Introduction: The author wrote the book on ‘Nursing Management of Cholera Patients in Zambia’ based on her documentation of her experiences while nursing cholera patients at her health institution in Lusaka, Zambia. She was the Infection Prevention Senior Nursing Officer.

Purpose for writing the book: The purpose was to enlighten health care professionals in hardest-to- reach rural geolocations on how to resuscitate and manage cholera patients

Results: The Book on ‘Nursing Management of Cholera Patients in Zambia’ was produced and published in 2011 by the University of Zambia Press, Lusaka.

Recommendations: The author recommends that all health care professionals should be encouraged to document their experiences in clinical areas which ultimately can be used in producing Health Learning Materials for upcoming health professionals.

Keywords: cholera, infection prevention, purpose, challenges, communities, nursing process, health policies and guidelines

The author wrote the book on ‘Nursing Management of Cholera Patients in Zambia’ based on her documentation of her experiences while nursing cholera patients at her health institution in Lusaka, Zambia. She was the Infection Prevention Senior Nursing Officer.¹

This book was launched by the Honorable Minister of Health on the 28th of October 2016. The Ministry of Health distributed this book to most Health Institutions in the country after the launch. Hence the book has been in circulation from that time.² The staff of the QTV attended the launch and so decided to conduct this review which took place on the 13th of February 2017. The Review was based on these critical questions

1. What is the Purpose of Writing this Book?
2. How does the book deal with the challenges nurses encounter while nursing the cholera patient.
3. How Can More People from hardest-to-reach rural settings be Enlightened on the Contents of the Book?
4. How do you protect the People/Communities from Acquiring Cholera?

The Book on ‘Nursing Management of Cholera Patients ‘in Zambia’ was published in 2011 by the University of Zambia Press I Lusaka. This book was launched by the Honorable Minister of Health on the 28th of October 2016. The review of this book was based on these critical questions.³

The purpose of this book is to increase the knowledge and skills of health care professionals that include the nurses, midwives, clinical officers and Environmental health Technicians on the resuscitation and management of cholera patients in Cholera centers. Especially in hardest-to-reach rural geolocations.⁴ In addition the book will guide them on how to equip the Cholera centers should an outbreak occur. The book also focuses on the resuscitation, care and management of cholera patients using the antibiotics of choice based on the microscopy, culture and sensitivity patterns.

The book also guides the health care professionals on how to set up intravenous infusions using Ringers’ Lactate / Hartman’s solution and 50 percent Dextrose that is given intravenously through the cannula during the rehydration. The use of the right size of the cannular depends on whether the veins are visible, partially visible or collapsed veins. A caution is made here for the nurse to note that the smaller the number of the cannular, the larger its lumen. Hence the 14G is used for visible veins, size 16G is used for the partially visible veins while 18G-20G-22 G are used for collapsed and severely collapsed veins in adults.⁵

It also emphasizes on Health Policies and guidelines.
It depicts the forms to be filled which are

1. Daily Clinic Records of patients
2. Visitors Surveillance Forms
3. Cholera Infected Areas surveillance Forms.
4. These conduct household, health facility Surveillance in rural communities and health institutions.
5. Infection prevention policy.

The last but not the least purpose is to encourage health care professionals to document their experiences from which books can be written as a legacy when we are gone. The Cholera book was written because I documented all my experiences as the manager of the Cholera center in my Health institution. This documentations lead to the development of Health Learning materials that was initiated by Dr. Ben Chirwa when he was working in the Ministry of Health. This book will help to build upcoming health care professionals.

The most recurring challenge is the ‘Fear of Acquiring cholera while rendering Care’ It is important to mentor junior and new qualified health care professionals when working at cholera Centers because cholera is a highly infectious diarrhoeal disease that is very eily transmitted to the career from the patient. This causes fear among the newly qualified nurses as they care for these patients. So they should be trained to know how to protect themselves from acquiring cholera while rendering care. Mentoring and rendering them support supervision in clinical areas builds up their confidence and proficiency levels on identifying signs and symptoms of cholera in rural settings and resuscitating dehydrated patients thereby lowering the morbidity and mortality rates.

The book deals with this challenge because it has both theoretical and practical components. At some point, these nurses were and some are still students undergoing their clinical experiences at the cholera centers. So the book builds on their theoretical knowledge from their training schools.

The component on the theoretical knowledge focused on the following topics.

1. Defining Cholera disease, the mode of transmission, signs and symptoms.
2. Diagnosing Cholera: The clinical presentation depends on the degree of dehydration.

