Diploma for a better future

Mpanshya, Zambia

More than half of Zambia’s population is younger than 15 years and is poor. Even worse for these young people is the lack of adequate perspectives to escape this poverty trap. Together with SolidarMed and local institutions, the Hilti Foundation has therefore launched a healthcare pilot that is creating new opportunities.

There are vast areas of open landscape with Mopanes, Albizia saman, mahogany and baobabs, and with unimpeded views of the African bush. Villages, the heart of local life, are few and far between. Bales of elephant grass line the roadside every now and then. Shortly before the start of the rainy season, the roofs of the round huts are newly thatched. The purchase of goods, apart from elephant grass, is limited to mangos and heavy bags of charcoal, all transported home on bi- cycles – despite the scorching heat of 45 degrees Celsius.
Poverty is already evident just some 250 kilometers east of Lusaka, the Zambian capital. Plantings from the previous season provide the current harvest. Food is prepared on an open fire; a rare luxury is fish from the Zambezi River, which has been smoked. The local market can be reached only if one has enough money for the bus fare. There is no electric power, no running water, and sanitary facilities of any sort are an exception. Everyday life is exhausting, and people are aware of being unable to escape poverty. There are schools, but no higher-level education. Skilled workers are desperately needed in rural areas, but there are no institutions that can provide young people with proper training. Some of them move to the city, but they will never return, increasing the negative economic situation as a result.

8000 caregivers lacking
Together with SolidarMed and local partners, the Hilti Foundation has launched a pilot project to help young people escape poverty and to help skilled workers to remain in rural areas. Currently, there is a shortage of 8000 nurses, caregivers, and midwives in Zambia. This number is continuously increasing, as the Zambian population grows by about 500 000 people annually, roughly comparable to the size of Zurich. On the one hand, it is prudent to invest in healthcare as a prerequisite for development, and to make independent life feasible. On the other hand, healthcare investment will facilitate the employment of nursing school graduates.

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Working together
«Projects established alone are not sustainable,» explains Martina Weber from SolidarMed. «One may have created a project. However, as soon as one withdraws, the risk that it will fall apart is great. We work closely with national and regional authorities, and with partners. And we were looking for partners who have already been active in healthcare.» Weber found what she was looking for in Mpanshya, where, since 2009, Toddy Sinkamba has been engaged in establishing a training center for nurses. Sinkamba, who is clever and possesses a great sense of humor, has struggled with countless challenges and continues to struggle, but he learns to master them with impressive energy and ingenuity.

Housing shortage

The first huge problem was the lack of decent housing facilities – for students as well as for teachers. In a region where cash is scarce, nobody has access to sufficient funds for constructing rental housing facilities. The hospitals that collaborated with SolidarMed were left to their own resources and, due to the tight financial situation, were only able to offer emergency shelter to staff members. This led to the untenable situation that people employed in hygiene-oriented professions were unable to comply with even the most basic hygiene standards. Taking a shower after hours of physical exertion in the hospital? A lavatory with running water? Some quiet and peace to recover from work? Being able to cook without first walking to a well? Impossible! Accommodation was rudimentary and overcrowded, thereby presenting an additional stress factor to the already burdensome workload.

Lack of experience
A second problem: How should students gain practical experience? Hundreds of trainees cannot attain the requisite practice in a 100-bed hospital. Many hospitals in Zambia cannot even offer the required 70 percent theoretical and 30 percent practical experience. Providing high-quality internships to students was important to Toddy Sinkamba and his team. «The Ministry is currently discussing if the nursing profession should be upgraded to a university degree program. The minister has stressed that the training program should, in any event, aim at providing practical experience. We not only need more healthcare personnel, but, above all, we need better-educated personnel. Here, in Mpanshya, we devote attention to continuous quality improvement», Sinkamba said.

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Housing space – an unbeatable advantage
With the help of the Hilti Foundation, the strong commitment of SolidarMed, and the school administration in Mpanshya, groundbreaking solutions were developed. These include the founding of a housing company, which has meanwhile commenced construction of seven employee residences. There is an ingenious twist to this process: Rent surpluses flow back into the hospital, enabling additional important acquisitions, such as ultrasound equipment. Moreover, surpluses can be used to refurbish already-existing buildings. The Zambian government also supports the housing company by granting housing allowances to healthcare personnel. Members of the hospital’s administrative team lead the housing company. They have a natural interest in managing the business in the best possible way, as they are the ones who must deal with any complaints that may land on their desk. And they are also the ones whose efforts to find skilled personnel are often futile. Being able to offer good quality living conditions is an unbeatable advantage in their efforts to recruit qualified personnel, and above all, to motivate them to stay.
In the meantime, thanks to Hilti Foundation’s investment and to the commitment of SolidarMed’s project leader, Klaus Thieme, seven employee residences and three student accommodations have been built. The lecturers, instructors and students are all impressed. They greatly appreciate the accommodation – after all, running water and sufficient privacy is considered a luxury, even in the capital. In the next construction phase, additional accommodation is planned, as well as
a newly-created position of building manager. The weather in Zambia is extreme. It fluctuates between extremely hot drought spells, torrential rain and even freezing winds – for which one needs a woolen cap, a scarf and warm socks. Material damage and wear-and-tear is accordingly high, and skilled workers who can repair the damage caused by climatic conditions are rare.

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Decentralized training program
The problem regarding practical training was also solved: Two additional hospitals in Katondwe and Chongwe were integrated into the project. Here, students are accommodated and supervised during their internships. This is a win-win situation: The rotational system allows students to become familiar with other key topics of nursing and creates many opportunities for students to practice their skills.
Mira Gora, a Polish nun and distinguished surgeon, heads the hospital in Katondwe. This type of medical specialization is desperately needed in the vicinity of the Zambezi River. Hippopotamuses often cool off directly under the water’s surface. If a fisherman collides with the back of this highly aggressive animal, its bite can cause life-threatening wounds. Broken bones, caused by the blow of a crocodile’s tail, or bites from leopards are also typical for the region. Located further inland, the hospital of Chongwe is known for its first-class maternity ward. Almost 2000 babies are born here every year. This offers soon-to-be-qualified mid- wives adequate opportunities to practice their skills under professional supervision.
But hospitals also benefit from this situation: They have more, as well as better-educated, personnel as of their second year of training. This results in an improvement of the overall quality of nursing in the hospitals involved: on the one hand, because teaching hospitals have an exemplary function; and on the other, because the General Nursing Council applies strict control guidelines in these hospitals.

Convincing the Ministry of Health
The world is complex. This implies that solutions must be well thought-through and «multisolutional». After just three years, preliminary successes have been achieved in the Zambia project initiated by the Hilti Foundation. «National exams took place in June», reports Toddy Sinkamba. «We have recently received a letter from the ministry congratulating us on our excellent work. Our students achieved above-average results.» Then he laughs. «Unfortunately, we did not find a check in the letter, but I hope we will be able to gradually convince the ministryto grant additional and urgently-needed positions for clinical practice instructors.»

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