Dr. Ray Markham is a GP in Valemount BC but was born and grew up in Zimbabwe. He is establishing the Zimbabwe/Canada Health Improvement Initiative which intends to collaborate with local institutions in health service delivery. His multidisciplinary team is currently in Zimbabwe and have established a blog post. Dr. Ray Markham is providing us with continual updates. Read his posts below (in reverse chronological order):
March 26th, 2015 We are in the mid point!
Well we have reached the mid point! We deliberately set this as a long weekend for members of the team to have the opportunity to explore a little of this beautiful country’s culture and scenery. We have had people going to game parks locally, some jetting off to Victoria Falls and a few road trips to resorts in Gweru and Bulawayo. A well deserved break from the hard work, and an opportunity to reflect on the adjustment that we have all had to make in social culture, culture of medicine, working environment, resource limitations ……and the runs….. among other things. One theme I hear through that reflection is although there have been challenges for each one of us ….and moments of what on earth am I doing here…… each of us has grown and sees value in being where we are at this time.
I see huge potential in the connections we are starting to make. One of the recurring themes, even this early on, is we get so much more out of this type of activity ( from clinical experience, through reflective and team building opportunities to aha moments where we see how we could do things better at home) than we contribute. However through investing in building relationships and supporting excellent existing local initiatives (from supporting amazing dedicated clinical staff and faculty through working together and open dialog to opportunities for faculty support in Generalist Family Physician accreditation initiatives in the works) I believe we can be a positive presence in Zimbabwe.
Specific Updates:
Community work in the Snake Park Area (Center of Total Transformation CTT):
This has been an amazing learning experience supported by the Ministry of Health and Harare Council Health services. We learnt that although the community is in Zvimba rural District, its closest clinic is Rujeko clinic in Dzivarasekwa ( singing waters) high density Suburb which is operated by Harare City Council. This Poly-clinic serves a population of 74 000 and is nurse led with a physician visiting 2 days a week. We have all the letters of approval and have started engaging in the community with the community health workers, supporting local health education and also with the Rujeko clinic the staff there have been most supportive in helping us learn the system. We connected and supported an outreach clinic from Rujeko clinic to the CTT area looking at screening for the 450+ orphans and at risk children, as our first clinical activity in Zvimba district. It is amazing to see, be a part of and hopefully enhance, such a well organised outreach opportunity. The students have really enjoyed the opportunity to engage in the outpatients clinic in Rujeko, but I must say the highlight seems to be the maternity clinics there. It has been excellent to see the work of the team addressing some of the social determinants of health issues (this trip has focussed on education and food security) and we look forward to witnessing the positive health impacts of this.
Karanda:
Our team has been welcomed at Karanda. We have had Physician, Nursing, Paramedic, and Lab members of out team on the clinical side; and then on the EMR and workflow support side, we have had Admin MOA and Nursing input, supporting the Hospitals’ endeavour to start working with an EMR and electronic billing system. Clinically I think this has been the most challenging place to work, where the sicker patients (75% of patients through out patients are from out of region travelling because of the availability of service) have interfaced in higher volumes. Here the resource limitations and impact on clinical outcomes are given a face and a name. This struggle has really demonstrated to me the value of having a multidisciplinary team in this context. It has been amazing to see this group pull together and support each other, helping overcome and grow through the challenges.
Medical Schools:
This team connected mainly with UZ but also NUST Medical schools. We have been welcomed into this context and our eyes have been opened to a number of opportunities. It is here that direct capacity building opportunities seem most apparent on both sides of the ocean, from the potential to help with faculty in developing a Family Medicine Masters program based out of the District Hospitals in Zimbabwe which would integrate medical student training in the rural context. Some early examples of potential benefit to the Canadian system include seeing the value of adopting some of the technology and systems already in use in Zimbabwe in things like point of care testing and patient held records.
Future potentials explored:
One exciting opportunity is the potential to connect with Murehwa District Hospital and see the opportunities for synergy both there and in the surrounding rural areas. There are a number of volunteer support initiatives in Zimbabwe which also have potential to tie in to our ongoing work. Keep your eye out for the breaking news!
I feel so privileged to be working with such resourceful and resilient people, and am excited to be walking this road together.
March 7th, 2015 First clinical team!
As I reflect, having been in Zimbabwe now for just over a week, coming ahead of the group was an excellent plan. We have been running non-stop learning the system here in Zimbabwe making connections and fleshing out our work plans. We have a multidisciplinary team of 25 coming over on this trip including Nurse practitioners, Nursing, Lab, Paramedic, MOA, Early Childhood Educator, some community volunteers, family members (including 4 children from 3 families, we call them our playground experts advising on that project) and 5 docs and 5 final year med students. We will be based in 3 locations over the 4 weeks focusing on mutual learning and building relationships in the healthcare context. These areas focus on differing levels of care from in community ( South of Harare in Zvimba District) to Mission/District Hospital ( Karanda Mission hospital and hopefully connecting with a Government District Hospital ?Murewa), and finally with the Medical Schools ( UZ in Harare and NUST in Bulawayo). The main focus is primary care, but we do have a specialist with us (Infectious Diseases).
This week and a bit has been breaking trail , visiting all the sites, meeting and discussing their wants and needs and then navigating the routes to help set up what is possible to do. Breaking trail is always hard work, but it has been amazing to see the support and pulling together to make this happen over this last week, a culmination of 1-2 years of prep work. This last week’s activities:
Connecting with the University in Harare registering the Med students for elective, setting up the work plan for our ID specialist and student and organising options for the other med students who are keen on looking into women’s health in Zimbabwe.
Connecting with the licensing bodies and finalising the licensing for everyone from Docs and Med Students to Nursing etc.
We took a road trip to Bulawayo to organise connecting with the NUST (Medical school) team in Bulawayo.
Visiting Karanda Mission Hospital to sort out accommodation navigation and work plans for our team there. In addition to the clinical team we will be helping them set up an EMR so hardware needed to be delivered set up remote connections opened from Canada and low and behold MOIS (our EMR who kindly donated 10 licenses and tech support for a year) is running in Zimbabwe.
Visiting the Ministry of Health to discuss what capacity building might look like within the health care system in Zimbabwe and receiving excellent support from them.
Meeting with local care providers and community members to introduce ourselves
The team arrives this weekend! I feel we have set the stage and am really excited to see how this plays out! The research shows that it will be easy to learn and grow from the trip, I believe each member of the team has also been coached and is poised to look at ways to make a difference to the system here ( all be it small). Let’s see if a complex adaptive system and appreciative enquiry approach works in real life! We have set up a team blog if anyone wants to follow how it works out.