South Africa

It has been over a month since I last posted, and much has happened. I was able to visit South Africa. MCC hosted its regional retreat for Southern Africa just outside Durban December 13-19th. Currently MCC has workers in South Africa, Lesotho, Swaziland, Zimbabwe, Mozambique and Zambia. Those of us at retreat came from 13 different countries on 5 different continents, our ages ranged from 3 months to 60+ and I can't begin to count the number of languages spoken between us. We would have bible study and workshops half of each day and then free time the other half. Most people spent their free time at the beach. There were a handful of us who were birders and went to a local golf course/birding area nearby several times. We all went to a local community Christmas caroling event one evening. The odd thing to me is how often I hear songs with cold and snow mentioned in them over here in Africa. In the evenings we would play games or watch movies. The last night we had our own services of carols followed by communion. It was good to step away from the grinds of daily life and reflect on the reasons we feel called to service. I shared a room with four other women, so there was not much personal space, but it was good to compare stories with others dealing with similar challenges and struggles that come with working and living in the region.

Prior to retreat, I traveled to Cape Town for a few days of vacation. That was lovely. There was so much to see and do and I had only three full days. I climbed Table Mountain and visited Robben Island where Nelson Mandela was imprisoned for 27 years. I visited the V&A waterfront and the Kirstenbosch botanical gardens. There are inexpensive tour buses (with headset commentaries in 9 or so different languages) that take you all about town and beyond. You can hop on and off at different sites as they run on a schedule and pick up at designated sites like a city bus would. I also walked along the shore line several times. Cape Town is a beautiful place with lots of history and a friendly feel. To me it felt like a wealthy version of Havana (shore line, historical architecture, political history of struggle, diversity of people) with a sprinkle of Portland's community spirit (taking care of the earth, sensitivity to homeless people, local cultural events). Considering that less than 20 years ago black Africans could not even vote and political apartheid and was still the norm, it is amazing where this country is today. I hope to get back to Cape Town again and see and learn more.

I returned from South Africa (with a head cold) in time to celebrate my birthday in Lusaka with this year's four SALTers (one year service workers in their 20s). Traveling on the buses around the holidays can be hectic, and with my cold I didn't know if I was up for the task, but I wanted to be back in Macha for Christmas. Thankfully my trip back went smoothly and I was able to settle in to my own space and see friends over the weekend before starting back to work on Monday.

Christmas day I went to church in the morning. It was raining hard, and people must walk. I was 15 minutes late and the second person there. An hour after the service was to start, we were posting notes that the service was cancelled when people started coming. So into the church we went to hold the service. An hour later we actually started with two men on the altar, two men and five women in the pews along with 30 or so children (our choir and skit producers).  By the end of the service an hour and a half later, there were perhaps 50 adults and 50 children. It was a small service, but full of heart.

That afternoon I gathered with 7 others. There were 4 from the US (one Jewish), three from the Netherlands and one from Zambia. We had a wonderful potluck feast and then some stayed around to play games.



I hope your celebrations with family and friends are blessed this season.

Flying Termites! Yum!

There is an interesting phenomenon this time of year in Zambia. After a big rain, the termites sprout wings and fly to any light source they find. They will sneak through any crack around a window or door and land in your food or the sink or on the floor.  If you manage to keep them outside with a strong porch light, it will be hard to get in or out without getting them in your face, hair and house. Overnight their wings drop off and they head off in pairs to mate. I swept up quite a pile one morning just on my 3'x4' front porch. You end up tracking in the wings like you would leaves or pine needles. People eat the termites themselves. It is a good source of protein. They put buckets of water under lights and let them collect and die. Then they spread them out to dry. Another neighbor has a whole counter full drying (these are just the ones that got into her house). You fry them up and eat them. At our recent MCC meeting here in Macha we tried it out. We had smores for dessert but said no one could have chocolate until they tried out the inswa (the Tonga word). At first the boys balked, but once all the adults ate some (they taste like popcorn to me), and the 20 somethings teased them, they gathered their courage and tried them.

So, if you come to Macha this time of year for a visit, you too can give them a try!

The Heart of the Matter

This post is way over due. I have struggled with how to present the situation of HIV/AIDS here in Zambia in a way to do it justice and for you to understand it on a deeper level.

Statistics tell part of the story, individual stories tell another part, but you can't leave out the cultural, social, economic and political factors both locally and internationally that play a part in this crisis here in Southern Africa. I highly recomend a book called 28 Stories of AIDS in Africa written by Stephanie Nolen, a journalist from the UK. She does a beautiful job of weaving all these complex pieces into the stories of 28 individuals from heads of state to rural children. She includes stories of doctors, scientists, pastors, grandmas, truck drivers, prostitutes, activists and nurses. For those who won't have a chance to read the book, here is my atempt at a snapshot of what I have come to understand during the six months I have been in Zambia. Most of my statistics come from the United Nations.

In 2011 there were 34.2 million people around the world infected with HIV. 23.5 million of those (69%) are in sub-saharan Africa. There were 7000 new cases a day in 2011, 97% of those occurring in the developing world. Zambia's overall prevalence rate is 14.2%. In pregnant women it is higher, 25% in urban areas and 12% in rural areas such as Macha for an average of 16%. In 2008 when the prevalence rate was a bit higher (16.4%) Ministry of Health data showed that 80,000 infants per year were born exposed to the HIV virus.

The most recent stats show 150,000 children in Zambia under the age of 15 are infected with HIV. 90% of these cases were caused by maternal to child transmission either during pregnancy, delivery or breastfeeding. The goal is to get maternal to child transmission of HIV below 5% in exposed babies by 2015. Then we will start speaking of elimination rather than prevention of maternal to child transmission. This is done by focusing on early enrolment for antenatal care (by 14 weeks), testing of both parents for hiv at the first antenatal visit, and early access to arv meds for those mothers who test positive. Mothers who test negative on the first visit continue to be tested every three months through out the pregnancy and breastfeeding period. Exposed babies also receive preventative arv treatment after delivery, some until they are weaned from breast milk. When mothers and infants are treated by these guidelines, the transmission rate is quite low. (Less than 1% in babies whose mothers are on the full lifetime regimen of arvs and around 12% for babies whose mothers are in the earlier stages of the disease and receive only a short course regimen during pregnancy and delivery).

I hear during the 90s there were funerals every day. As it is, I have personally heard of about 6 people who have died of AIDS here in Macha since I arrived in April. I'm not sure how people made it through those times, but the effects are still reverberating through the country. Almost every family has "dependents" orphaned relatives they have taken in to raise. Sometimes these dependents are treated equally, other times not. They may have to work more around the house, they may receive less support for their education (go to public school vs. private or have to miss more school to help at home), their clothes may be of lower quality than the other children in the household. There is an NGO term for these children, OVCs (Orphans and Vulnerable Children) and there are programs to try and benefit the most at risk, paying their school fees, helping the extended family to help them, but they really are quite at risk for abuse and neglect.

