Nursing at Mayukwayukwa

Patients waiting to see us in the Out-Patient Department of one of the clinics

With our students we worked in 4 different rural health centers around Mayukwayukwa. Almost all of them are staffed by members of the community who have minimal training in health care. The whole time we were there, we did not see one doctor, they simply don't exist there. At the main clinic there is one enrolled nurse who works night and day. When she is not at the clinic, the housekeepers and other support staff are delivering the babies. Seriously. In our experience here we have witnessed a lot of disease and death due to the lack of proper health care. In fact while we were here, one day we ended up running a clinic..on our own! Seriously…it was just Jessica and Lianne running this thing. We were diagnosing and prescribing treatment for about 50 patients. Conditions we treated included malaria, mastitis, gastroenteritis, diarrhoea, threatened abortion, dysentery, ophthalmologic conditions, splenomegally, dysentery..and many more. We diagnosed and treated patients of all ages (although mainly pediatric patients) with no diagnositic tests or laboratory tests, we didn’t even have a thermometer!

Jess drawing up a tetanus immunization

Working as clinical instructors with our students at the Mayukwayukwa health centers involved teaching our students to operate clinics. The running of a primary health care facility is not just seeing patients in the outpatient department (similar to the emergency department). A rural clinic usually focuses on maternal child health. This means that they run programs on certain days each month to monitor the health of children and women at different stages. With our students we ran clinics for children under the age of five where we monitored the growth of the child, gave immunisations, and health talks on nutrition and common childhood ailments. The students also ran antenatal clinics where the progress of the mother and baby is monitored. The mother also receives a tetnus immunisation, malaria prophylaxis treatment, and teaching regarding healthy pregnancies. These are the three main areas in a rural setting, but anything can happen at anytime as in any health care setting!

Lianne getting ready to weigh the 200 children who came to one of our child health clinics

Our students giving a health talk to pupils at one of the schools (1000 children attend this school!)

Our role was to train our nursing students so that they will one day be able to run clinics of their own. We noticed that there is a lack of critical thinking from our students and we are working to teach them to make judgement calls on their own. It is a tough job, half the time we feel like we don’t know what the right thing to do is because we don’t work in sub-saharan Africa! However, we do know how to ask questions, and the importance of reference books as well. We are shocked by how much we actually do know and have learned just by working and teaching at Lewanika. We are thankful for the training we have had at UBCO as we feel that they really did prepare us for working in all situations, anywhere in the world.

The Fate of Mayukwayukwa....

We have met other workers here, one group is working for the Zambian government regarding Land Mine Awareness. To be honest we never really considered that Zambia would have landmines, as this country does have a history of peace. But as we have learned from these government workers, there was fighting before the post-colonial days between Zambia (Northern Rhodesia) and Zimbabwe (Southern Rhodesia). Landmines are also all over the Zambian borders near Angola, Democratic Republic of Congo, Mozambique, and Namibia. Some of these countries are actively in conflict, others have not seen conflict in a while. There have been an estimated 400 deaths from Landmines in Zambia. They even said one month ago someone in our Southern Province from accidentally stepping on a landmine. Angola has the second highest amount of landlines in the world (second to Cambodia). There are new landmines still being laid in areas of fighting such as Angola, Sudan, and Niger. We have noticed many people with amputations around the camps and can only assume that many of these injuries are due to land mines or as a result of fighting.

Children collecting water at a local bore hole

We have been talking with many staff members at the refugee camp. Here are some things we have learned. UNHCR, the United Nations organization that is funding this camp, will be pulling out of here at the end of this year. The UN has deemed the country of Angola as ‘no longer in conflict’. Therefore Angolans can no longer consider themselves refugees. To be classified as a ‘refugee’, you must meet a list of critieria, and one of those criteria is that you are fleeing a country that is considered in conflict. Unfortunately the Angolans at Mayukwayukwa refugee camp are being told they have to go back to Angola. Many of them say they will be killed as they belong to the opposite party that is currently in government. Angola is also right in the middle of elections right now. Mayukwayukwa also has refugees from DRC, and Burundi, these refugees must also leave. But they cannot go back to their countries either, as they are still in conflict. Therefore these refugees must be resettled into another refugee camp, or they can be resettled in another country…such as Canada, Germany, the Netherlands, USA etc. Imagine the cost it would take to move a person or family to a new country (resettlement). Not to mention how difficult it would be for those refugees to integrate themselves into a “Western” society where they come from living a very different lifestyle. Where will they work? How will they afford to live? How do they deal with the cultural differences?

