About an hour outside Livingstone, we arrive to the first of several clinics we will visit while in Zambia. Simonga clinic is busy already with under five day. Babies breastfeed while toddlers play with each other tugging on clothing, and scoping visitors out warily. A tiny girl in pink tries to drag Mom’s purse across the concrete floor to show a friend. She bursts into tears when Mom lifts the bag out of reach. Another toddler wanders over to the immunologist in our group and he waves repeatedly engaging, until she holds out her hand for a high five. Then he is suddenly shy, racing back to his Mom.
Under Five Day
Simonga Clinic is without question in demand. Under five day brings a host of children with a range of concerns. Here in Zambia the primary caregivers are nurses. Volunteers are also crucial to the operation of this health care facility. We are here to speak to Moms and health care workers about their access to vaccines and the obstacles they face.
The Distance and Obstacles
This Zambian children’s clinic is eye opening. It is 9:15 a.m. and many Moms are already waiting. Some start out early and will walk as far as 18 kms today to get health care for their children. There are many common themes. Moms here all know how important it is that they get their children seen regularly. They very often walk with babies wrapped tightly in place on their backs and toddlers or other young children beside them. Most Moms speak of having no support from their husband. The care of the child is clearly all up to the females. Health care too.
Our Lusaka Visit to Unicef
Yesterday we spent some time in the capital of Zambia, Lusaka, where many NGOs (non governmental organizations) such as Unicef and USAID have headquarters. Zambia is a country of 14 million people. It is one of the most environmentally in tact centres in subSaharan Africa.
Here in Zambia 80 % of Zambians are under 35. Life expectancy is not high at 49-50. In Zambia 55 % of the population are children under the age of 18. This is the mandate for UNICEF – The 55 %. Children are the future of the country, but a strong future relies on healthy children growing into thriving adults and there are still too many threats to children here even in Zambia. Stunting is a health challenge that can impact a child’s lifespan and potential.
Zambia has many things working in the country’s favour. For instance, the government here supports and believes in building a strong health care system. Vaccines are highly important to health care policy and the government works hand in hand with many NGOs to build a thriving population. The UN Foundation, which started Shot@Life, a child vaccine advocacy and accessibility group, also works with the government of Zambia by funding and supporting groups like UNICEF and USAID.
HIV, Malaria and Malnourishment
Although improvements have been made, HIV and malaria are still leading causes of death and a large majority of children are malnourished and have stunted growth. The first 24 months of a child’s life are critical for brain development, so there is a new effort to educate mothers and get children adequate nutrition when they are still very young. Children who do not get the food they need can face life long consequences and may never grow into the potential they might have seen otherwise.
Kelfisea’s Story at Simonga Clinic
Today Kelfisea, 24, a mom of three children, aged 1 to 7 years old, has brought her youngest, David to Simonga. Two of her three children have had some health issues. David, in a red plaid shirt, seems a bit withdrawn while having his picture taken. Earlier, he was the small sweetheart running around trying to make friends with Purvi, the allergist and immunologist in the group. Like many kids in Zambia, he struggles with stomach issues. Here diarrhea can be deadly.
The Nurse in Charge
Nurse Mamakau Akafekwa has been working at Simonga Clinic for four years. She has been a nurse for 20 years and started as a community worker when she was much younger. She was a former member of the Red Cross and always loved helping people so nursing was a natural choice. Here she has one community health worker and one general worker and some volunteers who support the work being done.
Inside Simonga Clinic in Zambia
Simonga is four rooms with a very basic bathroom and limited access to electricity. Simonga Clinic serves 5,077 people in 4 different zones. There is a delivery room which is tiny and a vaccine fridge, an exam room and intake space. Other big obstacles to receiving vaccines can be cold chain related. Vaccines must be kept cold so that they are viable, and in places like Zambia the heat is a factor. Also electricity is not reliable.