ARVs (antiretroviral medications) have changed the face of HIV/AIDS around the world and a bit belatedly here in Africa also. People who have access to and adhere to treatment are now living with HIV instead of dying with AIDS. The ART clinic here opened in 2005. One of our first pediatric patients is now expecting her first child. We have several women who have had 3 children while on ARVs all of whom have remained HIV free. Not all cases turn out as well, but it gives hope that the crisis can be transformed and a future generation may be HIV free.

There are so many stories to tell, but I will leave you with two scenes I saw in the ART lab one day. I don't have a set work space, so I will sometimes grab a corner of the counter in the lab to sort through some charts. I looked up at one point to notice a young girl come in alone with her lab sheet and take her spot on the bench next to the adults waiting to have their blood drawn.  This young girl looked to be 9 or 10, her hair was neatly braided, her bright colored chitenge suit (fitted top and skirt made from the same chitenge material), was clean and pressed, she looked as if she were dressed for church. When it was her turn, there was still no adult by her side. She just moved to the chair and held out her arm. She was what we in the medical world call "a hard stick". The lab tech had to stick her at least three different times and still didn't get the blood he needed. Each stick she held perfectly still, stuck out her arm and just squeezed her eyes tightly shut. She never made a sound, except maybe an intake of breath. Afterwards I went and spoke to her and between my limited Tonga and her limited English learned her name and age. "Grace" was 10 and in the 4th grade in a town several kilometers from Macha. I saw her later in the hall outside pharmacy with a woman who looked to have been her grandmother. At that point Grace had 500 kwacha (10cents) in her hand. Later I saw her heading out the door with a lollipop. We greeted each other both times. The poise and joy that Grace possessed were quite inspiring to me.

A bit later a mother came in with an infant tied to her back and a 6 or 7 year old daughter holding her hand. Once again, they all were dressed in their best. First the mom calmly supported the young girl while she had her blood drawn standing in front of and leaning into her seated mother. This little girl shed a few tears but recuperated well. Then mom had her blood drawn, then she pulled the sleeping infant around to her lap to have his blood drawn as well. The scene went like clock work. It struck me how "normal" it looked, just a regular visit to the doctor. In fact, it is all so unjust. This mother most likely became pregnant with her older daughter not knowing she was hiv positive. If she lived near Macha during that time, even if was tested and knew her status, there were no meds available back then for her to prevent transmission to her baby. So the daughter is now also living with HIV. The infant will have a much better chance of being HIV negative as now his mother would have had full access to meds during her pregnancy with him and he will be followed till 6 weeks after he is weaned to verify that he is not infected. On the slight chance he were to be infected, he would immediately have access to hiv treatment.

I leave you with these snapshots.

PMTCT Training

 

Well, after three weeks without internet access, I think the situation is finally fixed thanks to my fellow MCCer Ingo. He was able to get the dongle I purchased work with my ubuntu operating system! Thanks to him I should be in more regular contact.

I had my first official training in PMTCT (prevention of maternal to child transimission of hiv) last week. There were three of us from Macha hospital who went. Two midwives from maternity and myself. The people who led the workshop are with AIDS Relief, a conglomeration of NGOs who work with hiv care in Zambia. The workshop was coordinated by Catholic Relief Services. There were participants from two other Mission Hospitals, one run by the Sisters of Charity and the other I think run by the Sisters of the Holy Spirit. There were also people from a church affiliated organization that runs clinics in Livingstone and Lusaka.

It was good to meet other people from different places and hear how they do things and get new ideas for how to improve care. The workshop used to be two weeks, but due to budget cuts, they condensed it into one. That meant there were certain things we only touched on briefly. There was a big emphasis on counseling and education which I am glad to see. People need to be informed if they are going to make good choices for themselves and their babies. We also went over documentation and the myriad of registers and reports we are required to fill out. It was good to get clarification on many things.

We stayed at Tooter's Golden Pillow Lodge. How's that for a name? It actually was quite nice. We each had our own rooms with small bath, a fridge. There was tv and ac. The ac was only working part of the time because of the low voltage and power outages, but it was nice to have warm running water 24 hours a day to shower whenever I wanted. We were on the outskirts of a town called Monze. I walked into town a couple times, but the evenings were pretty low key. If I had had internet, I would have had plenty of time to catch up with you all. As it was I read, knit, studied a little Tonga and watched a lot of soccer and rugby games. So much so that I now understand rugby more or less. CNN was also showing at times, so I watched the 2^nd presidential debate, heard about the shooting of the school girl activist by the Taliban, and saw coverage of the awful bombing in Lebanon It was ironic, I had just met a Lebanese man the night before at his restaurant. The last evening we had a party and the Zambians all wanted to see the makuwa (white person) dance, so I indulged them to great hoots of laughter! Here it seems 95% of people are born with the ability to sing, dance and keep time. It was a good week, but I missed Macha and was glad to get home. Have been catching up at work.

It was nice that Wednesday was Independence day. A day off mid week was good especially since I had been gone so long. It has made today, Saturday much more productive for me. Zambia is 48 years old as a country. God-willing I will be here for the 50^th anniversary of independence. That should be an exciting time to be around.

Just a quick post to let you know I haven't forgotten you. The rains have begun here in Zambia. I have had a good strawberry harvest and the mangos are ripening. Hope you all are well as your seasons are also changing.

Busy! Busy! Busy!

These are the words my Zambian co-workers use when they pass through a room with me pouring over registers and trying to get PMTCT documentation up to date.  I'm not sure if it is their way of affirming my work or their way of telling me to lighten up a bit.  Either way, I hear it a lot these days. 

The last few weeks have been busy.  There was the National Measles Campaign which I was not directly involved in, but which consumed the Maternal Child Health department  where I do most of my work.  All week long the nurses would gather there and prepare their supplies for the day before heading out to rural communities and vaccinating everyone between the ages of 6 months and 15 years.  They were also tacking on Vitamin A (to prevent blindness) Mebendazole (for deworming) and polio vaccine (though I think we ran short of that).  There were some communities they had to return to the next day because the response was overwhelming.  They ended up extending the campaign into the first part of the next week.  Besides the mobile clinics, hundreds were vaccinated right in our clinic.  We had lots of crying babies and kids all week.

