Hi, my name’s John and I’m a paediatric doctor from Ireland. I’m volunteering with On Call Africa in Zambia from March to June 2022. I have a strong interest in public health and tropical medicine so this placement is exactly what I was looking for!
Our offices are based in Livingstone, and the current objective from the healthcare side of the organisation is to make sustainable improvements to the health service in two rural communities in Zambia’s Southern Province; Kanyanga and Chalimongela, in partnership with local health authorities.
I’ve been here for just about 3 weeks now, so I’ll give a bit of a rundown of how it’s been going.
WEEK 1: Livingstone
After flying overnight from Dublin to London to Nairobi to Livingstone, I was collected at the airport and welcomed by the very friendly OCA team. The first few days involved orientation, induction, getting to know everybody and their roles. I was taught a few phrases in the local language (Tonga) and got to try out the local food. The facilities in the camp are lovely, with private en-suite bedrooms, a well-equipped kitchen, lounge area and a pool. The first week was about meetings and getting up to speed with all the interesting and varied ongoing work of OCA, and trying to make a plan of what projects might be suitable for me to get involved in. At the weekend I also got an opportunity to see the stunning Victoria Falls, witnessed a pair of giraffes stumble onto the main road and cause a traffic build-up, and was brought out by the team for a delicious welcome dinner at the waterfront.
WEEK 2: Kanyanga
Alongside Lizzy (volunteer coordinator / public health volunteer) and Victor (logistics manager / driver) I headed out to the bush of rural Zambia for the first time. It’s about a 6-hour drive, and thankfully we have got a sturdy Land Cruiser because the roads out to the community are unlike anything I’ve experienced! It was great to finally get out and see what the rural villages are like, after all the planning and anticipation of the few months leading up to coming out here. I was introduced to the health staff at the facility, of which there are 4 full-time employees, and had some chats about the challenges the Health Post is facing, and opportunities to make an impact.
Medication shortages are a major issue for the unit, and they routinely run out of basic medications like ibuprofen and salbutamol, while trying to provide healthcare to a catchment of over 24,000 people. The entire area also lacks running water, conventional toilets and electricity (except for a small solar panel at the Health Post), although OCA are currently working on improving Kanyanga’s solar energy capacity. I participated in an antenatal clinic, as well as an outreach clinic to a village called Siajumba about 15km away from the Health Post. The outreach excursion was challenging because several of the patients I assessed there needed admission to hospital for investigation but didn’t have the transport facilities or finances to get to Zimba (approx. 200km away). On the third day, before returning to Livingstone, I attended a HIV clinic and observed a consultation of a 12-year-old boy who was being started on antiretroviral therapy. It was quite shocking to see how limited the resources were in terms of blood tests and microbiology, in dealing with a potentially deadly illness like HIV, compared to the standard of care that would be delivered in Ireland or other high-income nations. I took records of all the medication stock cards from the pharmacy, with plans to work with the District Health Office and community staff on improving the medication stocking system, planning for this to become my main project during the placement.
WEEK 3: Chalimongela
After a weekend back in Livingstone, and an opportunity to go white water rafting on the Zambezi river, it was time to head out to the second community that’s part of OCA’s rural health service package. The drive this time was about 8 hours, and once again we were in for a very bumpy ride. This time my co-travellers were Lizzy and Mike (logistics officer / driver / musical sensation). We picked up Patrick (nurse-in-charge in Chalimongela) at Zimba so I was able to chat to him on the way down about the facility’s challenges and opportunities. He again highlighted medication and equipment shortages as priorities for the unit, among several other key issues. Chalimongela has a smaller catchment population of around 7,000 and only 3 full-time staff. We took part in another outreach clinic to a mining village called Chilobe, where we delivered a health education session about patient rights and the importance of the correct use of antibiotics. We also administered COVID-19 vaccines to those in the group who were willing to receive them. That evening, I assisted Patrick in filling out the monthly reports for the Health Post, which would be sent to the District Health Office. It was intriguing to see the different illnesses that present to the unit, and a useful way for me to get a handle on the patterns of disease in the area. Like in Kanyanga, I took photos of all the medication stock cards, with plans to upload and digitise these and aim to improve the efficiency of the stocking system for the Health Post. I learned that Zimba will be rolling out a district-wide HPV vaccination campaign for girls aged 9-13 years in June, so I will endeavour to get involved and offer assistance with that programme in whatever capacity I can. We returned to Livingstone on Wednesday evening, and I spent the rest of that week compiling reports on what I had seen, done and learned on the two trips. I also made a start on some exciting public health projects including the medication stocking system initiative, auditing the patient consultation process and prescribing practices, sourcing a register for patients with chronic diseases, exploring introduction of a mental health screening aspect to clinic appointments, and assisting with a training manual for community-based health volunteers in the two regions.
So far I have to say it’s been a phenomenal experience already and I’m really looking forward to what the next 10 or 11 weeks have in store!
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