What a first working day of the program! Our bus along with Emmie our driver was there promptly at 8:30 am and we got to Beit Cure Hospital at 9:00am on schedule.
It was a cool and cloudy day – possibly an omen to not have a good start, but it was quite the opposite in fact! The first 1 ½ hours we spent with Lars,who gave us a tour of the hospital and orientation which was great! Lars is a German who has been at the hospital for about 9 months now volunteering. His tour included all the hospital buildings including the main administrative building, as well as the children’s ward, physiotherapy, X-ray, ENT/Audiology, Out Patient Department (OPD) etc. Then we went back inside and he talked to us about Zambian culture and various topics. Interesting facts and things we learned:
- There are ~ 650 physicians in Zambia, only 50 are Zambians, all the others are outsiders, including a lot of westerners
- There are 2 neurologists and 2 ENT physicians in Zambia, one of each at Beit Cure
- The primary challenge for patients they see at the hospital is transportation: getting to the hospital and also going back once they are released
- The children who get orthopedic surgery get physiotherapy while at the hospital, but there are no services available for them once they leave
- Surgery for clubfoot could be avoided if a child is treated early in life, but many come to the hospital when they are much older
- There is also a challenge of having blood on hand for surgeries – since there is a large percentage of the population who are HIV positive and many do not want to get screened for fear of the stigma associated with that
- Patient confidentiality as we know it in the USA is not possible here: consultations occur in the same room for multiple patients; the pediatric ward has 46 beds – all in one large space; children’s’ names and other information is written on a large white board in the ward for the nurses to know at a glance which child is in which bed, etc.. We also saw a baby with hydrocephalus and severe cognitive impairment in the ward. Hard to see and I am sure the students will be affected by that
- About Zambian culture: it’s rude to say “no” so most people will agree to do what you ask them, although they may call later and say they can’t do it; “muzungu” is the term used for a white person from a western nation, but it could also be used for people who are not white, but obviously of a high status (as seen from their attire, etc.).
- Alcoholism is a problem among Zambian men, especially the poor
- Young white girls (i.e. our students) are likely to get marriage proposals by men who see them as a means to improve their status
- We talked about the different tribes: Bemba in the north of Zambia, Tonga in the south who are far more traditional and still practice polygamy, Nyanja in Lusaka and the east, being the top 3 among the 70 or so tribes that exist
- We talked about domestic abuse against women and children, which is often hidden and not reported because of the shame and stigma. Some of this again like India where it is always the woman’s fault i.e. she dressed provocatively, why did she do that? She was inviting trouble….and then he told us about Agnes, the little 5-year old girl we had seen earlier in a wheelchair with one leg in a cast probably due to club foot. Agnes he said has been raped and yet the family denies it and there is not much the hospital can do about it. It was shocking to hear this and totally unexpected as we had seen her cheerful little face in the ward and seen her wheel herself in her chair.
- Practically, he also talked about how change has to come from within, and that even people working with NGOs (non-profits) here don’t understand that they can’t force their beliefs on the Zambians
Finally Alfred our audiology partner showed up and told us it was time for us to go to our stations. So the students split up.
For the morning we had Kate and Erikka in the kitchen – they got to help make and serve the nshima; Emily and Anyea in the laundry; Elizabeth and Kelsey in the ward, Nicole and Megan in physiotherapy, Mel and Jordan to the OR to observe surgery and Jill and Jessica in Audiology. I ended up staying in Audiology to support the students where Jill first tested a 16 year old with chronic otitis media, bilateral eardrum perforations and a bilateral conductive hearing loss, scheduled for R tympanoplasty tomorrow. After that Alfred brought out a box of old hearing aids and we sorted several bags of really old hearing aids separating the dead and broken ones from the ones that worked, doing hearnig aid checks and making note of the specs on each. Jenn, Mel and Jordan joined us – they were thrilled after having observed a portion of a neurosurgery on a 4-month old having his skull expanded because his skull bones were fused, making room for his brain to grow. I also had Patson, the Audiology technician show us how he makes ear molds and Jill had a mold made for herself.
We stopped for lunch at 1:00, and had it at the hospital kitchen served by Kate and Erikka. Our choice of rice or nshima, greens and chicken. So a basic Zambian meal, and several students enjoyed the nshima.
In the afternoon we had: Jill and Megan in the kitchen, Jordan and Elizabeth in the laundry, Kate and Mel in the ward, Jessica and Anyea in PT, Nicole and Kelsey (with Jenn) in surgery and Erikka and Emily in Audiology. We continued the hearing aid sorting job and several other students joined us because they did not have enough to do at their assigned rotations. First to come were the kitchen group (Jill and Megan) because all they had to do was clean up the kitchen after lunch. Then came Jessica and Anyea because physiotherapy did not have many patients in the afternoon, and finally all the others ended up coming there. So we had some extra students participate in hearing aid checks.
We had a great little interlude with the ENT surgeon’s daughters age 5 and 7 who entertained us with their talkative chatter and imaginative play as the 5 year old was the “teacher” and led the class and the 7-year old told us all the story of the three little pigs. The students had a great time!
We left the hospital at 4pm. Jenn took a lot more photos at all the stations that I will try to get onto my computer and post tomorrow…..right now the e-mail is just not cooperating to send photos.
After a break till 6 pm awe went to Manda Hill mall and had dinner all together at Nandos.
Came back at 7:30 and then we had a meeting in our room with all the students. It was nice that they were able to joke as they came into our room calling it the “presidential suite”! :). We all sat on the floor and discussed the day: it was a great and very important conversation and de-briefing. Some themes brought up and discussed were:
- All students were very impressed with Beit Cure Hospital – the facilities, the staff, their honesty and friendliness
- They appreciated all the different stations including the kitchen and laundry, understanding the importance of all the details. For e.g. laundry had to be stopped in the afternoon because the water had been turned off due to a shortage
- They appreciated the creative ways that devices were being made for the patients at the hospital, like the wheelchairs being crafted out of lawn chairs, seats for the children with hydrocephalus, and other things being made of cardboard etc.
- They were shocked, saddened and deeply affected by Agnes’ story, and also talked about how seeing the real cases of hydrocephalus, spina bifida, etc. in person also affected them
- They talked about how children may be fit with hearing aids, but there are no rehabilitation services available to them. Same with the physiotherapy….available here at the hospital, but not after the child is released
- Also about the difficulty of the different languages for a child with hearing loss, because even if the child learns English at school, the family often will only speak in the local language
- They enjoyed the work in the Audiology clinic, but also talked about the “emotional endurance” needed to be a clinician day after day seeing these difficult cases and dealing with the emotional burden
- They talked about how the surgeries they observed were probably the most remarkable thing they have seen: a little baby getting a chance to survive in an environment with far less sterility than we see in the US. And how there was a power outage during the surgery which seemed pretty routine to the surgeons! There was a generator for the anesthesia to keep going but it was pitch dark for 30 seconds before the power returned!
It was a great experience for us as the program leaders to hear the students share all these lessons learned just from the first day of our program!
And we were not done for the day yet! We had to prep for tomorrow – we go to a school for the Deaf in the morning and are going to test the hearing of possibly 100 or more high schoolers. In the afternoon we will go to the Pediatric Center of Excellence – but more about those tomorrow.
Our final task of the day: packing our lunches for tomorrow! We made PBJ sandwiches, and took chips, cookies and oranges for a long and busy day tomorrow!