Back to Zambia

Getting to Chipata, Zambia involved some more disappointments.  After my poor experience with landing at the Lilongwe airport and then being asked for a bribe, I was feeling less than positive about the Malawian police.  I just hate that sort of thing — it leaves a terrible taste in my mouth when being asked to break the law or treated unfairly.  Luckily, I can exit the situation (either with cash or by simply leaving the country).  It would feel far worse if I could not.  But, my poor experiences were not over…

After our day of travel with our driver Hasan, we still had a half tank of gas (which we had paid for) in his car.  To get to the border, it would take another 1/4 tank (and then to return to Lilongwe, it would finish the tank — the final 1/4).  So, we worked it out with Hasan and the car company that we could pay a flat rate of 3,500 Malawian Kwacha (something like $30) for Hasan to drive us to the border.  No additional fees would be necessary (i.e. for gas), as Hasan assured us that there was plenty remaining for us to go and him to return.  We agreed on a time (8am) for pick-up, said goodbye, and went to bed.

8am the following day: we were ready to get to Zambia so that I could start doing interviews that afternoon (important for our tight timetable).  Hasan came at 9am (bummer – but expected, a little).  When we got in, I noted that where as yesterday, there had been 1/2 a tank of gas, today there was 1/4.  Hmmm.  Hasan had told us the night before that he was taking the car home (less than 10km from where we were; the half tank from the day prior had taken us 450km, so the missing 1/4 tank was confusing, at least).  So, we drove along and I communicated to Dustin what I saw with the tank, etc (if you speak English quickly, with some words missing, and without enunciating everything, those who don’t speak English perfectly (Hasan) don’t seem to follow what you are saying).

So, we reached just south of the border, and the tank read empty.  So, this was the moment of truth: would Hasan simply refill the tank and not ask for money (this would be reasonable — maybe he took some other people around after dropping us off the night before?  Or used the gas for some other reason?  or?).

Important interlude: Gas is very, very expensive here.  In a landlocked country, gas is one of the priciest commodities around.  And, because of this, there is a lot of siphoning.  We had heard that some drivers will siphon off gas and sell it or have the gas attendant give a receipt for a filled tank (and the customer pays as much) — but the tank is not really filled, and the driver and attendant split the difference in profit.  Knowing this about the siphoning *and* knowing that there was a quarter tank missing when Hasan picked us up *and* knowing that, as he had said, it took exactly half a tank to get to the border, we were suspicious.  And, very, very sadly, our suspicions were confirmed.

We pulled into the gas station and neither Dustin nor I made a move or a sound.  Hasan turned to me (I was in the front seat) and said that the tank was empty.  He needed to fill it and needed the cash to do so.  Umm – absolutely not.  He tried to explain that something was wrong with the tank.  He tried to explain that it was further than he thought.  He tried a few different ways…  So, I drew the tank — from empty to full, and then we went back through how half a tank took us 420 km, a quarter tank took us 150 km (to the border), and there was a 1/4 tank missing when he picked us up.  Up until that point, he didn’t realize that we had noticed the missing gas in the morning.  And he realized that we *really* were not going to pay.  Even if we wanted to (we DIDN’T), we couldn’t.  We literally only had 3,500 kwacha in our pockets (the agreed upon flat rate).  So, he paid for the 1/4 tank.

The last 10km to the border was incredibly tense — and so, so disappointing.  I am 87% sure that he siphoned the gas, but I am open to the possibility that maybe he didn’t (but someone else did?  or something was wrong with the car?  or?).  I hope that I am wrong, because I really liked Hasan up until then.  I hate to be finagled and manipulated like that, but I really don’t want to take advantage of people either.  Ultimately, Hasan gave in so easily after we pointed out that there was a quarter tank missing in the morning that I cannot help but think that he was involved in some trickery.

What a bummer of a way to leave Malawi!

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Malawi in Day

After spending less than two hours in Lilongwe’s town center, it was obvious that the rumors about the capital were true: there is not hardly anything going on.  There are around 600,000 people living in the capital, but it feels like far less live there given the lack of stuff to see or do.  We decided to take a tour of Malawi — the middle part — for our last full day in the country.  We hired a private car and scooted about the country.
From Lilongwe, we headed southeast to Dedza (which sounds a lot like Dustin’s cousin’s name, Desta).  It is one of the more famous pottery places and mentioned in the Lonely Planet as one of two places in mid-Malawi to see.  It took about two hours to get there…  Malawi (and Zambia, for that matter) feels a lot like Uganda — just a drier version.  As we drove around, I kept my eyes peeled for Lee Gordon’s orphanage (for those of you who knew Ezra, this is his mom), thinking that it would be so weird to run into her in Malawi!

