Interview with a rural health clinic nurse...

Eliack Shikamo, RN

My *host father Eliack Shikamo works at the medical clinic in our village. I decided to interview him about his work at the clinic because of the interesting and challenging work load he and his staff encounter daily. 

Eliack is a registered nurse and he runs the clinic.
On staff there are two enrolled nurses or CNA equivalents, an environmental technician, nursing support, and volunteers. There are no doctors on staff, though doctors occasionally make rounds during the year.

Eliack was born in a village of Solwezi called Shikamo Village under Chief Mukumbi of the Kaonde tribe. His father was a house maid for a white farmer in Kabwe, and second born of eight children: three brothers and four sisters

Eliack was educated through Ngungu Primary School in Kabwe, Kimale School (basic school) 1-9^th, then high school at Solwezi Technical Secondary School grade 10- 12^th. In 2004 he attended Solwezi School of Nursing and received a certificate of nursing in 2005.  He worked for the government from 2006 to 2008 then went back to school to become a registered nurse at Lusaka School of Nursing from 2008 to 2011. He graduated with a registered nursing diploma.

Eliack is married to Brenda Mwelwa Lunda who is an enrolled nurse. He and his wife work at Mumena Rural Health Center in Mumena Village in the Solwezi district. They have three children under the age of seven.

*Most Peace Corps Volunteers are placed with a host family in the village they reside. The role of a host family is to ensure the Volunteer’s basic needs are met, offers guidance with entering in the community, and shares occasional meals.

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Tell me about the clinic. What services are offered?      Mumena clinic is a rural clinic 56k from the referral hospital Solwezi General Hospital. We offer a variety of services from outpatient services, such as screening, dispense of drugs, and wound care. Maternal health services which provide prenatal and labor services-- a tiny room allows mothers to recover-- and postnatal services. Within maternal services we offer HIV screening to mothers aimed at preventing mother to child HIV transmission. 

     We counsel pregnant mothers and encourage them to come with partners to test both of them for HIV. If both are positive, they are counseled how to live with the disease and encourage taking the prophylaxis medication that helps slow progression of HIV. We offer a children’s clinic with programs of growth monitoring promotion and a segment that deals with immunization monitoring. We also offer family planning counseling, but have not been able to counsel on nutrition. General HIV/AIDs care is offered. 

     Our clinic has minimal testing equipment, but can draw blood and transfer to the hospital to help with treatment, especially HIV positive patients. The clinic wants to improve a transport system for treatment to the referral hospital. Our clinic is not a hospital. When cases come they are screened, admitted for 48 hours, initiate treatment; if patient is not doing well, then continue for a few more days and may be referred to the hospital.

How is clinic funded?      This is a government clinic; very limited funding. Every three or four months the clinic receives money to pay electricity and to buy supplies, but limits ability to work on other projects.

What challenges does the clinic have?      Limitations because of funds, and limitation of number of staff, the clinic should have at least 13 health workers, but barely has six. The few nurses the clinic has cause the nurses to work too much. Not enough accommodation which creates a hindrance for nurses to live here. Support from missionaries has improved water--garden taps to help staff to draw water closer to their homes. Don’t have the ability to have toilets in the clinic. The burden of disease and not being able to implement outreach programs for residents who live far from clinics. Services are limited to only 5k radius. People live 22k away without transportation. Emergency care is a challenge, for example, a mother is pregnant with complications has to find money from others to pay for a cab to the hospital.  One government ambulance is located in the township servicing the entire Solwezi district. It can take 1 hour 45 minutes to get to the hospital.  Mothers use public transport and deliver on the way. They need an ambulance.

Most common ailments?      Top ten: malaria; diarrhea; respiratory tract; STDs due to population growth; HIV and AIDs; skin infections; eye infections; tooth infections. Anemia is an issue, children and nutritional problems during rain season due to not a lot of food available.

I’ve heard you are calm, cool, and collected when dealing with snake bites. What is the procedure when treating a snakebite victim?      No natural skill, it is a skill that you learn: treat snake bite as an emergency, though depending on the snake that bites a person there are certain snakes that are really poisonous, but some aren’t as poisonous. At least what I do when handling an emergency there are four things to look at: one, ensure that patient’s airway is patent, then ensure patient is breathing. These two can be dependent on how they are positioned, then monitor circulatory system, feel for pulse, quick assessment, ensure access to a vein by inserting a cannula, set the cannula. You have to choose intravenous fluid or a plasma expander, and sodium solutions. If no saline solution then lactated ringers. Then after quickly give a cortical steroid. We don’t have the snake antivenin; government does not provide it. Depending on the snake, antibiotic is given and pain killer. Black mamba bites need treatment within 30 minutes or can cause organ collapse. Steroid and fluids prevents shock,  reduces inflammatory response from venom….may be referred depending on shape of person.

Do you deliver babies?      We assist delivering babies. In past people delivered from home, but now with Chief’s efforts, we have an increase  institutional deliveries  as  the mothers  are encouraged to come to the clinic. Community teachings encourage this; about 60 percent of women go to the  clinic, but number on staff is small, so may refer to a traditional birth attendant In village which defeats the purpose of encouraging people to go to clinic.

What’s your thought on Ebola?      Ginny, Ebola is real. Because I’m told it has been there in the Congo since 1976, except for being saved from getting Ebola in Zambia is surprising. Maybe its because of  the location affected is very far. Not because we have special precautions, but distance has been the savior. What the fatalities and the conditions cause I pray the disease does not spread to Zambia, because our preventative measures are still poor and challenging. So we’re just crossing our fingers; we are able to deal with measles, but we aren’t there to manage Ebola. People do not know what Ebola is; they call it bolla, like in football. They don’t understand what the disease is about.

How does your clinic compare with other clinics which are found farther in the bush?      It’s not easy for me to gauge of course, but then the only thing that makes me feel that want to come here because of the effort we put into the treatment of people. We are centrally located. Of course with the same challenges. But we are trying to address them in an appropriate way. Infrastructure we are the same, . Sometimes it is because of the sacrifice one just makes. We are available on Sundays. Other clinics just close down on the weekend.

With my host father Eliack Shikamo

     Since this interview I started volunteering at the clinic. It is a very busy place. The staff is professional and they make do with what little supplies and equipment that is available.

     Eliack and his staff and the volunteers work very hard every day. When on-call at night time Eliack and his wife will respond to knocks on their door at any hour, usually to tend to an emergency case. Right now three new houses are being built to house more nurses. This will ease the workload on the present staff once new nurses move in.

     I am aware of other clinics that actually lack any professional staff. Educated nurses sometimes prefer to live in the cities where there are more conveniences and well equipped hospitals. I give the medical staff a lot of credit for giving that up to help the people in need in the rural areas of Zambia. To do this work they give a lot of themselves to help improve the lives of others.