside our "Canadian" routines and allowing the nurses at Lewanika to show us their roles and responsibilities as nurses working in Zambia. For example, we noticed that in some ways the pace on the Postnatal Unit is much slower than what we are used to in Canada. Often times we would arrive on the ward, ready to hit the ground running with maternal and neonatal assessments, but instead, find the nurses tending to housekeeping duties such as damp dusting the ward and counting inventory. It took us a bit of time to get used to this routine but what we found is that this way of beginning the shift actually allowed mothers and their babies time to rest in the morning and it provided them with space to bond with their baby. Around 8 am the nurses join the doctors in completing rounds (assessments) and then the nurses follow thru on providing the ordered care and discharges. The nurses then gather the mothers that are being discharged and complete health education together as a big group.

Although the ward was a slower pace than what we are used to, it gave us the opportunity to ask many questions and learn from our Zambian colleagues. We learnt a lot about their vaccination schedule for children and how they adjust when the hospital supply of vaccines is low (something that unfortunately happens within a context of limited resources). In addition, we learnt about the most common sexually transmitted infections (STIs), how they are transmitted, and how they are treated. In fact, we discovered that advocacy for male circumcision after birth, as well as in adulthood, to reduce the transmission of disease is highly promoted at Lewanika General Hospital.

All in all, Ella and I (Amanda) valued this incredible experience and the opportunity to deepen our understanding and knowledge of maternal health in Zambia, and what that means in comparison to our health care system in Canada.

To conclude our first official week in Mongu, many of us gathered together for World Tuberculosis (TB) Day this Saturday to participate in a march to Mongu District Hospital in celebration of Zambia's many efforts to reduce the transmission and spread of TB. On the way, we attracted many children who wanted to hold our hands and march alongside us and the nursing students of Lewanika General Hospital. Once at Mongu District Hospital, we listened to speeches made by various leaders and professionals in the community and had the pleasure of being entertained by many talented performers and dancers. It was an honour and a privilege to be invited to take part in this event.

It is safe to say that having a nursing practicum in Mongu has been an incredible experience thus far and we are both looking forward to what is yet to come!

Ella and Amanda

March 24 - Hello from Beautiful Mongu

Hello,

During our first few days, we are becoming better at adapting to our surroundings. It was a bit of a culture shift at first since we are use to using different supplies at the hospital and home.
One challenge we faced was cooking for ourselves: the food here is different and not as readily available than what we are used to in Canada. In addition, we found out that unless you want to share our food with the ants, we should probably keep it wrapped or in containers. We are starting to better recognize the privileges we have as Canadians. However, we are making our way and trying new things!

We also spend the week at Lewanika General hospital where we worked along side a wonderful group of nurses on both the female medical and psych wards. During our time there, we worked on comparing the different types of conditions the nurses would typically see. We became more familiar with conditions we don’t commonly see in Canada such as malaria, HIV and dengue fever. It was one thing to learn about these conditions but to see them in a patient really helped to bring all our learning together. 

On Saturday, we were graciously invited to the March for TB that took place by the Mongu District Hospital. We learned that there was such thing as “Zambia time” in comparison to  Canadian time. Meaning that even though we technically arrived late, we were still much too early! We marched and then watched the Zambian marching band, dancers and officials giving speeches. What a great day though.

Overall, we are enjoying our time in Mongu, Zambia and look forward to the weeks ahead!!!!!!!

Sincerely,
Diva and Claire

Zambia Project/Save a Life Center

Hi; Madison & Kelsey here!

It was our first week of practicum, and our experience was more than we could have hoped for.  This week we were placed at the Zambia Project.  This included an experience in the Save a Life Centre and the Walk-in Clinic.  The Save a Life Centre works with malnourished babies and children in Mongu, while also working closely with their caregiver to enhance their nutritional status.  It involves education for the caregivers, weekly provision of food, supporting the caregivers in establishing a micro-business, as well visiting the child’s home to check in on them and to ensure that the child is improving.

We worked with mothers and their children at all different stages of malnutrition both through home visits and the feeding centre.  It was an amazing experience, which allowed us to build trusting relationships with moms and their children.  When we arrived at the centre each day, we were welcomed by the staff and a room filled with mothers sitting on the floor and active babes crawling around us. The mothers were very accepting of us and trusted us with their children, so much so that we often did not know whose child had been dropped in our lap until they came to grab them at the end of the morning.

