Author: Sophia Ann Hardten
I arrived in Zambia expecting to bear witness to great disparities between American and Zambian healthcare. My interactions within clinics and during home-based care, however, have revealed much more than I would have ever thought.
Home Based Care
Due to my lack of experience in medicine, I believed I would be limited in direct patient interaction during my Public Health Internship. I was expecting to be more of a shadow than a participant, quietly observing from the sidelines. I was pleasantly surprised to learn that medical work here in Livingstone is far from passive.
We are the ones in the driver’s seat while on home-based care visits—tending to wounds, analyzing symptoms, and deciding on medication and treatment courses. My knowledge and experience in medicine has grown immensely in these last four weeks because of the trust that has been placed in my hands.
During my Public Health Internship here in Zambia, home-based care has become my favorite aspect of the experience.
I was not expecting the medical atmosphere to be so warm and welcoming during home-based care. The communities are quiet, relaxed, and focused on connection. I do not feel the need to act professionally in the Western sense, where doctors place a strong emphasis on efficiency and results. Instead, I feel that connecting with patients here is just as important as discovering an effective course of treatment.
The communities are very tight-knit, so it’s not weird to just sit and visit with a patient before jumping into treatment. I never feel rushed to finish a visit, nor do I feel stressed that someone will be neglected. The laid-back environment within these Livingstone communities makes the experience much more personal, which has allowed me to become familiar and aware of Zambian life—common foods and activities, family structure, drug and alcohol prevalence, animal treatment, childcare, and waste issues to name a few.
I feel like each morning I get to see another side of Livingstone, engaging in a personal tour directed by our caregivers.
I also observed that our presence as medicals in the communities is extremely welcome, which defied what I initially expected. I know that America and other historically colonial countries have a dark history of impeding in situations where they are unwelcome, eventually making matters worse than better. I didn’t want to be another American entering without welcome, believing I had the key to improving the situation of a less developed country.
I find the opposite of my fears to be true—nearly every member of the community is friendly towards us and our role as HBC volunteers. Children will run up to us as we walk through with our caregiver; older men and women greet us happily with “Good morning” and maybe a handshake.
I will never forget when a patient of ours expressed his sincere gratitude for African Impact. He explained that we have managed to touch his community of Libuyu far and wide, both subtly and dramatically improving people’s health. I sometimes struggle to feel that I am making a direct impact on the lives of our patients during HBC since progress can be slow, but this patient’s gratitude was very motivating and humbling.
While driving to and from home-based care, I have grown so grateful for our drivers, Benny and Andrew. They are a crucial part of my time here, enriching my experience with impeccable knowledge and warm hearts. Benny and Andrew are so willing to answer all the questions I have. I can feel their readiness to share the love they have for Livingstone with everyone, and it helps me approach my work with great diligence and care.
Just by listening to Andrew or Benny speak, I can tell they have learned and observed so much about his country. I am grateful that they have shared so much wisdom with all of us, for I feel deeply connected to the communities of Livingstone, understanding this place much more than when I first arrived. They have helped me become familiar with my surroundings and given me the tools I need to approach those who grew up in a different community than myself.
Before arriving in Zambia for my Public Health Internship, I bought a book titled 28, a collection of stories about victims of HIV. Although the stories were accurate in the tragic repercussions of the HIV pandemic, the novel only slightly touched on the profound stigma surrounding the disease.
On HBC visits I found myself in a tough position, where I had to avoid contributing to the stigma while also maintaining the privacy of patients. Respect for my home-based care patients was my utmost priority each morning, so I refrained from mentioning HIV or AIDS to ensure their comfort.
Many prefer to keep their status secret from even the closest members of their families in fear of being perceived as dirty or accused of cheating. I never encountered a patient who confided in me with their status; I never even heard the words “HIV” or “positive” come from a patient’s mouth. I learned to wait until after the visit, then ask the caregiver about the patient’s status—that is, if they even knew.
If the atmosphere around HIV/AIDS were to be more open, I feel that the effects of the pandemic would be mitigated. Knowledge of one’s status prevents the disease from spreading and makes treatment more accessible to those already infected.
I found the most appropriate environment to openly discuss HIV/AIDS was within workshops. Students will engage more openly because workshops don’t need to be personal—they aren’t one on one visits like in HBC. I was happy to see the level of engagement during our public health workshops with eighth-graders and young adults.
I designed my workshop on common diseases to be an open discussion guided by questions about HIV symptoms and prevention methods, and students were much less shy than I originally expected. Upon leaving these workshops, I felt hopeful for the future of HIV stigma. I believe that at least with younger Zambians, the discussion around HIV is becoming much more open and less accusatory.
I would love to come back in a few years and see where the progress goes because I believe a healthy shift is taking place.
I arrived in Zambia expecting to bear witness to great disparities between American and Zambian healthcare. My interactions within clinics and during HBC, however, have revealed much more than I would have ever thought.
Americans are invested in healthcare for the purpose of optimizing a system that already functions relatively well; whereas Zambians are invested in healthcare for the purpose of not optimizing, but just developing a system that works.
The health of many citizens is hindered by a system that fails to account for immobility, poverty, and disease prevalence. It is all too common to see patients who do not take their referral to the clinic, test themselves for HIV, clean a wound that is infected, or fuel their bodies with proper nutrition. This lack of healthcare is due to a system that fails to properly educate Zambians on the importance of healthcare—in no way are these issues I have witnessed the fault of Zambians themselves.
The array of contributing factors to common diseases and basic health issues is so evident to me and others growing up in a developed country, but here, this information has barely been made accessible to the general population. I have grown frustrated at my situation, where I have grown up in a healthcare system completely different than the one here in Zambia, not having to worry about neglect or misinformation.
I understand that a solution is on its way, but I find it difficult to discern exactly when and how this solution will come about.
My time on this Public Health Internship has only made a small dent in this deeply rooted issue, which at times can be hard to admit. Every volunteer expects to walk away from their experience having observed tangible progress—a healed wound, a decrease in blood pressure, dietary changes—but I have realized that progress rarely manifests itself in this way.
Halfway through my experience, I grew frustrated with the fact that I wasn’t observing any evident improvements in health, resenting the visits where I could only hand out painkillers to temporarily fix a larger problem. I had to remind myself that the mere act of visiting patients is better than doing nothing at all.
I may not be making a direct impact, but I am certainly making a difference in the day of my patients, and I gradually became comfortable with that realization. I would like to think that we may not always embody help, but we constantly embody hope.
This 4-week Public Health Internship takes place in Livingstone, a town on the edge of Victoria Falls in Zambia. The internship gives you a chance to gain practical work experience while improving access to, and the quality of, healthcare in a rural community.
Doing an internship in a challenging environment where resources are limited helps you develop valuable skills such as adaptability, stress management, and patience, which better equips you to handle the unpredictability and pressure of working in healthcare.