June 29, 2010

John Deason
Lipscomb College of Pharmacy
Namwianga, Zambia
 

john deason dentist office

As time goes on I am getting more responsibilities in the clinic.  As of late, I have been working with a Zambian dentist named Ba Ian (Ba means Mr. or Mrs.).  He is a wonderfully kind and patient man that is very good at explaining his work.  A small skinny man in stature but hold tremendous respect with his patients; always keeping a smile on his facem, he whistles and tells his patients jokes to keep them at ease.  There is much you can take from his patient-provider interaction. 

He allowed me to assist him in his work, which sadly in Zambia is very simple.  If you have a tooth ache, 9 times out of 10 it a cavity (which gets marked down as chronic pulpitis), and a cavity equals extraction.  So needless to say, Ba Ian often refers to himself as a butcher since he mostly pulls teeth.  In helping him, I have actually pulled some as well.  He likes it if I have a rounded view of the job.  It’s actually no where near as difficult as it sounds (as apposed to the old cliché).  Teeth come out rather easily once you know how to pull; granted Ba Ian only gives me the “easy patients.” 

My chief job in his office is to write down the chief complaint with diagnosis as he goes around checking the patients in the room.  Generally he has four to five patients at a time and interacts with them all at once.  As you can guess privacy isn’t as big for everyone here as it is in the states.  Once he has diagnosed everyone, he gives them each a shot of local anesthetic (generally benzocaine or lidocaine) and has them all wait outside.  He calls them in one by one and does what needs to be done, then has them all wait together again as I collect the medicine they need post-op (which is simply and antibiotic and Panadol, what they call Tylenol).  The biggest reason for me collecting there meds (because they could simply walk to the pharmacy themselves) is that he wants to minimize their overall wait time so they can quickly get home without feeling so dizzy or sick.  Since I have instant access to the dispensary and know exactly what he needs, things go much faster and we can council the patients then and there and send them home knowing they got what they needed.

Besides the clinic, I was able to look in on a rare experience that few Americans get to see.  Sadly, the mother of Ba Leonard (the head cook, but also essentially main person in charge of the estate when the Hamby’s aren’t here) passed while we were here.  It wasn’t a complete shock since she was very old, but the parting was still difficult for the family.  Leonard’s son Harold took over in his stead for awhile.  He is doing a magnificent job.  There is no doubt that we are well fed.

We were invited to the funeral service the following Monday after her passing.  As with many things in Zambia, this service took a long portion of the day.  Throughout the entire time, both in the viewing of the body, traveling to the burial site, and finally laying her to rest, the Kasibi choir (whom I have mentioned in an earlier blog) stayed by her casket and sang church songs in Tonga.  Once the viewing had ended everyone packed into every car available and rode a long way down a rough dirt road to the grave site.  Once we got out (and stretched, since we where in the back of a ford ranger with 9 other Zambians) we walked through a grove of trees and say a large crowd already gathered there singing.  It was simply beautiful.  I’ve said before, everyone in this country was born able to sing and nothing could be more true.  All the men gathered on one side and the women on the other and they formed a large circle around the site.  Every song was in Tonga and in each a four part African harmony.  I’ll never hear the likes of such music again! 

Once the body was buried, which was a task in and of itself since concrete and tin had to be laid upon the casket to prevent any animals from digging anything up, they began speaking in turns.  There was a translator there for our benefit.  The most striking thing said was from one of the church elders.  As he spoke, he said, “Her spirit will not remain on earth as a ghost to haunt us as our grandfathers have taught us.  No, she will go to the place where all spirits go, and that is to heaven with Jesus!  Here at this time you have the choice to accept this or not; accept the truth or choose to believe your grandfathers!”  I was deeply moved at the display of the man’s faith and that here on the other side of the world, God’s people can still be found. 

Once everyone has spoken they began to call those in the family and others that were close family friends to come up and place flowers on the grave.  I was honored to have my named called with the rest of the Americans staying at the mission.  Once the flowers had been placed, a truck (lorry) pulled up carrying a good number of Zambians.  They instantly ran for the grave and began wailing and falling to the earth beating it with their fists.  Some in the crowd joined them.  I had never seen the likes but certainly wasn’t offended by the gesture.  Just as in all other things, it shows the outward expression of emotion that these people display.  I wish more people could be more like that.  It gives great peace of mind to see how someone is feeling so clearly.

