Lighting up St. Paul hospital in Kashikishi

The story repeats itself frequently: In a remote place in Africa there is a poor hospital, the hospital has helpers, helpers install hardware, helpers leave, hardware flops, everybody is unhappy, end of engagement, everybody is disenchanted… However, this is a story of how the sad ending is cheated out.

Kashikishi is located on the northern border of Zambia with the Democratic Republic of Congo, a 20-hour bus ride from the capital Lusaka. The whole region is poor, and the people live off the fish in Lake Mweru. The beautiful lake, 100 km long and 50 wide, provides the main source of animal protein to several hundred thousand inhabitants living on its shores. Agriculture yields vegetables, but depends very much on the whim of the changing downfalls in the wet season, an there is only kasav root to be milled into flour for nshima, the main national dish.

As the Basel Association of Medical Cooperation, founded by Swiss physicians, also including many persons interested in knowledge exchange and aid to isolated small hospitals in several countries, started a project with St. Paul Hospital in Kashikishi, Zambia 23 years ago. The main goal was to trade knowledge and experiences with doctors and nurses in a tropical region. Soon however, the poverty of the hospital in basic infrastructure became a pressing issue. It became obvious, that in order to install a cooperation on even terms, something had to be done to alleviate the many problems of the hospital team, working under harsh conditions. The patients themselves also faced great hardships while undertaking hour-long, sometimes day-long journeys to get help from malaria, tuberculosis, difficult birth problems or serious trauma, to mention only some. Many pressing problem were solved since, like the water supply, sewage disposal, biogas production, lack of instruments and machines, sanitary services, and the Basel team members became familiar faces to the Kashikishians. Working alongside the local doctors and nurses small legends, anecdotes and adventure stories were born, and remain cherished memories to all. One of them is a successful Caesarean section preformed in the night, by the light of a battery biker’s headlamp after all power sources failed, including the only diesel generator on the premises. Students from Swiss medical schools, having spent a month or two in the hospital, remember many similar stories. Many have left their heart in Kashikishi, and are returning whenever possible, maintaining several online blogs about their various experiences. However, the so frequent electric power failures regularly play a role in many of them. The power-hungry mining industry, combined with a hopelessly antiquated, crumbling infrastructure, make power breakdowns an everyday calamity. Francis, a technical person on the hospital and one of our fast friends, was very articulate about this on every possible occasion. The only viable answer to the problem was the introduction of solar energy.

Here is where Herbert Albrecht enters the story. Herbert is a wiry, ascetic technical engineer, and a habitual development helper, whose knowledge and experience we had the fortune to engage for our project. He, and a team of five students of various German universities, spend 10 weeks of their holidays within 3 years in Kashikishi. In high temperatures of the summer 2014, hot even for Zambian standards, they assembled a 15 kW photovoltaic electricity plant, mounted 100 square meters of solar panels on the roof of the hospital, had a solid battery house with instrument panels built, and laid more than a kilometre of cables. These cables feed special sockets in critical places around the hospital. The operating theatre, the maternity ward, the laboratory, the emergency room and the administration now function around the clock, no one is worried about having to perform an adventurous Caesarean section again, or live to see the life of machines and computers being sadly shortened by the variations in the power grid. The trip to the toilet at night, the coping with emergencies in the wards during darkness hours, the loss of precious plasma products in the lab freezers, all this is now history.

The finalization of this and other projects in the hospital was celebrated: The vice-minister of health and a number of personalities visited the premises, were impressed with the technical details, there was a religious service and a great party well into the night, everyone had fun. Well, how about the rest of the story? Is it all going to end in a few years for lack of maintenance and personal care by the builder?

The plane having barely landed in Zürich, Herbert wearing a secretive smile opens his laptop and wants to find out if “his” solar power plant is functioning properly. He clicks himself into the instrument panel, securely fastened to the wall of the battery hut in Kashikishi more than a thousand miles away. Immediately, he discovers that a rogue user in the operating theatre has connected a “forbidden” appliance into the solar power socket (turned out to be a power-hungry drill). A VOIP call to the maintenance team: the real success story begins here.

Besides doing the hard work of installing the hardware, Herbert has picked a team of four able-bodied men with interest for support work. The day always started early over many weeks, with a morning meeting. The men wear blue dungarees and have a smartphone each, compliments of Herbert. Late comers to the morning meeting pay a fine, albeit small, but due in cash on the spot. Herbert himself pays too! The men have been given personal instruments and tool sets of high quality. At the meeting, jobs are assigned for the day. Daily, solar energy technique in general, as well as electrician’s tasks in particular are explained. The men are tested for knowledge in questions of maintenance, on weak spots of the system, and in trouble shooting. With time, self-assurance and pride settled in. The men are recognized on sight on the hospital area. Team spirit prevails, and all jobs get done. Of course, Herbert still visits the instrument site, even when away in Nepal on another project, but he now rarely has to call. Rather, he waits for a call from Francis or another of the able bodied men in blue. He can advise and help them solve problems, which were all mastered to date.

We now continue planning an upgrading of the system, so that avid power users, like the x-ray machine, can be plugged in the system at any time. We now know, that there is a way to ensure continuity of care. We also know, that this process changes the way our friends see themselves, finding pride in what they do, and finding themselves appreciated in the eyes of their peers. Therefore, we find that building maintenance teams is a way to solve technical problems and to fasten bonds between us in the future as well. It is also a very nice picture to carry in one’s mind: The hospital, now shining in the darkness, is pair to the magically beautiful chain oflighted dots on lake Mweru, where fishermen work through the night.

• Photo: The maintenance team of the solar power plant in Kashikishi
• More information: www.globalmed.ch/

Contribution by Basel Association of Medical Development (member of Medicus Mundi Switzerland) to the Annual Report 2015 of the MMI Network