Reflections Pt. 1
We cannot believe our time at Chidamoyo has come to an end! Our entire experience here has been filled with the graciousness, warmth, and joy of the individuals that comprise this incredible community. Though we are ready to embark on other adventures here in Zimbabwe, this place will always hold a special place in our hearts.
As we reflect on the impact we have made here, we have come to many conclusions on how we can improve our service at Chidamoyo for future groups.
Continuity with village health workers: These individuals were essential in making our work at Chidamoyo sustainable as they will be implementing early detection and intervention plans long after we leave Zimbabwe. They were also integral in helping us communicate with patients and families as translators. We suggest that future groups organize these visits better to ensure that the village health worker specific to any given patient is the one facilitating the visit as opposed to a different village’s worker. They are not only able to provide contextual barriers and facilitators specific to their community, but then they are updated on the patient’s progress and can hold the family accountable in successfully completing home programs. Feedback given to us from the health workers themselves surrounded timing patient return visits on or near the same day. This is a more efficient use of their time, so they can accompany those in their communities to their visits more easily. We also suggest a projection of prognosis and plan of care be given to the health workers and family to clarify goals and outcomes. The health workers also asked that we perform more village visits during our stay to ensure children that are unable to make it into the hospital are being seen and their problems addressed. We took this into consideration and organized an extra day of village visits this trip, but future groups could take this into consideration when planning their allocation of time. In past trips, village trips were a more common occurrence, but given that our group had 9 people this time, transportation would require 2 vehicles, which were not always available for us. For our additional village days, we broke into two groups—one would go out and the other would stay working with Mr. Kamhuka. If going with a large group, we recommend suggesting to Kathy or Mr. Kamhuka that you split into groups so that you can maximize on village visits.
Early mobilization/in-patient physical therapy: Though we focused on other things for our in-services/educational sessions, we suggest that a future group present on the importance of early mobilization in an in-patient setting. Mr. Kamhuka sees certain patients in inpatient, but we saw a multitude of others that could have benefited immensely from physical therapy. Providing an in-service on why physical therapy in this setting is important (decreased hospital length of stay, decreased re-admission rates etc.) would be greatly beneficial to the team at Chidamoyo. It is not something that is focused on currently and it would be a major ‘cultural’ shift within the hospital, but we feel the more that it is emphasized, the closer it will become the norm. An idea to think about within early mobilization is education on the importance of early stretching and mobilization of burns. In our time at Chidamoyo, we saw many different patients who suffered severe burns to their extremities. Stretching and mobilization was started much later in these patient’s treatment plans, and with this development of significant contractures were evident. But, an important piece to remember with this is the lack of pain medication available. In the US we time our stretching and mobilization sessions with patients being seen for burn management to be at a time when pain medications have been administered and are kicked in. Here that is not always an option, so this may be a limiting factor in early mobilization of patients with burns and ideal burn management.
List of donations/supplies: We took inventory and considered what would be helpful to acquire and bring as donations in the future and compiled a list:
Vitals machines: The hospital only has one. We saw many patient who would have benefitted from more regular monitoring, including a 2 year old who had been stung by a swarm of bees.
Shirts for village health workers: Shirts or hats that designate these workers would improve their credibility and accessibility in their communities. It was requested by them during our meeting, but we had to explain that unlike the shirts they have received from major organizations for HIV prevention, we are a small student organization with minimal funds and are paying mostly out of pocket for the opportunity to serve here. They expressed understanding for our situation, but we also understand their need to have more credibility within their villages so that they can be more successful. They currently have t-shirts, hats, and messenger bags with messages about preventing HIV and other public health messages. Possible ideas include: (1) 5 major criteria for scanning child development (based off the Pathways brochure for 3, 6, 9, 12, and 18-month-olds), (2) Duties of village health workers to advertise their responsibilities
Shoes & clothing: Many patients don’t have access to shoes but need them for mobility. We wished we had brought more pairs with us to donate! Especially for children! All types and sizes needed! Also, clothing for all adults and children to be donated—always a need. We were mentioned this prior but didn’t prioritize this for donations. However, being here now we see the dire need for this.
Assistive devices: These are very limited and extremely helpful. Crutches, walkers, canes, wheelchairs, etc. Once provided to a patient, they are not returned to the hospital, so the stock is always needed to be replenished.
~The GROW Zimbabwe Team~