Becoming a volunteer Doctor for On Call Africa not only supports impriving healthcare in rural Zambia. It also provides doctors with further training and experiences they won’t get elsewhere. We interviewed Dr Greenan to find out more about his time in Zambia with On Call Africa
Why did you decide to get involved with On Call Africa?
I was planning some time out during my GP training, and was really keen on doing some volunteer work abroad. I’d previously done an elective in Tanzania and so was interested in returning to Africa. A friend who had volunteered before with On Call Africa recommended them to me. I was really impressed by the focus on health education and the training of community health workers, and the fact they have an eventual exit plan. To me this shows how they are working towards the longer term goals of improving the healthcare of rural communities in a sustainable way, rather than offering a temporary fix.
How long did you volunteer for and when?
I planned to volunteer for 3 months in early 2020, unfortunately I had to return home after 5 weeks due to the COVID-19 pandemic.
What did you get involved in during your time?
We would run clinics in rural areas during the week – this would often involve travelling long distances by car, setting off either early in the morning or even the day before. Before starting the clinic each morning we would run health education session for those who were waiting to be seen, on topics such as sexual health or hand sanitation. We would then start seeing the patients in the queue, with the assistance of Community Health Workers for translation. Also using this opportunity to supervise and train them in basic medical skills. I visited during the rainy season, so we did have some access issues getting out to the villages on occasions.
We would take the opportunity to visit local schools to run health education sessions, or meet with a local womens’ group to run sessions on subjects they wanted to learn about, such as identifying a sick child.
You kindly offered to steer the QI project for medical guidelines, can you tell me more about this?
When we were in Zambia last year, as a group of 4, we noticed some potential for improvement of the guidelines and medication formulary. Mostly in terms of needing to update them, and getting them a little more organised. It was actually one of the other volunteers, Simon, who led on this. Once we returned home he was able to organise a group of volunteers to take on different sections of the guidelines to rewrite and update them. I reviewed the respiratory guidance and immunisation sections. Having worked in the clinics there, I had experience in knowing what sort of layout and information would be useful. I think we’ve managed to produce some good guidance which will be easy for the future volunteers to access. It’s particularly important when dealing with conditions which aren’t common in your home country, particularly when signal is poor and googling is not an option!
What training did you provide the Community Health Workers and what impact did this have?
The Community Health Workers have had varying amounts of training. Many have roles within other organisations. The volunteers who had been before us had also structured the training and focussed on improving history skills, so when we arrived most had a really good grounding in history-taking, which was evident from their work. While running the community clinics, we would supervise the Community Health Workers in assessing patients, providing them feedback and using teaching opportunities as they arose.
We had started some work on taking basic observations such as temperature, and there was a training week planned in Livingstone which was unfortunately cancelled. It was really clear from some of the more advanced Community Health Workers how key their role is. They were already seeing and doing basic tests and assessments on patients in their villages, encouraging them to attend the rural health centre or our clinic for further assessment if needed, and they would also offer to follow-up on some of the patients we saw together so that they could give further advice.
They know their patients personally and are trusted members of their community, so I think they really are the future of healthcare delivery in rural Zambia.
Can you tell me about some of the people you treated?
We treated a lot of different patients and conditions; I was surprised that a lot of the problems were really simple things like coughs or back pain, which I think just shows how difficult it is for these patients to access any form of healthcare. Even getting simple painkillers would be difficult, so they would take the opportunity when our outreach clinics were running.
Even to reach these clinics, people might have walked for around an hour or so, and the rural health centres would be even further away. We also dealt with a lot of the effects of poor sanitation and water scarcity: diarrhoea and worms in children was one of the most common things we saw.
We also occasionally had some emergency cases: I remember transporting a patient to the nearest hospital (a good 3-4 hours drive away) with a suspected ectopic pregnancy.
How did you find the experience of the On Call Africa volunteer programme?
I’ve really enjoyed working with On Call Africa. The communication with the volunteers before, during, and after the trip was excellent. Particularly given the current situation with the pandemic, they have done everything they can to put safety measures in place for us and the communities they work with, and kept us really up to date the situation evolves. They’ve been really flexible as well, in terms of dates and arrival plans.
The team on the ground in Zambia were brilliant – Victor and Mike’s driving in difficult circumstances and excellent cooking were really appreciated, and I think together we all made a brilliant team.
You volunteered in 2020 and had to depart due to Covid-19, how did this feel?
We had to make a really difficult choice in returning home early. The decision had been made to cease travel into the rural communities because of the risk of transmitting the virus there, and then as the borders started closing we had to make a decision to return home quickly.
I was really gutted to have to leave early: we were making really good progress with CHW training and the plans to expand into new areas had been underway, and we were obviously concerned about the impact of COVID-19 in Zambia. But ultimately it was the right decision in terms of safety for everyone, and we were able to continue supporting the charity and the communities from back in the UK (as well as giving me a chance for a second trip out to Zambia!).
What is your lasting memory of volunteering in Zambia?
I think my lasting memory would be how we worked together as a team to overcome any challenges, whether it trying to free the car when stuck in the mud (which happened a couple of times!) or dealing with some of the more urgent patients.
I always felt like I was part of a brilliant team who were working to deliver healthcare to patients who have otherwise incredibly limited access.
You’ve continued to support virtually and have been key in developing responses to support Covid-19 and TB protocols. Can you tell me more about this?
I think we felt that we were leaving at a crucial time, with the pandemic just starting and the first few cases arriving in Zambia. We wanted to consider how we could continue to support and protect the communities and Community Health Workers we had been working alongside.
We had an opportunity to assist with the development of these protocols (I was particularly involved the Community Health Worker protocol) thanks to On Call Africa’s involvement with the Ministry of Health, and we managed to work together to develop policies which could be used by all NGO’s employing Community Health Workers to utilise their workforce effectively in the COVID-19 response and continued essential service provision. While also maintaining their safety (I found this particularly important to ensure, given that we had worked alongside many of them).
I felt like a really worthwhile project to be involved in, and I think reinforces OCA’s ethos in working alongside and reinforcing the existing healthcare systems.
How easy has it been to volunteer virtually?
I think during the pandemic, we’ve all got used to doing a lot of activities virtually, and volunteering is no different! We would have meetings online to discuss the work that needed to be done between us, and then work together on shared google documents and update each other via email. It was easy enough to fit it in around my UK employment as well, and I think enabled lots of different people to contribute their own experience and expertise.
Would you recommend the volunteer programme?
Absolutely. The experience was great, and the team as a whole are really supportive. It’s a fantastic chance to be involved in such a worthwhile project, and also to see Zambia which is a beautiful country.
For those about to embark on the training programme or visit Zambia, do you have any recommendations?
I would say to definitely go with an open mind, and be prepared for to experience something different from your UK work! Use your free time well, there’s lots to see and do in and around Livingstone – Victoria Falls, rafting and rhino safaris to name just a few.
You are planning to return to Zambia in March 2021 but in a different capacity, can you tell me more about this?
Having had to leave Zambia early, I was really keen to take the opportunity to go back out again, and realised that the perfect time would be on finishing my GP training. Obviously given that the pandemic is still ongoing, changes to the placements have had to be made: rather than travelling out to the villages we will be supporting staff in hospitals and also working alongside the Ministry of Health. Obviously there a lots of measures being put in place to ensure everyone’s safety, and I anticipate it being a somewhat different experience to last year, but I’m excited to see how things have developed with On Call Africa and what support we can give.
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