Reflections

All of us have returned to the US! Zambia was incredible, and we learned so much about the healthcare system and the scope of prosthetic devices. We spoke with each level of hospital in the country and various clinics during our stay. We learned that with government control of many facilities, patients rarely pay for service of basic sorts. We found two places that manufactured prosthetic devices; one was run by the government, and the other by the Catholic church.

The government-affiliated prosthetic service was located in Lusaka at the University Teaching Hospital. There were 4 prosthetic technicians working here. The majority of their manufacturing was for splints, needed for those who have their limbs but may experience trouble walking due to a birth defect or disease. They also make prosthetic legs from materials imported from Germany, Switzerland, and China. They do provide cosmetic prosthetic arms, although from our interviews many would prefer a functional arm.

Holy Family Rehabilitation Centre was the smaller facility manufacturing prosthetic devices. There was one prosthetic technician and one prosthetic technician in training working there. They also imported materials from Germany, and their products were significantly more expensive than those offered at the hospital.

Both facilities will allow the amputee to stay at the facility while the device is being manufactured. Overall, it seems like Zambia has very good healthcare and prosthetic services.

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That’s a Wrap

To find out market opportunity, Janak, Nick and Paul interviewed chemists, doctors and nurses to understand current screening, diagnosis and treatment pathway for Urinary Tract Infections (UTIs). UTIs are highly prevalent in Zambia, especially amongst women and children. Presently, the screening option available is 10-marker test strip which tests for all kinds of diseases including UTIs and diabetes, but is generally available only at hospitals and some clinics. Many patients come to chemists first, and are either referred to clinics or are given antibiotic treatments and sometimes symptomatic treatment directly. The clinics generally rely on symptoms and result of 10-marker test strip or pathology lab testing to make diagnosis of UTI. Some physicians do confuse UTIs with STIs, but most of them are well aware of the distinction. The medications prescribed for UTIs are common antibiotics like erythromycin, ciprofloxacin, amoxicillin etc. Potential market channels include chemists and government agencies that order supplies for hospitals and clinics.

The team also worked to characterize urban and rural Zambians’ understandings of diabetes, as well as the opportunities for screening and diagnosis in small clinics and regional hospitals. While there is a growing burden of chronic diseases, such as diabetes, in Zambia and other sub-Saharan Africa, there is also a strong government effort to educate and combat the disease. Government supported clinics have educational posters concerning “sugar disease” which highlights both the symptoms and causes of diabetes mellitus. Many local clinics have screening options such as urine dipsticks or glucometers. Larger hospitals regularly hold monthly clinics where patients can get their blood glucose measured and learn general symptoms of hyper/hypoglycemia, so they can do home treatment without the aid of personal glucometers.

Juli and Molly finished their investigation into the perceptions of UTIs in Zambia. Molly traveled to Siachitema to interview women attending a clinic there. Overall, very little evidence was found to indicate that UTIs were subject to a social stigma in Zambia. While few women were familiar with disease, participants almost unanimously stated that they would seek help from a clinic if they were to experience the symptoms of a UTI. These women also showed very little preference towards specific healthcare workers, and they indicated that they would be willing to share their symptoms with and get tested by CHWs.

Josh and Staci conducted surveys of hospitals, clinics, nurses, and community members in an attempt to better understand the current Zambian healthcare system. This was done with the ultimate goal of identifying social gaps that could then be filled or met using mobile health services. Among the most prominent findings of the study were the high frequency of drug and staffing shortages, the long travel distances to even the most basic of medical centers such as health posts in villages, the lack of low-cost medications at pharmacists and chemists when the clinics run out of drugs, and the absence of both specialty care services and advanced medical equipment/screening devices. The healthcare system is among the most advanced and progressive throughout Africa in that it is primarily free for its citizens, although this results in other gaps such as those mentioned above.

Brienna, Corinne, and Dr. Ritter went to town to speak with a man who was born missing a hand. His answers to our questions validated the information we had received from the clinics and hospitals. He said he would prefer to have a functional prosthetic to perform actions such as driving a car. He also told us he would be willing to travel hours to receive it. He did not have a job currently, which could be due to his disability.

We also started aggregating the information we have collected over the past several days in order to turn it into a short paper explaining the pathways and opportunities for improvement.

Today the Ukweli team took a break from healthcare facility visits and interviews, and  buckled down to aggregate all the data we have collected thus far.

Molly and Juli organized the interview answers from the last two weeks and identified patterns in UTI perceptions among the different areas in Zambia. Josh, Staci and Molly also assembled their data and created an outline for the healthcare pathways in Zambia. Nick compiled data from conversations with physicians and worked on the GHTC application, while Paul edited video footage for a HESE promotional video.

With all the accumulated data, the Ukweli team identified gaps in their findings and planned for the last week of interviews and visits that lie ahead.

A Day in Monze

Today, our team traveled to Monze to receive more information about the manufacturing and distribution of prosthetic devices. Monze is one of two locations in Zambia with prosthetists (with one also in Livingstone). We started at the hospital and gained basic information on the healthcare system. Amputees from the hospital are referred to Holy Family Rehabilitation Centre in Monze. Holy Family is where the manufacturing and distribution of prostheses takes place. There is one prosthetist and one in training currently working there. We found that the materials needed for manufacturing are imported from Germany, and fitting and assembly is done on site in Monze. Holy Family primarily relies on donations to bring the cost of the devices down for the patients.

Since there are only two locations that offer prosthetic services in Zambia, amputees in rural areas generally do not seek a prosthesis. Holy Family has a community outreach service with workers at health posts in rural communities. With this, they are attempting to reduce the number of those needing a prosthetic device.

The church running the Holy Family Rehabilitation Centre has a nearby Child Development Centre. This facility accommodates disabled children and their families. Those in charge of the centers provided us with tours of both, which were extremely impressive. They established the facilities with various needs assessments, and have done their best to overcome many of the challenges this area faces (particularly in terms of the distances to receive proper medical attention).

The Ukweli team was all over the Southern Province today. Paul, Nick, Molly, and Juli traveled to the Choma General Hospital and the Shampande Clinic to learn more from clinicians. Paul and Nick got some great information from the doctor running the diabetes clinic there, while Molly and Juli received a new perspective on UTIs from clinical officers at both locations. It’s looking like while our test strips may not have much use in more urban areas since healthcare is essentially free, they may find a market in more rural areas where people walk for hours to reach a clinic.

Staci and Josh visited Monze Mission Hospital today in Monze district to gain a better understanding of the referral system and the various hospital levels within the Zambian healthcare system. They also tagged along with the 3D printing team to Holy Family, a rehabilitation center run by the church that specializes in custom orthotics and prosthetics. They have now obtained a substantial amount of data regarding the healthcare system from the grassroots level all the way to the higher level administration at larger hospitals.

On Tuesday, Dr. Ritter turned in a letter to gain approval to speak with the nearby clinics. The following day, we had plans to visit two clinics. We instead visited two clinics and the hospital, and also visited the Catholic Church to get contacts in the next hospital in the referral system. Today we visited the last clinic in the area. We spoke with a total of 7 workers, including clinicians, nurses, and volunteers, and the physical therapist at the hospital. Our team gained a lot of information regarding the healthcare system and its pathways in Zambia, and how referrals work. We also learned that amputees are very rare here, and birth defects are much more common.