Back in Macha

This is my fifth day back in Macha after six weeks of travelling. It sure feels good to be home sleeping in the same bed, no longer living out of a suitcase and with no plans to go anywhere in the near future. My time away was full of many good things but the pace was beginning to wear on me.

I did some informal tallies of the six weeks that I was away from Macha. I was in four different countries (one in transit) and 20 cities/towns (5 in transit) While traveling between these different places, I road 19 times in a personal car, 16 times on a train, 10 times on a bus, 8 times on a plane and 3 times in a taxi. Most of that with luggage. Besides my 11 nights at orientation in Akron, I did not stay more than 3 or 4 nights in one place. Too frequently it was just one night.  As I say, I'm glad to be home.

There was a wedding while I was away, and one funeral that I have heard of. There was a 100% pass rate of the national nurses exam by the students from the Macha Nurses Training School. Apparently I missed the worst of the cold season while I was away. Things are much drier than when I left. The temperatures are very pleasant after 100 degrees plus humidity in the midwest, but the heat is on it's way.

I must tell you that I also passed the foreign trained nurse exam, which is great news! I don't have to repeat it in November. I still had to get a temporary work permit as the certification from the General Nursing Council will not be out till the end of the month. I need that certification to get my permanent work permit. I was only given 7 days upon entering the country this time, but went to immigration the next day and procured the temporary work permit. We were hoping to avoid that additional cost, but it was not to be. At least I am able to be here legally and work.  I need to report to immigration in Choma each month until my permanent work permit comes through. I will just try and time it with shopping trips.

So my first day back at work there were important "visitors". People from the Ministry of Health and Boston University/CDC were checking in on our PMTCT work. Apparently they advised us of their visit just a few days before. We actually did quite well, considering that there was a register that had not been updated in the last six months due to a turnover in staff and most of us not being aware that it existed. I have been given the job of getting it up to date. It was a good visit with myself and Mrs. Mabeta, the new charge nurse of MCH (Maternal Child Health) learning alot.

Here in Zambia, patients tend to carry their patient file with them. Just like in the States parents are given immunization cards for their children, here, pregnant women are given antenatal cards that they bring with them to each visit, children are given "under 5" cards, women receiving family planning are given family planning cards, etc. In the general outpatient department patients just have small notebooks that they buy from the hospital ($2 for adults, $1 for children) where all visits and prescriptions are written. Except for inpatients and ART (hiv) patients, no file is kept on record at the hospital. Instead, we have registers (log books) where this information is kept. My observation is that the cards have the most accurate information, which on one hand is good so that when the patient shows up here or at another clinic, the needed information is at the ready. There is no need to look it up in various registers (under 5, safe motherhood, pmtct, integrated mother/baby, family planning....you get the picture). However, the registers are big, bulky and cumbersome. Often you are seeing both mom and baby and so need to write in two, 3 or 4 registers and all those steps don't often get followed through on due to time constraints or someone else using the register etc. So, when it comes time to do a report or gather statistics, the information is not at hand, because the registers aren't up to date. At this meeting the importance of good documentation was reinforced by the visitors. We can't prove we are doing the work if we don't have the documentation. So, we are going to work on improving that.

I had a good meeting with the nursing officer Miriam after our time with the visitors. We have roughed out a plan of where I will focus my energies for now. I told her I want my work to be useful, sustainable and enjoyable. She also is concerned about the sustainable part, not leaving a hole when I leave. It is good to know we are on the same page there. We have come up with three main areas for me to focus on. Helping MCH with better documentation and follow-up of  hiv+ mothers and their babies. Working with the ART clinic's database of exposed babies. Helping with the monthly and quarterly statistic gathering for PMTCT.  I am still pulling together a schedule, and I hope to include going out into the villages 2-4 times a month with either MCH or ART.