Dedza Pottery lay on the outskirts of a small town, just north of the Mozambican border.  We spent about 30 minutes looking at the pottery (that was about all there was to see!  Interesting especially because it was a Malawi highlight) and then partook in the other highlight of Dedza pottery: cheesecake.  We had heard and read about this cheesecake, so we had to try it.  (In fact, while in the pottery shop, a Dutch couple was there, and they explained that they had the cheesecake in 1993, and they were returning now (2010) just to have some more.)  It *was* good (but mom’s is better!).  But it was especially fun to eat cheesecake in the middle Malawi, enjoying the view of the mountains/hills in the distance.

After Dedza, we headed east to Kungoni Art Center, another Malawian highlight.  It too was located off the main road, in the middle of nowhere (it felt).  At Kungoni, there is a huge and beautiful church, guesthouse, art center, and museum.  It was weird to see all of this pop out of the jungle-like environs (there was some serious foliage here).  We spent about an hour checking out the center and walking around the premises.  Kungoni is dedicated to preserving old, traditional arts and crafts (notably wood carving) in an economically and environmentally sustainable way.  They were preparing for a big art fair the following week, so we got to watch the community practice singing and dancing — fun!

From Kungoni, we headed north to get a glimpse and some pictures of the famous Lake Malawi.  We made it with about 30 minutes of daylight to spare!  We took some pictures, enjoyed the sound of the surf (it is a *huge* lake), and then headed west to Lilongwe.  What a day!!

Two last thoughts….
1.  We tried to explain to our driver, Hasan, that “Lilongwe” sounds a lot like “the long way.”  Even with his quite-good English, this was nearly impossible to describe.  “Sounds like” is a tough concept to get across!
2.  There are a ton of mosques in Malawi.  I was really surprised by how many there are…  and even here, in eastern Zambia (where we are currently), there are many mosques.
3.  We were stopped at one of many police check-points (they are everywhere — in Zambia and Malawi).  In all of my time in Zambia, I have never been asked for a bribe.  But, on our way back from Lake Malawi, the police officer asked us for a bribe — for some money for fanta.  To which I replied something like, “oh – I heard *that* never happens in Malawi…  I am sure you don’t mean for me to buy you some!”  I smiled.  She smiled.  And then waved us on.  Phew.

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Dustin gets frustrated!

Often, it is me who gets frustrated, not Dustin.  We talk a lot about Dustin is an even-keel sort of a person, and I am the opposite — I experience things much more like a roller-coaster!  My highs are a lot higher than Dustin’s, and my lows are a lot lower.  He stays somewhere in the middle.  So, it was surprising (and somehow comforting — even Dustin can get frustrated with things here) to see Dustin get pretty fed-up.

The whole process started as we were trying to leave for a day’s journey through middle-Malawi.  Since our trip was to take the whole day with a short night’s sleep, we opted to stay at the Korea Garden Lodge (an experience in and of itself — we even met someone whose husband is a Political Science graduate student, doing preliminary fieldwork in Uganda, and going to Duke — where Erik Wibbels and Mike Ward are; he had a class with Ward that didn’t go so well — pretty funny for those of you who know this back story!).  Anyway, we wanted to pay our bill, and we needed to use our credit card.  Bank of America, even being forewarned, decided to block the charge.  The result: Dustin spent two hours skyping with BOA before it was resolved.  It was so nice to have someone else deal with this sort of thing (thanks Dustin), I was able to relax a bit more and enjoy the lodge.

We ended up leaving by 10am, which worked out just fine as we got to see everything we wanted.  More later!

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Kumbali Lodge

After the eventful trip *to* Malawi, and hearing the strain of travel and living in a tent in my voice, Dustin booked the luxurious Kumbali Lodge for two of the three nights we were in Lilongwe.  To give you some sense of the place, it is where Madonna stays when she comes to Malawi :).  I asked if we got her room — but didn’t get an affirming or diconfirming answer, only a smile.  (And with some irony I suppose, there was a “new” mom and dad staying there, adopting a Malawian boy — maybe 5 years old?…  they were from Indiana and awaiting the visa approval — it was super interesting to watch and learn how they were choosing to become new parents, how the boy responded, and what we do!  There were only about 10 people in the lodge — I think that there are around half a dozen chalets — so people watching and eavesdropping was easy :).)

