Zooming In: Healthcare

This post is the second in our “Zooming In” series, which focuses on the environment we are entering and the population we intend to serve and learn from in Zambia. We will focus specifically on our skills and philosophy and how those relate to particular needs on the ground. Finally, as a disclaimer, we have not worked in or visited Fimpulu before, so we are primarily reflecting on our own study and past experiences in the larger village Mwansabombwe. That said, even though every community and village is different, there are some similar trends and challenges that we will almost certainly encounter. 

Writing about healthcare in Zambia is tough for me.

It’s tough because statistics are a wily beast that can be misleading and discouraging, and in the process of explaining the struggles and shortcomings of healthcare in rural Zambia, I do not want to minimize the progress the country has made in the past couple of decades, or the hard and dedicated work being done by the local healthcare workers on the ground. It’s tough because the battle is overwhelming, and the challenges are complex, and we don’t have all the answers.

These are the statistics. Officially, the HIV infection rate in Luapula Province, Zambia, is about 1 in 6 for men and 1 in 8 for women.  Moms have a 1 in 59 chance of dying during childbirth during their lifetime. The top causes of under-5 mortality are largely preventable:

Neonatal  – 34% (includes preterm or intrapartum related complications, sepsis/infection, and congenital conditions)

Malaria – 16%

Pneumonia – 13%

Diarrhoea – 9%

HIV/AIDS – 6%

Access to care is a very real issue for many Zambians. I vividly remember scouring a clinic for a healthcare worker when a toddler was poisoned and I didn’t know how to respond. No one was available—the usual staff were out on house visits. On another occasion, the clinic had nothing except Tylenol to offer a child who, along with his siblings, was almost certainly suffering from whooping cough. Well-meaning healthcare workers often give malaria medication to anyone with a headache and fever, and I have so much sympathy, because if it’s your kid that’s sick, then the possibility of contributing to the development of drug-resistant strains takes a temporary backseat. The same kind of over-treatment often happens with antibiotics, when they’re available. For rural folks, the clinic may be a long way away, and the lines are most certainly very long. The vaccination rate in Luapula is the lowest in Zambia, with 40% of kids missing some or all of their vaccinations. Burns are common, especially among children, and proper treatment is often simply not available or even understood.

Complexity arises with the fact that healthcare must be holistic. Meds and docs aren’t enough. Half of all child deaths worldwide can in some way be linked to malnutrition-- tired and malnourished bodies don’t fight off infection well. Effective farming techniques and a solid understanding of nutrition are some of the best medicine in the world. Traditional practices have a very tight hold on many rural Zambians. It is not uncommon to see a child with a charm tied around some part of their body to ward off illness, or an arm cut and rubbed with “medicine” powder to cure pain, or the same powder packed in the ears of a child with an earache. A woman once shared with me her fear that her family would disown or attack her because an in-law she didn’t get along with had died without any seeming explanation, and they believed a curse to be at blame. More than one Zambian expat has related to me the practice that some locals have of giving Fanta to their babies, because it’s just fruit juice.

But Zambia is strong, and Zambia is loved. I once knew a remarkable Zambian woman who had taken the initiative to be trained at the local clinic as a “malaria officer” of sorts. I often heard her educate her coworkers about how to prevent and properly treat the condition. A Zambian farmer who, with the help of Peace Corps, was successfully cultivating a variety of sustainable crops and a fruit orchard, was beginning to catch the eyes of his neighbors who saw his success and the vibrant health of his family. Choshen Farm is involved both directly and indirectly with healthcare in Fimpulu. Their Home-BasedCare program (which you can and should read more about on their site) includes community outreach, education, and provision in areas of nutrition, food security, and community orphan care. They also work with volunteer caregivers from Fimpulu who serve the chronically ill in the community “by learning and teaching about HIV/AIDS, nutrition, personal hygiene, disease progression, treatment options, stigma, and positive living.” And the Gospel of Christ seeps through it all, sharing a promise of love and hope and a power greater than any medicinal charm.

The creative approaches to Zambia’s healthcare situation are as multifaceted as the problems. Personally, my time in Fimpulu will likely be largely engaged with the following:

 

• Volunteering as relief or regular staff at the local clinic
• Serving as an on-call midwife
• Home healthcare nurse for chronically ill members of the community
• Assist in the regular under-5 growth monitoring clinics, including immunizations and health education
• Advising on community health initiatives involving food security, nutrition, HIV/TB/Malaria care, safe motherhood, etc
• Investigating opportunities around the region with the national Ministry of Health

If I could add a bullet-point (and I suppose I can… it’s my blog, after all…), it would be “Learning a whole lot about healthcare in the bush.” A bit over four months from now, I imagine that’s exactly what I’ll be doing.

***For a more "official" look at Zambia's current health status and the progress made, 

as well as the source for the above statistics, see the Countdown to 2015 Country Profile for Zambia***