Final thoughts…

The SLHS in Zambia 2016 program concludes…. a 4th group of Purdue University students had the opportunity of a lifetime to travel to Zambia, meet and work with each of our inspiring community partners, interact and work with the amazing children at the various locations, get clinical practice doing hearing (and vision) screenings, and also get some practice in providing professional development training by doing presentations and providing hands-on experiences to some of our community partners….

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We had a very successful program thanks to a great student team that was able to “go with the flow”, adapt to changing situations, work well together, support and help each other, take initiative to do whatever was needed, and never complain!

Here are some snippets to share about the past two weeks:

Challenge 1:

  • We were involved in a minor fender-bender en route to the airport that delayed us more than an hour while the police report was completed…
  • BUT – we made it to the airport and the gate in time (though we were the last ones to board the plane!) – Whew!

Challenge 2:

  • Emirates had no record of our overnight hotel accommodations in Dubai…
  • BUT – we were able to call our travel agent in Indiana and get it sorted out (while students waited patiently)

Challenge 3:

  • The hotel in Dubai said the payment had not been made, so we had to pay…and the emergency Purdue credit card we had got declined…
  • BUT – we paid with a personal credit card (and thanks to the travel agent for wiring the money back to my account ASAP!)

Challenge 4:

  • Christi’s room at Zebra Guest House was full of cockroaches…
  • BUT – she calmly walked out so as to not alarm the students and got moved to a different room

Despite this “starting trouble” – once we started our daily work activities we were on a roll!!!!

And here are some gems from our nightly debriefing meetings…

Cheshire Homes:

  • A child was using toes to cut with scissors and working together with another child to glue. The children didn’t let their disability define them.

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UNZA:

  • Question from a buddy: “What did you think of Africa before you came here? Did you envision naked people on the streets and lions everywhere?”
  • Zambians have the ideas and the technology – but they can’t apply them easily. They really have to problem solve to get things done. They understand the roadblocks and problem solve to get around them

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Mthunzi Centre:

  • I expected to be sad (going to an orphanage), but I actually felt happy
    • They have this place, like a big family and a father figure who takes care of them
  • I thought to myself: “why are they so excited we are here? We are the ones who should be excited!”

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Vera Chiluba Primary School:

  • I can’t believe we screened 400 students! (These are some of the best smiles of the UNZA students doing hearing screenings!)

Beit Cure Hospital:

  • Marriage advice from Chef Kelvin: “Be best friends, don’t make each other upset”

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The Haven:

  • “This has been the hardest clinic since we have been here. Younger kids were harder to work with”

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Special Hope Network:

  • “We are here for a short time – one place for one afternoon – but there is so much more. These kids’ life is not all happy times – we are not able to experience everything”
  • They mentioned Purdue University: “Purdue is back” – hopefully our program has a bigger impact in the long run

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PCOE:

“The job is never done” – nurse who lives in a compound and provides nursing care to other residents at the compound after her work day

Conversation between staff member and child:

  • “Do you know why you have to take these medicines everyday?
  • Because I have HIV
  • What happens if you don’t take the medicine?
  • I am going to die”

This is the reality of the lives of children with HIV…

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…yet there is so much work being done to improve the lives of children with HIV and with disabilities in Zambia. Each staff member at every one of the community partner organizations that we work with is passionate about improving the lives of these children, and we are indeed fortunate to have met and worked with each and every one of you!

 

 

 

 

 

Day 12: Last work day and farewell…

Today was an EXTREMELY busy day that started at 7:15am and ended at 10:30pm! We are exhausted!!!! So here is a very brief synopsis:

First stop: Starkey Hearing Institute to meet Dr. Alfred Mwamba who was our initial contact through whom this program began. I still remember when we applied for our first grant for the program in 2011 how he wrote us a fantastic letter of support that enabled us to make the exploratory trip to Zambia in 2012, and since then bring 4 groups of students (total = 43 Purdue students) for a life-changing experience from which we hope they have learned much and we keep learning every time we return!

thumb_DSCN3588_1024As always it was fun for our students to meet the audio tech students there, but we had to rush to get back to UTH to do our encore presentation. As of yesterday I guess we have officially been on Africa time!