The Lodge is located on a farm, and all of the produce they serve comes from the farm itself or from locally grown, sustainable sources.  Everything was clean, there was always hot water, the food was excellent (we had two three course dinners there plus what amounted to three course breakfasts :)…) — everything except the ability to make a martini (I’m no expert, but 2 parts vermouth does not equal a martini — and shouldn’t it be cold?) — made me feel so, so relaxed.  It was lovely.

The owners, originally from South Africa but living in Malawi for the past two decades, where quite personable.  They have two children who know help to run the place.  There son and daughter (now blanking on their names!) invited us to run with them on Monday afternoon in a group/organization called the Hash.  Neither Dustin or I had ever heard of the group — which was quite surprising to them.  Apparently, it is an international phenomenon — the original “runners with a drinking problem” (or the other way — “drinkers with a running problem”).  Around the world, at 5pm local time, all of these “hashers” get together to go for a run.  Depending on the group, there are varying distances plotted out (our Hash group had a 4k, 5k, and 6k).  One person has gone and plotted the course using x’s and o’s, and as you go, it is like a scavenger hunt, looking for the course markers.

We started out as a large group — maybe 30 – 40?  (for this group, it is quite small we were informed; it can get up to the 80s and 90s!) and ran the first 2k together.  Then, we divided between walkers and runners.  And then again some time later, between the 5k and 6k distances.  You can imagine a pack of mzungus (there were no Zambians, Indians, or anyone else but white, white people) running through fields, neighborhoods, etc around Lilongwe.  Quite fun, funny – and memorable!  Of note: Dustin and I chose to run with the 6k group, comprised of 10 people (and I was one of two girls).  Then, we came to a hill where our group of 10 split between the ones that wanted to “be a man” or not — so, six of us — I was the only girl — ran up a long hill at a quick clip (7:15 – 7:45 pace).  I was pretty pumped to running with the fastest guys up a big hill and be able to still feel pretty reasonable.  Yay for training!!

We got back to where we started (someone’s house) and then stayed for another hour, drinking beer (there were caseloads) and eating popcorn. As the close of the evening approached, strange thing happened.  The group gathered in a circle, and all the newbies and people returning to Hash after a break were “invited” to come to a circle in the middle.  Everyone was given a beer — and then the group started singing some intelligible song (I guess it was in English, but I couldn’t understand!).  We then had to drain our beers when told or pour to remainder over our heads or the heads of our spouses.  Dustin and I both finished our beers :).  Then, we stepped back into the large circle and other songs were sung…  And then it was time for demerits.  Guess who got called out?  Me.  For: 1. wearing cute/nice/indiscernible reasons shorts and for having my iPod during the run.  Another song, and another beer — wow.  I had no idea that I could drink a beer so quickly, but I guess under pressure from a new group, anything is possible.  And because of my black shorts and listening to Black-Eyed Peas (and I think because I was keeping up with the leader of the group during the run – both in terms of speed/endurance and because I was able to give him a hard time back), I was “baptized” into the group and given a hash name: “Black-Eyed.”  Apparently, we learned later, this naming is very significant and can take many, many times of running with the Hash group without a break before this naming process gets given.  Hah!  San Francisco Hashers: look out, here we come!

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Dustin!

“Yes!  I am going to see Dustin in 2 days, 12 hours, and 45 minutes…  I am going to see him in 13 hours and 22 minutes… ”

These were the sorts of thoughts I was having (and communicating, unfortunate for my travel companions!) as the days got fewer before I was to see Dustin.  Sadly, my amazing trip to Macha meant that Dustin had to spend the night by himself in Malawi before I could accompany him.  And that made the countdown all the more important!  I could not wait to see him — just to have someone with me traveling would make life easier, and especially my best buddy and favorite husband (hah!) — that would make it perfect.

Of course, because of this, it felt like a lot could go wrong.  And really, hardly anything did; but boy, did it feel like it.  My flight from Lusaka to Lilongwe should have been 1.5 hours.  However, because I was traveling on a Sunday, of course, the flight had to go to Dar es Salem (Tanzania) first before going to Lilongwe.  So, 1.5 hours turns into 6.5 hours.  Fine – at least I could expect that.  Then, in Dar, the former president of Tanzania gets on the plane (neat, right?) — but that also means a (slight) delay.  What an experience, but could we please get this plane moving?