We both felt a great mixture of emotions throughout this experience due to the fact that we working with sick and vulnerable children in difficult circumstances.
I (Madison) had a difficult time seeing babies and young children so sick.  There were times where I teared up looking into a child’s eyes, or saying goodbye after a home visit.  I repeatedly held the children and looked into their eyes and whispered,  “You are so strong, you are so loved” because in that moment I felt the need to tell them their worth, even if they didn’t understand.  I am tearing up writing this, not because I am sad, but because I want to hold onto those moments forever, and I absolutely will.  The spirits of these children are resilient.  They are so happy with what they have, to be held, to dance with you, or just to be with you.  I have been given so much strength from these children, and they have taught me so much in such a short period of time.  I feel hopeful; because of the Zambia Project these children have the ability and chance to grow, learn, and ultimately be a kid again.

I (Kelsey) felt very humbled by this experience. I found the most valuable experiences to be the home visits because prior to this experience, I didn’t have a real idea of the factors that contribute to malnutrition. Through the home visits, I was able to get a glimpse of each family’s circumstances and obstacles. The strength and determination that I witnessed from these families gave me a new understanding and appreciation for the mothers who try so hard to provide for their children despite having the odds stacked against them. I felt very grateful to be a part of each family’s journey and to gain a new perspective by looking at life and circumstance through a different lens.

Thank you to the Zambia Project for their patience, knowledge, and welcoming arms, and we’re so thankful to have been a small part of these families’ journeys.

All our love,
Kelsey & Madison

Hello from a small cabana in Mongu,

This week we (Erin and Julia) were placed in the labor and delivery unit at Lewanika General Hospital. After receiving our placement site at 9pm the night before, we quickly rushed to prepare for the week ahead. We were both very eager and excited to start this placement as this area of nursing is one we both feel very passionate about.

Day one, we quickly joined in on rounds with the nurses, clinical officers (in Canada this job would be similar to the role of a nurse practitioner), and physicians. We soon realized just how busy this ward was as we rushed the first actively laboring mum down the hall into the labor room. With a physician, a nurse, and ourselves, we helped mum deliver a beautiful newborn boy within 10 minutes. We were grateful that both mum and baby were healthy, and that the birth was relatively easy. As the physician left the labor room quickly to tend to his next patient, the nurse cared for mum while the two of us had the privilege of performing the newborn assessment. Prior to our departure to Mongu, we were prepped on the differences in labor expectations in Zambia in comparison to those in Canada. In Zambia, the women are alone in the labor room, and bravely and quietly endure labour without pain medication. It was amazing to see the strength of these women.

Day two, we were working with a colleague who we grew very fond of over this week. He is a clinical officer who works on the labor and delivery floor. We are so grateful that he spent many hours teaching, testing and working alongside us. During this shift, he called us to assess a patient and as he and Erin were doing an exam they found 5 toes! Mum was again quickly rushed to the third labor room (as the other two were full) and within 5 minutes the clinical officer helped mum deliver a footling breech baby naturally (for those of you not in healthcare, this means baby comes out feet first and this can be very complicated, yet our colleague made it look easy - very impressive!)

Day three, definitely a tough but rewarding day. We were involved in a situation where we, along with another Zambian colleague, provided emergency life support to newborn twins. We worked with the resources available and used teamwork and innovation to utilize emergency equipment. Luckily, with grace, nervousness, and a lot of sweat, both babies started crying after 5 minutes - definitely the longest 5 minutes of our lives and what a sweet sound! This was an emotional moment for both of us, and we were both very happy that mum was able to take home two new family members.

Day four, a hard day to end on. After a slow morning, we witnessed the more rare and heart-breaking side of labor and delivery that involved the loss of a life. Apart from the scary but positive outcome we witnessed the day before, we had only witnessed the "happy endings" prior to this day. It is hard to put together words to say about this situation, it pretty much just sucked.

Looking back on the week as a whole, we are both very grateful for the learning opportunities as well as our ability to help where we could. The colleagues we worked with over this week were welcoming, kind, knowledgeable and incredibly resourceful. Although our Zambian colleagues were trained in a different country with a very different healthcare setting, all of our goals and passions for maternity patient care aligned. We will forever remember this intense, exciting, and sad first week that facilitated so much learning.  

