Tuesday, September 30, 2008

National Immunization Day

Once a year in Namibia it is National Immunization Day (NID) which is a series of days whereby the goal is to vaccinate every child under the age of 5 for polio. This is no easy task for a country that has one of the largest land to people ratio, and most of the country is desert. Every year it is a major government campaign and they require a great number of volunteers from the community to help. So we were ready to jump on board.

Daryl and I went to a training day to become “Quality Monitors”. This role involves monitoring the vaccination teams to make sure that they are doing everything as told (correct dosage, proper storage of meds, proper tallying, and so forth) and also going into the villages to do home visits once the vaccination teams had gone through to see if there were any children that were missed. Seem simple? Well, not in Namibia.

The first major problem was the selection of volunteers. We have heard from many foreign workers the challenge of education in Namibia and we got to see some of it first hand. Most of the volunteers looked like they were in their early 20’s but it ranged to a few who were middle aged. The training was done in English, which was helpful for us, but one of the many barriers for them. Yet the problem seemed much more complex then basic English language issues as I was astounded by the lack of comprehension for very basic instructions. After a FULL day of training (when we could learned what we needed in a short session) the volunteers where called upon to review different sections, but many would decline saying they still were not clear, even though we were going out the next day. The crazy thing is that the statistics of how many kids were vaccinated’ collected by these so called “Quality Monitors” were going to become the World Health Organization statistics!!!!!

On the actual day, it was no surprise that things were running behind, as they were struggling to find drivers to take the monitors and vaccination teams into the field. Everything was chaos but I was finally teamed up with another girl and we hopped into the back of a very beaten up truck. We were off to the boonies for the day and it was quite a lot of fun. We had to drive through extremely thick sand (it is a miracle we didn’t get stuck on numerous occasions) into areas with no real road - so to get directions we had to ask the few random walkers where to go and they would point and we would drive. The “roads” were sometimes so narrow that our car barely fit between two trees!

It was a long day of walking between huts and driving crazy roads but we worked hard to do as many home visits as we could. When we got back at 6:30pm, and we collected our data, I was told I needed to stay for the oral report, which ended up taking anther 3 hours. Every group had to discuss their statistics, in English which is already a problem for most of them. The statistics were often interesting. My group was the only one to have come across children who missed the vaccine, which seems unlikely to me that every child was vaccinated in the whole region accept for the ones we came across. Another group said they had visited 51 children and 56 were vaccinated… Even with the head nurse explaining the impossibility of these statistics in their first language they could not comprehend what was wrong. Next time I see a WHO stat, I will take it with a grain of salt.

It was a very interesting experience.

(Photo is of the caregivers and kids under 5 lining up for their oral vaccine).

Wednesday, September 24, 2008

Rehabilitation at Rundu State Hospital

Three mornings a week I work in the Orthopaedic Rehabilitation ward at the hospital. I work with 3 others, a physical therapist and an occupational therapist (both from Zimbabwe), and a ‘rehab therapist’ who is Namibian and has been there for 10 years.

When I first arrived, I was very curious to see what my life as a therapist would look like in a hospital setting. My first morning I was welcomed and right off the bat was given my first patient without even having a tour of the facilities. I had to ask where the sheets were, was there lotion available, where the assessment sheets were (there are none), along with many questions as my patient stood beside me waiting. There is only one communal treatment room with no privacy, and I have found in general that patients here have a lot less privacy needs than back at home!

The OT and PT both watched as I did my assessment and they didn’t seem to have any patients, until around 10 am when all the patients showed up at the same time. I was confused by this and quickly figured out that the therapists don’t have a schedule (one reason I heard was because they didn’t think patients would show up for them so why bother). Well, I knew that system wasn’t going to work with me so I did some trial runs with a schedule and have been booked solid for 4 months, with my patients all showing up on time! Funny that even after 4 months, I am still the only one doing it. I think a big reason is because they tell their patients to show up sometime the next week, and usually the patient doesn’t show up, which means less work for them. So they sit around a lot and get paid for it while I work (happily) non-stop for no money at all!

