Funding for this phase of the LHAP was provided by MediShare International, the Rotary Clubs of Palo Alto and Los Altos, California, and the Rotary International Foundation.
Temporary installation
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The Luapula Health Assistance Program (LHAP) is a major project of the Bush Hospital Foundation, MediShare International's Partner in Europe. Mike Marks, MD, an Associate Member of MARCO, is the Medical Director and Project Manager. Mike knows this area well, having visited this region on several occasions and personally developed the proposal. This project supplied and upgraded all the main hospitals in the province, eight in number plus their many remote feeder clinics. This was accomplished by shipping over 1.5 million dollars worth of drugs and equipment to the hospitals and clinics. This Radio Communications Project is part of the effort to upgrade the health services in the north by bringing outlying clinics and rural health centers into daily contact with the doctors at the hospital for consultation and to enable the expeditious dispatch of an ambulance if available, to transfer emergencies when necessary. Funding for this phase of the LHAP was provided by MediShare International, the Rotary Clubs of Palo Alto and Los Altos, California, and the Rotary International Foundation. |
Temporary installation |
This is NOT the Zambia (click here for map) you might know. the Zambia of tourist launches on the Zambezi River. The Zambia of Victoria Falls.
In this Zambia, one of sixteen African women dies during pregnancy and childbirth according to the World Health Organization. Of the many grave statistics on health care in Africa, this is one of the most preventable. Programs focusing on maternal and child health help in many countries, however their success is heavily dependant upon the quality and availability of medical facilities.
Zambia, the former British colony of Northern Rhodesia, is a large, landlocked country as big as France and Greater Germany, but with a population of only nine million people. It ranks 143rd on the UN's Human Development Index (out of 162 countries) and suffers from problems typical of most sub-Saharan African nations: HIV/AIDS (an estimated 20% of all adults are infected), refugees (200,000 from four neighboring countries), and economic stagnation with high debt and very little growth in its GDP. It is divided by an area of Zaire - still referred to as the Congo - into two sections. Luapula, the area that this project serves, is in the northwest.
The population of this province numbers over one and a half million. In addition there are about 50,000 Congolese refuges in various nearby camps.
There is virtually no industry. The people either fish or are subsistence farmers. Although subtropical, the province is on a high plateau (900' - 1500') and therefore relatively cool - 18-26 degs. C. day time average according to season, and wet: up to 1.5 m. of rain per annum falling entirely between November and April. This province is almost entirely surrounded by water and is about 100 by 400 kilometers in size. The great Lake of Tanganyika is along the Congo border to the north.
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Far to the west of the Luapula river and northwest of Lake Mweru are the killing fields of the Congo (now Zaire) civil war. Refugees still cross over into Zambia at the rate estimated to be at least 200 a week even when there is no immediate fighting. Other than at Kasenga, where there are four doctors on the hospital staff, there is no infrastructure, such as roads, power, telephones, etc. in this vast area. Refugees migrate into Luapula Province, where they end up in the refugee camps at Kala and Mporokoso. Congolese refugees and northern province marsh dwellers (on an island in Lake Bangweulu, 50,000 people) rely on Luapula Health Services, already under funded and understaffed. The three doctors at St. Paul's Hospital on Lake Mweru, for example, estimate a true catchment population in excess of one million, which is the official total population of the entire province. The Northern Area (to which this proposal is directed) has the problem of great distances with few or no roads, and nearly non-existent communications resulting from no or little dependable power. |
Due to this lack of communication and transport, the hospital receives many referral cases in bad condition. Most of these cases come from the northern part of Nchelenge, Chiengi and Kaputa Districts, where there are no roads, not even tarmac, few trails and little public transportation. Although the hospital has an ambulance, it cannot be used dependably because of this lack of passable roads and lack of communications with the hospital doctors.
St. Paul's Hospital
| St. Paul's Hospital is the only hospital in Nchelenge District. This district isolated in the extreme Northern part of Luapula Province, 450 km from Lusaka, the capital, and 250 km. north of Mansa, the provisional capital. |
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 Clinic and antenna pole behind |
Health services are provided by eleven Rural Health Centers (RHC) and St. Paul's Hospital. The hospital also serves patients from Chiebngi and Kaputa Districts, since those do not have their own hospital. The hospital even serves patients from the Uganda refugee camps just across the border. Nurses and/or aides - no doctors - staff the RHCs. |
THREE MAJOR EMPHASES
Referral of complicated general and in particular maternal cases for further management to St. Paul's Hospital by RHC staff or Trained Traditional Birth Attendants (know locally as TTBAs) is delayed by several hours, days, or doesn't happen at all, because of this lack of communications. Most referrals are urgent and maternal and perinatal morbidity and mortality can be significantly reduced if emergency calls and consultation can be done by radio instead of by staff members who often have to walk both ways to the hospital to even gain permission to bring a patient in for treatment. This can involve a round-trip of a few kilometers up to as many as 230 kms. (130 mi. approx.) - taking several hours or even days. If the patient is accepted for treatment, he/she too must be transported by stretcher carried by two staff members walking to the hospital. It is clear that many seriously ill patients cannot physically withstand the time loss and the rigors of such a trip - and morbidity is unnecessarily high as a result.
| Reliable communications: Until now there has been no reliable and fast way to communicate between the district health officer, the district pharmacist or personnel officer and the RNCs. This inhibited the timely offering and supply of drugs, vaccines, food for patients and other requirements to run the centers efficiently. Health center staffs had to walk to Mchelenge or Chiengi to arrange for these necessities, leaving some centers without trained staff for hours or even days. |
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PROJECT DETAIL
The project consisted of installation of new radio equipment and solar panels to those RHCs that do not now have power and communications and upgraded the few radios already in use in the hospital, the two district health offices and the 15 Rural Health Centers. Due to total lack of or erratic supply of electricity, all radios are powered with solar panels. This system makes it possible for RHC staff to consult with the doctor in the hospital - a 'luxury' not previously possible. The radios are also used to report all notifiable diseases to the District Health Officer upon diagnosis. The DHO can now communicate to the centers when a vehicle is traveling in their direction making more efficient use of the little transportation that might be available.
An important side benefit results since the solar panels are configured to provide additional power for small refrigeration units (also provided), making possible for the very first time, for the RHCs to store and use medications requiring refrigeration.
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This system consists of twelve 100-watt transceivers (Kenwood TK-80, 1.8 - 30 MHz), power supplies, and all associated antennas, lightning protection, solar panels, and licensing fees for one year. The project also provides training and support in the use of the equipment.
This system has been installed, tested and staff members have been trained in its use by Suntech Appropriate Technology, Ltd., a well-known and experienced communications company. |
 Staff testing the communications link |
The total cost of this communications system was just over USD $30,000, and was funded by a partnership between MediShare International, the Rotary Clubs of Palo Alto and Los Altos, CA, and Rotary International. The balance of the project, consisting of the provision of carefully selected medical equipment, instruments, supplies and drugs, was provided and funded by the Bush Hospital Foundation, in the Island of Jersey, UK. This phase of the project will be completed by summer, 2004. Direct Relief International, of Santa Barbara, California, provided all the equipment and material in this phase.
June, 2004
Los Altos Hills, California
Robert C. Smithwick, D.D.S.
Director Emeritus, MediShare International
Member, Palo Alto, CA, Rotary Club