General Site Information
Rujeko is a located about halfway between Lake Chivero (see accommodation section) and Harare. Googlemap 1507 Rujeko Street, Dzivarasekwa, Harare, to see the location.
The clinic essentially serves as an general outpatient clinic and low-risk maternity ward, run mostly by nurses (“sisters”) and midwives (fully trained nurses when then extra training and exams in labour and delivery). Midwives here see about 300 births/mo, so it’s a great place to gain experience in normal deliveries. Patients register with the clinic, pay 25USD, and are then covered for care up to 6 weeks post-delivery. Nurses at the clinic are also involved in outreach programs in the community, with special focus groups for sex workers, HIV positive patients, and other high-risk groups.
Accommodation (same as CTT)
We stayed at “Norman’s House”, which is located at 17 Eagle Heights Road, Lake Chivero. (Googlemap “Lake Chivero Recreational Park” and the house is located right beside that). It’s about a 45min drive from Harare.
Norman Conlon is a friend of Dr. Ray Markham’s, and he has kindly rented out his home to us for the past two years. There are a few bedrooms, and one large living room. Depending on the number staying, we had some people sleeping on good mattresses in the living room (all bedding/towels provided), and others in the bedrooms. Internet is mediocre here – ok for sending an email once in awhile, but not for extensive web browsing or skype. There is a pool, an outdoor garden shower (amazing), two bathrooms in the house, and one toilet outbuilding in the garden – all with flush toilets and hot water.
Food was looked after as a group, with your rent including all meals for your time at Norman’s house. Norman’s sister Susan was with us (as Norman was out of town while we were there), and she is a fabulous cook. Dietary requirements are well accommodated for, and expect lots of fresh fruit. There are occasional trips to town (including weekend trips to the markets) where you can buy extra food and wine/etc if you desire.
For those interested, the roads around Norman’s house are good for morning runs, before it gets too hot. You can run towards the Lion Park (about 5km round trip), or towards the Bird Park (shorter run). Chat with Ray or Susan about directions, and also take part in any weekend trips to properly visit the Lion Park and the Bird Park!
Health Providers for Rujeko
As mentioned, the main health providers are nurses and midwives (specialised nurses). You can call any female nurse or midwife “sister”. There is a doctor who occasionally visits the clinic, but it is rare and short when he does (we never met him). Nurses are highly competent, especially in the maternity ward, and they will educate you on monitoring labour and delivery with the minimal resources they have. If you show interest and ask questions, you can do a lot here. Because the clinic is not a hospital, it does not have the capability to manage higher-risk patients. Any woman with signs of pre-eclampsia, breech presentation, or any other high-risk issues will be sent by ambulance to Harare (usually Parirenyatwa Hospital), which the patient must pay for (20USD).
Our Role
- Education for us:
The nurses are, for the most part, very enthusiastic teachers who are willing to share their expertise with us. You can generally be as involved as you would like, from observing to managing the whole delivery including suturing tears. In addition to deliveries, there are also daily check-ups for pregnant ladies at all stages, which are great to be involved with for high-volume physical exam skills, as well as getting experience with equipment you likely won’t see in Canada (like putting your ear to a plastic cone (fetoscope) on mom’s abdomen for fetal heart rate monitoring). The clinic also runs newborn visits, so you can see different stages of development and practice your newborn exams, as well as meet some of the fantastic ladies and babies who live near the clinic. During quiet times, you may want to walk over to the outpatient ward and ask staff there to shadow/help, but we did not explore much in this part of the clinic. Although the outpatient polyclinic has been established to provide general health care, there is a particular focus on management of HIV and TB given the high prevalence. This may be explored as a unique learning opportunity to understand the stages and subsequent treatment considerations of these illnesses.
- Education for patients:
There may be an opportunity to sit in on an education session set up for expecting moms, where you can give general information about pregnancy, things to look out for, things to do, and anything you can think that might help new moms. You can offer a question-answer period with them and do the best you can. Some patients speak enough English to understand, and you can ask for help from the nurses (all of whom speak English).
- Education for nurses:
Part of our goal in the project is two-way learning, so if there is an opportunity for us to exchange knowledge, do! One of our group members set up an impromptu teaching session with nurses based on MORE OB modules, then left educational books/pamphlets when we left. Small learning opportunities, approached with a respectful attitude, are important for maintaining relationships and building on current knowledge in the clinics we visit, so keep an eye out for these opportunities.
- Outreach facilitation:
One of the connections our project was trying to build was between CTT and Rujeko clinic to maintain some healthcare presence at CTT for the kids there who require regular monitoring. This is ongoing and hopefully can be built on in coming years.
Common Health Issues
Prenatal care
Normal stages of labour
Newborn checks up to 6wks
Identifying high-risk pregnancies
Prevention of mother-to-child HIV transmission
Possible exploration for HIV and TB management in general population