Archive for the ‘Management Trip Report’ Category

Continuation: The Farthest Reaches of Our Impact Evaluation

Monday, June 10th, 2013

This post is a continuation of the last update on our blog, a trip report by George Muwowo, program manager of the Riders for Health evaluation. For more information about Stanford’s work in Zambia, please visit our website.

CONTINUED: On the second day of our trip to Itezhi-Tezhi district, our team ventured to two health facilities, Kaanzwa and Ngoma, both were accessible only by poorly maintained roads.

A typical road in the Itezhi-Tezhi flood plain, cut-off by running water. Davis Albohm

A typical road in the Itezhi-Tezhi flood plain, cut-off by flowing water. Davis Albohm

Ngoma, although well stocked with medical supplies, is located inside the Kafue National Park and patronage is limited to a small population comprising Wildlife Police camp staff and their families. Mambwe Ng’oma, the Stanford Data Collection Officer working in this area, collected data at this center at the beginning of the study but had a difficult time traveling there because park regulations restrict access due to large and dangerous game such as lions and elephants.

Next we visited other distant health facilities. Unbelievably, because of the vast distances, we spent more time on the road than at the actual health facilities. This gave us an opportunity to understand the distances and obstacles our DCOs face. Even with a vehicle we could not reach the two furthest health centers: Nansenga and Mbila. The roads are poor and the vehicle basically can only run at 30 km per hour for most of the journey. We however managed to reach seven health centers in four days.

More about the dusty roads in Itezhi-Tezhi, these have a fine deposit of alluvial soils from flood waters in the low lying areas. But higher ground is not spared by the dusty conditions. A slight movement of  our vehicle’s wheels raises a lot of dust particles. A large number of health centers are located in the flood plains which are seasonally inundated and for most part of the year are impassable by vehicle. The grasslands are devoid of woody vegetation, dominated by grass and bush fires in the dry season are common. Due to flooding the district tends to have seasonal routes as well, created by vehicles during the dry season. There are no standard roads and they are difficult to map, because they shift to a large extent after every rainy season. Only housing infrastructure is permanent and is built on higher ground within the flood plains.

An EHT providing health education at an Itezhi-Tezhi health center. Davis Albohm

An EHT providing health education at an Itezhi-Tezhi health center. Davis Albohm

We kept wondering how these settlements received their supplies of food, medicines, clothing, etc. We got the same response from everyone; that supplies are stocked prior to the rains starting, which could be in November, earlier or later. The rains stop in March or April, but the plains remain impassable until somewhere May or June. On average, for six months in a year residents are cut off from the rest of the district.

You can never run out of amazing surprises in Itezhi-Tezhi district. While there is no gas station operating as a business entity we had to plan ahead of each day to ensure we had enough diesel to take us into the field. The only gas station in town belongs to the electricity supply company (ZESCO) for its private use, but has extended this facility to the community. It operates at unreliable hours, which again ensures that our work remains unpredictable in Itezhi-Tezhi!

Earthquake Strikes Research District

Monday, April 22nd, 2013
The expansive flood plain of Itezhi-Tezhi district.  George Muwowo

The flood plain of Itezhi-Tezhi district. George Muwowo

George Muwowo, author of this post, is a Stanford University program manager based in Livingstone, Zambia. He oversees on-the-ground administration of the Riders for Health evaluation. For more information about Stanford’s work in Zambia’s Southern Province, please visit our website.

In this article I provide a recount of exciting field experiences from our work on the Riders for Health evaluation.  My approach is from a social and logistical perspective, providing lessons for future work. The first visit to Itezhi-Tezhi in July 2011 still remain fresh in our memories due to the earthquake which sent the town into panic. I will also share stories  from other research districts.

Itezhi-Tezhi is a small town in the south west section of the Central Province of Zambia. It is the seat of the Itezhi-Tezhi District. It lies west of the town of Namwala on the border of the Kafue National Park.

Itezhi-Tezhi came into existence when the Itezhi-Tezhi Dam was constructed on the Kafue River in the early 1970s. The dam was created to hold and regulate water flow in the river for Kafue Gorge Power Station, 260 kilometres downstream. The town’s estimated population is 4,000 and the largest employer is the electricity company ZESCO.We made several trips on the dam wall because this is the only route south east of the town to get to some remote rural health centers. Itezhi-Tezhi district boasts of vast quantities of aquatic and terrestrial natural resources which sustain local livelihoods and beyond. Besides other species, breams are the dominant fish in the lake and the Kafue River.

Almost half of the land surface cutting through Itezhi-Tezhi central business district is a Game Management Area because of its status as a buffer zone for in-situ wildlife management in the Kafue National Park (KNP). KNP is the largest wildlife sanctuary in Africa. Small and large game are present in this park and includes Lions, lechwe, hippo, impala, elephant, monkeys and so on and so forth.

Our first project trip to Itezhi-Tezhi was meant to familiarize ourselves with the district health officials at the district head quarters (District Health Office) as well as to visit some of the remote rural health centrers including those located within and near the KNP.

The first stop was at the District Health Office to meet the District Medical Officer (DMO). The DMO was very welcoming and took time to listen to our stories on health care delivery and challenges thereof. The chat delved into project background, Ministry of Health project approvals, planned activities, data collection process and associated data collection tools. It was generally a good meeting and we quickly retired in the parking lot to plan how the rest of the day will be spent.

At that moment, in a seemingly serene environment, far from the hustle and bustle of the cities, Itezhi-Tezhi woke up to a rude shock of the Earth.

Home with collapsed roof after earthquake. George Muwowo

Home with collapsed roof after earthquake. George Muwowo

A significant earthquake rocked the town. Unconfirmed sources claimed a measure of 5.8 on the Richter Scale, but regardless of the strength, there was enough movement to scare the town and cause great panic. It was the talk of the day.  Out of panic, health officials and all able bodied patients sprang out of the hospital building to watch from a distance. Cats were seen jumping off the roof tops of hospital buildings. It was a mind boggling event and was on news broadcasts all over the country within a short time. Luckily there were no lives lost.

When the incident occurred we were leaning on the tail body of our Ford Ranger truck. We noticed unusual movement of the truck and nearby buildings, followed by a heavy sound from down the earth’s crust. Earthquakes are unheard of in Zambia, but there have been isolated incidents of earth tremors. While the town was readjusting to the earth quake we decided to start with our field visit to the clinics.

Health Centres in Itezhi-Tezhi are sparsely located with distances in the range of 25 kms to the nearest and more than 250 kms to the furthest clinics. However within town there is an urban clinic referred to as Hospital Affiliated Health Center (HAHC) which attends to all urban dwellers. The team comprising of myself, Davis Albohm, Lawson Mwamba and Mambwe Ng’oma decided a visit to the HAHC and found the Environmental Health Technologist (EHT) conducting Health Education to a group of mothers and their small babies. We also checked the motorcycle transport available at this clinic which also had a store room for the entire district. We spent a full day in the district as we were combining activities between the team to ensure maximum utilization of time.

To read about the second day of our trip, stay tuned for the next blog post.