Arrival in Lilongwe was smooth and easy.  We waited for the president to deplane (ok, but can you go a bit faster?) and then went to immigration.  I, of course, was first in line (of about 10 passengers).  So yeah, we waited, and waited, and waited some more (ok, more like 10ish minutes) for *someone*, anyone to arrive to stamp our passports.  Finally, one person did but maned the Malawian desk.  Cool – if you are Malawian, you should get to go first.  But then I should go after you, as I was first in line.  Did that happen?  Of course not.  Everyone got out of line and clustered around the desk, complaining first about fairness and competency in Malawi (these were Zambians) and then proceeded to go first through immigration, leaving me last.  When I finally was getting my passport stamped by a good-natured guy (with the Zambians just on the other side of the counter), we talked about how the Zambians acted.  I loudly proclaimed something to the effect of: “yeah, I know they say they are so concerned about fairness, but you know, I was actually first in line, and I am trying to see my husband whom I have not seen for 5 weeks, and *somehow* I ended up last.”  I got some good stares from Zambians, and boy, did it feel good ;).

I get my bags (quickly!) and move through the customs area.  Of course, I am stopped.  Why? Because I have two duffel bags, and I have to open them to inspect them (and everyone else is passing through, and I am getting, ahem, annoyed).  So, I deeply sigh, and put away by passport, etc.  I start opening the bags for inspection (a pain in the patootie), and then all of the sudden, DUSTIN APPEARS.  As if his presence verifies the ok-ness of the two duffel bags, I am then allowed to pass through customs and greet Dustin!  YES!

Wanting to scoot out of that dreadful airport quickly, we rush to the taxi with the bags.   Dustin doesn’t remember what the driver looks like, but he does remember where the car is parked, so we head there.  And then we wait.  The driver is nowhere to be found, Dustin doesn’t know where to look (or whom to look for!), and I am desperately wanting to leave.  What a reunion!

The driver arrives (finally), and we skedaddle out of there.  Welcome to Malawi.

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Prayer

So, yeah…  Over the course of my adult life, I have gone in lots of directions about prayer: what it is, how it works, and why people do it.  I am surprised to find that here, in Zambia, my encounters with prayer have been fulfilling, meaningful, moving, and authentic.  Prayer has come up both as a topic and as an act in a relatively surprising number of times during my six weeks in-country.  After careful discussion, it seems that this is because of two reasons: (1) people doing health care here are often based at missions, which are at the core, religious, and (2) people involved with development and health care tend to be very spiritual (for lack of a better word) people.  They are, in a nutshell, very interested in humanity, suffering, and living a full life — and much of that ends up centering around some sort of spiritual quest, angst, or desires.  This has led to many conversations that go to the core – and that has been quite fulfilling and enriching.

Many of my “prayer” experiences in the states have felt inauthentic and rote.  Here, for whatever reason (be it me or the situation or the people or??), these experiences have just felt deeper.  People do not seem to pray at the prescribed times but when seemingly struck by the desire to do so.  Somehow, that feels better to me.  And, when people pray here, it seems to be more about the experience than about the outcome (i.e. “let me be open to the possibility” rather than “please let this thing happen”), which fits rather nicely in my own sort of theology.  (And, for what it is worth, this whole process seemed to start with Nada praying with and for me before I left, so it is not only a Zambia/health care worker phenomenon.)

I feel surprised by how comfortable I am around these prayerful people.  Travel produces growth, expected and unexpected.  This is one of those unexpected outcomes :).  So, I will take this new openness and ride it for a while before I try to figure it out too much.  Over the past two or so years, I have been super interested in meditating, practicing yoga, and finding some quiet time alone.  Perhaps this is just a next (or parallel?) step for me.  Who knows – but it is part of the journey!

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Macha = Wow

One of the best stops and learning experiences of the trip so far has been to Macha Mission Hospital and MIAM Research center.  The IHME team (Nancy, Matt, Peter, and I) had been hearing about Macha for some time, and we got to meet the outgoing director, Dr. Phil Thuma, during one of our meetings in Lusaka when we first arrived.  Macha Mission Hospital was started by Dr. Thuma’s parents; Dr. Thuma (Phil) has been the director for the past 30 years.  As we learned, during those 30 years, Dr. Thuma, trained as a pediatric doctor, has focused on combating malaria in his home, Macha.  He started with a focus on malnutrition but soon learned that was a desperately difficult problem to solve, and one for which his toolkit was quite limited.  Malaria, on the other hand, was a top killer of the kids coming to see him, and he was very interested to learn how to prevent and treat it better — and he felt like this was a disease he could combat.

