Tuesday, 13 September 2016

Rhi's Zambian Healthcare Adventure

As well as working with one of our pupils, Lawrence, during her time in Zambia, my sister Rhi used her healthcare skills in many different ways. Here she tells us about some of her experiences...

Rhi with Lawrence at Kapumpe

During the time I spent in Zambia I had the privilege of seeing a number of different local healthcare facilities. As a healthcare professional (Occupational Therapist, or OT) from the UK I have been interested to see both the similarities and differences between healthcare offered in Zambia compared to what our National Health Service provides back at home. I also had the incredible opportunity to offer support to a few adults and children with different health challenges of their own.

One of the biggest difficulties faced by so many people living in Ndola is the lack of available health information and education. Coming from a culture with the opposite problem where patients diagnose themselves (often incorrectly) using Google, I loved being able to teach a handful of people from the local community how to look after their own health. In Zambia, many myths are passed down through generations about different causes and treatments of illnesses that we would probably find bizarre, so it has been great to spend some time teaching the physiological explanations and helping the local people understand things a bit better. I expected some resistance to the information that I was sharing, but in reality I ended up being really impressed and encouraged by their enthusiasm to learn.

A very useful book we were able to buy for the Arise Project

My main opportunity for teaching was with the Arise guardians. The guardians have a weekly meeting of singing, prayer and encouragements from the Bible and during some of these meetings I was asked to conduct some teaching sessions on managing common health difficulties. It was a lot of fun teaching the guardians different exercises they could do to help ease pain and strengthen their muscles, and also having to put everything into picture format as many of them are unable to read. I also ran two sessions about food hygiene, looking at what food is good for us and the healthiest ways to cook. These sessions ended with the guardians putting what they learned into practice by cooking lunch for us all to enjoy together (see previous blog post entitled ‘Masterchef – Zambian style’).  We subsequently realised how much this knowledge is needed when I was asked by a local organisation called Beyond Ourselves Zambia (BOZ) to teach the cooks at their four local schools. You can read more on the BOZ blog here.

Teaching guardians how to look after their knees

Running cooking lessons with Beyond Ourselves Zambia school cooks

In June I was grateful to be taken on a tour of Ndola Central Hospital, the main hospital in the city of Ndola. It was interesting to note the differences between this hospital and the ones I have worked in in the UK, particularly in the equipment and furniture that is used until it is beyond repair, rather than being disposed of at the first sign of wear. Perhaps the most reassuring thing was how familiar everything felt with similar hospital departments and layout.

Ndola Central Hospital entrance

Ndola Central Hospital building

During my tour of the hospital I also visited the Physiotherapy department. The physiotherapists there explained that they did not know of any Occupational Therapists working in the whole of Zambia and asked if I would come back to see some patients for them. I returned to visit the department on two further occasions and met a few of their lovely patients. I visited one of their patients at his home as he had been in a car accident 12 years earlier and a spinal injury had left him paralysed from the waist downwards. His biggest wish was to be able to feed and drink independently so that his family did not have to be present 24/7. I was faced with the challenge of finding equipment for him that wasn’t available in Zambia. I tasked the carpentry and maintenance team at Kaniki Bible College to make me a bed rail, giving them the specifications that would be used in the UK, and Charles the carpenter did me proud! I was also able to get hold of a few smaller aids from the UK which enabled the patient to achieve his dream of feeding and drinking independently. Just the smile on his face made my whole five month stay in Zambia thoroughly worthwhile.

Charles and the new bed rail

The patient now able to drink independently

Coming from a culture where you need a DBS (Disclosure and Barring Service) check before you can work in healthcare, I was surprised how often I was informally asked to get involved with treating people and providing advice. At a local school supported by BOZ, there is a lovely girl in Grade 5 who has had hemiplegia (weakness down her left side) since she suffered a brain injury when she was a year old. Her mother has struggled to find the right support for her, especially since her father died who was the breadwinner of the family. I was able to teach the girl and her mother some exercises to help her muscles, but it was still frustrating for me to see how much her life and education are limited by her disability, as if she were in the UK she would have had a much wider range of support.

Teaching mother and daughter

Another person I loved visiting was a 10 year old boy who lives next door to Kapumpe School. He was born with a spinal condition which has left him with clubbed feet and no sensation in his feet or legs. The impact of this disability has meant that instead of being in Grade 4 at the local primary school, he is still in Grade 1. Because his family cannot afford the aids that he needs, he has had to miss a lot of school. He is a bright, friendly and determined boy who finds very inventive ways to manage even though he is unable to walk. Unfortunately he has developed large sores on his feet, so following the advice of a friend experienced in healthcare in Zambia, I visited him regularly to provide and change dressings. As specialist products are not available here, I have challenged our mechanic (who is also a tailor in his spare time!) to create a special pair of shoes for this boy who has never had a pair of his own. Visiting this boy and his family reiterated to me the lack of education given to patients and their families, as I discovered that nobody had explained to them that his condition would never improve and that he would face these challenges for the rest of his life.

Boy from next door (in wheelchair on right) and his cousins, showing off his wheelchair and hand bike

Being taught about wounds and dressings

During my time in Zambia I also had the opportunity to visit a rural mission hospital and our local children’s hospital, as well as being able to talk to local healthcare staff. I found it interesting to hear about challenges similar to those faced in the UK, although to a far more extreme degree. Lack of staff, resources and funding mean that staff in Zambia are expected to lift, move and treat patients in ways that would be deemed unacceptable back home. The lack of the litigation and blame culture that we face in the UK means that healthcare staff in Zambia do not have the same fear of being sued and are not faced with the same red tape and hoops to jump through that staff working for the NHS so often are. However, this also seems to result in less responsibility being taken for decisions and mistakes that are made.

Mpongwe Mission Hospital

Equipment at Arthur Davidson Children's Hospital

As with the NHS, healthcare in Zambia is generally free to patients. However, patients are expected to pay for more specialist or expedited services. There are so many things we often take for granted as part of the NHS’ healthcare provision that are very different here. In Zambia there is approximately one nurse per ward. When patients are admitted to hospital they must have a friend or family member with them throughout their stay and attend to their hygiene and care needs. These bedside carers are not given their own beds so must either sleep in a chair next to their loved one, or share their hospital bed! As some patients are kept in hospital for many months, this is a big commitment for their friends and family members, who are also often expected to provide food for the patient. Things that we would expect to be a part of free healthcare treatment in the UK, such as anaesthetic for an operation, are sometimes billed to the patient.

The healthcare staff I have seen whilst I was in Zambia impressed me with their ability to do so much with so little. Nonetheless, I also found that the Zambian culture of not sharing knowledge can also apply to the healthcare setting, which was frustrating to watch as I believe that teaching self-care enables people to look after their own health and reduces their reliance on healthcare services. Perhaps the most important thing I learned from my experiences of Zambian healthcare is how easy it is to come to a developing country and think you know so much more than people who live there, but after spending time with them you realise they have far more to teach you than you could ever imagine!

No running water means hospitals have to be inventive!

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