The following week, there was a Trachoma campaign.  Trachoma is an eye infection which can cause blindness with repeated infections over one's lifetime.  Apparently the health district we are a part of has a high incidence, though I've heard the hospital sees so few cases they have a hard time teaching the interns what it looks like.  Regardless, we were part of a pilot project which is trying to eradicate the disease by treating everyone with a one time dose of zithromycin.  They had tall handmade wooden sticks which were colored coded to tell by a child's height how much medicine they should get.  The adults all got 1gm.  I heard that some who took it on an empty stomach suffered from vomiting or diarrhea.


We had a couple dozen nursing students here for three weeks from Livingstone.  Their time at Macha was their "rural experience".  There was usually 4 or 5 of them in MCH on any given day. There was also a group of Dutch medical students around the hospital, though I haven't seen them much.  This past week a group of nursing students from Indiana Wesleyan have arrived for three weeks.  It really is amazing how the hospital absorbs all these students for learning experiences when we already have our own nursing school and students.

We've had lots of "visitors".  Visitors is the term Zambians use for high officials of the Ministry of Health or NGOs who come to check up on our work.  You can always tell when they are coming because instead of the calm slow pace of the start of an ordinary work day, you come in to find almost everyone there on time and everyone running around straightening things up etc.  Similar to work places in the US when JAAHCO, OSHA or the Health Department are expected.

The entire hospital had a performance review by the Ministry of Health this past week.  The same day they arrived, the Aids Relief people came to check in on our PMTCT work.  I was unaware they were coming, but was grateful for their visit as I was able to learn things and get answers to some questions.  I was also able to participate in a meeting they had with the Community Health Workers.  These are the volunteers at the village health posts associated with our MCH department.  I had been wanting to meet face to face with these workers and start to understand the realities of their work and see how we could work hand in hand.  These workers have been trained in PMTCT, and besides counseling and educating people in the community, they also help track and notify hiv+ moms and exposed babies who have defaulted in their care.  I was able to get their phone numbers and hand them a list of the moms and babes from each of their regions who needed to be contacted to come in for care.  Hopefully, I then can get feedback from them to fill in some of the gaps in information I have.  They usually know these women by face and name and where they live.  They often know details of their personal circumstances which can help us provide better care. They are a crucial link in the PMTCT program.

Tomorrow I leave for a one week training in PMTCT.  It will be my first formal training and I am looking forward to it.  Betty and Grace, the two women who were here this past week with Aids Relief will be teaching the class to health care providers.  It is being held at a hotel in a town a few hours from here.  I hope it goes well.

Chobe!

Well, I finally did my first tourist thing here in Zambia.  I was invited short notice to accompany a pediatrician, who had been volunteering here at Macha for a month, on a weekend trip to Livingstone to see Victoria Falls and go to Chobe National Park in Botswana for a two day one night safari.

The falls were beautiful, though a bit dry this time of year on the Zambian side.  The safari was incredible, and well worth the money. I saw around 60 species of birds, most of these during our first morning riverboat cruise where one of our guides was quite informed about birds. Of the 60 some species, all but half a dozen or so were new for me. (I hope to update my bird list soon, I have been having quite a bit of internet problems of late.) We saw lions, buffalo, crocodile, giraffe, zebra, baboons, elephants, wart hogs, monkeys, mongoose, many types of antelope, hippos, water monitor lizards, and a jackal. (I hope to put a complete list at the bottom of this post for those interested in more details.)

It was so amazing to see these animals in their natural environment.  Our guides were great and gave us all kinds of fun facts about the animals.  For instance, wart hogs and hyenas will share dens since one species is diurnal and the other nocturnal.  Water monitor lizards are the crocodiles worst enemies because they eat their eggs.  Crocodiles can live up to 120 years.  Giraffes spots get darker the older they get.  Hippos, though living in the water, eat only grass and when they defecate, they swirl their tails and their feces spreads out in the water to feed many species.

We saw thousands of impalas, they became quite common to us, but I became more and more fond of their elegant markings, they became one of my favorites.  We saw a two-month old baby elephant nursing and a newborn baboon (still with dark hair and bare pink ears) clinging to its mom.  We had a close encounter with an elephant who came to within 5 feet or our vehicle (their eyesight is not very good) before sniffing us, flinging its trunk, turning its head and walking off. Some of the most scenic sights were just looking out over the plains near the river and seeing hundreds of zebra, antelope, giraffes, wart hogs and baboons all mixing together or seeing in the distance long columns of elephants heading across the flat to the rivers edge in the heat of the day. We laughed at the giraffes getting a drink of water and were struck silent by the sight of several lions awakening from their days rest as the sun set and heading out for the hunt.

We saw a total of 13 lions in two different groups.  One group had a large male several females and a scruffy 2 1/2 year old male with only the beginnings of a mane.  The other group was all female. There were a couple elephant carcasses near our camp (closer than our guides let on), so we heard lions all night long calling with their deep guttural sounds. Thankfully there was a full moon so trips to the letrine during the night weren't so scary.  In the morning we drove to the elephant carcasses and the big male lion and one female were still feeding with many vultures waiting in the trees for the lions to get tired and go to bed for the day.  The lions ran away when we approached though the female quickly returned to feed on the baby carcass.  The male with his muzzle still bloody from feeding kept at a distance.  The female would keep an eye on the vultures and the adult elephant carcass as she was feeding on the baby.  Occasionally, just like a house cat, she would pull up short, settle down on her haunches and then bound towards them and chase them away.  Then she would return to the baby carcass some 25 yards away and continue feeding.

An interesting note of our safari participants is that we were largely volunteers.  Amy and myself from Macha, a Peace Corps couple from Botswana and a VSO couple from Choma. Both couples had adult children visiting them.  There were also two women in our group who were volunteering with a lion conservation group in Zambia.

Many of you have asked when would be the best time of year to visit.  If you want to go on safari and see the animals, September is best (perhaps August and October as well).  This is the dry time of year when the animals can't hide in the grass, and a time of year when most water sources dry up and they need to head to the river once a day for water.  Though other times of year would be good for the falls.  I have heard that Victoria Falls is one of only 3 or 4 places in the world where you can see a moon rainbow.  On a full moon night in the rainy season when there is plenty of water and mist at the falls, apparently you can see moon rainbows.

I must thank my friend Amy for some of the pictures in this post.  Her camera had a better zoom and better definition, so some of the shots are hers.

New Girls Hostel

Yesterday was a big day for the community of Macha. It was the official opening of the girls hostel at Francis Davidson High School. Unlike most high schools in Zambia which are boarding schools, Francis Davidson is a day school. The students who come from far away must find their own lodging, and this leaves the female students particularly vulnerable and their enrollment and academic performance are much lower than the male students. Also, their drop out rate (often due to pregnancy) is much higher. The teachers, students, church and parents have all expressed the need for a place for the girls to live for years. Typically this is not the type of project that MCC helps with, but they kept asking, statistics were produced and the female students wrote letters about their experiences and their need for a dorm. The funding was raised from three groups of people.  A large BIC church in Canada called The Meetinghouse, several BIC churches in Pennsylvania and friends in Winnipeg. The project was finished on time and within budget. The PTA made all the bricks locally in the community. You could sense the ownership of this new building.