Phil’s proactive and careful approach has led to some dramatic successes in malaria control and prevention.  Phil, along with his wife, Elaine, have been working at Macha tirelessly for many years.  For the first part of his time at Macha, they alternated between living in the states and living in Zambia.  However, around 10 – 15 years ago, they chose to move to Macha and focus their time and energy on developing the malaria (and now disease) research institute.  As a result of this hard, diligent work, Macha and MIAM has some of the best and longest records of malaria incidence rates and everything else possibly associated with it (i.e. rainfall) for the past 30 years.  Which, in Zambia and anywhere, is an amazing feat.

Phil and his team have done very thoughtful research, learning about what works and does not in combating the malaria parasite.  They do focused studies and long-term evaluations of what is happening on the ground in the Macha area.  Phil has a true team approach; it is not just a mzungu making the process work.  With Phil’s principles and leadership, everyone in the area is completely committed and professional.  MIAM is an incredible place where the gold standard of any kind of development work — local buy-in and ownership — has been met and exceeded.  In fact, the Thumas leave for 3 (and now 6) months every year, and everything runs like clockwork.  Phil will be stepping out a primary leadership role this year, and local Zambians, carefully groomed and mentored, are taking over.  Phil wants to be able to spend his time on rounds rather than doing administrative work.  He also hopes to continue to look at numbers and do research.  MIAM is as close to perfection in development and health work as I have seen so far.

Part of the appeal of the trip was created both in the ways we got there and in the generous, Holden-esque hospitality that we received.  IHME paid for us to take a Cessna plane from Lusaka to Macha.  Flying in small planes is always a treat; you really get a sense of the landscape and scenery, and this trip proved no different.

Once we arrived, we were met by the gracious and warm Mrs. Thuma.  She is someone with whom you feel right at home, immediately.  There are no pretenses or expectations — it seems just a sensible honesty and interest in connecting.  She is a gem!  After getting a lovely ride to the MIAM and Macha Mission Hospital HQ, we were shown our rooms (clean! spacious! running, warm water!  wifi!) and given a tour of the immaculate grounds.  We were in the remote bush of Zambia yet it felt completely inviting and professional.

Following the tour and lunch, Phil met us and took us on a tour of the MIAM research facility complete with its own colonies of Anopheles mosquitoes (quite hard to grow), laboratory (I saw my first malaria parasites!  WOW!), and office spaces.  It was a great introduction to the challenging and interesting work done at Macha, and we were all enthralled with the place.  (Sierra and Jesse — seriously, go and work there!  Do some doctoring + research + development work in a lovely setting!)  Dinner was out at a local restaurant where the Thumas asked the four of us (Peter, Matt, Nancy, and me) all sorts of questions about us — quite the table-turner, as we are usually the interviewers not interviewees.

Bright and early Saturday morning, we had a full breakfast prepared by Elaine and then we were off to the hospital to accompany Phil (now Dr. Thuma) on his rounds.  Rounds are hard — you see and smell and sense many things that otherwise you are shielded from.  Luckily, given the time I have spent with Jersey with kids who are quite sick, I felt relatively prepared for the experience and could still engage…  but it was tough.

We saw a girl (maybe 6 or 7?) who had fallen into a fire and had been in the “ICU” for one and a half weeks.  So far, she had been given pain meds (not enough) and had her wounds cultured.  The antibiotics they have were not enough nor powerful enough to kill off the bacteria growing all over her legs (her burns covered both of them).  What would have done the trick was Cipro, but the pharmacy was out.  The moment Dr. Thuma lifted the blanket covering the tent over her legs, she started crying for fear he would touch them.  All he had to do was smell the legs, and he could tell that the infection was not responding.  Her father sat somewhat despondently by her side.  There was simply nothing to be done by wait, offer some pain meds, and hope for the best.  Of course, all of us had Cipro with us (part of our travel med kits) — and we sort of exchanged glances like “I have some – do I offer it?  how?”  And Dr. Thuma sensed this — he said later the he knew the common response would be to offer meds or to arrange a shipment of drugs, but that was a short term, one time solution — and there are always people needing that.  He counseled us to think more in the long-term about how to make it so Cipro was always available when needed — and that is a lot harder than just giving up some meds.

