Education Programmes for Nurses, Clinical Officers, Medical Licentiates and Physicians in Western Province, Zambia

It’s July, and we’re 3 months into the dry season. The floodplains and lakes are shrinking. The herbivores are congregating near the large rivers, now significantly below their high-water levels. The animals compete for both moisture and for food. These are good times for the carnivores, their prey all neatly compressed next to one another.

For us, this trip is like no other. We’ve come to Western Province Zambia this time to formally evaluate the effectiveness of the teachings that we’ve offered to health care workers who staff some of the most remote clinical units on the planet.

During the last three years two of our nurses taught at the rural nursing school for six months. A science grad, now a medical student in Australia, spent time retro-fitting and making operational old computers at the same nursing school. Canadian nurses, family physicians, surgeons, and an anaesthesologist have taught the nursing and medical aspects of 40 different essential surgical skills, techniques of inguinal hernia repair, hypertension, diabetes, intensive care monitoring, and life support systems. We’ve also sent two annual iterations of our UBC Okanagan nursing students to Mongu, replete with professorial and teaching staff. Apart from the education of the students at the nursing school and the impact of our nursing students, we’ve also taught 90 nurses, midwives, clinical officers, medical licentiates and physicians.

And now for the fun part of tracking them down at their front line working sites to find out if these teachings are having any impact on improved patient care, improved outcomes and more job satisfaction for the worker.

Cameron J, at the ripe old age of 23, seems like an improbable leader of this evaluation team, and yet the universe has seen stranger things happen before! In fact, he’s the perfect person for the job. He’s the right person for the right job at the right time. Under the veneer of his youth lurks a remarkably mature and compassionate human being. Now a member of the first graduating class from Quest University, Cameron brings with him the eclecticism that is unique to that new and remarkable institution of higher learning. As a third year student at Quest, he came to Zambia with one of our essential surgical skills teams and performed an in depth evaluation of that course. With the support of his university mentor, he cut his first set of teeth in the art of international development evaluation.

Then, as the planning for this evaluation trip began, he spotted the opportunity of his young life-time, reaching up like a receiver waiting in the end zone to catch the ‘Hail Mary’ pass.

Cameron J was ready and the pass was perfect. You’ll have to wait until the final evaluation report is published to find out if he caught the ball or if he fumbled the play. You may get a clue as to the outcome if you listen carefully for the roar of the crowd!

Lianne, who has already cut her ‘ten thousand hours’ teaching in Zambia is back with the team to evaluate physicians, nurses, clinical officers, medical licentiates and midwives. This is her sixth trip to Zambia. She first became infected with the ‘Africa bug’ when, as a nursing undergraduate student, she went to Ghana with Mamma Fay as her professor / mentor.

It was Lianne, along with Jessica, who went to teach for six months at the nursing school in Mongu, Western Province.

It was Lianne, along with Jessica, who returned to Zambia to teach our UBCO nursing students along with Fay, now leader of student teaching in Zambia.

It was Lianne, along with Jessica, who rode the Tour d’Afrique with Bill to raise money for the Okanagan Zambia Health Initiative.

And so, it’s only appropriate that Lianne should be a member of this evaluation team. At the age of 26, she fits the job like a fist fits the glove, another trump card for youth, passion and vigour!

The third member of the evaluation team is Dr Andrew Silumesii, CEO of the Lewanika General Hospital in Mongu, capital village of Western Province. Andrew can only be described in superlatives. Without his help and support, OkaZHI could have achieved nothing – absolutely nothing! It was Andrew who supported our teaching efforts at the nursing school. It was Andrew who supported all of our teaching programmes. It was Andrew who supported Fay and her UBCO nursing students. It is Andrew who encouraged us to undertake this evaluation effort. A husband, and a father of two young boys, Andrew is the very model of commitment and passion for the health of his fellow Western Province citizens. He understands the needs of his people like no one else. We are honoured that he would join the team.

The fourth member of the team is Bill – whilst the founder of OkaZHI, he sees himself mainly in the role of cheerleader and the writer of blogs. Noted, it was Bill who actually threw the ‘Hail Mary’ pass to Cameron J, 49 years his junior!

Preparation for this evaluation trip was intense.

Key to the groundwork was having Bill’s daughter Rebeccah as counsellor and advisor. Rebeccah is a senior international development evaluator. Now an independent consultant, she has experience with CIDA, IDRC and with several other NGO’s. She is personally modest about her achievements, but father Bill has huge ‘bragging rights’ as to her successes.

Working with ‘Rebeccah’s grid’ for international evaluation, modified specifically for Zambia, Cameron J went to work, logging dozens of hours fleshing out questionnaires and interview formats to match the grid. With input from all key OkaZHI members, and an application to UBC human behavioural ethics department, Cameron J entered the end zone, nervously awaiting the ball now lofted high into the sky.

Lianne, for her part, was able to list all of our students, their locations and their contact numbers. With her uncanny sense of context and her knack for social networking, she coordinated our logistics like no other.

Andrew, with his Ministry of Health 4×4 vehicle and his driver Mr Mulambo, was to become our ‘eyes and ears’ on the ground. His commitment to the success of this venture was absolute.