Lots of government and church officials were present for the several hour ceremony. A tent was even rented for the guests of honour to sit under. Parents and teachers found shade under a few trees, but most of the students were out in the sun. There was singing, traditional dancers, many speeches, a ribbon cutting ceremony and a tour of the hostel. When it was all finished they served all the guests lunch. It was an exciting day.

There are still some finishing touches. The outdoor kitchen needs to be built for the girls to do their own cooking. A house for the matron needs to be built and a good water supply connected. Mattresses and curtains are still missing, but some of the girls are moving in on Monday. The entire hostel which will house nearly 60 girls (only three toilets and three showers to share amongst them all!) cost $40,000.

Over the last few weeks, as I have mentioned the opening of the hostel to people in conversation, several of them, especially women leaders in the community would comment on how needed this hostel is and what a benefit it will be for the girls. There are over 200 female students at the school. The girls had to apply for a place in the hostel and a committee of about 6 people (teachers and church leaders) chose the most needy (usually those from farthest away with no family locally to live with). Hopefully the benefits of this new hostel will be sensed soon, you can already sense sighs of relief.

Not a Good Patient

So, I was down sick this week, again. I think this is the third illness that has caused me to miss work since I have been here.  My co-workers are all very understanding and tell me I need to be home resting, but I have a hard time, sometimes listening to what my body needs. Thankfully, I am able to do some work at home on my computer since I am involved in a lot of data gathering and management. I had a cold that started about 10 days ago. Able to work the first couple of days, rested over the weekend, went to work Monday (a mistake) home Tuesday and Wednesday, back Thursday (sent home by my co-workers) and stayed home Friday. My energy is finally picking up today, Saturday. I guess it is just a whole new germ pool that I need to get used to and build up some immunity to. Mentally it is a challenge for me to be ill. A true test in patience and grace.

There were some good things that came out of the week. I was able to read most of two books. Shake Hands with the Devil, about the Rwandan genocide and failed international/UN attempt at stopping it. Not light reading, but an eye opener. Then I am almost finished with Unbowed, the autobiography of Wangari Maathai the late 2004 Nobel Peace Prize winner who started the Green Belt Movement in Kenya. She has lots of perspective and insight into the Africa of today and what has contributed to it's state in today's world. I had known of her briefly for her environmental work, but she is an all around inspiration of peace and justice in the world. In seemingly simple grassroots ways, she connects all the important pieces of the puzzle to the complex world we live in today.  As one of the first African women to receive a Phd, she used her opportunities for the betterment of her country and the world and stood up nonviolently to some pretty powerful people and institutions along the way. What a loss to this world her premature death was. I highly recommend this easy read. Fun fact for those of you from Kansas City, Wangari went to undergrad at Mt. St. Scolastica in Atchinson, KS in the 60s and worked at the lab in St. Joseph's hospital in Kansas City during the summers.

I also was home one day when Bridget, a woman from the village of Lupata stopped by selling her beautiful hand made baskets. The quality was excellent. I couldn't believe when she told me the price of just under $3 US. These baskets would have sold for $60 or $80 in the States. She understood enough English to tell me where she got the grasses/reeds (from two different neigboring towns) and to tell me that it takes her two days to make each one. Once my Tonga is better I hope to visit her at home and learn more about basket making. I paid more than the asking price for the basket I bought.

I also have been cared for by my neighbor Jaeron who has been bringing me food here and there and just checking in on me.Which is very sweet of her considering she has to listen to my coughing all night ( she and her husband share a duplex and a bedroom wall with me).  One day, she hollered through my window "Lisa do you want to go on an adventure?" She had a big butcher knife in her hand and led me to the banana grove in our backyard. She had spotted a bunch of bananas that the birds were getting to so she had me do the honors of cutting down the whole plant to get to the bunch. They have ripened beautifully and I am sharing them with friends.

Maria, Patricia and Racheal

I want to tell you about three new faces for me. I will start with Maria. I was taking a walk one evening through the dry brush near the water tank when I heard pounding and conversation so I turned off my path and found Maria and Naomi sitting on the ground with legs out in front of them pounding away at white quartz rock turning it into piles of golf ball sized pieces to try and sell. They had old feed sacks wrapped around their chitenges (colorful wraps women wear here as skirts) to protect them from the flying rock shards. Both Maria and Naomi had to have been in their 60s. Luckily Maria's English was pretty good, she even pulled up from her memory the word slab when I asked her what the rocks were used for (the concrete slab which a house is built upon). I have also seen them used in landscaping/mud removal or prevention around buildings. The rocks are natural in this area, sticking out where erosion occurs and just needing someone to dig down and break off big pieces or pull up large rocks.  Maria worked at the hospital for 27 years before retiring. She was using a sledge hammer and Naomi was using some old piece of metal from a vehicle of some sort that had a heavy head. I shivered to think of the shock their hands, wrists and arms were absorbing which each blow of the hammer against the rock. Maria told me it took them three or four days to make a heap and they could sell it for about $12 US. I thanked Maria for answering all my questions and let them get back to work. I keep meaning to go back (with my camera) and visit again, but I have not made it.

Patricia is a 12 year old seventh grader who loves to read! This is a rare thing in Macha. She quickly moved on from the children's story books I have and is borrowing some old children's encyclopedia's that were in the house when I got here. She borrows one at a time and usually brings them back the next day. While here, she often picks up some of the adult books on the shelf and browses through them asking what certain words mean. Winter, precious and souls are a few that come to mind. She also likes to look at my map of the world. She seems to be a sponge for new information. Patricia is the youngest of three girls I also am one of three girls. From there our similarities part. Patricia's father died four years ago, her mother three years ago. I am assuming from AIDS, but I have not asked. Patricia was raised in the Copperbelt an area in the Northwest of the country where the primary language is Bemba. When their parents died, the girls were split up. Her oldest sister now 17 is in Kitwe with friends. Her other sister 15 is with an uncle in the town where they grew up. Patricia was sent here to live with her grandmother. It is just the two of them in their home. She says they get along. I have not met her grandmother yet, but hope to soon. Patricia seems to mentor some of the younger children around and so far is a young twelve, not trying to grow up too fast. I look forward to getting to know her better these next few years.

