Visit to Mumbwa District

Week one in Zambia is almost finished. It's a beautiful day here about 75-80 degrees, blue blue sky and just a few clouds. Totally pleasant to be outside (which is where I need to be after posting this my second blog entry)!

I'm here for three weeks to evaluate the PMTCT (prevention of mother-to-child transmission [of HIV]) logistics system. I was here last year to help design it and then train the trainers who trained all 67 Districts in Zambia in the new system. Basically, we had to figure out a way for nearly 600 small health clinics and posts to be able to be adequately supplied with ARV drugs for HIV+ mamas. By taking even just one dose of nevirapine at the outset of labor, mothers can greatly reduce the transmission rates to their children. The reason the U.S. has very few pediatric cases of HIV is due to high adherence and access to PMTCT services for HIV+ moms.

Unfortunately, the simple reporting/ordering system that we designed has not really worked. Of all the 67 districts who were trained (2 people per district), only 30 districts trained their facilities (and most didn't train all their facilities- only 150 or so of all 600 PMTCT sites have trained staff). So next week, five teams of four people are going out to five different districts to determine what the problem was!

This week two teams went out to test out our assessment survey tools. I travelled to Mumbwa district with one of our local staff members- a very sweet 35 yr old man Yapoma. We drove about an hour and a half west of Lusaka to Mumbwa. A very peaceful drive with intermittent rain (the rainy season just started!)- lots of farms and flat green space- if you didn't know you were in Africa you might have mistaken it for the heartland of Illinois! We travelled on a nice blacktop road that seemed only to go straight and right off the horizon. After arriving Mumbwa town, we went straight to the District Health Office to make our presence known. We had alerted the PMTCT Coordinator Phyllis that we would be there today; however, upon arrival of course she wasn't there. We met with the Director of Planning & Management, Morris, and he approved our visit. Politics are very big here- you can't just show up somewhere and start asking people at the clinics questions without going through the provincial and district health offices (kind of like states and counties in the U.S., respectively).

After bidding Morris adieu, we headed out to our first health centre in Lutale- about 40 minutes from Mumbwa town. We turned right off the blacktop and followed a dirt, rocky road for about 30 minutes until we reached the small village of Lutale. It was right around noon time at this point, and the morning rush at the clinic was over. The health centre in Lutale was of decent size, and the in-charge called the MCH coordinator (who was on leave) from her house (a few buildings over) to come over and talk with us. I wish I had photos, but it's always hard to take photos at a clinic- wondering what should be private and what shouldn't be. Hopefully I'll give you a good visual.

Maureen came in a t-shirt with a kanga type cloth wrapped around her waist as a skirt. She wore camoflauge canvas slip-ons. Yapoma and I spoke with her in the MCH (maternal and child health) ward. Pieces of paper were on the walls with with handdrawn graphs of malaria statistics and other childhood illnesses. Posters encouraging getting tested for HIV and for sleeping under bed nets were also on the walls. The clinic has no phone- only a radio that can be used to communicate with the District (or also pick up a local Zambian radio station as it was during our visit). The clinic also had a solar energy system to power itself- as it was not connected to any other main electrical grid. The 12 batteries were being charged along the wall near where I was sitting. Water? Probably from a bore hole somewhere in the village.

She told us that mom's in her village are getting tested for HIV and in need to PMTCT ARVs, but they are not always available at the District. She attends over 20 births per month in that small ward. Because more has been done to discourage women from giving birth at home, she has seen a dramatic increase in the number of mama's coming to deliver at their health centre. Imagine giving birth with no running water or steady supply of electricity. In the U.S. we believe that natural child birth is having a baby at a birthing center with your whole family, no drugs, and lots of pillows and comfy beds (or a bathtub)...well I would definitely say the mamas of Lutale have us all beat!

Maureen was not trained in the new PMTCT logistics system, but she hoped that we would be able to help her provide the proper medicines to her moms and to their babies. As we were getting back in the Land Cruiser, we saw Phyllis (the District PMTCT coordinator) and chatted with her some about the challenges of the system. Her father is also the chief of Lutale village- so she was also paying him a visit. We gave her a quick ride back into town, stopped for quick lunch of chicken and chips, and then headed to the village of Luili for our next clinic visit.

Another 40 minute drive from town down a dirt road, we arrived at the tiny two-room clinic. We met a CDE (Classifed Daily Employee) Jean. CDE's usually only have a 12th grade education and are hired on quickly without formal contracts b/c the contracting process with the government takes over a year to process! We greeted Jean at the end of her day. She was completed her log books and stock records (go jean!), but she was happy to answer a few of our questions. In Luili, most women give birth at home since the clinic is so small. The clinic has a number of Trained Birth Attendants who go to the houses of the mama's and assist with labor and delivery. Since the mothers do not visit the clinic for delivery, it is very difficult to ensure that they take the ARV's that they are given during pre-natal visits. Jean was very frustrated because while they do their best to counsel HIV+ mothers, it's hard to even know whether or not they take the medicines they are supposed to take- since Jean rarely sees them until after the birth of their child for an immunization or well-baby visit. Jean was preparing to see over 60 babies the following day for the under-5's clinic. All by herself, this very smart, very capable girl is providing the only source of "professional" health care in the village.

We left Jean feeling inspired for the hard work that she is doing and also hoping that we could do something to help. Yapoma and the driver David managed to bargain for three big bundles of charcoal from some of the women vendors on the side of the highway as we were leaving Mumbwa District. Less than $20 US for three HUGE bundles. The young ladies selling it lifted each bundle on top of the Land Cruiser cautiously shielding their eyes from the falling bits. And so we rode away from the sunset, a trail of black charcoal bits and dust following us back to the capital, Lusaka.

That was just Tuesday! But it was definitely the highlight of the week. The rest of the week was filled with office work, dinner and visiting with work colleagues, the 44th Independence Day of Zambia (Friday- a holiday) and tonight dinner with a friend from D.C. who is also in town and staying at my hotel!

The teams are out all next week so I should have more interesting stories then- and photos! Stay tuned and thanks for reading