The Superwoman of the Mukuni Health Center

Just a short 20 minute ride east of the bustling tourist town of Livingstone lies a royal village called Mukuni. There is still an acting chief of the tribe, whom you can visit for a price, as he sits on a stump of an elephant’s leg that doubles as his chair. Another touted tourist adventure in Livingstone is a visit to the Mukuni Big 5 where you can see safari animals on the Mukuni’s land. One can literally lie down with lions, walk with cheetahs, or ride on elephants. Beyond the animals lies a health clinic that serves a catchment population of over 8,000 and is staffed by a single woman and two to three community volunteers. This woman has become the definition of a superwoman.

Mukuni was the fifth clinic I had visited over the past two weeks. The other clinics were bustling with patients, doctors, nurses, and community health workers; many patients sat quietly on benches outside the exam rooms as they awaited their turn to see a service provider. At Mukuni, the clinic was desolate and deserted as we arrived during lunch time. Luckily, this quiet break in between patients gave my team the unique opportunity to speak uninterrupted to the superwoman and her dedicated community volunteers.  They graciously showed my team around, told us about the common health trends at that clinic, and answered our questions about electronic health record systems. Because of Mukuni Clinic’s close proximity to Livingstone I wasn’t expecting to hear that this clinic was run by a non-clinician, my superwoman, and had no trained doctors or nurses on staff. My superwoman is an environmental health technician – a position I was unfamiliar with before coming to Zambia. Environmental health technicians are similar to clinic administrators in that they are trained to ensure that the environment of the facility is safe and hygienic. But, despite her non-clinical background, she delivers babies daily, takes blood samples, and dispenses drugs because there are no other clinical staff available to treat patients. The community health workers accompanying the environmental health technician similarly have no formal medical background or training. To add fuel to the fire, there were two nurses that had left for leave and, though several months had passed, the district had yet to replace them.

A common day for this superwoman involved anything from performing rapid testing for common diseases, handing out antiretroviral drugs (ARVs), or doing pediatric check-ups. She worked around the clock, with the help of her volunteers, and took a short nap in the afternoon before heading into a night shift. On top of all this, she is the mother of twin 4 year olds, who played in their house behind the clinic as we visited.

As superwoman told us her story of how she runs the clinic by herself, my heart began to break. How could it be that someone without any clinical training or background was given such grave responsibilities? Where are the doctors? Where are the nurses? Livingstone General Hospital is just 10 kilometers down the road, how are there no clinical service providers to spare?

The hard reality is that Zambia, like most countries in Africa, has and will continue to experience a shortage of trained health care workers. I knew the facts prior to coming to Africa, but seeing it in a real clinical setting was like a punch to the gut and I couldn’t do anything to help.

Fortunately, Zambia has recognized the shortage of health workers and is actively working to improve the human resources gap. But, it may not come soon enough. Not only are there a lack of medical institutions where one can obtain a clinical degree, the exams are difficult and the drop-out rate is significant. The University of Zambia – School of Medicine accepts 100 medical students per year and the drop-out rate is as high as 30%[1]. Additionally, policies regarding the placement of health care staff (known as the Establishment) make it difficult to fill positions where a health care worker is on leave for an extended period of time. Lastly, the distribution of health workers across the nation favors placement in urban areas rather than rural areas.[2] In a country where up to 75% of the 72 districts qualify as rural[3], this significantly impacts the ability to place skilled health workers in clinics where they are most needed. Zambia is currently running at approximately 43% of the World Heath Organization’s recommended staffing levels. Additionally, the existing clinical health workforce is only 41.1% of the Ministry of Health (Zambia) recommendation.[4]

It was my first experience in Zambia where I felt helpless. I was moved by her commitment to the people of Mukuni village, yet saddened by the lack of support from the district health office. And, for the first time ever, I had a thought that has never entered my mind– maybe I need to pursue clinical training in order to deepen my impact in low-resource countries. My own future started to unravel as I thought about the possibilities of taking EMT courses or going to nursing school, all with the hopes of coming back to a low-resource country to lend a hand.

While my skills and knowledge are not clinically based, I am reminded that the support I am able to give with my public health knowledge, drive, and yearning to make a positive impact on Zambia’s health system is just as encouraging and important.

I look forward to not only going back to Mukuni Clinic to visit my superwoman and check in on the progress of her staff, but to see Zambia pull itself out of the human resource gap and strengthen health systems and educational opportunities for those that find their calling in the clinical arena. The reminder of her superhuman powers, selflessness, and desire to help her community, inspires me to continue working to strengthen Zambia’s health system while also pursuing new opportunities that will equip me with the skills to help Zambia achieve these critical development goals.