After all the wailers stopped, a few personal effects of the deceased were placed amongst the flowers and we parted.  The rest of the day was rather somber.  I was exhausted emotionally along with everyone else and turned in early that night.  I was able to still take in the words the elder said which comforted me greatly.  

The more I see into the lives of these people, the more I find that I love them.  From the kind jokes to cheer a patient to the broken hearted cries in the middle of an African savannah, these people show you sincerely who they are and welcome you into their lives to share in their struggles and joys.  God has greatly touched me with this opportunity to know people so open and kind.  Again, as always, I pray I can do my best to play a role in His great works.

June 28, 2010

Jennifer Hunt
ASPIRE Appalachia scholar
College of Public Health - East Tennessee State University

hunt 2 health fair

Since the start of my internship, I have already experienced so much about health administration from a rural health perspective and have had the opportunity to be involved with some amazing projects that assist the county’s rural population.

My internship is located in Cocke County, Tennessee with Rural Medical Services, Inc (RMS).  RMS has clinical centers located in both Cocke and Jefferson County and serves the surrounding counties.  While the Appalachian region, which RMS serves, is rich in cultural heritage and traditions, it is also often plagued by high levels of poverty and low levels of education.  In April 2010, the Newport Micropolitan Area reported 2,190 people unemployed resulting in a 13.4% unemployment rate, down from the March unemployment rate of 15.7%. According to the most recent estimates from the State of Tennessee, Cocke County has an average high school graduation rate of 61.2%, under the state average of 75.9%; Cocke County also has only 6.2% of the population that holds a Bachelor’s degree or higher.  Cocke County has  a population o 7,426 of 20.6% of its population is below the poverty level.  

My first day at Rural Medical Services (RMS), I was able to attend the both the monthly staff meeting and the Board of Directors meeting.  The staff meeting included all providers from each of RMS’s five clinical centers, along with the CEO, CFO, Operations Director, and the Human Resources Director.  Although RMS is a health system, the clinics are run with an element of autonomy at each center (the CEO jokes that he calls each center his “little fiefdoms”).    In addition to clinical responsibilities, providers are charged with the administration of their clinics.  Reports were given from the Medical Director, the CEO, CFO, and Operations Director.  Following these reports, a roundtable type discussion was held that let each provider from each center discuss any topics with which they were concerned.  An interesting topic that was discussed at the meeting was the passage of the new health care reform bill.  The CEO, as well as other providers, voiced concerns about the impact to their patient population as a results of the bill’s passage.  RMS experienced decreases in patient population with the changes in TennCare, RMS  and is concerned about the effect this bill may have on their patients.   It was stressed that RMS must continue to strive to be patient friendly.

The Board of Directors consists of two representatives from the patient population from each center, the CEO, CFO, Human Resources Director, and the Operations Director.  The Board meeting is run similarly to the staff meeting, but in a more formal matter with a call to order, motions, quorum, etc.  At the first Board meeting, provider patient-visit goals were discussed as well as the bid process for remodeling the Newport Center. It was interesting to learn about the bid solicitation process RMS must go through in order to remodel a facility. 

Another interesting administrative aspect that I was able to participate in was the walk-through of the Chestnut Hill Center remodeling project.  The Chestnut Hill Center is located in Jefferson County, TN across from Bush Brothers, Inc.  In May 2010, Bush Brothers, Inc. bought the facility that housed both the RMS Corporate Office and the Chestnut Hill Center.  As part of this purchase, Bush Brothers offered to relocated the clinic to an old school house located approximately half a mile down the road from the current RMS facility.  Bush Brothers, Inc.  agreed to pay for renovation of the old school to convert it into a brand new health center facility for the patients of the Chestnut Hill.  The new center will contain 7 examination rooms, a nurse’s station, 3 doctor/provider offices and lounge, a clinical laboratory, patient waiting room, billing center, and a procedure room.  RMS will lease the building from Bush Brothers, and Bush Brothers (in addition to paying for the renovations) has forgiven the first year lease payments for the facility.  RMS and Bush Brothers has a long standing relationship in the community and Bush Brothers viewed this remodeling project as a way to give back to the residents of the Chestnut Hill community.