Your mum and baby fans,

Erin and Julia xx

Hello from Mongu, Zambia, capital of Western Province!  This week, the majority of us were at Lewanika General Hospital, which is the only second level hospital for Western Province (population of 1.2 million).  This means that smaller district hospitals refer people here from more rural areas.  There are various wards in the hospital, and Lauren and Adia were on the male surgical ward (which also has a one-room, two-bed intensive care unit for all patients), while Matt and Mallory were in the OPD (Out Patient Department), which is similar to an Emergency Department in Canada.  We have learned A LOT this week about working in a low resourced area, where improvisation and critical thinking are impressively demonstrated by the local staff, on a daily basis.

We chose to write this post as a group because we shared an experience that none of us were prepared for, or will ever forget, but that we were able to support each other through.

Lauren and Adia were involved in rounds on the surgical ward when Mallory and Matt rushed through to the ICU with a trauma patient on a stretcher.  A team of physicians, nurses, and nursing students packed into the small ICU room.   The room was cleared by a physician, who instructed all non-essential staff out, but who graciously allowed Matt and Mallory to stay and continue to assist.  Lauren and Adia, looking through the open ICU room door, noticed that Matt and Mallory appeared fatigued, and entered the room to offer their assistance.  From that moment on, we supported each other, communicating our thoughts and actions, and over the next 90 minutes, the four of us worked with our Zambian colleagues to continue and assist with the resuscitation efforts.  Our feelings of frustration were obvious to one another as we struggled to perform the interventions we knew were necessary, but were hampered by the limited resources at hand. Having said that, the ingenuity of our Zambian colleagues and other medical staff from around the world was incredible, using the items available in ways we would never have imagined.  Everyone involved did the very most they could, but in the end, the patient succumbed to their injuries.

This was our first experience being actively involved in a trauma case of this nature. For all of us, the learning was beyond having to use strong clinical judgement and reasoning; we had to adjust within a new context.  Upon reflection, we all voiced our gratitude for the presence and support of one another, and the expertise of the various medical professionals who offered guidance and encouragement.

We give thanks to one another, our fellow students and friends, and our instructors, who continue to help us debrief.  We learned how to do a lot with very little, and decidedly did the very best we could.  We also agree that the trauma suffered, in this particular case, would have been unlikely to have a different outcome regardless of location, resources, and interventions.

Ultimately, through various conversations between all sixteen of us, we have come to realize that much of the learning we experience here will, unfortunately, result from facing some challenging situations and incredibly difficult circumstances, some with happy outcomes, others not.

Matt, Mallory, Adia, and Lauren

Week one on the children's ward with Sam and Tanner

Hello everyone!

Tanner and Sam here after a busy week on the children’s ward. We've definitely had a great experience and learned lots due to the very friendly healthcare team and patients at Lewanika Provincial Hospital. We have learned a lot about different conditions such as TB, malaria, fungal infections, sepsis, malnutrition, burns and fractures. Our daily routine started out with morning rounds with the doctors where we were routinely quizzed about the patients conditions, if we did not know the answers they were always great about teaching us. Next we would help out with the daily nursing tasks and then set up some play therapy in the afternoon. When we arrived on the ward there wasn’t much evidence of any play therapy, largely due to the the staffing shortage, high patient ratios and limited resources. Every afternoon we set up a large playroom in the kitchen and filled it with a large box of toys from the storage room that we supplemented with donations from Canada.  The children were hesitant at first but by the end of the week they were jumping out of their bed with excitement when it was time for play therapy. There were lots of smiles, lego, bubbles, music, hand puppet crafts and drawings that we would hang above their beds afterwards. 

My (Sam) favourite part of this week being on the children’s ward was interacting and playing with the children. There was this one child who wasn’t interacting with the other children during the play therapy, withdrawn, had a flat affect and wouldn’t speak. Seeing a child like this was very shocking for me, usually the children I see around this age were able to interact and play, smile/laugh/talk, and look around in curiosity. After 2 sessions of trying to get her engaged and playing we didn’t see much progress. However, on my last day on the children’s ward I went to check in and say hi to this child. I walked in to her room and started to wave, smile and talk to her, she looked me straight in the eyes and let out a little smile. This was the first time I have ever seen this child smile. It made me so excited and happy to see just a little smile from her. It showed me how vital the 2 days of short play therapy truly helps the children develop and get better. The time I spent on the  definitely enhanced my passion with working with children. I am so thankful for this experience.