We stayed with Dr. Thuma for 4.5 hours, going from kid to kid.  For the weekend, the number of kids in beds was somewhere around 60 — so he needed to discharge half or the hospital would be overflowing by the time Monday rolled around, and the really sick kids would not be able to get support.  He tries to keep the kids around as long as possible to help but only when practical.  As he went from patient to patient, I listened carefully as he spoke the local dialect, watched the interactions between him and mothers/fathers and children, and how the nurses and other staff would follow and do additional directions and care.

The final area we visited was the TB/HIV/AIDS group where mothers and children were relatively isolated.  Many of these mothers and children who have TB also have HIV/AIDS, so the need to treat the TB and the need to treat HIV/AIDS needs to be balanced.  It was very interesting to watch him discuss the need to drug compliance with the ARVs and the TB medication — especially with the TB meds, if someone stops taking them, it can lead to an increase in drug resistant TB which is very difficult to treat.

In the second room, we met a small child.  He had been admitted two weeks prior for malnourishment.  His skin had stopped producing pigment (a result of mineral deficiency), he was impossibly small and non-responsive, and he had TB.  His mother had brought him in and had basically given up.  However, he was a little fighter, and even Dr. Thuma was impressed that he was still around — and in fact had started to put on some weight and the mother started to hope again.  Dr. Thuma said that was the most important thing; many mothers come in with a relatively fatalistic sensibility and believe (sometimes rightly) that it is very likely that their child will not make it.  When that loss of hope happens, it is much more difficult to help the child survive.  When we were doing rounds, it was discovered that this child who had started to recover now had measles (there is currently an outbreak in the country).  We were witnesses to the mother being told that her child now had measles — and it was a waiting game.  What incredible heartache and sadness — and she was all alone.  My heart just broke for her as she took deep sighs, one after another after another.

As we left the hospital and walked back to the Thumas for lunch, we talked about our experiences and what really makes a difference.  Dr. Thuma said that the biggest difference he has witnessed is the increased education of girls.  As more and more girls can go to school, and go to school longer, they are prolonging sexual encounters and pregnancy.  And, when these girls do get pregnant, they tend to know more about how to care for the children (and how to find out more information about what is happening).  They also seem to have fewer children as well, which increases health for everyone involved.

Last tidbits from our time there…
1. What is very, very important for success is to know deeply the local culture.  The Thumas have been a part of the Macha community for quite a long time.  They speak the local language, participate in the local life, interact with all of the village chiefs, know the medicine men (important when they are treating diseases — and sometimes creating infections), and understand how to make health care accessible.
2.  HIV/AIDS is a serious, serious problem here.  Everyone says it, I have read it multiple times, but seeing the health care delivery and the amount of resources required to combat it is incredible.  What is interesting is that now with PEPFAR (go America!), people everyone are having access to some pretty powerful drugs that work well.  That is great.  However, because people are living longer and fuller lives, there is less vigilance and stigma around the disease, meaning that people are more willing to continue to engage in risky behavior.  Also, kids born with HIV and AIDS are living — and who knows how long that will be…  That is neat, but then the issue of disclosure comes up.  When do you tell a child that s/he is HIV positive?  Some kids have reacted by suiciding; others have been told their whole lives and are simply diligent about scrapes and taking meds.  Finally, PEPFAR financing is completely dependent on American citizens’ (and more pointedly, congress’s) support.  Without it, PEPFAR will go away as will the “miracle” meds.  And what would Zambia do then?  It feels good that taxpayer dollars are making a profound impact in the short-term, but the long-term dependence on something so necessary poses a serious problem.

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Mazabuka

Mazabuka is one of the agricultural capitals in Zambia.  Zambia sugar is the prime industry around, and the entire area is filled with sugarcane.  On the road from Monze to Mazabuka, the air was filled with this dark smoke.  I was perplexed at first, but the driver explained that as they prepare to harvest the sugarcane, fires are set to burn the leaves and get the dangerous animals out (i.e. snakes like black mambas).

Mazabuka ended up being a relatively boring stop for me.  I was done with travel and done with interviews — not actually “done” but just feeling that way.  As there was no camping available, I ended up plopping down at the Linga Longa Guest House near the center of town.  It was a nice enough place — mostly I was thrilled to be sleeping in a bed rather than in a tent.  I got myself organized and headed out, setting up interviews and trying to figure out what is happening in Mazabuka that makes it so special (so said the Provincial Health office!).