On arrival in Lusaka, Cameron and Lianne explain our mission to Dr. Joseph Kasonde of ZAMFOHR. He is supportive and offers helpful advice.

Lianne, Cameron, and Bill travel to meet Andrew in Kaoma.   The trip from Lusaka to Kaoma takes 6 hours aboard the Shalom bus, the soundtrack of the journey alternating between earnest sermons and the spirited beat of Zambian music. 

There is more drama in our meeting here than we anticipate. We find ourselves at the Cheshire Home orphanage in Kaoma.

“Isn’t that the orphanage where ‘Lianne’s baby’ was sent?”

In October 2008, when Jessica and Lianne were teaching at the nursing school in Mongu, a premature baby girl was born. The mother suffered a placental abruption, and bled to death. The baby, at 28 weeks gestation, and weighing only 900 grams, was left to die – the mortality for this degree of prematurity being overwhelmingly high. The chances of survival for a baby like this admitted to a Canadian neonatal unit would be about 50% – in rural Zambia, that this infant might survive is unimaginable!

After 24 hours without feeds, Lianne and Jessica appeared, initiating a round the clock vigil, adding frequent feeds with infant formula. A month later, Fay, Gary and I – visiting in Mongu – saw and photographed the baby, then about 1 kilogram in weight.

Now three years later, and recognizing the poignancy of the moment, camera ready, I followed Lianne to the orphanage in Kaoma.

Then it happened. Tears welled in Lianne’s eyes as the baby was brought to her – perfectly healthy – still asleep from an afternoon nap.

Talking about evaluation, this child is a miracle as measured by the only criterion that really matters: a live and healthy child.

Mwewa was our first candidate for evaluation. If the world had a few more Mwewa’s, we would surely live in more harmony. A physician extraordinaire, it was such a delight to see him again. He attended two of our courses.

Driving north to Lukulu, we saw the newly acquired Chinese mobile hospital deployed for the first time in Western Province. The current expectations are that these units will flounder – but that’s a topic for another day, and a challenge for another evaluation team!

Returning to base at Sister Christina’s in Mongu, we had nabbed 7 completed evaluation interviews with attached questionnaires, and we had visited two of our intended 8 villages. The team’s confidence was soaring.

Mongu – home to 55 health care workers that attended our various and sundry courses – was a state of controlled madness as we tracked down most of them for their participation in our evaluation process. Two things stood out – the willingness of all to participate, and the frankness of their responses – ideal conditions for a successful evaluation outcome.

As is our usual custom, we met with Dr Sitali, the Chief Medical officer for Western Province and the Permanent Secretary – think Premier.

And then, no visit here could be complete without meeting with SK – Silumelume Kufunduka Mulambwe – retired Zambian diplomat and direct descendant of the first Barotse king.

Notable were interviews with Drs Liywali, Idi, Kamanda, Kongola, Kazuma, and with  Nurses Precious, Lillian, Mumbuwa, and Pelini.

And now, we’re off to Kalabo on the far side of the Zambezi floodplain.

Much as I love Mongu and all of the people there, Kalabo is one of my favourite spots. Home to our students Frederick, Arthur, Patson, Willard and Justine, and to the District Medical Officer, Douglas Shingini, there is a spirit of adventure and courage that I find hard to describe.

It’s not the most remote village that I’ve ever visited. That distinction goes to Tuktoyuktuk, but it ranks a close second. Here they don’t suffer the extremes of cold seen in the western arctic, nor do they see a season completely devoid of plant life and agriculture. Here they grow rice in the low waters of the floodplain and maize at the peak of the rainy season, also enjoying a continual supply of fish from the rivers. What makes life here more difficult, and unlike Tuktoyuktuk, is the lack of infrastructure and access.

Tuk has an electronic radiology service. Kalabo struggles with basic x-rays, that is, when the power system is up. Tuk has an all-weather 24/7 air medivac system. Kalabo has an airstrip, but no aircraft or ambulance support for patients.

Even with the high waters receding now, we were still able to travel the 74 kms across the Zambezi by boat through deep channel trenches.

We’re heading south now to Senanga, Sioma, Shesheki and Sishili as our destinations. That will bring us to the Caprivi strip border with Namibia, and Livingston as our nearest major town.

At the trip’s end we had made contact with 74 of the 90 professionals we taught – all working at their remote sites of employ.

All in all, we gathered an enormous amount of data.

Even though the final report has yet to be written, you know that Cameron J caught the ball in the end zone because of the roaring of the crowd.

Yes, they all found the teachings to be most helpful.

Some quick snippets:

(Remember that some of our students had only 10 days of training as opposed to a 5 year residency training in a first world country!)

“Our wound infection rates are down.”

“I’ve been able to do bowel anastamoses.”

“I’ve done 60 inguinal hernias since you taught us.”

“I placed a chest tube in a two year old with empyema – and she survived.”

“I’ve done three leg amputations.”

“I’ve done a splenectomy for Sickle Cell disease.”

“Doing Caesarean sections is easier now.”

“I feel more confident.”

“We used your templates to start our Hypertension and Diabetes clinics.”