At this time Mayukwayukwa has over 10, 000 refugees. There is no way they will be able to clear all of these people out of here. Realistically what will happen is the UNHCR will pull out of here in December, leaving so many of these refugees behind. While the UNHCR pulls out, so do all the other NGO’s working here (e.g. Red Cross, African Humanitarian Association). There used to be many NGO’s working here at Mayukwayukwa, but once they heard word that UNHCR was pulling out, so did they. The World Food Programme (WFP) currently supplies food (and by food I mean maize meal) to the majority of the people here. Some of the refugees are able to supplement this by farming, but not all are capable. The WFP had a meeting last week in Lusaka and made the decision to pull out at the end of October. I asked one of the workers here what are all the people going to do that depend on this food for survival? He said to me ‘They will starve’.

Here is a tent containing food from the World Food Programme...looking very empty




To sum it up, most Angolans will be “voluntarily” repatriated back to Angola. A few, maybe 100 if they are lucky, will be resettled overseas to developed countries. The rest are going to be without food by the end of this month. The remaining refugees will be staying at the camp while all the developmental and humanitarian aid pulls out leaving them helpless.

The Life of a Refugee

Children of the camp

Mayukwayukwa was established in the 1970’s and has over 10, 000 refugees from Rwanda, Burundi, Democratic Republic of Congo (DRC), and Angola. The camp is divided into 53 Sectors, with most refugees living with people from their own country. An interesting fact is that not only have we had to deal with multiple tribal languages, but most of these countries don’t even speak English. Rwanda, Burundi and DRC all speak French as their first language, whereas Angola speaks Portuguese. Jessica is loving that she can once again practice her once fluent Francais, and Lianne is in love with the Portuguese as it is so similar to Spanish. We have come with 12 of our nursing students, and two other instructors (Mr. Mumbuwa and Mrs. Ngwila). The purpose of this experience is so that the students really get to learn what nursing in a rural setting really means. Therefore they have had to plan and cook all of their meals on charcoal stoves, and sleep all together in two tiny rooms. Not to mention they have to cook for very demanding instructors! (NOT us by the way….we have been eating the food like good little girls) Jessica and Lianne have really had to ‘go with the flow’…and eat truly Zambian dishes. This means eating the Zambian staple food ‘Nshima’ (a maize porridge) twice a day! The students have had a hard time dealing with Lianne’s vegetarianism, so she pretty much gets 4 eggs a day. We have the hugest portion sizes, because they worry we don’t eat enough. One lump of Nshima has the caloric intake of two big macs, how do these people eat it everyday????

Over 80% of the refugees are women and children in refugee camps all over the world. That is because it is often the men who are left behind to fight, or end up dying in war.
It has been interesting talking to the refugees; the women have really opened up to us. The one topic that comes up when we talk to the refugees is ‘suffering’. Everyone expresses how much they have suffered, they feel trapped in this whole cycle of poverty. For them they don’t see hope to escape the refugee camp, and make a new life for themselves. Many of the refugees have been here for years. They can’t go back to their own countries for various reasons, some belong to the opposition party and will be killed if they return, others have no family or homes left to return to. The sad truth is that these refugees don’t have access to proper health care, food security, safe water…all the basic things for life. But this is better than what they had in their home countries. So what are they to do?

A woman and her cute baby at one of our clinics

Many refugees also left their jobs when they left their countries. But in Mayuwayukwa there is little opportunity for work. So many refugees have skills, and were once working professionals..they want to work, they need money for their families to survive! But yet again in the refugee camp there is no opportunity,. And then if they get the chance to get into a town in Zambia, they have a hard time integrating into the Zambian society. Meaning some the locals do not want refugees, or people of another nationality coming to live in their country. It must be hard to feel like an outsider wherever you go. Again comes the question ‘What do these people do?’. They are stuck in this vicious cycle of poverty.