Finally I want to tell you about Rachael, the most vibrant one year old I have seen yet in Zambia. Rachael's mother has hiv, and we had called her in because her last CD4 count was under 350 indicating it is time for her to start full HAART, a three drug regimen that she will be on for the rest of her life. Because she is still breastfeeding Rachael, this is even more important. As the head ART nurse was talking to mom and explaining her lab results and the next steps, little Rachael was wiggling and smiling and clapping and flirting with me.   Rachael has been taking Neveripine daily since birth and a daily dose of prophylactic antibiotic since six weeks of age. She was due for her one year hiv test.  I carried Rachael next door where the testing takes place with mom close by. Thankfully she tested negative. I just could not get over how active and engaging Rachael was. Most babies that age are pretty stoic and observant around here. Rachael's love of life was contagious and we were all laughing at her at some point. Mom is not married, but you could tell this baby was getting lots of love. I asked the nurse to ask mom who all lived in their house. Sure enough, mom still lived with her parents. So this little one had three adults to love her up, and it showed. So many kids have stressed out parents with many to take care of, you could tell this little one had lots of one on one attention. I hope I get to see more of her.

Back in Macha

This is my fifth day back in Macha after six weeks of travelling. It sure feels good to be home sleeping in the same bed, no longer living out of a suitcase and with no plans to go anywhere in the near future. My time away was full of many good things but the pace was beginning to wear on me.

I did some informal tallies of the six weeks that I was away from Macha. I was in four different countries (one in transit) and 20 cities/towns (5 in transit) While traveling between these different places, I road 19 times in a personal car, 16 times on a train, 10 times on a bus, 8 times on a plane and 3 times in a taxi. Most of that with luggage. Besides my 11 nights at orientation in Akron, I did not stay more than 3 or 4 nights in one place. Too frequently it was just one night.  As I say, I'm glad to be home.

There was a wedding while I was away, and one funeral that I have heard of. There was a 100% pass rate of the national nurses exam by the students from the Macha Nurses Training School. Apparently I missed the worst of the cold season while I was away. Things are much drier than when I left. The temperatures are very pleasant after 100 degrees plus humidity in the midwest, but the heat is on it's way.

I must tell you that I also passed the foreign trained nurse exam, which is great news! I don't have to repeat it in November. I still had to get a temporary work permit as the certification from the General Nursing Council will not be out till the end of the month. I need that certification to get my permanent work permit. I was only given 7 days upon entering the country this time, but went to immigration the next day and procured the temporary work permit. We were hoping to avoid that additional cost, but it was not to be. At least I am able to be here legally and work.  I need to report to immigration in Choma each month until my permanent work permit comes through. I will just try and time it with shopping trips.

So my first day back at work there were important "visitors". People from the Ministry of Health and Boston University/CDC were checking in on our PMTCT work. Apparently they advised us of their visit just a few days before. We actually did quite well, considering that there was a register that had not been updated in the last six months due to a turnover in staff and most of us not being aware that it existed. I have been given the job of getting it up to date. It was a good visit with myself and Mrs. Mabeta, the new charge nurse of MCH (Maternal Child Health) learning alot.

Here in Zambia, patients tend to carry their patient file with them. Just like in the States parents are given immunization cards for their children, here, pregnant women are given antenatal cards that they bring with them to each visit, children are given "under 5" cards, women receiving family planning are given family planning cards, etc. In the general outpatient department patients just have small notebooks that they buy from the hospital ($2 for adults, $1 for children) where all visits and prescriptions are written. Except for inpatients and ART (hiv) patients, no file is kept on record at the hospital. Instead, we have registers (log books) where this information is kept. My observation is that the cards have the most accurate information, which on one hand is good so that when the patient shows up here or at another clinic, the needed information is at the ready. There is no need to look it up in various registers (under 5, safe motherhood, pmtct, integrated mother/baby, family planning....you get the picture). However, the registers are big, bulky and cumbersome. Often you are seeing both mom and baby and so need to write in two, 3 or 4 registers and all those steps don't often get followed through on due to time constraints or someone else using the register etc. So, when it comes time to do a report or gather statistics, the information is not at hand, because the registers aren't up to date. At this meeting the importance of good documentation was reinforced by the visitors. We can't prove we are doing the work if we don't have the documentation. So, we are going to work on improving that.

I had a good meeting with the nursing officer Miriam after our time with the visitors. We have roughed out a plan of where I will focus my energies for now. I told her I want my work to be useful, sustainable and enjoyable. She also is concerned about the sustainable part, not leaving a hole when I leave. It is good to know we are on the same page there. We have come up with three main areas for me to focus on. Helping MCH with better documentation and follow-up of  hiv+ mothers and their babies. Working with the ART clinic's database of exposed babies. Helping with the monthly and quarterly statistic gathering for PMTCT.  I am still pulling together a schedule, and I hope to include going out into the villages 2-4 times a month with either MCH or ART.

My Time in the States

Well dear followers, I obviously did not get around to posting while in the States. I do apologize. Time was fuller than I expected and I focused my energy on being present to those I was with.

Orientation was a good time to reconnect with a few, meet new friends and make connections with those who will also be in Africa, and put faces to the names of staff in the North American offices. There were 29 of us in orientation from Bolivia, Brazil, Canada, Congo, Egypt, Mexico and the US. We were headed to work in Afghanistan, Bolivia, Burundi, Canada, China, Colombia, Congo, Egypt, Kenya, Myanmar, Nepal, Nicaragua, South Sudan, Uganda, US and Zambia. Hopefully I will get a chance to visit or have visits from some of the folks in Central and East Africa. I have the advantage of living only three hours from Victoria Falls, a common vacation destination on the continent.  

MCC had kindly allowed me to stay in the States for a planned family vacation in the Black Hills in honor of my parents' 50th wedding anniversary. Originally, there was a week between orientation and my family trip. Orientation was shortened, and the airlines bumped my flight to the States ahead by one day, so I was able to squeeze in several visits to dear friends on the East Coast I had not seen in awhile.

The easiest east coast friends to visit were Sue and Kevin, formerly members of Portland Mennonite Church, now living in Akron for the past several years. Sue works for MCC, so I saw her frequently throughout orientation. She was my go to person. It was great to spend time and catch up.  I also went to their house for dinner one night and got to catch up a bit with Kevin.

Before orientation I was able to visit my friend Corbin and family. Corbin and I met through SOAW and helped start the Catholic Worker together in Portland. We hadn't seen each other in about 7 years. We walked about Troy, visited a nearby Peace Pagoda and mostly just hung out, played games and caught up. It was so great to meet 11-month old Riley.

The weekend after orientation I spent at Cape Cod with Cole, a friend from Holden whom I had not seen in a couple years. The weather was so pleasant after the heat and humidity of Akron. We walked on the beach, went to a wetlands, walked about the village of Barnstable where Cole's parents live, and visited Provincetown one evening.