The second week of my internship included helping with the annual RMS Health Fair held at the Lincoln Ave Baptist Church in Newport, TN and La Gran Commision Baptist Church in Morristown, TN.  These health fairs bring a number of services to the community that they would not otherwise have access to such as lab work, physical exams, pap smears, prostate exams, mammograms, eye exams, bone density scans, spinal screenings, and hearing exams in addition to health resources from other area organizations.  All these services are provided free of cost to the community!  Although the fair didn’t start until 9am, many people were waiting in line as early as 6 am to make sure that they could be seen and it was apparent that many of these people relied on this health fair to receive their health care. 

My main project for the summer is to conduct both patient and employee satisfaction surveys.  The patient survey asks a variety of questions to determine the overall patient satisfaction with both their respective clinical center and the RMS system as a whole.  For example, one question asks patients to assess the level of satisfaction of the centers was “Please rate the treatment received at this facility.”  Patients completing the survey rate their level of satisfaction on a scale of one to five, with one being very satisfied and five being very dissatisfied.
           

I have been collecting the surveys periodically since the start of my internship, but the final collection date will be July 1, 2010.  I will record and analyze all the data and will present my findings to both RMS staff and the Board of Directors in a PowerPoint format.  I will also include an analysis of the rating percentages for each facility on a separate handout sheet.  The purpose of this survey is to help the community by showing RMS and the centers what the patient population perceives as most important and will in turn to use this input to identify and implement quality improvement initiatives.

The employee survey is set up in a similar manner, with the goal of the survey being to assess the employee satisfaction at RMS.  I will begin collecting and inputting this data during the week of June 27th, 2010 for a presentation to the staff and Board of Directors at their monthly meeting.  I think that this employee survey will be extremely beneficial to RMS because they have never done an employee survey and it will provide a good indication of the overall morale of the staff. I am anxious to see how my presentation of the survey results to the staff and Board of Directors will be accepted.  I hope the results will encourage staff and providers reevaluate reconsider how things are running administratively within their center.

June 22, 2010

Frist Global Health Leaders Arrive in Zambia


Two Lipscomb College of Pharmacy Students Send Their First Impressions of Namwalia, Zambia

Global Health Leaders Brittany Latimer and John Deason arrived in Zambia last week. This is Brittany's first time in Africa, and this is John's first time outside the United States. Though both are dealing with a touch of culture shock in Namwianga, Zambia, they report a warm welcome at the local church, a fun time with kids over food and dancing, and a challenge with the local clinic to understand how best they can translate their knowledge of clinical care given the limited resources available for the patients.

We invite you to read their blogs and see their photos!

Brittany Latimer
21 June 2010: Arriving in Zambia: Understanding Health Care Limitations in Namwianga

John Deason
21 June 2010: Sunday Morning Church and a First Look at the Clinic: John Deason in Zambia

Water=Hope Campaign at Darien Lake and Philadelphia: End of the First Leg of the Tour with Impressive Results!

Philly Vols 

Brande Jackson is keeping us up to speed with blogs and photos from each stop on the tour. We are excited to see the numbers of volunteers continue to increase as well as the new members and donations! We had our best night ever in Philly -- with wonderful volunteers, fans, and activists. Read the blog:

22 July 2010: Water=Hope at Darien Lake and Philly: Bringing the First Leg of Tour to a Close!

We need your donations. Donate today to Water=Hope Campaign. We will be using your dollars to build wells around the world, and we will be announcing which countries those wells in which those wells will be built in the next few days.

Follow the Water=Hope crew and volunteers on the road on our Facebook page.

Yours,

JED signature 

Jenny Eaton Dyer, Ph.D.

June 23, 2010

by Brittany Cannon
East Tennessee State University: College of Public Health
Roatan, Honduras

This past week I was involved with the coordination and follow through of community health fairs on the island. These health fairs are vital for the public in that they enable us to reach out to those living on the island and perform various health screenings for people who do not understand the importance of and/or do not have the funds to get these health screenings on their own. 