  • We were late reachign PCOE yesterday morning due to traffic
  • Late this morning as well…
  • Late to UTH for the afternoon presentation (which we gave to about 11 students who are practicing physicians who have returned to specialize in pediatrics)
  • And even a few minutes late for our farewell dinner with all of our community partners – traffic has been crazy!

Here we are ready to depart for our farewell dinner…

thumb_DSCN3715_1024And now to just acknowledge each and every one of our community partners for their inspirational work and for allowing us the honor and privilege of working with them, their staff and children: we are lucky to have gotten to know all of you these past 5 years!!

Pezo and Katelyn from PCOE – thank you for allowing us to rotate through all your stations and learn so much

Dr. Uta from Beit Cure Hospital – thank you for being so gracious and teaching our students about ear care in Zambia

thumb_DSCN3722_1024Sr. Clara, Judith, Rajiv and Charity from Cheshire Homes – we had a wonderful first day this year with all of you and the special little children at Cheshire

Milika and Lauren from Special Hope Network – we missed the Nelsons sorely this year, but as always were so impressed with your amazing staff and the work you do with the children at Garden and Ng’ombe

Mr. Malama from the Mthunzi Centre for allowing us to screen his “boys”! 🙂

thumb_DSCN3734_1024And as always the Mwambas for that’s how it all began….

thumb_DSCN3729_1024Tomorrow we shop and leave for home….

Day 11: PCOE Day 2

Today was our second day at PCOE and we were to be there at 8:00. We reached the hospital in time despite terrible Lusaka traffic….thanks to our terrific driver William!

thumb_DSCN3552_1024but were stuck in traffic within the hospital! So we finally got out of the bus and walked up to the building!

Upon arrival we were told that indeed they had arranged for us to provide our presentation to the 5th and 7th year medical students at 11:00! So we first observed and participated in their early intervention and autism groups (sorry no pics allowed) and some students also rotated through the neurology consultations and Adherence.

At 10:50 Christi and I walked over the the UTH Outpatient building with Sr. Ornella and went into a lecture room. Although there appeared to be a projector in the room, it was not connected and we were thankful that we have our small portable projector that can go anywhere and serves us so well!!! After taking a few minutes to find an outlet that worked and an extension cord, we started around 11:15 – there were about 30 medical students who attended.

The students were very engaged, asked lots of questions and seemed to appreciate the information that we shared – especially the practical aspects.

While we were gone the students continued rotations and also worked on making some AAC cards and sequence strips for PCOE at Pezo’s request.

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We had a little down time after that as we waited for the final patient to arrive: and a game of “Mafia” was begun!

Thanks Team PCOE for having us again this year – we always enjoy our time with you and learn so much about the work you are doing!

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As we were driving away from PCOE we got a call from them – they want yet another “encore” of our presentation: this time to post-graduate students!!! So we will have a VERY busy day tomorrow!

Some of us went for a walk again today  – another beautiful winter day in Zambia with bright blue skies….the zebra outside the Zebra Guest House is always a fun friend for our two week stay 🙂

This time our goal was to find fritters to buy at the roadside and eat them(since we were so successful with the roasted corn on the cob last time!) And indeed after we passed a couple of corn vendors, we did run into the fritters (fried bread)!!! We bought them from Charity and her grandson…

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And enjoyed them as we continued our walk 🙂

thumb_DSCN3571_1024We had our final nightly “pow-wow” today in Room 12 (tomorrow will be a long day and we will likely be getting back too late after our farewell dinner to have a pow-wow).

thumb_DSCN3575_1024And after discussing the day and prepping for tomorrow we had the funnest team bonding activity: a game of MAFIA! Whitney was a great narrator which made the game a lot of fun.

Ready for Mafia with the lights out and iPhone flashlights lighting the room 🙂

thumb_DSCN3577_1024Hard to believe that tomorrow will be our last work day here for this year and we will have our farewell dinner with all the wonderful people we work with!

Day 10: More student reflections on a difficult day of learning

This year’s students have been phenomenal about sending in reflections for the blog!! Here are two more about today!!!