It became clear that many people were not going to be able to meet with me, so I chose to head back on my third day as early as possible.  Because of this, I wanted to get to bed early so that I could be up early!  Over the next 12 hours, I had one of those “what am I doing in this place? Get me outta here!  How much longer do I have?” experiences — mostly just the result of lots of little things going wrong…
1. I had a mosquito in my net, resulting in little sleep and lots of anxiety about getting malaria.  Hah.  That would be ironic, wouldn’t it?
2. I got up early to no water — let alone hot water.
3. I finished packing and getting ready early so that I could have breakfast at 7am before my scheduled 8am meeting.  I was there at 650am.  The cook arrived at 745am.  Um, oops.
4. I finished my meetings at 10am and hoped to get on the 1030am bus.  It never seemed to come.  The 1200 bus that I was scheduled to get on came at 1pm.  During the three hours of waiting, I listened to a couple of Zimbabweans talking about how absolutely incredible Mugabe is, how terrible the whites in Zimbabwe are, how amazing Qaddafi, Hussein, the Russians, and Chinese are, and how corrupt and immoral Americans are.  Interesting on most days — not on that day.
5. The bus was supposed to take 1.5 hours.  I left at 1pm and arrived in Lusaka at 330pm.  That extra hour and a half resulted in a half a chocolate bar being consumed on the bus (a serious commodity for me) and a huge scoop of ice cream with oreos :) once I arrived in Lusaka.  Emotional eating = yes.

Basically, it was a day which required a beer (and obviously more chocolate  at the end :).  It is funny how on one day, none of that would be frustrating and in fact would be entertaining, but 0n another day, it is just about all I can do to just breathe (and remember that each breath taken is one step closer to getting home).

Mazabuka: thanks for the help and the time, but I was glad to leave!
Posted in Zambia and Malawi | 1 Comment

Rural Health Care

Makunka Rural Health Center in Kazangula District is located about 60km from Kazangula over terribly bumpy, dusty roads.  Based around a Catholic Mission, it has three sisters who run the center and gets a visit from a doctor twice a month.  The hospital receives much less than $1000 per month to cover all of its operating costs (and possibly even as little as $300, although that seems impossibly low to me — maybe something was lost in translation?).

My entire visit to Makunka was filled with one surprise after another.  I was first invited to come along for the bimonthly visit by one of the visiting district doctors; I politely deferred an answer until I knew more information about what meetings were possible when.  I never ended up confirming a visit, so I assumed that the visit was off, which was fine with me as I had plenty of work to do.  I woke up in the morning, enjoyed breakfast with some new friends, packed my bag — especially notable was the significant sum of cash I packed for some shopping later in the day.  As I was preparing to head out, around the corner comes the driver of the District Land Cruiser, requesting that we leave soon else we be late.  “What??” I thought — “Where I am supposed to be going?  And for how long?  And what about my plans?  And…??”  Well, it was clear that I was too go along, so go along I did.

As we drove along, the driver explained that we were to pick up Dr. Chara and some lunch, and then we were off to Makunka.  The greyness in my brain was clearing — somehow, it had been communicated (or not) that I was coming along.  So much for my day and my plans!  We picked up the character of a doctor, Dr. Chara, and we were off.  Dr. Chara immigrated to Zambia 30ish years ago and has been working in the country every since.  And if this gives any indication of the drive: have no fear, he is a believer, I am a believer, and so was the driver.  And by believer, I mean in Jesus Christ.  Good thing I passed that test (if you know what I mean).

We arrived at Makunka around 2.5 hours after leaving.  The wonderful Sister Cecilia greeted us; Dr. Chara left me to my own devices, and the 3 hours at Makunka began…

Sister Cecilia was somewhere in her late 50s to early 60s.  She has run this center for somewhere around 30 years.  She grows all of the mission’s vegetables and fruits; these agricultural goods are what the patients and families are fed (the government stopped supplying enough funds to feed those needing inpatient care; therefore, many of those who would benefit from 24 hour treatment are sent home and only the most vulnerable or needy can stay).  Sister Cecilia took me on an extensive and generous tour of the entire facility, from kitchen and storehouse to office to male and female wards to the labor and delivery room.

In the labor room, a young girl of 17 was in labor with her first child (out of wedlock — seems to be somewhat of a norm here, which I have been surprised by).  Her mother was there with her…  You could tell when the new mother was have a contraction because she flexed her foot (and only one of her feet at that!) — other than this minor display of pain, she showed no emotion whatsoever.  At that point, she had been in labor for 14 hours.  Her mom just stood next to her — she didn’t hold her hand or grimace with her or in anyway empathize the way I would expect (surprised again).  She only watched and would occasionally tell the daughter to move or something.

