Nurse/Midwife Regina Banda looked resplendent in her white uniform, starched white cap and a garish yellow apron printed with slogans from Zambia’s eradicate polio programme. “I want to ask you a favour, doctor,” she began. Tuesdays are outreach clinic days, when a nurse travels to a nearby village to vaccinate the children. Nurse/Midwife Grace was scheduled to do the clinic, but she had not yet returned from annual leave. Mr Chulu, the public health inspector, would have stepped in and done the clinic, but he had gone to the District Health Head Quarters at Mwambe to get essential supplies. Each clinic has a budget for buying cleaning products, but often these are not available locally, so he was looking to save some money by purchasing stock at a cheaper price. But he wasn’t here to do the outreach clinic. The nurse on night duty, Mr Mwanza, was sleeping and had other business to attend to.
“The mothers are still waiting in the hot sun with their babies for their vaccinations, doctor. Will you help us?” said Regina. How could I turn her down?
It had been a stinker of a clinic, after the long Easter break, with no full clinics on Good Friday or Easter Monday. Just when I thought the queue was diminishing, more people would turn up. I was left on my own without an interpreter (Daillies, my usual helper, had been dragooned into being the pharmacy dispenser). When the patients arrived, they were asked if they could speak English. Those who could were diverted to my room; those who couldn’t, saw Regina. As the morning wore on, some patients were tired of waiting and decided their English was good enough to see the doctor, who had a shorter queue. This led to some interesting conversations.
Dr: “How did you get a black eye?”
Dr: “Sorry, what happened to cause your eye to become bruised and swollen?”
Patient: “I fell off my bike.”
Dr: “When did this happen?”
Patient: “In Lusaka.”
Dr: “When were you in Lusaka?”
Patient: “I have not been to Lusaka.”
Dr: “Do you have any other injuries? Your hands look normal.”
Patient: “No, just my eye.”
Dr: “How did you manage to fall off your bike and only damage your eye?”
Patient: “I cycled into a pot hole.”
By the time Regina and I finished off the last few patients, it was 12:50pm. We had been consulting non-stop since 8:15. It felt like I was back in the NHS, consulting under time pressure in the surgery. I asked Regina to get the vaccines and supplies ready as I tidied up my room. We drove 5km down the road towards the airport and Regina indicated that we should turn off into a small village. But there was no turn off; it was just a gap in the long grass. The car bumped down a makeshift track for 100 metres, swerving to avoid tree stumps and chickens, finally arriving at the vaccination arena. All the children had been weighed, their health cards marked up, divided according to what vaccine they required. “So we have 14 children for measles vaccine?” I asked. “Oh, Doctor Ian, I didn’t put any measles vaccine in the cold box. I will telephone Daillies to cycle here with it.”
I reassessed the situation and decided it would be better if I drove back to the clinic and got the vaccine. Regina sent a volunteer lady with me so I wouldn’t get lost. By the time we returned, the immunisations were well underway. I drew up the vaccines, Regina stuck them in babies’ thighs. She also administered the oral vaccine (polio and rotavirus).
One of the vaccines came as a single dose ampoule, the other as a two dose ampoule. I was a bit confused by this, and thought I might have thrown a half-used ampoule of vaccine in the sharps bin. I caused consternation when I dismantled the cardboard sharps container to see if there was any liquid left in the ampoules. There wasn’t, but it took the volunteer fifteen minutes to put the container back together again (there are ten specific moves you have to make to do this).
We were nearing the end of the clinic, and just needed a few more syringes. The box was marked 0.5ml, but inside were 0.05ml BCG syringes, with tiny needles. Another SNAFU. But we improvised using bigger syringes and needles, and set off back to the health centre at 14:10 to do the afternoon consultations and look in on the three patients in the wards. By the time we had finished, it was 16:30 and I felt completely bushed. No lunch or tea breaks, not even a drink of water. I hope it calms down tomorrow.