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