Blood glucose tests and blood pressure readings are administered at the health fairs.  Diabetes and high blood pressure are prevalent on the island.  I was able to perform over 200 blood sugar tests and blood pressure readings last week.  In addition to testing I was also able to inform people who came to the fairs on the importance of monitoring their blood pressure and ways in which they can manage high blood pressure.  Likewise, I was able to educate those with high blood sugar about diabetes and ways to keep their blood sugar level in control.   If either test turned out to be extremely high I referred them to Clinica Esperanza where I am currently working so they can be more thoroughly examined and when appropriate receive further care or medication.  At Clinica Experanza, no one is turned down due to their inability to pay so if they can get transportation (another barrier) they will be seen by a doctor at the clinic. 

Health screenings are an important component of public health.  By planning and implementing these health fairs I am able to reach a number of communities and interact with people that are far from the clinic and might not otherwise seek out these sorts of tests or even know the significance of such tests.

Many of the people I spoke with did not understand what diabetes is much less how to control it. This is a real problem on the island because much of the diet consists of fruits and non-complex carbohydrate (white flour) products which are known to contribute to spikes in blood sugar levels.

 I am organizing and will conduct three more health fairs this week and have also put together a program on nutrition. I will be conducting this class at the clinic to inform people on the importance of making health conscious food choices.  For example, soda (soft drink) consumption is huge here so hopefully through this class I can help people understand how what they put in their body relates to their health.

 

June 22, 2010

by Brande Jackson

Our show at Darien Lake - located between Buffalo and Rochester - had us a little concerned about being able to recruit volunteers, since it is a bit of a drive from either city. We were excited to have a great crew of volunteers come out and join us: a mother, daughter & aunt team of Susan, Carol and Melissa, as well as Corey, Chelsea, Cary and Lyndsey, who are a combination of friends, sisters and fiances that all drove into from Rochester!  Our team did great, helping us sign up lots of new supporters and raising lots of money for our well building projects, working all night to talk to Brad fans about the importance of clean water.

Darien Lake Vols

We got a lot of support from the crowd from the minute the doors opened until the very last fans left the venue; Nick and Francis, pictured below, kept talking to us long after security ushered everyone out and loaded up on Water = Hope materials to help spread the word among their friends in Buffalo.

Nick and Francis_darien lake

An overnight bus trip brought us into Philly in the morning. On a personal note, I’ll admit to some bias: I love doing shows in Philadelphia, I’ve always gotten a lot of support for the campaigns I’ve worked from the fans there, and everyone seems to be in a perpetually good mood! Our show Saturday night lived up to my expectations, giving us the biggest night we have had yet on the tour.

Our night in Philly was a direct result of an AMAZING volunteer crew that we can’t thank enough: Bill and Brianna are high school students and friends who worked so hard all night that it felt like we barely saw them, LeeAnn is a huge Brad Paisley fan and supporter of water initiatives like this, and was a huge help at our busy booth, Neil and Yang are cousins; Neil is an exchange student from China and Yang took a train up from Washington DC just to join us and help out!

Philly Vols

Then we had ‘the girls’: Angelina and Danielle are old friends who frequently volunteer together, and Sara, Angelique, Samantha and Rebecca are all friends and in high school. Both groups of ladies took to the parking lots to talk to the tailgating crowd before the doors opened, and they took on our ‘friendly challenge’ of which volunteer could sign up the most volunteers with a passion. Early on, it looked like Angelina and Danielle would take home the Water = Hope hoodie prize (together, the two of them signed up well over 300 new supporters!) but the sister team of Sara and Angelique edged them out; they signed up 200 new supporters EACH, a record for the tour! 

The crowd in Philly was full of love for Water = Hope; fans are really excited about our well building project, loving the idea of country fans working together to bring water to a community that needs it. We had our biggest night yet both in new Water = Hope supporters and in the money we were able to raise for the wells, and we also signed up lots of new Philly volunteers to join our incredible team of campaigners!

In the meantime, there are all sorts of ways to support Water = Hope: text H2O to 25383 to give $10, and you can sign up and a part of one our amazing volunteer teams by http://waterequalshope.com/volunteer/. You can also check out more photos from the tour (and tag yourself if you are in them!) on our Facebook pagehttp://www.facebook.com/hopethroughhealinghands.

