Saturday, January 17, 2015

Training day 3

We had a busy final day of training with lots of information to share and celebrations to be had. 

We began the day by meeting three students who had passed their 7th grade exams which allowed them to go on to secondary school. These kids had worked very hard.  Unfortunately they all three had lost both their parents to AIDS. They would not be able to afford the fees to go to secondary school.  Fortunately HealthEd Connect has a fund that helps orphans and vulnerable children who do well in our school go on to secondary school.  The students were so excited to hear this.  They have dreams of being lawyers, doctors, and accountants.  Being orphaned has left them with little help from their families. Now they can continue to pursue their dreams. 

The 3rd day of training began with the groups identifying health care professionals in their community with whom they could share the information they learned. The hope is that they can partner with the professionals in the clinics in educating the people.  We did a few role plays to bring the point home. 

The first was with Sherri demonstrating what not to do. I played the role of the doctor in the community and there was much laughter at the two of us as actors. I then enlisted two actors from the crowd to share the info with me who again played the doctor.   I was very impressed with how much they learned. Given the noise of multiple translations and discussions at each table I wasn't sure how much was learned. Clearly the message came across. 

The next session allowed the groups to share what they do in each of their communities. This gave each group a chance to learn about all the possibile activities that the health workers could engage in. 

The first group was from the Congo. These women are traditional birth attendants who work tirelessly to deliver babies in their villages.  Here's a couple of them demonstrating a birth with lots of laughter by all. 
The Malawian women weigh babies and teach the mothers about health issues. Here they are trying to teach family planning to a pregnant woman with a baby on her back and another in her arms. It's nice to see that all health care workers can laugh about the work they do. 
The next group from Zambia demonstrated a home visit on a woman dying from AIDS. I'll blog more about this in another entry. 
This Zambian group demonstrated the child support specialist group that helps orphans work through their grief that comes from losing both parents. 
The final group was from Zamtan where we have just started our third school building. The health workers demonstrated digging the foundation for the school.  To help with the costs of the school 53 volunteers took a day to dig the foundation. Education and health are so interwoven that all of the health workers were there to help dig the foundation. 
To end our training day, each person received an official certificate indicating that they passed. It was a true celebration with singing and dancing. 

We even had time to celebrate Jac's birthday. That's quite the knife he's holding!

The training is over. It was three long days but I'm impressed with how much was learned by women who have had limited formal education.  I probably learned just as much. I hope this information will be helpful as they return to their communities. 

Visit to our new school at Zamtan!

Up until this time, we have most of our time with the health workers.  However, a big part of HealthEd Connects work is with community schools and supporting orphans and vulnerable children. 
Zamtan is our newest school and the students currently meet in this temporary structure and in the church nearby. 

Here is the new school building. Much more sturdy and water proof!
Seeing the two schools next to each other emphasizes the upgrade that the new school building brings. 
There have been some delays due to a cement shortage among other things. Here the men are working hard to prepare the floor. You can feel the sense of pride and excitement that comes with this new school building. 
Every student gets fed a lunch while at school. Here the kids line up for their food. 
Many of our students come from families where there is not much food to eat. The meal that our volunteer cooks prepare ensures that they have at least some nutrition when they come to school. 
I loved seeing them gathered together eating. 
Here's the whole group eating on the porch of the new school. 
Rotary recently contributed a burrhole which makes getting water for the porridge much easier. This woman has her daughter on her back while she pumps water for the kids. 

The students in their classroom. They performed a few songs for us while we were there. 

I'll end with this girl who had a great smile and the most adorable hairdo. These students are why we support the building of these schools. 

Home visits and palliative care

Our last meeting of the day was with our Kafwe health workers to discuss their home visiting program.   They visit people in their homes who do not have the family resources and support. Their patients mostly have HIV and TB and they work to support them as they seek treatment through antiretroviral therapy for HIV or antibiotic therapy for TB.  

Most of their patients have very little support and when they are sick there is no one to earn money to provide for their children.  Many of the patients eventually succumb to their illness and die.  These women are providing palliative care to many of the patients they treat.  As a physician trained in palliative medicine I wanted to see if there is something I could teach these health workers as they care for their patients.  

When I treat folks in America that have a terminal illness my team often asks the patient two questions. First, as you look to the future, what are you hoping for?  This question is often posed after a discussion around the seriousness of the patient's illness and many times patients have specific things they hope for like to be able to attend a grandchild's wedding or to be free from pain or to have their financial affairs in order.  The second question is what are you worried about?  These two questions help us to understand the patient's hopes and fears and we can hopefully begin to tailor our care and support to meet the patient's goals and needs. 

