Follow-up day 1: Kafue

After much to-ing and fro-ing I have managed to start the follow-up of the Lifebox and SAFE Obstetric courses at long last. Ok, its not very far out of Lusaka but it is a start! Basically I was getting fed up of waiting to start - the plan was/is to do so at the very South, in Livingstone but the past fortnight there has been a promise of starting but basically not, so I bit the bullet and started locally. At least then there is some forwards momentum!

I'd also forgotten that when you arrange to meet at 8am in Zambia that means anywhere between 8-9.30am! However as I was kindly getting not only a lift but assistance from one of the clinical officers Mebby I couldn't complain. In fact it allowed me to sit at the cafe a little while and read through all the paraphenalia I had with me whilst sampling a pretty decent Cappuccino (from the best barrista in Zambia for the third year running no less!). So I wasn't too short changed!

  On our way South to Kafue through the rush hour traffic we took a back route and detoured past the hospital at Chilenje - which is currently a Level 1 hospital (has wards for surgical and medical problems and some obstetrics but no operating capacity). However they are upgrading it and turning it into a more substantial building that will have theatre capacity. And this will be the base hospital that Mebby will work at when it's done early next year the hope. So that was an interesting sight past all the scaffolding and mud due to the torrential rain. In fact that torrential rain stayed with us for the hour and a bit we drove to Kafue. 

En route Kafue - rain!

The plus was that the road was certainly in better nick than it was when I was last here. In fact the surface was pretty decent throughout and I think I only counted two pot holes. The other major plus of driving in pouring rain is that the police checkpoints all seem unmanned and we sailed right through them unhindered. I suspect they were all inside sheltering from the rain and the usual interest in the driving licences were waiting to be satisfied on a sunnier day!

Map to locate Kafue - second dot down from Lusaka!

 As we get close to Kafue (50km south of Lusaka), Mebby then turns to me and asks if I know where the hospital is. Ummmm, negative! This is a sprawling industrial town made famous by a hydroelectric dam across the river Kafue. I'd been through it en route elsewhere in the past but never really looked for the hospital. Never mind, we thought, there is a petrol station here so we'll stop and ask directions. So Mebby gets out and asks the three guys there for directions. She is clearly getting conflicting advice. I follow a little bit of the conversation - not by using Nyanga but by their dipping into English... blah blah blah cw Right blah blah straight on, blah tenga cw left. I now know how English people feel when Welsh speakers lazily use English in their sentences!! So poor Mebby, and by now, confused Mebby gets in the car not really much the wiser apart from the fact we've learnt the hospital is behind us! However by complete fluke I look in the mirror as she reverses and I see a parked land rover emblazoned with MoH (ministry of health) Kafue District Hospital. Quick, I said. Let's ask them. So we zoomed backwards across the forecourt in a reverse and screech to a halt in front of the very much amused driver. He nods at our predicament and calls over to a man in a white car filling up with petrol. It seems we are now to 'follow that car'! So that's what we did and slightly embarassing as we crossed the road we see the pretty obvious hospital signs! So we get there in one piece!
 
 The next task is to meet with the Medical Superintendent of the hospital. It's the protocol. We must meet the head of the hospital before speaking to staff. So we find the office and wait - she is on a ward round! She eventually arrives, reads through the official letter that we have (signed and stamped from the permanent secretary of health) and is happy with that! We also give her a recruitment poster which we've made to promote the MMed Anaesthesia programme to entice more applicants to come to train to become physician anaesthetists at UTH. She was very happy to put this up on the wall which is great. here's hoping some budding anaesthetists will see it and apply!

Recruitment poster for all hospitals and will also feature on the Ministry of health and the University of Zambia websites soon

 And then, we get to meet with one of the two clinical officer anaesthetists that had attended the courses we had run in the past. So I conducted the interview and asked all the questionnaire relevant questions, discussed problems and tried to answer any further queries. It all went smoothly, so I thought! At the end of the interview I asked where her colleague was and could I see him next. Ah, yes, he's working in Lusaka today part time. Wait a minute, I'll ring him.
 So she does and finds out he 'knocks off' (finishes at 13.00) so she advises us it would be better if we drove to meet him at the clinic where he was working part time. We set off in the car, back in the rain. I ask if we should double check before setting off. No, apparently not, we should wait til we get closer. So we got closer, ie the outskirts of Lusaka and pull across and ring him. He asks where we are, it seems he had got straight on a minibus after the phonecall and made his way back to Kafue. Well, was actually en route within 5 minutes of Kafue. Arghhhhh! Oh yes, there it was, the beauty of communication, communication, communication!
  There was only one option! We turned around and headed back to Kafue in the rain!

Heading to Kafue - mark 2!

 We meet with the candidate and pick him up at the bus shelter. It seems he makes more money as a basic medical officer clerking in patients for medical problems such as malaria or HIV or respiratory tract infections than he would working as a part time anaesthetist in UTH. So he does this on his days off to 'make ends meet'.  A soberingly interesting fact. We conduct his interview in the theatre rest room not the superintendent's office! This is great as it gives me the opportunity to look through the remarkably green theatre! And also to note the anaesthetic machine. It is an old donated one from Italy which they have had to revert to as their actual anaesthetic machine (also donated) is now broken and sits in the rest room as the local hospital electrician (and general maintenance guy) cannot fix the leak in the oxygen supply. It's been out of action for a month now. This is one of the reasons so many donated equipment stay in their boxes or are collected in a 'graveyard of mechanical objects' that cannot be fixed. Donating the latest spangly piece of kit is all well and good but if it cant be fixed locally then its going to be pretty useless in the future. However the new, but very old machine is a draw over (basically a machine which allows the patient to breathe and draw the air or oxygen that drives it through the machine themselves and doesn't necessarily need a supply of pressurised oxygen or gas to drive it). This is a great piece of kit and is widely used in many low income settings, however the fly in the ointment here so I was informed is that only one of the 4 clinical officers had ever been taught how to use the machine and so the others were 'sort of learning' on the job... It certainly puts the old adage "see one, do one, teach one" back on the agenda!

An all green theatre...

The draw over anaesthetic machine

The theatre restroom (thankfully not so green) with the defunct anaesthetic machine that cannot be fixed and the dummy baby ready for a neonatal life support skills station.

During both interviews it became apparent that the teaching of the neonatal life support had markedly changed these anaesthetic practices and that they have really taken on board the teaching and stressing that ventilation of the ban with rescue breaths is far more important than the constant suctioning that seems to still be taught amongsts the midwives here. In fact, these clinical officers have taken it a step further and have run their own teaching sessions for midwives about just that. Which is phenomenal! What a great thing to hear, that the course has not only taught and changed the practice of anaesthetists but is being dissipated to other healthcare providers and really making a difference to the outomes of the next generations of Zambians. Fantastic and worth every extra mile we travelled back and forth to hear that!