As Sister Cecilia prodded the uterus, she discovered the new mother could not urinate and her bladder was full.  Right then and there, she sterilized her hands, got some sterile plastic tubing, and “helped” her urinate by placing the tubing up her urethra.  Wow.  Ouch. But this new mom hardly showed anything.  Amazing.  And during it all, she had some contractions.
The last patient I saw was a man covered in burns, all with varying degrees of healing.  He apparently has epilepsy (but there is only one working CT scan in the country and it is in Lusaka; therefore diagnosis is done clinically).  I learned it is quite common for epileptics to have seizures near the fires and get burned.  This man had no caregiver, and lived alone.  Thus, appropriate management of his epilepsy was difficult as he could not remember when he had taken his medications due in part to when the seizures occur and for how long and (apparently?) the longer the epilepsy is untreated, the more brain damage occurs.  This patient seemed to have limited brain functioning (his was middle-aged adult), so that made medicine compliance all the more difficult.
After all of this, Sister Cecilia invited me back to the nunnery for nshima and vegetables (nshima is much like fufu, for those of you who are familiar — a pasty starchy glob used for dipping into one sauce/gravy or another).  It was really a lovely meal, and we spent a good deal of time just chatting about life.

As our time together ended, it became clear to me that the stars aligned somehow…  I placed the cash that I had in my purse for shopping in Sister Cecilia’s hand.  It felt absolutely perfect and right to pass along the money designated for the day’s shopping to the Health Center.  Sometimes, it is strange how these things happen, isn’t it?

Dr. Chara and crew piled back in the car, and we were off to Livingstone (and another intriguing conversation, this time on the topic of HIV/AIDS and homosexuals — let’s just say that his and my beliefs were, ahem, quite different), and full day finished and another eye-opening experience had.

However, the surprises did not end there…   I went to the district office the following day, telling my new secretary friends (Lillian and Grace — no joke Sierra — that is their names and they were thrilled that your twins have the same ones!) about my experience with Sister Cecilia and in particular the birthing experience.  As I am talking, around the corner walks Sister Cecilia!  She had driven the new mother into the hospital.  It turned out that the baby was breach, and while these babies *can* be delivered at the Rural Health Centers (I didn’t realize a breach baby could be delivered vaginally??), this new mom was too tired and too small to do so (she had been in labor for two days at this point).  I gathered from Sister Cecilia that they started the drive early in the morning and got the hospital by noon.  The roads are terrible, and trying to drive over them while having contractions and nearing the two day mark was exhausting for all involved, especially the mom in labor.  Sister Cecilia did not know how the mom or baby was doing, but she had to return to the Makunka to care for the other patients.
Rural Health Care is hard.  I learned it is not just because of the distances and access to supplies, but because of the hard choices that need to be made in the face of these limitations.  Those who run these centers are at the frontlines of health care delivery, and I do not envy their tough jobs.  What I also learned is how important it is to have competent staff; without that, referrals of tough cases and ability to handle emergencies is stilted.
Posted in Zambia and Malawi | 2 Comments

Children in Africa

In my travels to Africa, one of the many things I have been impressed by are the children.  They seem so “tough” and “resilient” — being carried on their mother’s backs for hours without hardly a peep, taken on long journeys over terrible roads without batting an eye, waiting interminable lengths of time without needing to be entertained…  It just seemed to me that these kids understood that life was a struggle and that this time on the backs or laps of their care givers (be those care-givers grandmothers, mothers, or barely-older siblings or cousins) was just that — a moment.  I had exalted these little folks to some sort of strange status and compared them to the “demanding” children of those back home…  I would often think about how kids back home could hardly sit still for an hour let alone eight hours.  I just assumed that American/Western kids were softer than the kids here (which still might be true!).

However, during a conversation with an occupational therapist who works primarily with children at the University Teaching Hospital in Lusaka, I heard a different perspective on this phenomenon.  She informed that the reason why these kids are so quiet is because many are being delayed developmentally.  The kids eventually catch-up, but when they are quite young, they are raised either by mothers who are busy growing and selling food or by siblings who are barely old enough to take care of their own selves.  This leads to a lack of interactive play and encouragement of those “noisy” neural pathways which American kids seem to have in abundance.  *Importantly*, she said, this does not mean that these kids are less intelligent nor are they unable to catch-up.

While my personal jury is still out on how much this really is a matter of toughness versus stimulation, it is food for thought for the rest of you :).

Posted in Zambia and Malawi | 3 Comments