Then it was off to NYC where I was able to see my friend David who is now living in Brooklyn. David and I worked together for MCC Work and Learn Teams after the earthquakes in El Salvador in 2001, and hadn't seen each other since. He was my life saver during that stressful six months. David and his family met me at Penn Station on their way home from church and helped me navigate my way to my Aunt Jan's apartment where I would be staying. We visited over pizza and I played hide and seek with the kids before they headed back home.

The next day I met up with my dear friend Julia at Grand Central Station. Julia is a Maryknoll sister who has served the last 4+ years in East Timor as a high school teacher. We also met through SOAW and had last seen each other in 2007 when Julia had visited the Catholic Worker. Julia was in the States on renewal, and the Maryknoll headquarters are just outside of NYC, so we were blessed to have a few days of catching up. We walked along the High Line (a park created on an old elevated train line), explored Central Park and even took a day out of the city to hike at Bear Mountain State Park. Ran into some Appalachian Trail thru hikers and had fun talking trail with them.

Then it was off to the midwest for time with family. Over the last few months, my Dad has developed bad back pain caused by stenosis of the spine which has become quite debilitating. He must now walk with a cane and any movement causes pain. He has a good attitude, pointing out that he has much to be grateful for, 73 years of life without any pain till now. Surgery is scheduled for Monday August 21, we pray that it will be successful and he can have some relief from the pain and return of mobility.

My dad's health meant the family vacation to the Black Hills was cancelled. Instead we all convened in Kansas City where my parents live and then went down to the Lake of the Ozarks and hung out as a family there for a few days. It was not the trip we'd planned, but we were able to be together as a family. We even tried to take some photos, but my youngest nephew was not in the mood to cooperate.

My niece and oldest nephew will be in college when I return. One nephew will be nearly 13, the other in double digits (ie 10) and the youngest will be in first grade and reading. Three years may not be long in an adult life, but children change so quickly. It was good to have some time with them.

With MCC's consent, I was also able to stop a night in London on my way back to Zambia. No, not to see the Olympics, but to see my friends Kath and Steve who I had worked with in El Salvador back in the early 90's. The last time I had seen Kath and Steve, I held their newborn son David who is now in university. We had stayed in touch over the years mostly through their Christmas letters which I would usually respond to by letter or e-mail. We avoided London and instead hung out around their village of Hassocks. Steve and I walked about the countryside around the South Downs one day and Kath and I went to Brighton and the seashore the next day. The countryside near their home is beautiful, with some lovely old windmills. We had dinner with their daughter Anna and pulled out all their photo albums of El Salvador and reminisced.

I am a person rich in friendships. I am grateful for them all. I thank each of you for the chance to reconnect and for hosting me along the way. May it not be so long this time before we meet again.

Leaving for the States

Just a quick post to let you know that I am still here and well. Today I head to the States for a few weeks. I will participate in MCC orientation in Akron, PA and get to see several dear friends while on the East Coast. Before heading back to Zambia I will spend time with my family to help celebrate my parents' 50th wedding anniversary. Then on the way back to Zambia I will stop overnight in London to see friends I worked with in El Salvador 18 years ago!  It will be a busy few weeks. I am looking forward to seeing everyone, but there are things here I will miss.

I will miss the termite hills. I will miss the people standing outside on the hospital lawn warming themselves in the sun on these cool winter mornings. I will miss the flowering trees on my way to work that gift me with something beautiful and sweet smelling to carry with me during the day. I will miss the children at the preschool very near this flowering tree that always greet me on my way home for lunch with a chorus of numerous shouted “how are you?” or recently “how are you today?”. This is one phrase that school age children through out the country learn, as greetings are very important in Zambia. The standard response is “fine, how are you?” I know I will be getting odd looks back in the States when I respond in that way. I will miss the fresh bananas, lemons and papayas from my yard. I will miss the glorious singing at church. I have finally bumped into all three of my favorite singers there and have been able to tell them how much I appreciate them sharing their music with us each week. I will miss the women in their chitenges greeting me with a big smile, hands together and a little curtsy and the men with their hands to their heart. I will miss the the left hand supporting the right arm  whenever giving or receiving something from someone or when shaking their hand. These are all signs of respect which I find very endearing and have readily adapted. I will miss the mild weather and the beautiful skies and sunsets.

I feel that I am getting a better picture of what my work may or will be. It is not crystal clear yet, but it is coming into focus. I believe a time to step away from the information I have gathered and look at it from a distance will be good.  It may give me some insight into how to go about achieving the goals of my job description. At least I hope so. Relationships with the key people I will be working with continue to grow and that is important. My Tonga is still in need of plenty of work. At times I wish I could have a couple months of direct language study without working at the hospital but hopefully I can manage to language learn and work at the same time. It is going to require more self-discipline than I have had so far.

These last few weeks I have had a circle of friends with which to hang out with during off hours. They have all been a blessing for me during my weeks of frustrations with adapting to the new culture and work. They, have listened to me vent and encouraged me to play and helped me to get out to the villages and connect with the people. They will all be gone upon my return to Macha. A shout out to Esther, Fiona, Rachel, Kylie, Stiin, Sarah, Andrew and Allister.  Thanks for the fun times. Stay in touch.

I hope to continue posting while in the States about discoveries and learnings from Zambia.

ps I am going to try and attach a photo to the Village Visits post of the choir in their blue uniforms I spoke so highly of.

Bike Ride to Bulebo

I was so excited to return to Macha and be here a whole month before having to leave again. My week, though, had some frustrations, mostly around work, so I have been working on self-care and staying focussed.

My position is a new position, and we are all trying to figure it out. No one is really my direct supervisor, and figuring out what my job will concretely be is largely up to me. There is a general goal, but how I go about that is not clear. I am creating my own way. I have of course been in and out as has the nursing officer and now another key person who I have been trying to sit down and meet with is out all this month. I would like to spend more time in the ART clinic and the nurse in charge of ART agrees with this, but he will be out all next week and it needs to go through the nursing officer first. This week the acting nursing officer was dealing with alot, including the senior nursing students doing their final clincal exams. So I will try and find a time this week to meet with him.

In the meantime, I have been sitting in front of my computer a lot, dealing with data. I also have been trying to pin down a time for a Tonga lesson without success. Thus the need for self-care.

I borrowed a bike for a ride one evening, went for a walk with a friend to the dam another evening. I have been trying to visit people. I harvested my lemon tree Saturday morning (with a few scars to prove it) when the power was out and took bags around to various people. A few of us got together to play a game the other night and some friends had me over for dinner last night. Community is always important. This is the first time I have lived alone in many years, and though I enjoy it in many ways, I have to be more proactive in socializing than when living with others.

