Namwianga, Zambia

Day One: The Clinic

This is my first time traveling to Africa, so for me it is a very exciting time.  I wanted to have a very open mind, but I had no idea what to expect.  In only a week I have discovered so many cultural differences.  The main differences I noticed were time, transportation, and friendliness.  In Zambia the people are not concerned about being punctual.  The people are never in a rush and they don’t mind waiting.  As compared to a pharmacy in the US where people want their prescription filled in fifteen minutes or less.  Mostly everyone walks to where ever they need to go since gas is about $9 a gallon here.  Also you have to be a great visual learner and use a lot of landmarks to remember where you’re going because there are no street signs.  There are just a lot of dirt paths that start to look the same.  The Tonga people are so friendly and peaceful.  Zambia is very peaceful, and the people greet you wherever you go.  Here everyone looks out for one another and it feels very much like a community. 

One of the biggest differences that I have noticed is healthcare.  I saw this first hand when I went to the healthcare clinic in Namwianga.  The clinic opens at 9 am, after the workers morning devotional, closes for lunch from 12:30-2 pm and then closes for the day at 4 pm.  They are open from 9-12 on Saturday and only open for emergencies on Sunday.  My first day there I worked in the pharmacy with another Lipscomb pharmacy student, John Deason, and the dispenser, Michelle.  They don’t even have a pharmacist, just a dispenser which is the equivalent to a pharmacy technician.  A dispenser has to school for two extra years after high school and has a general knowledge of the medications.  Once a patient sees the clinical officer they go straight to the pharmacy with their prescription and the dispenser fills the prescription.  They don’t collect any payment. 

Recently there was a new law made that any patients that come to the clinic do not have to pay.  They do not pay for medicine or to see the “doctor”.  This has made things quite difficult because the clinic basically runs off donations since they do not receive that much money from the government.  Therefore the pharmacy is very under stocked since they only receive one shipment at the beginning of the month.  They have less medicine than two shelves of medicine in a pharmacy in the United States.  Once they run out of medicine they have to do their best to substitute it with something else or the patient is out of luck.  They only had a couple of antibiotics.  For example if a prescription is written for Amoxil (because most of the prescriptions are in brand name, not generic) and the medication is not in stock, it will be substituted with Chloramphenicol.  Sadly, chloramphenicol is only reserved for very serious infections and is more of a last line agent because of its toxicity.  However since it is so cheap it is used a lot in third world countries.  Since they have so few resources they can’t take a lot of factors into consideration when choosing an antibiotic.  Although it may not be the optimal treatment, I am just thankful that at least the people here are getting some form of treatment. 

The most used prescription was paracetamol (which is also known as acetaminophen) because most people carry packages on their head or back if they’re not carrying their babies.  Some diseases don’t even seem realistic to treat here in Namwianga since it is a very rural area.  HIV/AIDS patients seem almost impossible to treat at an optimal level.  They send workers from the clinic out into the villages to try and get people to come into to get their medicines.  Also it’s hard to keep medicines in stock, because they have little money to work with.  Most people don’t have refrigerators.  After a suspension is mixed up for a child it is supposed to be stored in a refrigerator, but what do you do if you don’t have one?  We are just so blessed here in the United States.  Yes we may spend the most money on healthcare than any other country and still not have the best outcomes, but we have so many more resources and are so blessed.   

Day Two: The Patients 

The second day at I was at the clinic I observed the clinical officer working.  You may be asking yourself what is a clinical officer?  A clinical officer is equivalent to a physician’s assistant in the United States.  They don’t have many doctors here, so clinical officers serve as doctors and are at the highest end of the spectrum.  There are normally two clinical officers on duty but since one here at Namwianga is on leave, we are left with only one.  As soon as the clinic opens there is already a line of about five to ten people long.  Each patient has an exercise book where the clinical officer and nurses chart.  They keep all the patients vital signs in there along with their diagnosis, prescriptions, and any notes that they may have.  Once the patient has seen the doctor and/or gone to the pharmacy they turn their books back into the record room where they are kept. 

The clinical officer’s door is always open so patients don’t receive much privacy unless it is a highly sensitive issue.  One major difference is that an entire family will come in to see the clinical officer as opposed to parents seeing their personal doctors and their children going to a pediatrician in the United States.  It’s much easier for the family but it can be somewhat of an inconvenience

There were a lot of patients coming needing wound care or complaining of previous wounds.  There were three very memorable experiences that stuck out in my mind.  The first experience involved a man’s two young sons.  The younger son was less than 10 years old and had an inguinal hernia.  He was referred to a hospital in order to have surgery to repair the hernia.  The older son had a form of warts that started all the way in his left armpit, migrated up his shoulder onto his neck, onto the left then right side of his face and onto his chest.  He has had the warts since birth, but it has been spreading over the years.  The second experience included a lady who was in so much pain that she was doubled over and had to be carried out of the car to a wheelchair into the office.  She looked very emaciated and it was very unnerving to see her in so much pain.  She was HIV positive and possibly even had AIDS.  She had not yet started on her antiretroviral drugs and since she was in such critical condition she was referred to the closest hospital for treatment.  One woman came in with a prolapsed uterus and had to also be referred to a hospital for surgery.  There are so few resources that after the clinical officer examined the woman on the examination table he wasn’t able to change the sheets. 

The line of patients seemed to be never ending.  No matter how many people the clinical officer managed to see, the line only seemed to get longer.  The dentist had to take ten to fifteen patients in order for them to be able to get through all the patients in time.  The Clinical Officer had no reference materials in order to double check his initial diagnosis or to check the dosing of a medication.  He totally relied on his memory for everything.  He also didn’t have a peer that he could consult.  He was pretty much on his own.  It was quite an interesting experience to see firsthand.  The staff at the clinic has very few resources to work with, but they make do with what they have and try to do their job to the best of their ability.