June 21, 2010

by Beth O'Connell
East Tennessee State University
College of Public Health
Cygera, Rwanda

beth_rwanda photo_family

Health Education            

Health education has been quite a success at the local high school. The Senior 3 class was very interested in and had many questions about the previous HIV/AIDS education. I based the next class on their questions. The following week I chose malaria as the topic because of its prevalence in the area. The students were misinformed about transmission of malaria. They thought that it was transmitted through unsafe drinking water, as so many of the other common diseases. I think that this may have been a communication error in previous education about removing stagnant water which breeds mosquitoes.  I continued health education in the general paper (essay) classes which I mentioned in my last update.   Students have turned in the required information on their selected health topics. The topics they could choose from were as follows: malaria, food contamination, safe water, community safety, and HIV/AIDS .  The students’ personal experience stories are educational for me and very eye-opening to the severity of these community health problems. The quality of their work varies widely. Ensuring that each student learns has involved individual study sessions after school hours. The students know where I am staying and come to visit me for help, sometimes voluntarily, sometimes by my request. I am in the process of grading the papers and discussing the topics with them. It has been helpful to the students to spend so much time discussing major health concerns in their community. This education has served a total of 112 students. Teachers also learn and ask questions.

Hand Washing and Water Treatment

My hand washing campaign has transitioned from group audiences at the school and church to individual homes in the village.  Each home visit has involved education through a translator and giving of written instructions in the local language and providing soap. I have also been providing each home I visit with a water treatment liquid produced by U.S. Aid. This treatment kills many of the biological contaminants in the local water. Some people are familiar with the product and its use, but are unable to afford it; others have not seen the product before.  I have provided an amount which should treat drinking water for an average family for one month.  This is only an estimate, because the bottle does not say how much water it will treat.  The instructions only say how much to use one cap-full for twenty liters of water.  Also, family sizes vary largely.   The education at each home includes information about boiling water as a method of killing contaminants.   They do not have a word for boiling, so I have explained that they must cook it until bubbles cover the surface for several minutes. This outreach into the community required the permission of the village elder, Anastasie Mukabashanana. We met and discussed my plan, after which she gave her blessing for the home visits. I then began the campaign with the village leader, giving her the items and education. She or one of her aids has been accompanying me on the home visits. The people in the village have been very receptive and thankful and this has been a rewarding experience.  A day of visits involve several hours of hiking at a time in significant heat; the terrain is hilly and the footpaths are rough.  The living conditions and lack of education are staggering and these visits have been incredibly educational for me.  We have visited 72 homes, which housed 332 people.   The local church congregation was also given this water treatment product.  There were 115 participants at the church, many of whom will share the liquid with families at home. This is a total of 554 participants in the safe water education. There have been a total of 706 participants in hand washing education to date. The difference in the two numbers is 112 high school students.  They are benefiting from bio-sand filters, and therefore were not given the water treatment liquid.

Bio-sand Water Filtration

Following up on the bio-sand filter installation project, I have overseen the “feeding “ of the bio-layers daily.  The Rwandese Health and Environment Project Initiative (RHEPI) that originally installed the filters has been helpful in continued maintenance. On Tuesday June 8, a RHEPI representative returned at my request to investigate slow flow rates of four of the filters. Other minor maintenance has been required, which I have performed with guidance from RHEPI.   Four of the filters are currently working well, with flow rates of about 0.7 liters per minute.  RHEPI will be returning soon to replace the sand in the one that is still flowing poorly.  After I leave, the school secretary has promised to maintain the two located at the school. The administrator at the children’s home will maintain the three there. The major maintenance is required during the initial setup, and further maintenance should be as simple as using the filters daily. Should there be problems, the school and children’s home have my contact information and the contact information of RHEPI.  On Friday, June 18, I travelled to Kigali to visit the RHEPI office to investigate options for future projects through partnership with them.

Malaria Prevention

I continue to work toward protecting the children and caretakers of the Faith and Hope Children’s Home from the hazards associated with mosquitoes and other insects.  I again sprayed the homes again with insecticide one month following the initial treatment as recommended by the manufacturer.  Also, I paid for and arranged the replacement of two broken windows to avoid insect entry into the homes. Communicating with a technician for such a project to specify exactly what needs to be done and how much it will cost can take several hours. I will spray the homes again in one month and have instructed the home administrator about using the insecticide after I leave. Also, to make the screening over the windows more permanent, I have hired a local technician to put wooden frames around the screening. Spiders have become more prominent with the change of seasons, so the efforts to avoid mosquitoes have also been useful in avoiding the spiders.