The Zambian government uses something called power shedding, which means the power is turned off every day for hours at a time. They now publish a schedule ahead of time to let people, and health care clinics such as this one know when the power will go out. Vaccine refrigerators like the one in Simonga use electricity to keep vaccines cold. They are able to keep the unopened vaccines cool for 12-14 hours without power. Now many vaccines also come with a sticker on the bottle that will tell you if the maximum temperature has been exceeded. In that case the vaccine will no longer be effective.
Simonga Clinic Services
Women can and do give birth here. But if there are any complications, an ambulance is needed. There is one ambulance for the entire area and distance is great. HIV testing is often done here and the staff also provide prenatal care. Immunizations are a big piece of the puzzle at Simonga Clinic.
There are many obstacles to making sure lifesaving vaccines are delivered at the right time to all who need them. Many volunteers and community leaders also sensitize the community to the reasons why vaccines are so important.
Other Health Issues in the Area
Right now in this clinic it is also cold and flu season. There is, as always, a lot of diarrhea.
Along with immunizations, wellness visits, and treating sickness, Vitamin A and deworming are also administered here. In the rainy season Malaria is expected to spike again and in winter come the respiratory infections. Occasionally workers will do outreach too but distance makes that very hard to do in this area of Zambia.
Here, in various areas of Zambia, many Moms and Dads will tell you their hopes for their children when you ask them about health care and vaccines. Mercy and Kelvin are here today because Kelvin, 3, (pictured above) has an upset stomach. He tells his Mom that his stomach hurts often. Both Mercy and Kelfisea say lack of food is a huge issue for their families.
Not surprisingly, Mercy is in charge of making sure her son gets his vaccines on time as needed. She hopes he will grow strong enough and healthy enough to attend school. Many Moms of girls here volunteer candidly to all of the writers in our group that they want their daughters to be nurses when they grow up.
Obstacles to Care in Zambia
Transportation to Simonga Clinic
In Simonga many Moms arrive in a group. It’s better to walk together because most come a very long distance. As a result, the nurse here has structured the clinic days accordingly so that vaccines are all done together and regular under 5 days are done on a specific day of the week as well. Most moms walk great distances to get here in sweltering heat. It is expected to be close to 40 degrees Celsius today. Moms like Kelfisea and Mercy often leave extremely early in the morning to find the way here before the hottest hours of the day. Transportation is one of the greatest obstacles to children getting vaccinated here.
Animals are also an obstacle to health care here that is extremely unique to this area. Elephants in Zambia can cause a lot of disruptions. In fact elephants, although majestic, can also be extremely destructive. One night after dinner we watch one crossing a main road with two others following. At the side of the road there are groceries scattered and a bicycle that has been abandoned. The bull elephant picks up the bike with his trunk and tosses it in the air. He scours through the groceries to log what is there. All traffic stalls that night and backs away to give the animals a wide berth.
In SIMONGA Moms and Grandmothers are in Charge
Volunteer Sefina Chile, 66, often spends five days a week helping at Simonga Clinic. There is always something to do from washing blankets or cleaning the floor, to weighing the babies and helping Moms. Sefina Chile is a grandmother to 8 and a mother of four. She tells us that all of her children and grandchildren are well. Sometimes she is the one who brings the little ones to the clinic when necessary.
The Maternal Role in Health Care
“When my grandchildren are sick I bring them with me to the clinic. They know not to be scared because Grandma is with them.”
Chile has volunteered for about 2 years. She walks about 5 kilometres to get to the clinic on the days she helps or brings her grandchildren for care. At 66, she is one of the oldest women in the community. She is also a trusted role model to her family and many others. My children want to be sure their children get vaccines because they want them to be well, she says.
“In my family I am in charge. I tell them get your vaccines and live a healthy long life like me.”
Background on My Trip
Read More about my time in Zambia here – > Lusaka and Jubilee Ministries
I travelled with Shot@Life and the UN Foundation as a recipient of the Zambia Fellowship this October. I received transportation, accommodations, excursions, and meals while visiting Zambia. My opinion is my own and my stories are truthful. Stay tuned for more all this month. If you want to help children in communities like Simonga, join Shot@Life.org.