Filling the medical treatment gap in rural Zambia

Editor's Note: This post is part of a GlobalPost Special Report titled "The Seven Million," about the many challenges faced worldwide in an effort to reduce child mortality. As part of this project, GlobalPost health correspondent Marissa Miley is reporting on pneumonia in Zambia.

KITWE, Zambia — In this mining city in the country’s northern Copperbelt region, a can of multi-insect killer sits on my desk, a container of insect repellant lies on my bathroom counter, and a mosquito net shrouds my bed – all practical complements of the small hotel I’m staying at. Even though I’m on prophylactic antimalarial medicine and it’s not peak mosquito season – it’s winter here – with malaria so prevalent in the area, it feels like no preventative measure can be too great.

Over the past few days, concern about malaria, a disease spread by just one bite of a parasite-carrying mosquito, has come up repeatedly in conversations at the health centers I’ve been visiting in this area of the country. I worry about malaria, the mothers bringing their children for check-ups say. We’re testing for malaria, the health workers say. If a child has a fever, it seems, the community’s thoughts immediately turn to the infectious disease.

Their focus is for good reason – after several years of reductions across the country, new cases and deaths from malaria have been increasing since 2009, and are actually higher today than they were in 1990. The United Nations Development Programme estimates that today, three children under five die of malaria in Zambia every day. 

But a fever can mean a host of other things, too, including pneumonia – the leading single cause of death for children under five in this country, and the focus of my trip here. Zambia has a population of more than 14 million but only 0.1 physicians per 1,000 people. (In the US, we have 2.4.) Even though nurses and clinical officers (a bit like physician assistants in the US) form the backbone of the health care system here, there are also too few of them, especially in rural, hard-to-reach areas. So with so few professionals, how does a child get accurately diagnosed and treated?

To supplement the country’s over-stretched cadre of formal health care providers, the Zambian government has trained thousands of volunteer community health workers who have a host of health-related responsibilities – from educating families about the importance of handwashing to counseling couples about family planning.

These volunteers live in the community – housewives, peasant farmers, mothers, grandfathers, local do-gooders – and those I met in my travels told me they are primarily motivated by a desire to help their neighbors. Many of them regularly tend to their maize crops in the morning and later work five to eight hours a day, for free, providing advice and care at health posts and on house calls.

Lufwanyama district, where I’ve spent the bulk of my days in the Copperbelt, is an expansive rural area largely west of Kitwe — a flat, dusty land that stretches nearly 4,000 square miles near Zambia’s border with the Democratic Republic of Congo. The epicenter of copper and emerald mining in Zambia may be just a couple hours’ drive away, but cars are a rarity on the dirt roads here. Hay-colored elephant grass slaps against the doors of the car as the road, which will lead us to Kamupundu Primary Health Care Unit, narrows.

More common than cars are people walking; women carrying babies strapped to their backs and children in uniforms on their way home from school. The village here is dotted by small thatched huts and bags of homemade charcoal ready to be sold at the local market. There is no electricity here yet.

I’ve traveled to Lufwanyama with the nonprofit Save the Children to report on the government-run community health worker program that aims to fill the treatment gap, and to see how that program is contributing to addressing childhood pneumonia in Zambia. For the past four years, Save the Children has expanded the scope of the country's program in Lufwanyama in part by training the volunteers to distinguish among the leading causes of child mortality and morbidity here — pneumonia, malaria, and diarrhea — in a framework called "integrated community case management." 

On the health post’s walls hang hand-written tallies of children’s illnesses. Even though respiratory infections are a major problem in Zambia, last month, only two children in this health post had suspected pneumonia. Fifteen had malaria. Health statistics for the Copperbelt province published in 2011, the most recent year for which data are available, show that Lufwanyama had the highest incidence of malaria in the entire province.

So it's surprising to me to hear that one of the challenges faced by Elizabeth Kafumo, one of the health workers here, is the stockout of rapid diagnostic tests for malaria that can show, within 15 minutes, whether a child has the disease. While Elizabeth has learned to differentiate among common childhood illnesses here, she does not always have the right tools from the government to help her apply her knowledge and skills. 

I think back to my hotel room and the abundance of preventative measures I have at my disposal. The shortage of RDTs at this health post is part of a larger pattern I've seen play out over the course of my reporting here, from inadequate supplies of insecticide treated nets to zinc to child formulations of amoxicillin, and it's one that I'll continue to report on for the duration of my trip in Zambia. 

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