Lisa Common

Lisa goes to Zambia

I was absolutely delighted when Elizabeth Duff notified me that the Iolanthe Midwifery Trust had granted me a student award to fund my negotiated placement in Zambia to work with a HIV/AIDS charity called SAPEP (Simalelo AIDS Peer Education Project). The award made it possible for me to enhance my midwifery education by experiencing care provided in a very different setting to the consultant-led, well-resourced and high-tech environment in which I train in Nottingham. This award made it possible on my limited student income to broaden my horizons and immerse myself in another country and culture.

I arrived in Lusaka, Zambia’s capital city on 8 September 2007 with a midwife colleague. I was in Africa for the first time in my life and it felt like the start of an amazing adventure. My time spent with SAPEP was extremely helpful in gaining an understanding of the challenges faced by Zambia. Zambia is working towards achieving something called Millennium Development Goals (MDGs), designed to free men, women and children from the dehumanising conditions of extreme poverty and give everyone the right to development by 2015. SAPEP initiatives are delivered by volunteers who live in the rural communities, understand local needs and are accepted by local people. I saw an example of how this works when I was given an opportunity to help a midwife at her antenatal booking clinic in Nampeyo, a rural district about a one hour ride out of Monze. Most of the work is conducted outside the clinic under a tree as the interior is for people sick with AIDS related illnesses. The midwife never knows how many people will turn up to her clinic and when 12 arrived, we clearly had our work cut out. The care provided was very familiar; we took a history, measured BP, urine and weight, then took blood samples for the compulsory syphyllis test. In addition, women were given a supply of iron and folic acid tablets and medication for tetanus, if it was indicated. The midwife will see women during their pregnancy on four occasions and refer any high risk cases to Monze Mission Hospital usually two weeks before their due date where they will be admitted and ‘wait’ until they go into labour. Everyone else in this area will give birth at home, usually with the support of their mothers, sisters or a traditional birth attendant who may be skilled or unskilled.

Picture shows the antenatal booking at Nampeyo Clinic

Lisa with women from Chona Village

The lady in front is breastfeeding & another baby is looking at Lisa with suspicion as her mother said she was frightened by her white skin

Once we completed all the bookings the SAPEP Anti-AIDS Club performed a play as part of an antenatal lesson. Simply, the play involved a woman whose husband forbade her from attending for antenatal care and she ended up having a difficult labour and a baby who was sick and had sores. Her friend was assertive with her husband and did attend for antenatal care and had a healthy baby in good condition. The club members then facilitated a discussion which involved asking the women watching whether they would take a test to find out their HIV status if their husband forbade it. Only two of twelve women raised their hands. The club then explained PMTCT and how their baby can have a future free from HIV with appropriate care. The midwife later counsels women about HIV testing and offers them the result within 20 minutes. By providing women with simple information, SAPEP is having a major impact on HIV transmission rates in the areas in which they operate. In 2002, SAPEP reported that sexually transmitted diseases reduced from 33 per zone to an average of 8 per zone in the two year period from January 1999 to December 2001. So their work is really making a difference to the lives and life chances of the next generation. We were told that as much of the communication in rural areas is by word of mouth, our presence as visitors from the UK would be helping to raise the status and importance of antenatal care and getting tested to protect the next generation from HIV.

I also learnt how traditions, customs and other factors influence the spread of HIV/AIDS.

From a midwifery perspective, the maternal mortality rate in Zambia is shocking when compared with the UK- 7290 per million next to 3 per million. The crisis is fuelled by a shortage of skilled practitioners to attend births and undeniably, is implicated in nearly 1 in 10 children not reaching their 5th birthday. Life expectancy for a baby born in Zambia today is just 40 years. I saw a baby brought in to a clinic by a young mother whose birth had been attended by a local village woman two days previously. The umbilical cord had been severed completely and the woman had walked several kilometres to bring her sick and bleeding baby to the hospital.

The time I spent at Nampeyo brought home to me why women do not have their babies in hospital or with the assistance of trained assistants. People do not have cars and they are lucky if they have a bicycle. The tracks are rough, there are no street lights and they are very, very far from town and other settlements. I was happy that I was able to spend some time with the Zambian White Ribbon Alliance for Safe Motherhood in Lusaka and give them a copy of Gill Gordon’s Training Manual for Traditional Birth Attendants and UNICEF’s Born Free From HIV pamphlet, to help with the development of a training programme for TBA’s.

I had the opportunity to work alongside the midwifery and obstetric team at the Monze Mission Hospital with its School of Midwifery and excellent scheme to train Clinical Officers up to obtain medical licences. These training schemes provide much needed health staff to work in clinics around Zambia. In a clinic we visited near Lusaka, we met a qualified nurse who had sole responsible for a population of up to 15,000 – this is typical and demonstrates how desperate Zambia is for, and to keep its trained staff. The standard of education is excellent, with their students and clinical staff using the same practical skills and terminology that I have been taught in the UK. However, the equipment is often in poor condition and short supply. But not once did I see the staff despair or moan about their facilities. They were always realistic but looked to the future with optimism about developing their health service. They said it would be great to have electric labour beds, automated blood pressure machines, infusion pumps, CTGs, incubators and so on, so that they could improve the comfort and care they provide to high-risk pregnant women. But what shone through during my time in Zambia, was that they had a passion and enthusiasm to provide care to the women and families that needed it, despite all the challenges they are facing.

Lisa riding a motorcycle around the Zambian bush (without a map)!

I will be eternally grateful to the Iolanthe Midwifery Trust for supporting me to undertake this placement. Look at me, I’ve backpacked around Africa, I’ve shared guest houses with cockroaches, I’ve eaten weird and wonderful food, I’ve helped to birth a baby in Zambia, I’ve helped to build a roof for an elderly woman, I’ve washed orphans clothes, I’ve watched boys play football and taught kids to play frisbee, I’ve taught pre-school children how to sing ‘Incy Wincy Spider’ and I’ve seen the Victoria Falls and camped in a National Park with elephants, lions and hyenas. I have just started my third year as a student midwife and I feel that my life is ahead of me with so many possibilities. This trip has helped me to believe in myself and recognise that I am strong and resourceful and can do almost anything. I feel connected to Zambia forever and am sure that I will return when I am qualified to help develop their health service, perhaps by helping to train TBA’s to provide good, safe care to women.

What impact has this placement had on me? In practical terms, I am now President of the ZambiAIDS Society at the University of Nottingham, a fundraising society dedicated to supporting PEPAIDS, the UK charity that funds SAPEP. I’m involved in organizing Rag Raids, supermarket bag packs, club nights and much, much more as a result and have a £5,000 target to reach. I wrote an article about organizing my placement for the Autumn 2007 edition of Midwifery Matters and have submitted a further article which I hope might be published in the next edition about what it was like. I hope my writing will motivate and inspire other students to undertake visits which will enhance their university experience. I have also given a presentation at my local RCM branch, to fellow students from my course and midwives from the Trust where I train about Zambia. I feel passionate about the potential organizations like the White Ribbon Alliance for Safe Motherhood www.whiteribbonalliance.org can make to improving maternal and infant health and can see my future being connected in some way to international development.