Heath Systems in Zambia

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Yesterday we took a field trip out to a rural health center (RHC) in Kamwanu and rural health post (RHP) in Katumbi. These are the primary contact points for people in rural villages, far away from Macha hospital. The idea is to have a network of health stations with various services that will serve as the ‘rapid response’ health centers. In the US, we just drive to the ER or a rapid response health center anytime of the day or night, and for most it won’t take more than 30 minutes of driving to get medial assistance. Here in Zambia there are very few vehicles, so the vast majority of people walk wherever they go –including getting to the health center, even if that involves bringing someone with a broken leg to the health center, of if there are complications in a birth. Thus if the only health care is at the isolated hospitals, that leaves most of the people many miles from modern medical assistance (there are of course the traditional healers, but for the sake of simplicity I’ll leave them out of this). Even with the rural health centers being closer to where people live, many of the rural health centers are only open certain days of the week.

Rural Zambia is very rural - here is a small homestead. Also, note our shadows - we took a 'local taxi' to the RHC

Kamwanu Rural Health Center (as we were driving away)

These health stations are organized such that several rural health centers (RHC) surround each hospital. A nurse and a community healthcare worker staff the RHC. At the center they give vaccinations, address basic needs, are trained birth assistants, do check ups on kids under 5, and can address physical injuries (to a point). They also have rapid diagnostic tests to screen for malaria, and drugs to treat anyone who is infected with malaria. In addition to administering healthcare, the staff of the RHC are also responsible for health education in the community and cleaning the buildings. A team from the hospital will visit the RHC regularly to bring supplies, and have special health clinics. The day before we visited the group from the hospital had been at the RHC doing circumcisions (see post 5/28/13 for relevance). On the day we visited, the nurse was away at a training session, so the healthcare worker who has served at this outpost for the last 13 years was staffing the RHC alone.

This woman has served this RHC for 13 years, and through it serves ~ 1000 people.

Each health center outpost is itself surrounded by a series of rural health posts (RHP). We visited the Katumbi post that also serves as a VCT (Voluntary Counseling and Therapy) center for HIV testing. Volunteers from the community staff each of the RHPs. As Dr. Thuma has said, volunteerism is a luxury afforded to those who have extra time and money – those luxuries are not common in rural Zambia. The woman who serves at Katumbi RHP said that she was chosen by the health committee from her village 5 years ago, and has served since. The initial idea was that each post worker would volunteer their time to the community, and in exchange they would be repaid ‘in kind’ by help from the community, either help plowing her fields, or with harvest etc. Unfortunately that system hasn’t actually worked in practice, so this woman truly volunteers her time. After she had talked with us, Mike asked why she continues to volunteer if she isn’t being helped by the community for her efforts- and her reply was simply that she had made a commitment to the headman and health committee of her village, and so she was continuing to serve.

Katumbi RHP and VTC, two rooms, and exterior space under the grass roof.

Larry and the RHP volunteer.

Each RHP volunteer attends an initial 6 weeks of training at the hospital, and then may attend other trainings as needed. At the health post she is trained as a traditional birth assistant, she can test people for HIV, and has been trained to test for malaria (although she doesn’t have the test strips or drugs to treat malaria yet). We asked her how many people give birth in the village vs. come to either the RHP, RHC or hospital for delivery. She said everyone goes to one of the health centers (since that’s official policy in Zambia). In fact, in her village, there is a fine for anyone who delivers at home instead of delivering at a health center – 7 kg of corn. The RHP volunteer is also trained to go out into the village and do health education, and to encourage people to be tested for HIV (and remember, this is all on a volunteer basis IN ADDITION TO all of the normal work that a woman does in the home).

The RHP. From the left, Dr. Thuma, Mike, the volunteer, Evan, Phil, Stephne and Emily.

 Each RHC and RHP can contact the central hospital by phone, and if they have a patient who needs to go to the hospital, there is a bus that goes Monday, Tuesday and Friday and can take you there, or you can walk to the hospital. After we had asked her many questions, she asked us a few questions, one of which was ‘do you have rural health posts in your country?’ This question is so interesting to me- and reminds me again of why it is so valuable for students to actually GO and SEE what life is like in other places in the world. It shouldn’t be surprising that a woman who has lived her entire life in the Zambian bush wouldn’t know about ambulances, EMTs, or the ER. It shouldn’t be surprising that she wouldn’t assume that everyone has a car (or two) and can easily drive to a health center (or be lifted by helicopter if they need to get there quickly!). AND, the RHC and RHP system is revolutionary to their health system in Zambia where not too long ago it was the traditional healer, walk miles and miles to the hospital or bust! And it makes sense that she would think it’s a good system for other countries as well (and it is!). What we too often forget is that this volunteer (who works on M, T, R mornings) IS the local ER. We, on the other hand, sometimes complain when we wait 3 hours at the bright shiny ER for a broken leg to be treated. 

 

The students had a LOT of fun riding to and from the RHC. From the left - Caitlin, Caleb, Zak (Caleb and Zak's birthday is today!), Preston, Annie, Evan, Phil, Mike.

Late addition pictures from Caitlin of our 'local taxi' can you figure out what it is?

Can you see the cows in the distance? There are cows EVERYWHERE here! Each night my lullaby is cow bells jingling as the cows walk down the path. 

Most of the homesteads we passed had a bunch of people waving to us, so we waved right back!