Conclusion

In doing all this, I have educated myself as well. The interventions and education that I have done in the last two weeks have been predominantly beyond what I have learned in classes at the College of Public Health at East Tennessee State University. I have used my skills on how to find information, which I learned in various classes while doing papers and projects. The World Health Organization and Centers for Disease Control and Prevention websites have been excellent resources for lesson plans at the school. I just happened to notice the water treatment liquid at a store one day and then looked into it. Communication has continued to be a necessary and difficult skill to use. This includes communication with the people I am educating with community gatekeepers and people all helping me.  I have learned that attitude and creativity is very important in accomplishing a task.  Many times, it has been up to me to come up with ideas and find a way to make them happen.  Motivational skills and a positive attitude have been necessary to do this.

My field experience has been very busy and successful so far. I look forward to seeing the results of some of the interventions that will produce tangible results soon. For example, the bio-sand filters will be producing drinkable water beginning July 4. I also look forward to continuing health education at the school. Despite challenges, this experience has been very educational and rewarding. I am excited to see what the rest of the internship holds in store for me and for the village of Cyegera

 

June 21, 2010

by Brittany Latimer
Lipscomb College of Pharmacy
Namwianga, Zambia

brittany latimer_zambia 1

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. 

 

June 21, 2010

by John Deason
Lipscomb College of Pharmacy
Namwianga, Zambia

John Deason_pharmacy in zambia

           This is my first blog posting on my trip in Zambia.  I’ve been in one week so far but it has seemed much more.  Things operate so differently from how they do in the states, especially if you have never left the country!  My first taste of Zambia was really on Sunday since much of my first day here was just spent traveling.  We traveled to a small village called Kasibi where we attended church.  It was one of the most humbling services I have ever attended.  The church was no larger than the den at my parents’ house (and we don’t have a huge house).  On the walls were either tacked or duct taped posters depicting Jesus or various biblical events.  Most looked like they were thirty-plus years old and were very weather worn.  The roof was tin and full of holes.  I doubt very seriously that it kept the congregation dry during the wet season.  The benches were small and old with no backings and were only long enough to truly fit four grown men tightly. 

            Despite the meager appearance of this place, the verse “that where three or more have gathered there [God] shall be” never rang truer.  I cannot describe the absolute joy I felt the entire time I was there, from the time I was greeted in Tongan (their local language) song, to our dismissal by circling the church and having all members in attendance shake each others hand in Zambian style (which is much easier to show rather than describe).  What delighted me most was that we somehow fit 100 or so individuals in this place!  There was no room to even breathe!  I could only think how wonderful it was that so many craved the word of God. 

            Afterwards we traveled back to the village where they had prepared a traditional meal (rice, chicken, and cabbage) and had their village band play us some beautiful music on their makeshift instruments.  All of the local children gathered around the band and danced in a circle.  It’s amazing how even the children of this country have more rhythm than those that get paid to teach it in our country…

            My first taste of the clinic came on Tuesday.  All I can say is I’m not in the States anymore.  I was taken back how much they can do with absolutely nothing!  The people having a prescription for Amoxil (a very common antibiotic) had to be dispensed Chloramphenachol instead!!! For those that don’t know, in the U.S. this has been reserved as a last line drug for serious infections where there is nothing else you can give due to it being so difficult to tolerate.  In essence, we have such a richer health system we can afford drugs with much better side affects while the people in Zambia have to take whatever they can get just for a sinus infection.  It was heartbreaking…

            I wish I could say the pharmacy was the only department in need, but it didn’t stop there.  The triage station (that they called the OPD, or Out Patient Department) took the vital signs of each patient wanting to see the clinical officer (Zambia’s version of a PA).  The ear-thermometers they used to get the temperature didn’t operate that well in the cold and had to be kept in the nurse’s pocket to keep it warm enough to work.  In addition, they were out of disposable covers so the tips were caked with earwax because they didn’t have enough alcohol pads to clean them in between patients.  They had only one size needle for all injections (23 gauge) which could be a little painful even to the tough patients. 

