We Have Changed

 
 
Aka Kalema (pictured on the right) is a clinical officer at the Nansenga Rural Health Centre, about two hours drive from Lusaka. As rural outposts go, it is not in a remote area, but far enough removed from the city to mean no physicians are available. Clinical officers are the equivalent of physician's assistants in the United States, but given the lack of doctors in Zambia, their role is greatly expanded. Aka is the highest level of health care provider available in a large network of rural villages surrounding the clinic. He sees children, adults, and assists with deliveries when birth attendants are not available. Except for two weeks out of the year, he is essentially on-call 24 hours a day. Officially the clinic is open 8 am to 5pm, but once or twice a night Aka may be awoken from his nearby living quarters to see patients. Medications can be in short supply. Aka has an impressive knowledge of medicine- but then again, he must, where there are no doctors. In addition to his clinic duties, he is also administrator, statistician and public relations for the small but busy clinic. While he describes satisfaction with helping the people of his community, he admits to fatigue and stress. Like anyone, he yearns for growth, and would like to go to medical school and be a doctor some day. But his three years of training for work as a clinical officer, as well as his years of experience, count for nothing when applying to the few competitive spots for medical school in Zambia. In addition, the financial burdens of medical school are great. And yet, realistically, he cannot leave- his training is not recognized in neighboring African countries or overseas in the UK or US.
A great deal of care in Zambia and the rest of Africa is provided by such hard-working non-physician providers. "Task-shifting", that is, the shifting of tasks in the health field from physicians to non-physicians such as Aka, is a key element of providing health care where there are not enough doctors and nurses. But this shifting means a heavy burden is placed on their shoulders. In some remote rural areas, in fact, the "sweeper"- the janitor, is the only one available to provide care.