I (Tanner) had many highlights of the week. When we first got on the ward we got a lot of stares and uncertain looks as we stuck out like a sore thumb. Initially the children were very shy and hesitant to interact with us but after a couple days we received huge smiles and lots of waves as soon as we stepped foot on the unit. Another highlight of my week was steeping outside of my comfort zone and advocating for a patient. There was a patient on the ward who was getting an extremely painful procedure done without any anaesthetic or pain killers, the screams could be heard across the ward. I immediately went over to see what was going on and started to advocate for some pain killers. Analgesia was then ordered but they unfortunately did not receive it until the procedure was already over. I then continued to advocate for this patient as I felt the appropriate measures were not being taken, with the help of Alex we were able to take this case to a higher level where it was taken very seriously and measures were put in place to make sure it would not happen again. The power gap between specialists, doctors and nurses is huge here which makes it extremely difficult for health care workers at a lower level to speak out and advocate for better care, this week I really felt that I was able to lead by example and create change by standing up for my patient. 

Each day after clinical our 10 person house has a large family dinner on the patio, we rotate cooking for the family every night so each one of us only has to cook once a week. Afterwards we usually go for a walk down the road to watch the sunset over the flood planes, this usually turns into a large crowd of children swarming us “mukuwa’s” and starting a soccer game in the sand. 

Thanks for reading and stay tuned for next weeks post!

Sincerely, 

Sam and Tanner

x

Hello Everybody,

After a busy last couple days we are finally getting settled at Liseli Lodge in Mongu and almost over the jet lag.

Our bus ride to Mongu only took 10 hours down a partially paved road with many potholes due to the heavy rain. As we passed through Kafue National Park we saw many antelope and even an elephant! The whole journey was lush and green, we passed through many small villages where vendors congregated to the bus selling their various goods (oranges, bananas, peanuts, you name it) though the windows of the bus.

Once we arrived at Liseli Lodge we split into two houses (one of 6 and one of 10). Some of us are getting close and personal sharing beds and cozying up under our mosquito nets at net. We have woken up naturally to the Zambian sunrise due to the jetlag. Our mornings this far have been spent sipping our instant coffee in the cool(ish) morning air and enjoying each others company. We are continually learning to enjoy the simple things.

A few highlights thus far:

We celebrated St Patrick’s day and Erin’s birthday with the staff of Liseli Lodge and the Catholic Brothers and Sisters who also reside in Mongu. We were told to bring a “party trick” to the celebration - our group decided that singing an acapella version of Oh Canada would be the best we could do on short notice! Our new friends celebrating with us loved it, and included us in various Zambian dances. This pushed a lot of us out of our comfort zones as we quickly found that not many of us have much rhythm! We had lots of laughs throughout the night and feel so welcomed by everyone we celebrated with.

Last night we all loaded up into our friend Santos’ minibus and ventured down out onto the Zambezi flood plains to enjoy the sunset. This was a fantastic way to spend time all together, as well as to appreciate firsthand the beauty of this country. I think for us all, the red glow of the sky setting over the 50km expanse in front of us is a sight that we will not soon forget. 

Today (March 18th), we unpacked and repacked all of our 16 suitcases filled with medical supplies, toys and crafts, teaching materials, baby clothes and many many days for girls kits! We will be distributing these materials to our different practicum areas throughout the next couple of weeks - depending on need and use at each location. The days for girls kits will likely be given to 4 different schools, a local girls football team and to girls we meet during our outreach visit to rural areas surrounding Mongu - this is all still in the works! We want to express our utmost gratitude to everyone who generously donated supplies, clothes, crafts and kits - you rock and we are thinking of you often!

Cheers!

Sam, Lauren, Matt, Tanner, Erin

New Beginnings

Hello friends, family and blog followers,

I am updating on behalf of myself and the other 15 students who have just safely arrived in Lusaka, Zambia after two very long days of travel. We will be spending one more day at here at the lovely Palmwood lodge before collecting our many bags and heading to our final destination - Mongu!

We have all put many hours of preparation into this trip and I think I can speak for the whole team in saying we are so excited to finally be on Zambian soil, soaking in some sun and getting some rest before we begin the busy weeks ahead. For the last lag of our journey we will pile onto a bus early Thursday morning and drive down an old dirt road for hopefully no longer than 12 hours before reaching Mongu.

We will hopefully be updating the blog at least once a week (if wifi permits) during our travels in an attempt to share some of the amazing adventures, people and places we will encounter along the way as well as to reflect on our purpose for this trip and what we are learning throughout the process.

Thank you so much for following along as we transition from students to RNs in a new and incredible culture. We can't wait for what's in store!

With gratitude,

Erin