July 09

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LivingWell in Zambia, chapter 2: field trips

Live Well activities cover peri-urban and rural communities, with two hubs: Lusaka (the capital) and Chipata (a town in Eastern Province, near the Malawi border). In our first week, we went to Kenyama (a compound in Lusaka city) and the district of Chongwe (about an hour from Lusaka) which was fairly rural. In week two, we travelled east to Chipata and visited two more rural districts.

Kenyama was shocking in terms of the conditions in which people lived in the compounds, however it was the more rural communities in Chongwe that affected me more. To see the thatched mud and brick huts from the road is a curiosity. To meet the man and his wife who live in one is something quite different. He was immaculate in a white shirt, smart trousers, a blazer and leather shoes. A gentleman in the truest sense, who commanded respect from his presence. How anyone can look quite so polished from a dwelling without electricity or running water is beyond me, but I couldn’t bring myself to ask.

The health centres are a connection between Live Well and the community. Usually a focal point, they are over-subscribed, under-staffed and woefully lacking in facilities and supplies. Though I knew they would be completely different to home, I was still quite shocked by the level of resources they have and the age of the facilities. Many of the staff are community health volunteers as due to shortages of medical staff (typical healthcare centres only have one or two nurses; most have no doctor). Keeping records on each patient is attempted; tests for malaria or tuberculosis are noted along with basic data such as weight and height. The system makes me feel better about my appalling archiving efforts!

As it is currently harvesting time, most of the men are away in the fields, but on Wednesday in Chongwe district, mothers bring their babies to be weighed, checked and vaccinated. Many of the mothers are children themselves; teen marriage is common in rural areas and I estimated many of them to be under 14, carrying their babies, often with a toddler too. The birth rate here is such that women will have about 6 surviving children; there are so many children everywhere! The babies don’t look unhealthy; grubby maybe, but not small. In Zambia, one in 16 children will not survive to their fifth birthday, so these clinics are critical in improving survival rates for both mother and baby. Particular issues are tuberculosis, malaria and water borne illnesses from unclean drinking water.

Many of the Live Well community health entrepreneurs (CHEs) are community health volunteers working in these clinics. They are using Live Well products to supplement the supplies available. The government provides medicines and medical supplies free of charge, but often the clinics don’t have them to give out. So if you go into the clinic with a toothache, they might not have any painkillers available free, but they can sell you a couple of Grand-Pa tablets (GSK paracetamol based painkillers, made in South Africa). They will make a small profit and the patient gets what they need. We allow the CHEs to split the packets, so you are just paying for the two pills you need, and not a whole box, which makes it much more affordable. There are lots of NGOs in Zambia focusing on immunisation, water purification, contraceptives, etc. supplying the government at subsidised rates or in some cases, for free.

This month we’ve added some new products due to popular demand from the CHEs because there are often shortages in the clinics: umbilical cord clamps and surgical gloves. It’s unthinkable at home that you would need to provide your midwife with these basic items. I still have a lot to learn about the supply chain to clinics and how resources are managed, and it may be that we can find a more systematic way to support shortages… but for now it’s great to see that CHEs are helping people on a daily basis.

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Some of the rural dwellings. The walls are clay and brick, and the roof is thatch. There are no doors or windows.

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Another health centre. Zambian triage. Patients are waiting to see the healthcare volunteer at the window to be evaluated to determine whether they go into the centre to see a nurse.

 

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Health centre record keeping. Each patient has an exercise book with their information in.

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One of the health centre buildings in Chongwe, with lots of mums and babies waiting

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Some of our lovely Live Well community health entrepeneurs (most of whom work as community health volunteers too) with some of the Live Well staff taken in Eastern Province. This was taken during a restocking – the sales officer drives out to the community at an appointed time and the CHEs come to buy what they would like to sell.

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The Grand-Pa tablets and headache powders; in South Africa, many people prefer the powder rather than a tablet.