From Ellen:

Today was much different than other days we have had in Zambia this trip. We went to the Pediatric Center of Excellence (PCOE) in Lusaka, which is an “advanced” hospital in Lusaka that focuses on treating children that have been diagnosed with HIV. I use quotation marks around advanced because it was not what you would expect from an advanced hospital in the states, but it works for them and PCOE is a model for other Zambian hospitals. They are still using paper charts at this hospital, and I spent an hour and a half with “Captain Jerry” and Liz getting the patients charts ready for tomorrow’s appointments – and we didn’t come close to finishing. We put in the papers that would be filled out at the next appointment in the file and we also made sure previous test results were in the file. I would say at least 50% of the test results were not in the file where they should be. We started out completing the files that were “ready” and then we went back to the files with missing paperwork. After some consulting with Jerry’s co-workers, they were able to find some of the missing test results and more files were complete and ready for tomorrow! I had to leave (and just as I was getting a hang of the system) to go to my next rotation, but I am assuming they found and completed the rest of the files. When I initially walked in, my thoughts were “this is a complete disaster,” but as we were leaving everything was working out. It was just a completely different system than I am used to, but it works for them! The “flow” of this hospital is also very different compared to hospitals in the US. They are given an appointment date with no time, and they are expected to be there early in the morning, and they stay until they are called back. It is on a first come, first serve basis. They start with triage, then they go to adherence, they see their doctor and nutritionist if necessary, and then they will pick up their drugs at the pharmacy. I don’t know if I, or the rest of American citizens, could get used to this. In the US, we are angry if the doctor is a half hour late to our appointment, and every single patient here clears their whole day to get their treatment. The whole concept of timing in Zambia is different. They are much more relaxed, and everything seems to move slowly compared to what I am used to. It has definitely taken some patience and adjusting!

After my rotation in the filing room, I went to sit in on an appointment with Sister Ornella, a neurologist at PCOE. At this time, she was seeing an 8-year-old boy who had severe epilepsy and developmental delays. He was there for a 3-month appointment, so Sister Ornella was just checking on his overall health. The mother stated that her son’s seizures had slowed down, but that he had recently gotten a cough. They discussed the medications that were prescribed, and we learned that he was prescribed a dose for an infant at a clinic in Lusaka, and Sister Ornella stated this was doing nothing to help him. The dosage is not common knowledge, so it was in no way the mother’s fault, but it was just sad to see that whoever prescribed this medication was so negligent. It is very important that children are given proper health care, especially when they are HIV positive and it was evident that this wasn’t happening at some smaller clinics in Zambia. Sister Ornella stated that she is no longer surprised when she sees mistakes like this, and that was hard to comprehend. I think in the states we often take for granted that quality health care we do receive, and I didn’t realize how different it could be in other countries.

The other rotation I did was the most eye opening. I was observing adherence, which is where patients go to speak with a counselor who will determine if they are using their drugs correctly. I have only read and heard about the HIV prevalence and actually seeing these young children today who were all HIV positive was heart breaking. We had learned a little bit about HIV before coming to PCOE, but I don’t think anything could prepare us for this experience. I observed three different children today, two who didn’t know they had HIV. They were both still taking their medications regularly, and they were able to explain how many pills they took, what time they took them, and what would happen if they didn’t take them. One of the kids was fourteen and didn’t know why the was taking this medication. All he knew was if he didn’t take his medication he would “get sick and die.” It was hard to hold back tears when he said this, and at first I was kind of angry that he didn’t know why this was happening to him, but after seeing the caretaker’s emotion and talking to the counselor I understood a little bit better. The mother was scared to tell the child, which I understand. The counselor told the caretaker that they needed to tell him as soon as possible, and she told her about support groups and techniques to make it easier for everyone. The workers in the adherence room were excellent support for these caretakers and patients!

Overall, today was a lot more learning than doing and it didn’t directly relate to our field, but I feel like I learned so much. I didn’t truly understand this situation in developing countries, and it really opened my eyes to the problem. I am so glad there are places like PCOE that work these patients and families and try to make this heartbreaking experience better for all involved. After our rotations, Dr. Krishnan and Ms. Masters gave a presentation on hearing loss and speech and language delays, and it was clear the attendees were very interested and thankful for the information.