This is Abdul, he is a refugee from Burundi. Jessica was able to practice her French with him..lots

The Office of the United Nations High Commissioner for Refugees (UNHCR) is the organization that deals with refugees on the ground. It was established on December 14, 1950 by the United Nations General Assembly. The agency is mandated to lead and co-ordinate international action to protect refugees and resolve refugee problems worldwide. Its primary purpose is to safeguard the rights and well-being of refugees. It strives to ensure that everyone can exercise the right to seek asylum and find safe refuge in another State, with the option to return home voluntarily, integrate locally or to resettle in a third country.In more than five decades, the agency has helped an estimated 50 million people restart their lives. Today, a staff of around 6,300 people in more than 110 countries continues to help 32.9 million persons.

Zambia is one of the top ten host countries in the world for refugees. Zimbabwe, Democratic Republic of Congo (DRC) and Angola are three of the countries that border Zambia, and considering the state that all three of these countries are in right now..you can see why people would be feeling these countries. Zambia currently hosts 113,000 refugees, with the majority from the Democratic Republic of the Congo. The area where we will be going receives refugees from DRC, Angola and Rwanda. The name of the camp is Mayukwayukwa, it is located within the Kaoma district of the western province of Zambia. We will be taking our nursing students to this refugee camp for two weeks, there they will completing the community outreach part of their nursing programme.

We will post more upon our return!

Jessica and Lianne

More experiences from the HIV clinic....

A few of the countries surrounding Zambia and their HIV rate

The topic of HIV is continually on my mind. After traveling to another HIV ravaged country, Malawi, it just makes me realize how big the problem of HIV is all over Sub-Saharan Africa. The life expectancy of a Zambina is 39 years, there are many reasons why this number is so low…and one of them is HIV. It is interesting to note that you really don’t see much of it if you were just a tourist traveling through sub-saharan. It is once you start integrating yourself into the culture and seeing the everyday reality of a Zambian, does the shock of the reality of HIV really hit. The Zambians go to funerals ALL the time here. We always see groups of vehicles around town carrying friends and families to funerals. At night as I am going to sleep, I can hear the people living around us singing funeral songs and wailing. This has truly been a wake-up call for me.
This ‘wakeup call’ has just driven me to continue working at the HIV clinic. There is so much to know about HIV care, it is so complex! I have taken my usual attitude of just throwing myself into the madness at the clinic and asking as many questions as possible...so I can learn as much as possible about HIV care. And I am telling you that once the clinic opens its doors on Monday morning….it is overwhelmed with people each and every day. It is truly organized chaos in there, and so full of people that there is no room to even move. The clinic is constantly overcapacity, and just further emphasizes the epidemic this country is facing.

I often see babies such as this HIV positive baby...

I have had a many memorable moments and then again some really sad ones too. Today I was looking at the lab results for one of my patients. They use what is called a CD4 count to monitor the level of HIV in the blood, and to see if the HIV medication is working properly. I could tell she was nervous about the results, and wondering if her CD4 count had increased. (The CD4 count should be increasing once a patient is started on medication) So I looked at the results, and told her that they had increased. She was so happy that she gave me the biggest hug right in front of the whole clinic. These are the moments that I enjoy most.
There have been many heartbreaking moments as well. Today I had to tell someone they were HIV positive for the first time. It is very much like delivering someone the news that they have cancer. Except here we know without a doubt that this disease will kill them, and much sooner than if they lived in Canada. It is so unfair. I looked at the test results and said to her, ‘you are positive’. Those few words just completely changed the course of her life. I saw it in her eyes..and it was a look I will never forget.
I will also never forget having a mom and young son come in who where both HIV positive. The mother had been non-compliant with her medication for various reasons. After three months of being non-compliant with HIV medications, patients have to be completely taken off the medication and are not allowed to return back to taking them. This is not to be cruel, but it is actually because the HIV virus has already had a chance to mutate and now the medications will no longer be effective in stopping the HIV virus from multiplying in their body. If someone stops taking their medications properly they are ‘just putting another nail in their coffin’ as a nurse at the clinic so bluntly put it. This situation occurred with the mother and son. Because the mother had not been taking her medications properly, she was not given anymore meds. Unfortunately so was her young son because she had not been giving him his medications properly. The nurses told me he had only been off his medications for one month, and they could already tell he was deteriorating. To me he looked so sick, and it was heartbreaking knowing that his quality of life could be improved with just these simple meds, but it was too late. So unfair that he really had no choice in the matter. It was hard for me to watch as a bystander, and not be able to jump in there and fix things…like I am so used to doing as a nurse!