My Namibian co-worker has been a particularly big challenge for our rehab team. In four months, I have only seen him treat a handful of patients. The OT and PT really struggle with it because he is constantly pushing his responsibilities on to them. He is suppose to be available to us to help translate, but most of the time he is not there, and when he is he asks other patients to do it for him!! When he is called on it he gets very upset and uses his authority as the Supervisor of the ward to get out of personal responsibility. I am fortunate that I only have one Namibian in my ward, compared to Daryl and my other AIM colleagues because sadly apathy runs rampant in the local work ethic here and has a poisonous effect in the work place.

One joy I have working here compared to the private setting at home, is that I don’t have to handle any money. Patients pay their small hospital fee and if they have been referred to our ward, I can treat them for however long, and however often I want without having to feel that money is a barrier to patients receiving treatment. It makes everything a whole lot less complicated. From what I can see, patients have been very appreciative for the time that I give.

The cases that I treat are mainly patients with chronic pain that have been coming for treatments at this hospital or others for some time with no resolve. It is especially challenging because there are literally no resources available for me to look things up and cross reference. I am in the process of trying to order some text books in order to help me, but also to help stimulate and challenge my co-workers. I have done a number of training sessions with my OT and PT colleagues but it hard when there is not even a muscle chart to refer them to and to teach from. I hope to see some change in this area before we leave.

So there is a basic review of what my hospital life looks like. I have many sad and interesting stories that I will have to post some other time, so stay tuned!

Thursday, September 4, 2008

This afternoon at Home Based Care

Every Thursday we go into the village of Kaisosi with our volunteers and do home visits with the orphans at our project. We primarily check their health and the volunteers have a medical bag full of supplies for wound care, cough syrup, thermometers, and some other random things. Normally kids complain of headaches (the sun shines all day without a cloud in the sky and they don’t drink water - a good recipe for a headache), or they have a cough (viruses run rampant in the community due to poor hygiene and low immune systems).

But today was a unique experience.

Our time started out with a conversation with one of the volunteers who informed us of some major issues that are currently in the local church we attend. We will need to tread carefully as to not take sides and burn bridges. There is obviously a lot we don’t understand.

Soon after we ran into a situation where an Auntie was beating her 6 year old nephew with sticks. We (the volunteer, Shelley and I) ran over to step into the situation and take the boy away. The little boy, Jacob, is in a family well known to us due to the many issues that have been raised in the past. We had already removed his 12 year old sister for the same reasons of abuse. The Auntie is an alcoholic with no children of her own, and of course the beatings get more severe as the alcohol intake increases. The siblings’ parents are no longer in the picture (the father abused the girl when he was around) and so extended family now “care” for them. The community has tried to deal with the situation by talking to the Auntie and reasoning with her, but they don’t seem to understand that an alcoholic who is sober for a day will claim many things until the next bought of alcohol when the cycle starts again. So, Jacob held Shelley’s hand for the rest of our home visits until we were done (Jacob is the one on the far right).

Walking along, gathering more and more kids who all wanted to hold our hands, we came across a group of young girls who were all standing in a row with the sand all marked out in a big T in front of them. I asked if they were about to play some sort of game and the response was that they were practicing being in a beauty pageant! So I asked them for a show, pulled out my camera and we had fun “make believing”.

Carrying on we ran into a huge commotion with people running and crowd’s gathering. We found out that a man had just been caught for stealing 5 cows. In this culture, it is considered very bad and along with catching the thief comes beating him to a pulp. We still had little Jacob along with us and so weren’t interested in sticking around to have him observe another round of physical violence.

When we were wrapping up we needed to come up with some short term solutions for our little dude, who when I stopped him to look him in the eyes nearly burst into tears. We held a meeting with some of his distant relatives who agreed to temporarily house Jacob, and we have an appointment with a social worker on Monday about the situation. I haven’t seen a lot of first hand abuse. It’s not easy. We pray for wisdom in the days ahead.