Our health workers have been using these questions over the past year.  What they discovered is that their patients are most worried about what happens to their family if they were to die and they worry about the cost of the funeral.  The patients they see have so little resources that all they worry about is how their family will survive without them. Their basic needs are not being met so that is all they can think about.  I asked if they could make plans for the future including who can watch their kids when they are gone.  Like our own culture, most Zambians do not like to talk about their death or to make plans for after they're gone.  Unlike our culture, however,  I was told by this group that their traditional beliefs make it even harder for they fear that if they make plans for after their death(like who will watch the children after they are gone), they will die shortly afterwards. They also mentioned that there is nothing to plan for given that they have nothing to give anyone when they die. 

I've learned enough about death and dying to know that it is an extremely cultural experience and it is not my role to  pretend to know I understand this culture. I did discover that these women are providing true palliative care to the patients they care for. They provide physical support by cleaning the patients that are unable to do so and to help them find some food. More importantly they support these patients emotionally and spiritually by caring for them, listening to them and praying with them. They also can help provide transport to the hospital when needed. 

You can imagine the emotional toll this can take on a health worker. Their patients need so much and they are only able to offer a little aspirin and their physical presence most of the time.  Given the emotional toll, we've been working with them to make sure they have good self care and support one another as much as possible.   One practice they have begun doing is a rememberence service where they list the names of the patients who have died over the past year.  We do this in palliative care often and it gives us health providers a chance to remember and honor those we have cared for and grieve their loss. 

At the end of this session I had an opportunity to make my own homevisit to a community member who was asking the Kafwe for help.  I had some trepidation going to the house knowing that I had very limited resources at my disposal and unsure of what I would find. 

The young man we were seeing let me into his mud brick home.  He had injured his back lifting cement blocks for his job. Through help of translation, I learned that he had pain shooting down his leg.  I also learned that when he had similar pain last month he went to the clinic and they took X-rays of his hip which I reviewed through his window. I performed an exam and diagnosed him with lumbar radiculopathy.  We gave him some aspirin ( the only NSAID we had) and I gave him precautions and showed him bending at the knees not the waist when lifting heavy blocks.  
It was not the emaciated AIDS patient I was expecting, however, his problem could be very serious and potentially threaten the life of his family and himself. If his injury persists, he could lose his job and be unable to provide for his family with three small children. I felt totally inadequate to deal with the depth of his problem and continue to be in awe of the health workers we work with.  I am so proud to be able to work with them. 

Wednesday, January 14, 2015

Training Day Two

The important part of the training occurred this second day. Much information was shared with each other and you could tell that these women were thirsty for knowledge. 
In the morning everyone started with tea and bread. The women all ate in the cookshack which normally is used to feed the students. 

We peaked into a few of the classrooms to see what the students were doing. Unfortunately we Americans stuck out like a sore thumb and were a bit of a distraction as soon as they noticed us. 
This little boy had to wait around while his older brothers and sisters enrolled in school. He's too young to go now but will hopefully be in school in a year or two. 
The fifth grade greeted us with waves and smiles.  
There was much singing and dancing as we opened our second day. I will post some of the videos when I return to the states. 
Here Idah is sharing some of her experiences with the group.  I met Idah in 2000 when I went to Malawi. Her son Prince and I became good friends. I learned on this trip that he named his first born son after me. He may be the only Jeffo in the country. 
At lunch time we met the girls who are just starting 7th grade. They are all part of the GAP (girls achievement program) which encourages girls to stay in school. Unfortunately, girls receive many pressures to stop going to school and we know that educated and supported girls and women improve the whole community much more than the boys and men. 
Our friends from the Congo made it to the second day. Travel in and out of the Congo can be very difficult. These women and their colleagues back home delivered close to 1400 babies last year. 
The women practiced through role plays. This group was showing how they could educate their communities about Ebola. 
We've walked several days to and from the center. This was the first day it didn't rain. 

More to share tomorrow. 

Monday, January 12, 2015

Spread the Word Not the Disease: Ebola Facts and Fiction

We just finished a great day of training. There was much laughter and singing and sharing of information.  We divided in our various location groups for ease of translating and to have participants share in small group discussions. Here is the Malawi delegation at their table.