Yesterday afternoon Fiona, a Scottish doctor here for three months, and I took a three hour long bike ride out into the bush. It was a great afternoon. With minimal Tonga, no road signs or maps, but a great sense of adventure,  some food, water and sunblock,we headed out. We were really hoping to make a loop. It was quite funny because after riding through the tall grass and past several villages we had very different opinions of where we were in relation to Macha hospital, but we just laughed and kept going. The people we met, who spoke little more English than we spoke Tonga kept telling us we had to go back the way we came to return to the hospital but we kept continuing on, thinking there must be a way to loop back on one of the many village paths. 

We ran into an older gentleman who asked if we were headed to the big bridge. That was exciting for us, because we had wanted to get to a river. So we headed that way, and soon found the bridge and a nearby bar with people hollering at us to join them. We smiled and kept biking. The river was not very inviting with it being the dry season and all. We got the name of the river and the bridge from people on the other side. On we went to a junction in the road with a sign for a school. We wanted to turn back by 4 in case we got lost. It was 3:30 and we decided to keep looking for a loop. Eventually we got to a village on top of a hill where people pointed forwards instead of back when we asked the way to Macha hospital. We did have to cross the same river, without a bridge this time, but it was way dryer in this spot with big sand bars and small streams of water we could step across and push our bikes through. We are guessing people were telling us to return the other way not knowing the height of the river at that crossing. Anyrate, we were quite pleased with ourselves for having found a loop.

Now that we were on the path home, we decided we would be up for stopping and visiting at a house if the chance presented itself. It soon did. We were biking past a house near the football (soccer) field in Bulebo when the women greated us and clapped their hands and said "come". So we went to sit with Grandma Mwaanga, her grandaughter and great-grandchildren and another woman and her child whose connection to the others we didn't quite figure out. The two older women were degraining maize and the younger woman was milling ground nuts in the traditional wooden mortar and pestle. Tonga stools were brought out for us, the bottom of Fiona's was a bit rotten and she immediately fell over which provided for lots of laughter. Grandma Mwaanga's granddaughter did most of the communicating with us. She has 6 children, 5 girls and one boy including two sets of twins. Six month old Choolwe (a common name in Tonga which means luck) and 3 1/2 year old Progress were at mom's side when we arrived. When we sat down, we were a bit too close for Progress's comfort and though she shook Fiona's hand and we tried to sit a distance from her, she still got up and walked away. Later in the visit she was back hovering close by, and even said something directly to me at one point, but I couldn't understand her. Then when her two older sisters Mavis and Natasha arrived carrying water, she was even more engaging. We never did meet Progress' twin Precious. We sat and helped the women finish with the maize. Took a few pictures and headed on our way. I was a bit frustrated not being able to ask simple things in Tonga. I hope to remember where the house is and go back for another visit when my Tonga is better.

Today I have stayed near home. Went to the big BIC church here in Macha. There is a trio that sings every Sunday who are just wonderful. The bigger choirs are wonderful also, but those three are something special. One day I will meet them and thank them for their powerful singing. I am blogging and journaling and still have some lemons to deliver. I also want to go visit the principal of the nursing school who helped me prepare for the exam to say thanks. Then I want to visit my Tonga teacher and try to arrange a new tutoring schedule. Tomorrow is Monday, and the beginning of a new work week. I hope it will be a bit less frustrating than the last. There is much to be grateful for.

My First Game Park

As I write this post in Macha, the young children are noisily gathering for the Bible school session on my back porch/yard. It is hard not to go out and say hi, but the electricity and therefore internet connection has been down most of this weekend, so I feel I need to take advantage. Their teacher (a local youth) has just arrived and order has been restored. A little scolding, a prayer and now a song. I will write with their joyful noises as my background music.

After my nurse's exam on a Thursday, I had to stick around Lusaka to go to immigration on the following Monday. This was the perfect opportunity to e-mail my friend Linda who I met on the plane and see if I could come for a visit. Luckily, it was good timing for Linda, so I had a wonderful day, including an overnight with her and her family just outside Lusaka. I got to see my first game park, and get a window into a different part of Zambia, the white culture.

Linda's husband Ian is a third generation Zambian. His grandfather came here in 1902 from Scotland to work as a railroad man. He bought a piece of land along the railroad in what was then a rural area and now is just on the edge of Lusaka. The Lilayi farm is a big agricultural operation with four generations of the Miller family currently living there. There is also a worker community there of about 30-40 families. The two big crops I learned of were cabbage and seed maize. If I remember right, about 30 years ago they bought the neighboring farm and converted it into a lodge and game park. When they did this, they were one of the first, but now there is quite a bit of competition.

When I first arrived, there was a polo match going on. There are apparently 4 polo clubs in the country and they have one of the nicest fields there on their farm. Linda pointed out and/or introduced me to a few of her family members and then we took off in an old open jeep land cruiser for my own private game ride. I saw zebra which was probably the most fascinating for me. There was one who was quite compliant in posing for a picture. I also saw hartebeest, puku, bushbuck, waterbuck and duiker. All of these, I believe, are from the antelope family, but are of different sizes, coats and horn designs. I also saw a couple warthogs. The grass was still tall, so Linda says we probably missed a lot. My only disappointment was we never saw the giraffes, not hard to miss, and apparently not shy, but we did not see them on our ride. At the end we went to some stables and saw some orphan elephants who were very cute. We weren't supposed to touch them, but they tried their best to make us break the rules,  reaching out and flirting with their trunks. Did you know elephants have pregnancy gestation of 22 months?!?!? The babies are usually 200 pounds at birth.

We made it back by dusk and joined the polo players in the club after their match. We had a home cooked meal there provided by one of the player's and his wife.  Then Linda and I headed home for tea and pastries which I had brought along. Ian joined us later and we talked politics of all things. He had had a few drinks with his team mates, so I think social etiquette was pushed to the side. He seems like a compassionate man and told me his perspective of some of Zambia's recent history.

In the morning I took a walk about a bit of the farm. I talked to one of the workers who was in charge of the cabbage seedlings. He said each week they plant 280 trays of cabbages with 200 starts each. This is all year round! They are six weeks when planted in the field.

After the walk I got to meet one of Linda's sisters-in-law who is an anthropologist and works in hiv/tb research. Most of her colleagues are medical people and she has been to Macha before. Linda and her family are very gracious folks. They treated me like one of the family. Perhaps we will see each other again.