From Liz:
We spent the day at the Pediatric Center of Excellence where the majority of patients have HIV. I learned a lot, but it was hard for me to see the prevalence and sad stories of families having to tell their young children that they have this infection and will have it until they die. They usually tell the children by the age of 10 that they have HIV, but the youngest person they have told was 71/2. I started the day in Adherence, which is where they ask the patients questions about how many pills they take, what time a day they took their pills, the expiration dates, among other things. The first patient was a girl and her grandmother, and the grandmother was not watching the girl vigilantly. Some of the pills had been put in a different pill bottle, and the counselor explained that this is not acceptable and to never do it again. She took the bottle away and very sternly told the grandmother the proper ways to make sure the child swallows the medicine and that everything stays in its original container to make sure the expiration date is still valid and that the child is taking the correct pills.
My next observation in Adherence was a mother with her 2 kids, a 10 year old boy and an 8 year old girl. The counselor first asked the boy why he was taking the medicine, and he replied that it was because he has HIV. She then asked him what will happen if he were to stop taking the medicine, and he promptly responded, “I will die.” She explained that first he would get very sick and not be able to go to school, and he eventually would die. But she also reminded the young boy that we all will eventually die. The counselor also inquired who the boy has talked about HIV with, and he stated “no one.” She praised the boy for being so smart and disciplined. At the same time, my heart broke that society has this negative stigma surrounding HIV, and kids often lose friends and are made fun of. I appreciated this though, in the sense that PCOE stresses that they do not want HIV to define the patient. Yes, they are open to ask questions to the PCOE staff and their family members, but they do not want the stigma to negatively impact their emotional well being and social lives. The counselor asked these tough, yet realistic questions multiple times, Next, the counselor asked the younger sister the same questions, and she did not know why she was taking the medicine. The counselor then turned to the mom and told her that it is time to tell her daughter and that she will have a brother to support and encourage her so that she did feel alone. The mother’s eyes welled up with tears and she slightly shook her head, as she was trying to deny that this day would come. I had to compose myself because I almost started to cry right there, but I cannot imagine that the hardest days for these parents and children are yet to come. I felt very uneducated and unexposed to HIV, as I do not feel like we talk about it much in the U.S., but it was a humbling experience to realize that my illnesses are so minor compared to how much these skids and parents have to be monitored. These kids are so young with so much life ahead of them, and I pray that places like PCOE will continue to educate and support families to raise awareness and reduce the prevalence of HIV here in Zambia.
The next rotation was the filing room, and then I observed a physio session. A young girl with cerebral palsy was unable to told her head up, and the entire time she screamed and cried. It was interesting that the mom was not very responsive and did not attempt to calm the child. It took everything in me to not just get up and start soothing the baby or singing to her help her feel comfortable. I was just there to observe, so I learned to accept that culturally parents do not interact with their children as much as parents in the U.S. Parents do not realize that language begins at birth, and all types of interactions shape the child in their first 3-5 years of life. Ms. Masters and Dr. Krishnan did a great job explaining those parenting styles and strategies in the presentation to make known what children need and what parents can do to make sure they are reaching milestones. Parents and staff seemed to be very responsive and appreciative of the presentation. I just could not believe that parenting strategies that are second nature to most of us, they have never heard before! I enjoyed observing and being exposed to new things today…it’s safe to say that this was the most eye-opening day so far for me.

 

Day 10: Pediatric Centre of Excellence (PCOE)

Not a lot of photos today, but we had a great learning day at PCOE. To our delight when we arrived we saw a flyer advertising our training presentation for the afternoon!!

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We had about 25 people attend the presentation including several parents who learned strategies to facilitate language development in their young children.After the talk Sr. Ornella, one of the pediatric neurologists asked if we could possibly present it again to the medical students again tomorrow! If that is able to happen, what a great educational experience we hope it will be for the soon-to-be physicians, who are often the first point of care. We hope they may use the information to help counsel the families of the children they see.