This is presented under the following:

1. No dehydration
2. Some dehydration
3. Severe dehydration
4. Shock
5. Stage of recovery

The book emphasizes on the use of the Nursing process (Orlando, 1973) under

1. Nursing Assessment that has two components of history taking and physical Assessment.
2. Nursing diagnosis with the actual diagnosis that has 3 components of the problem, the cause and the evidence while the potential nursing diagnosis has two components comprising of the potential problem and the cause.

Planning and goal setting: the nursing care plan has five columns comprising of the following:

1. Nursing problem identified
2. Nursing diagnosis
3. Objectives/Goals
4. Nursing intervention
5. Evaluation.
6. Nursing intervention-This is the independent response of the nurse to the patient’s health care needs here are three (4) key areas to monitor during the nursing intervention.

These are the following:

1. The Pulse rate
2. The blood Pressure
3. The urine output
4. Evaluation

 The book ends with the policies. The nurses derive the guidelines that guide their practice from the policies.

The students are posted to health institutions all over the country on completion of their studies. So they go with this book for consultations during clinical experience wherever they are posted. This is specifically important for those who work where there are very few or no medical doctors. In the rural areas, the frontline health care workers consist of the 'community-based workers', the Enrolled nurses and Midwives. These work at the Health Posts. The supervisors support them to conduct Outreach Sessions where they conduct Information, Education and communication on personal hygiene practices, maintenance of environmental sanitation and healthy life styles. Also in my own capacity, I have initiated a project called Zambia Movement for Community Health Action (ZAMCHA). That can be contacted at this website www.zamcha.org’.

During this era of construction of bore holes and Septic Tanks, people are health educated on the importance of boiling and storing their drinking water at 56˚C for thirty (30) minutes. During the IEC, they are reminded that the Boiling point of water is 100˚C. So they can boil the water for some three (3) minutes during which time the Vibrio Cholera micro-organism will be killed. Also they can use Pitkings enzymatic preparations to liquefy the solid matter left after the fluid matter drains into the Soak ways. This liquefaction facilitates the sucking out of the liquid into the trucks with their tanks. The trucks finally dispose of this liquid into sewage ponds like the one in Garden compound in Lusaka.

The response has been overwhelming. Evidenced by the absence of the copies that were donated to the School of Medicine library on the shelves as the students borrow them out due to constant demand.. Also the book is cited in their assignments, and dissertations as well as anecdotal reports of consulting the books in their clinical areas. The Book can be obtained on the Amazon.com’website’.

In summary, all the purposes of writing this book have been met as most readers have commented on the usefulness of the book in their health institutions. So the author recommends that all health care professionals should be encouraged to document their experiences in clinical areas which ultimately can be used in producing Health Learning Materials for upcoming health professionals.

I acknowledge the following people’

1. All the nurses who worked at the then Cholera Unit of the University Teaching Hospital, Lusaka, Zambia when it was in existence.
2. The Ministry of Health
3. The Disaster management and Mitigation Unit of the Vice President’s Office
4. The Lusaka District Director of Health, Dr. Makasa Chikoya and Dr. Kabaso for reviewing the book, the then Director of Public Health and Research, Dr Victor Mukonka,
5. The Director of Clinical Care and Diagnostic Services, the late Dr (General) James Simpungwe, the Deputy Director of Clinical Care and the Chairperson of the National Infection Prevention Working Group, Dr. Gardner Syakantu,
6. The then Executive Director of the University Teaching Hospital, Dr. Peter Mwaba,
7. The Chairperson of the of the Safety and Occupational Health and Infection Prevention Committee and the Consultant in Microbiology laboratory,
8. Dr. Chileshe Lukwesa, a senior officer in the Microbiology Laboratory
9. The Zambia Union of nurses Organization (ZUNO),
10. The Director of Nursing Services, Mrs Mercy Mbewe
11. The Nursing Services manager, Miss Agnes Malewa.
12. Dr. Shula- Malindi Chanda from Choma General Hospital for final editing of the book
13. The secretary, Mrs Majorie Mwango, for formatting the book
14. The University of Zambia Press
15. Prof Mutale William Chanda and children for their support

Ministry of Health, Disaster Management and Mitigation Unit of the Vice President’s Office.

The author declares no conflict of interest.

1. Chanda DO. Nursing Management of Cholera Patients in Zambia. Zambia: University of Zambia Press; 2011.
2. Rafi S, Querehi AH, Saeed W, et al. changing epidemiology and sensitivity pattern of Vibrio Cholera at Rawalpindi; 2004.
3. Wilkinson JM. Nursing Process and Critical Thinking. USA: Pearson; 2007. p. 10–11.
4. Park K. Textbook of Preventive and Social Medicine. India: Barnasidas Bhanot; 2002.
5. Chanda D. An Infection Prevention manual for community and Health Care Institutions in Developing countries. Zambia: Maiden Publishing House; 2004.