Prevention messages like this can be seen all over Zambia

At times it is hard not to be overwhelmed by this disease. I always knew that HIV was a problem in the world, but to be honest it was never truly until nursing in Zambia that I realized…they aren’t lying when they say that millions of people are dying of AIDS in this world. I am embarrassed to admit it, but I don’t think I truly grasped the reality of HIV until it was staring me in the face. It was when I started physically touching these patients and caring for them that it hit me. Now it is my job to make everyone in the world gets it like I just got it.
Anyone want to help?

Jessica

Malawi: The warm heart of Africa

Don’t worry everyone..we are alive and well. Here is some information to introduce you to Malawi, the beautiful country where we spent the last two weeks!

Landlocked Malawi ranks among the world's most densely populated and least developed countries. Like many African countries, Malawi was once a British colony called Nyasaland. It became the independent nation of Malawi in 1964. When translated, the name Malawi means Lake of Stars. It is bordered by Tanzania, Mozambique and Zambia, and it is slightly smaller than Pennsylvania.

Fishermen on Lake Malawi

The economy of Malawi is predominately agricultural with about 85% of the population living in rural areas. Major agriculture products are tobacco, sugarcane, cotton, tea, corn, potatoes, cassava (tapioca), sorghum, pulses, groundnuts, Macadamia nuts; cattle, and goats. Agriculture accounts for more than one-third of GDP and 90% of export revenues. The performance of the tobacco sector is key to short-term growth as tobacco accounts for more than half of exports. The economy depends on substantial inflows of economic assistance from the IMF, the World Bank, and individual donor nations.

Tea Harvesting

Tobacco Harvesting

The government faces many challenges including developing a market economy, improving educational facilities, facing up to environmental problems, dealing with the rapidly growing problem of HIV/AIDS, and satisfying foreign donors that fiscal discipline is being tightened. The life expectancy of a Malawian is 43 years, which is comparable to Zambia. Estimates take into account the effects of excess mortality due to AIDS (the AIDS rate in Malawi is 14%, which is also quite comparable to Zambia….and really high!!); this can result in lower life expectancy, higher infant mortality, higher death rates, lower population growth rates, and changes in the distribution of population by age and sex than would otherwise be expected.

