Working and Living in Namibia as Medic – EWM Alumni reports back…

Expedition & Wilderness Medicine alumni  Sarah McMurtrie has recently returned from Namibia having worked at a remote Bushman clinic, a post advertised through EWM, a has kindly written her impressions up to inspire you!

Based in POS 3: Epukiro- North East Namibia 1800 elevation.

Nearest town and district hospital 100km away at Gobabis. Facilities include an Accident and Emergency, TB ward, women’s ward, and maternity and paediatric ward.

Gobabis- 200km from Windhoek (capital of Namibia). Windheok has two major hospitals: Windhoek Central and Katatorah Hospital. It is Gobabis hospital that is the closest place for the people of Epukiro to get an x-ray and it is also the closest place for blood tests and TB sputum samples to be processed. The samples can be taken in Epukiro but need to be transported to Gobabis hospital.

Epukrio/ Pos 3 is a community of San Bushman and Herero people. The settlement is a mixture of small brick buildings and corrugated iron roofs, simple shacks made from wood, cloth and open fires. Communal living within a sandy compound- with relatively infertile land. No toilets so families use the bush – raising sanitation problems and risk of spreading and contracting worms.

The village itself contains two small shops  selling sweets, sugar, oil, soap, tinned goods and two bottle shops ( bars selling bottled beer). A government building involved in agriculture. The state clinic run by nurses  – here everyone pays the equivalent of 7 euros for treatment, there is also an ambulance that can make trips to Gobabis hospital.

There is only one communal tap for the whole of the Bushman community and until one month ago the Bushman were buying water from the Hereros.  There are also a few Shabeems, these are shacks selling cheap alcohol blasting out local pop music, this is unfortunately where a lot of local people – mainly the Bushmen – spend their time and money.

The Lifeline clinic in Eupikro was set up by a Namibian family in 2003, all part of the foundation called N/aankuse. This is a free clinic for Bushman people and where Hereros pay the equivalent of 7 euros. It is run by a permanent Namibian nurse (working there for more than six years) and a resident doctor who comes for at least one year. It is staffed by local people – a receptionist, two translators and a gardener. Volunteers come throughout the year, nurses, doctors or students for an experience.

As a paediatric nurse I came for 4 weeks to the Lifeline clinic. The clinic opens from 08:30- 17:00 Monday to Friday. There are three consulting rooms, family planning and immunisation room and small emergency/ rhesus room. On average 25- 30 patients are seen each day, anything from birth upwards.

For children there is a lot of diarrhoea and vomiting. Immunisations, dehydration, rashes, worms, tinus capitas, occasional broken bones and rapid malaria testing. Tonsillitis, upper and lower respitory tract infections.

For adults a lot of TB patients and TB sputum samples taken- these have to be processed in Gobabis. HIV related illnesses and HIV testing (which has to be done at the State Clinic). Upper and Lower respitory tract infections, chronic pain, arthritis, unknown wounds from insect bites or animals. Family Planning- Ladies coming in for their two or three monthly injections, fungal rashes, STI’s. Alcohol related problems or injuries.

It runs like a GP surgery. Patients histories are taken, these take a long time as most patients speak Bushman, Herero or Africans.  Nearly all consultations require a translator and frequently it is hard to get clear patient histories and the exact information. Patience is needed and often the presenting compliant turns out not to be primary compliant.

Temperature, blood pressure, weights, saturations, heart rate and respirations are all taken. Urine samples, stool samples, TB sputum’s, BM’s taken when required.  For children MUAC (middle upper arm circumference) taken between the age of 6 months to 6 years.

Examinations taken – listening to chest sounds, looking in ears, throats, feeling for lymph nodes, assessing limb from range of moments, pain assessments. Vision examinations (an eye doctor visits the State Clinic every other month). Abdominal examinations feeling for enlarged spleens and livers, or looking out for distended abdomens especially in children.

The clinic has a pharmacy, frequently dispensed medications are paracetamol- but only one or two days worth as alcoholism is a big problem in the village. Methysal gel – to rub over muscle aches- very popular in this community. Ibuprofen – only a few days worth- it’s the Herero ladies with high blood pressure which like this. Oral Antibiotics given for infected bites, secondary lesions and open wounds, also respiratory bacterial infections and some tonsillitis. Albendazole- a de-worming tablet given to the over 2 years.  Zinc is given for diarrhoea to prevent a reduction in the immune system. Multivitamins are given as standard to nearly all patients that come through the door. Blood pressure meds and oral rehydration solution. Kez shampoo given for Tinus Corpetus, Vitamin A given frequently to children and Intra Muscular contraceptive injections.

The clinic also runs outreaches to neighbouring villages- in particular POS 10, about 10km away- to a local school, and to other local community centres at least once a week.  Basically taking a mobile clinic to the villages , providing nearly all the same facilities.

The Life Line clinic is a busy clinic and each day is varied, if it isn’t busy with medical conditions, then it maybe that a crowd of kids come by to see if we have any shoes, clothes or just to sit in the waiting room or hang around outside under the tree.  My work in the clinic came to an end in December – just in time for the Christmas party. Hot dogs, flap jack  and fizzy pop for the kids of POS 3. I Lasting memories of our Christmas photo around the Christmas tree- even the chief joined us!

Find out more about the Lifeline Clinic

Sarah McMurtrie