Heather Ashcroft (Zambian Project Coordinator) describes one of her weekly visits to Ngwerere Rural Health Centre
Weekly visits to newly trained Clinical Officers are a critical part of the implementation of the Virtual Doctors Project into rural health centres. After initial training, I visit each site once a week in order to review the files the clinical officers want to submit and help them through the process. As practice makes perfect, the clinical officers then become responsible for building the Project into their own weekly schedule.
Ngwerere Rural Health is approximately 20 kilometres outside the centre of Lusaka on the Great North Road. Kennedy Mulenga is the only Clinical Officer at the site which services a catchment area of approximately 12,000 people. I visited this site in February 2014 and Kennedy invited me to sit in the consultation room during the treatment of a patient and see how he uses the VDP system in practice to help him with the case.
This particular case involved six year old Towani (shown sitting on the floor in the photo) who came to the clinic along with her mother and her 9 month old baby sister. Nelia was feverish, irritable and suffering from painful sores on her lower body. As the mother is HIV positive, Kennedy ran tests on Towani to see if the infection had been passed onto her daughter. When the test came back negative, Kennedy wanted to know whether there were complications with her condition due to her diet. Towani was the height and build of a three year old child and her distended stomach pointed to severe malnutrition. The mother explained that Towani ate nshima (ground maize) for most meals, with the occasional banana.
Kennedy made some preliminary suggestions to the mother and advised that he would call her with a date for her to return to the clinic. He then used the VDP system to submit a patient file, along with the patient’s history and photographs of the lesions on her abdomen to an expert, looking for advice on the best medication for her condition. The expert was able to diagnose her with kwashiorkor (malnutrition due to lack of protein) and advise on a course of treatment and medication.
Kennedy explained to me that he was able to call patients who needed to return to the clinic, or advise on a return date by which point he would have received feedback from the expert. The feedback in this case involved a dietary program for the patient which the mother could implement immediately. Medication was also recommended, however, this was not stocked at the clinic and the patient was referred to the hospital with their prescription. Not only was the timing of the patient’s return to the clinic in line with the expert’s response to Kennedy, but unnecessary referral for treatment at the hospital was prevented. Unfortunately rural health centres still remain under stocked in terms of medication but time spent in waiting rooms and in consultation in this case was minimised and Towani is already on the road to recovery.