Wowee Malawi

Sunset over Lake Malawi

Our students were on a two week break as we have finished the lecture portion of their semester. We thought we would take this break to do some travelling and get to know more of Southern Africa. Many people have told us about how amazing Malawi was so we decided to go and see how beautiful it was for ourselves.
We first had to bus from Mongu to Lusaka. Our high priority was to try a veggie burger at Steers, the local fastfood joint (seriously there is no where to eat in Mongu). We were excited to be in the big city and be able to blend in a bit more. Then we took another looooooong bus ride to Chipata in Eastern Province, Zambia. This bus ride was suppose to be 5 hours as promised by the bus operator. However it took us 15 hours! The bus left 2 hours late, broke down for 3 hours and we had to wait on the side of the road in the blistering sun for someone to drive the part to us from Lusaka. Then while we were driving, someone threw a rock at the window and smashed a window two seats up from us. It was like being in a war and a shot was fired and everyone hit the ground. But don’t worry moms, we are ok. The plan was to get to the capital of Malawi that day, but we spent the night in Chipata to avoid travelling at night.
The next trek was from Chipata to Lilongwe, the capital of Malawi. It goes as follows: cab to border, change money illegally inside cab, flirt with border guards, stamp passports, cab to the nearest town, grab a minibus, and finally off to Lilongwe…In the capital things were a little hectic as always. Jessica luckily made a friend on the bus who “helped” us get a cab to our hostel. He was a little upset when she wouldn’t kiss him, but what did he expect, they just met right? Ohhhhh Africa.
We spent two nights at a great hostel where we met some fun people and lounged by the pool. Our favorite ones were two guys from Israel, they would make us their traditional coffee at their campsite..on their little campstove. Has anyone ever had Israeli coffee before?? It is strong stuff! This was just the beginning of the many Israeli’s we would run into during this trip. We learned that the reason for meeting so many young Israeli’s is that they all must put in 3 years of Army service once they turn 18 (both men and women). Once they are out…they all just want to see the world and travel!
We took another bus to get to Mzuzu where we spent one night to avoid traveling in the dark. The next morning we mini bused to Nkhata Bay on Lake Malawi where, after 5 days of travelling long hours, we decided to spend an entire week just relaxing.
Our resort was beautiful. There was no room in the hostels when we got there, but the owner let us stay in a chalet for two nights at dorm price (4$). The chalet was so amazing that we ended up staying there all week (10$ a night thereafter). We had a private little beach, and the view of the lake was outstanding.

The chalets where we stayed on Lake Malawi

We met so many fun travelers from all over the world. We ate at unreal buffets where our plates were heaping with both comfort food and local dishes as well. The majority of our days were filled with swimming and sun bathing. However, we did frequent the markets in town and a few boat trips as well. It was free to borrow snorkel gear from the hostel so every morning we snorkeled and saw the glorious cichlids (over 850 species of cichlids in Lake Malawi) which is the fish found in the lake. Lianne went scuba diving and saw mama cichlids fight off predators and then all the babies would hide in her mouth when she felt threatened (up to 40 fish in her mouth!!).

Chiclid Fish we saw while snorkeling

The feel of Nkhata bay was extremely laid back. The place was filled with Rastafarians and mostly every night the place had live music. One thing we did notice was almost everyone smoked, which is quite different from Zambia as no one there does! This is probably because Malawi’s primary export is tobacco..so that means supply is plentiful for the locals.
We were very sad to leave Lake Malawi as we knew that we were leaving behind such a beautiful place. We also knew we had to make that loooooooooooong trek all the way back to Mongu.

Well we made it back, no break downs on the way back ..or rocks thrown at our bus! We stayed an extra day in Lusaka, to stock up on a few things from the big city that we can’t get in Mongu. We were so excited to go grocery shopping and get items that we are unable to find at our local grocery store (which I must say is lacking in many things!!) Our most exciting finds were hair conditioner, mustard, salad dressing, salsa and taco shells. In the big city we went out with friends who took us bowling and for sushi. Yes we had sushi in Africa, it was actually pretty good..but really expensive.
The last leg of our journey was the bus ride back to Mongu. Pretty cool that to get to Mongu we have to drive through one of the biggest game parks in Zambia. On this trip we saw zebras on the side of the road! (as well as the usual elephants, antelope, impalas, warthogs, etc) It was so nice to be in familiar territory again. We got off the bus station and instead of being hassled and ripped off by all the cab drivers just waiting for the tourist mizungus (white people)…we had our local trusty cab driver Max waiting for us! It feels so good to be home. It got HOT in Mongu in those two weeks that we were gone. We are worried because everyone keeps telling us that October is the hottest month. We are both already sleeping with no covers, and fans on continuously. We are going to be in big trouble once October hits!
We were also very excited to return back to Mongu because Cam had just returned from a trip back to Canada. He was waiting for us with so many care packages from home. It was really Christmas in September!!! Cam was also able to bring back much needed textbooks, and computer software that will go to help the school of nursing. Thank-you to everyone who sent stuff with Cam, it was the best Christmas ever.