I almost jumped with joy when my supervisor told me to join the SmartCare team on a trip to the Copperbelt Province to provide technical support at rural health clinics that would act as ‘model sites’ for the implementation of SmartCare. SmartCare is an electronic computer based system that allows patients to seek medical attention from any health centre that has Smart Care through the use of SmartCare CARE Cards. SmartCare was recently introduced in Zambia and people are still trying to understand what it is and how the system works. I had heard about SmartCare prior to joining my placement organization, but I did not have any first-hand experience with it and I was eager to see how the entire system worked. I had been at my placement organisation for a month and this was my first trip outside of Lusaka.
I learned that we were going to visit different government clinics throughout the Copperbelt Province in order to install SmartCare computers and orient health facility staff. The idea of visiting government clinics brought back childhood memories of when I visited government hospitals my mother worked for.
My mother is a nurse and worked for the largest government hospital in Zambia based in Lusaka (University Teaching Hospital) until I was in the 6th grade. I loved the moments my dad would pick me up from school with my siblings and drive us to the hospital to pick up my mom. My brother and I would play hide and seek while running through the hospital as we waited for my mother. Not only was it a game of hide and seek, it was also an opportunity to see other patients and other functions of the hospital. Sometimes we wouldn’t leave the car, but would watch the crowds of people that went into the hospital to seek medical attention. Going to the hospital always made me grateful for my life and appreciate what I had.
Years later my mother joined the private sector and worked for an expensive private clinic. It was so different from the government hospital she had previously worked at. The private clinic had much fewer patients and they would be described as the “rich” in society. The nurses were all kind and caring towards the patients and in my eyes, they had the best health care.
My family was on a scheme at the private clinic so every time we needed medical attention, we would go there. I began to forget the conditions of the government clinic as I was now accustomed to the private clinic which offered the best health care and, in my mind, everyone in Zambia was receiving a similar high standard of health care.
It was during my trip to the Cooperbelt that I was reminded how government clinics, especially rural government clinics, operate in a very different way than the private clinics. The clinics were fairly crowded and most times under staffed. I couldn’t imagine that these clinics were using or attempting to start using SmartCare because technology in Zambia is still growing and people in rural areas are still trying to get acquainted to it.
During our trip our team visited the district Medical Officer who accompanied us to the clinics. The team worked together to set up the computers and install SmartCare. I also had the opportunity to orient staff to the SmartCare system and sit with a member of staff from the registry to help issue CARE cards. As I was explaining the benefits of SmartCare to the patients, I felt a positive response. People were interested and happy with the innovation of SmartCare. The clinic staff helped sensitize patients on the use of SmartCare and I had the chance to interact with health workers.
The following day, we went to a small clinic in a remote setting. Despite the clinic being small, they had a lot of people and were very busy. I was impressed with how every person who came to the clinic came with a SmartCare CARE card. I sat with the clinician as he attended to patients. A young 13 year old girl walked in with her two younger siblings, all with CARE cards. Unfortunately, they all had Malaria. I watched as the clinician attended to them and sent them to the lab for malaria tests. As they waited for the results I had a chat with the girls. The older one told me she was in 7th grade and wanted to be a teacher after school. I encouraged her to work hard at school if she wanted to live her dream. I asked her how she felt about SmartCare and the CARE cards and she told me she loved coming to the clinic with her CARE card because it made her feel like she had an ATM card.
I spent two weeks in the Copperbelt Province moving from one clinic to another and the most devastating part of my trip was learning that a nurse from one of the clinics had died from Malaria. I was so sad and wondered how a nurse could die from Malaria. It made me realize that Malaria is still a problem in this country and even though health workers were sensitizing people about Ebola, there could be a situation where attention is so focused on Ebola that Malaria becomes ignored.
After two weeks in the field, I was in a car heading back to Lusaka with my team, full of knowledge about SmartCare, and with a deeper understanding of the quality of health care patients receive in some parts of Zambia. I was glad to head back home but was looking forward to returning on a monitoring visit.