We spent time discussing what each of their communities were saying about Ebola.  
It was fascinating to hear the various reactions in the different communities.  There was a lot of fear expressed by many in their communities especially during the past few months when there was a neighboring out break in the Congo.  I learned that there is a lot of misunderstanding and misinformation about the disease ( not very different from the hysteria in the US in October) and how important accurate information can be. We then had the health workers act out their village's perception of Ebola.
This woman has passed out and everyone is worried she has Ebola. The plays were hilarious and have a good sense of the rumors that were around. The plays also cut across language barriers.  I will write a separate blog containing more insight into Ebola but I think this is a very important topic for these health workers. 

As you can imagine feeding 30 people is no small task. Fortunately our community center is equipped for the task and some of the volunteers cooked for us. Here us the cook shack.
Inside the cook shack the yummy food was being cooked. 
We had fish for lunch. 
A lot of charcoal was needed to support the group for the week. 
And here was the finished project. 
I had the uneviable task of teaching after lunch. I taught them the funky chicken to shake off the post lunch sleepies. Fortunately, there are no pictures to share!

Overall it was a really good and productive day. I look forward to another full day tomorrow. 


I've had varying thoughts and opinions on the issue of Ebola over the course of the past several months. When I heard that HealthEd Connect was going to be facilitating a training, my first thought was    to question why we should spend all this time and resources to train on Ebola. With the so many dying from AIDS, malaria and dysentery, what would be the use in discussing a disease that is not even in the communities where are health workers live?  Currently their risk of contracting Ebola is zero so why do we need to educate them on this topic?  

After traveling around Africa the past week and listening to officials from the Zambian government as well as our local health workers, I have been made keenly aware of why we should be doing this training.  

First, Ebola is a scary disease. It's death rate is very high for a contagious disease and when people die from Ebola, they are isolated, scared and their loved ones cannot comfort them for fear of contracting the virus as well.  

When anything is scary we as humans tend to overreact and the fear builds. I remember the level of fear created by the media in the US a few months ago and the irrational responses many communities and governments made due to fear.  Their reactions were not based on rational science, rather made due to irrational fear. 

The same is true in Zambia, a country that borders the Congo which had a limited and under publicized outbreak a few months back.  Given the proximity to an affected country, there were many rumors and myths formulated about Ebola.  People were avoiding foreigners and others were worried that their fever meant they had it. There was even a story of one man entering a crowded market and shouting loudly that one of the other men in the market had Ebola which caused people to flee. When there is a scary threat there is a tendency to respond with fear.  

Second, Ebola is a serious illness and requires a serious response.  When the media exaggerates a situation, I tend to respond in the other direction. I downplay the seriousness of the so called crisis blaring from my TV.  I realize that there is no Ebola in the communities where HealthEd Connect works, But I'm  now also realizing that it still impacts these communities.  As the tragedy in West Africa is teaching us, if we don't take this disease seriously, the situation can spin out of control.  

Third, education is the key to responding in a serious, rational way. Without knowledge we make things up. When we have accurate information we can make an appropriate plan to respond.  By training our health workers in Ebola, they can work to dispel myths and rumors and if another outbreak occurs, they can help contain the disease before it spirals out of control. 

Last, trust is vital in dealing with this disease. We have the problem in West Africa because of lack of trust.  The people in these countries don't often trust their government officials or the hospitals near where they live. Likewise, the governments of West Africa were slow to ask for help likely due to lack of trust in the international community. Without trust there cannot be a coordinated response. 

Our health workers are very trusted by their communities.  By participating in this training they will gain further trust on a relevant topic that has been lacking in accurate information. This allows them to gain more support and trust to work on the issues currently facing their community.  I guess this Ebola training is important afterall. 

Sunday, January 11, 2015

Sunday preparation

Today was a day of celebration and preparation.   We began the day at church. We shared in singing, prayers and worship. The service ends with everyone greeting each other and shaking hands. 

As soon as church was over we were greeted by the sinkhani health workers from Malawi. They've been traveling for two days to get here.  They were greeted by shouts and singing from their Zambian friends.  

We are making the final preparations for the training which starts tomorrow. 

This includes getting water from the big tank so that everyone can bathe. 

We are still waiting for our health workers from the Congo, Zamtan, and Kasompe. It's uplifting to already feel everyone's excitement. 

Sunday preparation

Today was a day of celebration and preparation.   We began the day at church. We shared in singing, prayers and worship. The service ends with everyone greeting each other and shaking hands. 

As soon as church was over we were greeted by the sinkhani health workers from Malawi. They've been traveling for two days to get here.  They were greeted by shouts and singing from their Zambian friends.  

We are making the final preparations for the training which starts tomorrow. 

This includes getting water from the big tank so that everyone can bathe. 

We are still waiting for our health workers from the Congo, Zamtan, and Kasompe. It's uplifting to already feel everyone's excitement.