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Zambia: Challenges in Medically Remote Areas

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AAR Japan
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Under the scorching heat, a pregnant woman is making a 5 hour journey by foot to the hospital to give birth. The woman goes into labor while she is still making her way to the hospital, and gives birth on the road without anyone to help her. This is a story from a health center officer in a sub-district only 20km away from Lusaka, the capital of Zambia. AAR Japan reports the current situation and its activities in Chisankane community.

One health center for 10,000 people

For the 10,000 people living in Chisankane community, there is only one medical facility – the Chisankane health center. The furthest residence in the community is 75km away from the health center. Furthermore, as there is no means of transportation, the people in the community have no choice but to walk the distance. It will be difficult for any woman who wants to go to the clinic for pregnancy, child birth and child rearing, to make the journey. After conducting a hearing, AAR Japan found that 8 in 10 women experience child birth without the support of a skilled birth attendant and many women do not receive adequate prenatal care. "If possible, I would like give birth at a medical facility. However there is no transportation… and even if there is someone with a vehicle, I cannot afford to pay them" one woman in the community said.

I Want to Get Medical Care at the Mobile Clinic but…

For people who live afar, a mobile clinic makes a visit to their area once a month. The staffs of Chisankane health center use their bike or hire a car for transport, and borrow facilities such as a school to provide maternal and child health services, including vaccination and weighing children under 5 for nutrition, prenatal care, course on family planning, access to contraception, and HIV testing. However, the mobile clinic is not running as efficiently and effectively to meet the needs of the people. A community health committee consisting of community volunteers should provide support to the medical staff of the mobile clinic by preparing the visit site, weighing the child, record keeping, and other activities that can be conducted without a medical degree. However, in Chisankane, the volunteers are inactive, and as there is no one to provide support, the two medical staff from the mobile clinic must prepare and provide all the services.

Some days, as up to 200 women and children wait to get service from a single mobile clinic visit. Although the medical staff tries their best to attend to the medical needs of the women and children, the waiting line continues to grow. Some women wait all day, only to return home without getting any medical service. AAR Japan was surprised to learn that some women travel from the day before just to visit the mobile clinic.

Lafina (19), who lives far from the visit site of the mobile clinic, leaves the day before the scheduled date of the visit, and stays overnight at a relative’s home nearby the visit site. AAR Japan felt that the women in the community hold the chance of receiving maternal and child health services to great importance. However, AAR Japan was disheartened to find that some woman must go home without receiving any services from the mobile clinic. Another challenge is that the people in the community lack the necessary knowledge on maternal and child health. After conducting a hearing, AAR found that majority of the people in the community did not know how many times pregnant women should go for prenatal care check-ups or the danger signs of high risk birth.

Project to Protect the Health of Mother and Child Begins!

To improve the current conditions of healthcare in this community, in February this year, AAR Japan began a 3 year project to protect maternal and child health in Chisankane community. In the first year, AAR Japan will strengthen the foundation by building a new health center and invigorate the capacity and functionality of the community health committees to improve mobile clinic service. As premises to the project, AAR Japan brought together the village heads and explained the project, and received a very positive response to our approach. Usually the village head appoints the volunteers to serve in the community health committees, but many volunteers raised their hands in most villages as soon as the project began. AAR Japan felt that this was a big step forward as previously, there were only a handful of members in each committee.

In May, leaders of each committee participated in training. They received training such as leadership skills to proactively manage the committee and discussion on how to handle problems within the group. Daniel (L) who participated in the training said “I learned how to work with the different members. I used to work alone, but now I know how to work as a group”. Towards the end of June, committee members participated in a technical training to support the mobile clinic. The members learned how to weigh and properly record the weight of the child and how to measure the blood pressure. Immediately after receiving the training, some committees proactively held a meeting to prepare for the next mobile clinic visit. In the future, AAR Japan will conduct training for members of the committee on monitoring the health of mothers and children, and teaching people in the community the correct knowledge on pregnancy and child birth. AAR Japan is looking forward to working together with the promising members of the committee to support woman in the community and the mobile clinic.

**We would like to express our gratitude for your donations and the Grant Assistance for Japanese NGO Projects (subsidized by the Ministry of Foreign Affairs) and Ricoh Social Contribution Club FreeWill for enabling the implementation of the activities mentioned in this article.*