            God has certainly led me to a country of his people great in need.  I can only pray that I can be his humble servant and give back the blessing that God has bestowed me to his children he so dearly loves.

 

June 17, 2010

by Katie Skelton
East Tennessee State University
College of Public Health

All is going well here in Urubamba, Peru where my day begins at 4:45 am each morning. I wake up, get dressed, grab a quick bite to eat and head to the local bus station to catch an early bus to the local villages. By the time I arrive in the communities, it is 6:30 am. It is imperative for us to arrive in the villages as early as possible as the village families work in the fields in the morning so we must arrive before they set out for their daily routines.

For the past few weeks we have gone house-to-house to gather as much information as possible from the local communities. The purpose of our survey has been to determine the main health problems in the area. Our surveys are now complete and after many grueling mornings, the results have been analyzed. The problems are vast: nutrition, diarrhea, intense cough, lack of health education, and more. We have determined that the most pressing issue in the area surrounds none-other-than water in terms of both availability and quality.

The Sacred Valley is affected by water in every imaginable way. It impacts every area of their lives from health to their daily activities and jobs. Sadly water here is rationed and is turned off at different times of the day for various parts of Urubamba. I personally have experienced the effects of the lack of water; there have been stretches of days when I have been unable to bathe because water has not been provided to my home. As you might expect, I am unable to drink the water or eat anything that has been washed with it. Regrettably a number of my co-workers have become sick due to infections from drinking the water.

Although life here in Urubamba is impacted by water, the effects in communities fifteen minutes away are even more devastating. The majority of these families rely upon agriculture for their sustenance. Without water their crops will not flourish, they cannot give water to their animals, nor can they cook, clean, or do normal daily activities.

To obtain clean water these families must purchase water from a truck that makes trips to the area and of course, this is not enough water for all of the families. Aside from the shortage, this water is expense and families must also carry the water home.

From our surveys, we pinpointed many of the recurring health issues of the approximately 180 families in our target communities. Many of their problems are related to fecal-oral contamination, giardia, and other parasitic infections. People are treated for their illnesses but quickly experience re-infection as a result of drinking dirty water. To help solve many of these issues, I am currently working on a proposal to provide water filters to each of the families in our target population. These filters will allow families to have clean water free of parasitic infections. Through focusing on water we are hopeful we can help improve the health status and quality of life for the residents of the Sacred Valley communities.

 

June 15, 2010

by Jenny Eaton Dyer, Ph.D.

frist at global health gathering 6.14

Last night, Hope Through Healing Hands hosted a meeting for local, Tennessee global health nonprofit institutions, universities such as East Tennessee State University, Vanderbilt University, and Lipscomb University, and faith communities to gather for an authentic sharing of stories, interest, and work.

Senator Bill Frist, M.D. keynoted the event, discussing the unique city of Nashville, as a hub for health care, music, and faith, and how these 50 organizations might intersect especially with the faith communities given a shared global interest in caring for the widow, protecting the orphan, and over all – loving our neighbors – even if across oceans.

Jars of Clay, an amazing group of men who have been longtime activists in the movement against the HIV/AIDS pandemic, shared the stage with Senator Frist. They sang an apropos song for the evening, Two Hands. Dan Haseltine, the lead singer, spoke eloquently about his longtime vision of a unified front of global health advocates in Tennessee who might work together, hand in hand, to face the issues of global proportion. Their experiences and work have led them to found Blood:Water Mission, a Nashville-based nonprofit focused on building wells in Africa. In terms of raising awareness and advocacy in the United States, together we are stronger.

The goal of the evening was to allow a space for the coalition representatives to genuinely get to know their fellow colleagues better. Hope Through Healing Hands’ hosted small group sessions for a sharing of goals, missions, and work as a beginning for deeper relationships beyond the meeting. We want to encourage a robust network of friendships and partnerships among the global health community, especially for those times of global crisis and emergency relief.  

We wish to offer a special thanks to Brentwood Baptist Church for kindly offering us a facility, gratis, to host the event. We look forward to the inclusion of more faith communities and their involvement in the global health coalition in the future.

jars of clay 6.14global health gathering small group 

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