From Erin:

Our day at the Pediatric Center of Excellence was very eye opening for me. This center offers aid, counseling, and medication for children with HIV and AIDS. Being from the United States, I don’t know anyone personally that has HIV or AIDS so this center really was overwhelming in the fact that most of the young children we saw today had this disease. I was able to sit in on multiple 6 month check-ups, observe the nutrition counseling that they provide for the families, and see adherence appointments where the nurses counseled patients on their medications and gave advice to the patient and caregiver. Most of the young children that I saw contracted the disease from their mothers during childbirth. Because they have had HIV their entire lives, it hasn’t yet been explained to them why exactly they are taking medications and going to the doctor so often. I was not aware of how bad the stigma was regarding HIV and AIDS in Africa, but have learned that many parents put off telling their children about their status because they don’t want to have to tell them that they gave it to them. 10 years old is the suggested age at which parents should disclose this information to the children. Even when the child learns about their HIV status, they are counseled to not tell anyone else because it is likely they will get bullied at school. However, today I saw 2 children who didn’t even know why they were taking medicine. One of the young girls had been told that it was because she had a heart defect, which really struck me because she thought she was dying because of her heart. She also mentioned that no one monitored her taking medicine and finally it came out that the young girl hasn’t taken medicine for HIV since April. The nurse even seemed devastated because this young girl doesn’t know how dangerous it is for her to not take her medicine. I witnessed the nurses practically begging the parents to tell their children about their health condition because the nurses do not believe it is their duty to do so. The parents are responsible for this but some fail to take action. During the appointments, I observed again how independent the children are in Zambian culture. The nurse or doctor spoke to the patient, even if they were 10 years old. The child was asked how much of each medication they took and at what times exactly during the day. In the United States it is very common for the parents to just answer for the child and I was amazed at the responsibility put on the child with something as important as this. Although I was reminded that because this disease is so reliant on medication it is important that the child takes responsibility early in case anything would happen to the parents. A nurse even asked a caregiver if anyone else knew about the status of her child just in case something would happen. I was also surprised at how the appointments were conducted at PCOE. In America, we have the full attention from the doctor and have complete privacy. Especially in patients with HIV and AIDS, I assume the appointments in the United States are conducted with a sense of confidentiality, yet here we were sitting in on these appointments hearing everything about the patient. This made me feel out of place and guilty for sitting in on such a private matter for this family, but have learned that this is normal in Africa and the appointments often are not conducted with full attention or privacy for the patients.

Whitney with Jerry at the Registration desk…

After our rotations at PCOE were completed, Ms. Masters and Dr. Krishnan gave a presentation on speech and language development to parents, staff, and members of the community. During the presentation it dawned on me yet again just how second nature stimulating language for children is to many people in the United States, yet these people could have been hearing this information for the first time. The parents who asked questions at the end of the presentation had a sense of desperation in their voice for answers regarding their delayed children and I could just see the heartache that they go through on a daily basis. Everyone seemed very appreciative of the presentation and we are hoping that this information can be spread to many doctors in Zambia so they can counsel parents on methods and activities that can be performed at home to stimulate language development. We go back to PCOE tomorrow and I can’t wait to learn even more from the amazing staff and from the eye opening experiences I know I will have.

Tonight we also packed our final lunches for the program! Our daily routine after the day’s work is to eat dinner, and then meet for a discussion of the day and prep for tomorrow – after we pack our daily lunches of PBJ sandwiches, chips, fruit and cookies.

Can’t believe that we only have two more work days left for the SLHS in Zambia 2016 program!!

Day 9 Addendum: Evening walk

Since we got to Zebra Guest House early after our work day today, a few of us decided to go on a walk. Along the way we had a Botany 101 lesson. This is a banana flower…

And this is papaya or pawpaw (not mango) 🙂

thumb_DSCN3535_1024I always enjoy the beautiful bougainvillea flowers each year…

thumb_DSCN3534_1024And we really lucked out because we found Dorothy with her little roadside stall selling roasted corn on the cob!

A fun evening walk!