The Big Exam

Well, guess I better write a bit about my foreign trained nurses exam. It was quite a cultural experience. The exam was held at the University Teaching Hospital's Nursing School where I had studied a few weeks before. It was to start at 9am, but we were to be there at 8am to handle formalities. I car pooled with my friend Rachael. We arrived at 7:15. I did not want to worry about getting stuck in traffic! We didn't even move from the waiting area to the room where the test was held till 9am. While we were waiting, I spoke with several of the other nurses gathering for the exam. I had met two of them the day before when we had to go to the General Nursing Council office to pick up our letters of invitation. One, who was from the UK, was sitting the exam for the third time. The other one was of Indian ethnicity, but I'm not sure where she was from. The morning of the exam I met two women from South Africa, one from Nigeria, one from Northern Ireland and one from Zambia (who must have trained outside the country). I also got to reunite with Esther and Solange, both from the Congo, who were part of our study group a few weeks earlier.  There were a few others who I did not meet personally. We were 13 in all, 12 women and one man. I didn't meet anyone working in Lusaka, we all seemed to come from rural provinces, many working at mission hospitals.

They had assigned us seats in the big lecture hall. When we went into the room, we had to leave our books/bags down front and take only our pens/pencil/ruler and eraser to our seats along with our letter of invitation and the receipt we had paid to take the exam. Once we found our seats, they came around and checked our papers. We were assigned a number and that number was to be placed on each page of the exam booklet and on the front. Our names were not to be visible to the people marking the exams. There was then the official opening of the sealed packet, the handing out of the booklets with the test questions and the paper for writing the essays and a reading of the entire exam before we started at 9:50. I actually appreciated the reading of the exam before our time started, because it took away the anxiety of not knowing what would be on the next page. Also,with the multiple choice questions, it gave you a first read through that didn't count as part of your time, so it was quicker when actually answering the questions.

We had three hours.  The multiple choice, matching and fill in the blanks part was 100 questions worth 25% of our score. Then the other 75% was based on three essay questions. The pediatric question was compulsory and was on lobar pneumonia.  The medicine question was hepatitis A, the surgery question dealt with burns and the tropical medicine one was ascarius (roundworm).  I chose the first three mainly because I didn't want to have to draw a diagram of the life cycle of the roundworm (though I know it, I'm not much of an artist and I'm not neat, both of which are important) and it asked for three medicines you could use to treat it, their dosages and side effects. I only knew one for sure, and was not aware of it's side effects, if any. So the only drawing I had to do was of the lower respiratory tract........pretty basic, but it looked like a 5th grader had done it. The questions involved definitions, signs and symptoms, medical management, nursing management, possible complications, prevention and patient education. They broke down how the questions would be scored for you, so you knew where to place your focus. Nursing management was 50%. Two of my questions I had to come up with a nursing care plan with five nursing diagnoses. The third one I used the traditional Zambian format of describing all the elements of nursing care. The study class a few of us took part in prepared us for this. Most of the nurses taking the exam had not heard of the class and we were giving them a crash course before the exam started. I focussed hard on not using abbreviations and giving a rationale for every intervention.  These were also points they had told us in the class we took. I wrote and wrote until my hand was cramped and there were only two minutes left to go. My writing was pretty messy by the end (never a strong point of mine) but I hope I did okay. The results will probably come out when I am back in the US. They post it on a bulletin board for all to see at the General Nursing Council.

On the way home, I had to stop at the MCC office. Eric very graciously offered to take me to lunch and for ice cream as a form of celebration. Half way through lunch I came down off my adrenalin rush and was ready to go home for a rest!

After 25 years of no formal schooling or exams, this was a bit stressful for me. I have always in the past been a good exam taker, especially with multiple choice questions. This exam, however, was very different and something about knowing 50% fail the first time made it all the more intense. I feel I did my best, and we will just have to wait and see. I'm glad it is over and can focus now more on work, language study and settling in to Macha.

Visits to the Village

Hi folks. So sorry it has been almost two weeks since I have posted. The past few days I was been preparing for and sitting the foreign trained nurses exam. The exam was yesterday and it is a relief to have it over, but more about that in my next post. Today I want to talk about my visits this past weekend to "the village".

Going to "the village" means leaving the hospital campus and heading out to the more rural areas where people live more traditionally. On Saturday I went with several other people including my Tonga teacher Bina Tiza and her son (Tiza) to visit Bina Tiza's mother who is in her 80s. In Zambian culture, any family member who has a job with a salary is responsible for taking care of others in their family with economic needs.  Bina Tiza is the only remaining child of her mother, her three brothers have all died. Bina Tiza herself is widowed and was severely ill for a few years. She is also still raising her two children.  Her daughter Taonga is in 11th grade. Her son, Tiza is 21. Though he has tested well and is very motivated to attend university, economically it has not been possible. Usually Bina Tiza sends Tiza out with food and such for her mother because she is unable to walk the 3 miles or so to get there. Today we got a ride, so Bina Tiza could go along.

As we arrived at her home, Bina Tiza's mother who is thin, stooped and wears thick glasses started singing in Tonga that her guests had arrived. She was dancing and clapping, it was quite a welcome. We all shook hands with her and were introduced, she is quite blind, so it was hard for her to really see us.  She has a wife of one of her sons living with her to help her cook and keep the house clean. She also greeted us. We went in to the small central room of the house and sat on the very worn out furniture. We talked for a bit, then presented the gifts we had brought. I brought some lemons from my tree, someone else had brought bananas and oranges. Bina Tiza had brought heart medicine, candles and matches, a bar of soap, a bag of charcoal (which her mother was glad about because she has been cold in the mornings and will now be able to warm herself), a papaya and some beans.  We were served bwate, which is a fermented corn drink. The conversation was mostly in Tonga. Some was translated, though, and I became aware of how sharp Dinah's mind is and what a sense of humor she has. Bina Tiza is much like her mother.  After awhile, Tiza took a few of us outside to show us around.

Villages are traditionally family members all living near each other. This village Maliko was named for Bina Tiza's great uncle, the oldest brother of her grandfather. So the people in the nearby houses are all cousins and such. After a bit of time, some of these family members came to the house and joined our conversation. There was the main house, another shed, a cooking hut (with the traditional grass roof) an elevated food storage bin and a letrine. Outside the shed there was also a fire ring and some food drying racks.  The yard was very well swept, a common thing here in Zambia. People keep their yards tidy.

After posing for pictures, we set off for Macha. On the way home in the back of the pick-up truck (covered by a camper shell) Tiza and I had an interesting conversation as we bounced down the bumpy track. We talked about the cost of university here (2-4 thousand USD/year). He would like to study engineering or business or environmental science. He knows quite a bit of history and is very committed to helping his community and country. He was quite the teacher/tour guide for the young college students with us. He told me more of his mother's story, and how his parent's met. His father is actually from Malawi, though the tribe he is from is both in Malawi and Zambia. As Tiza pointed out, the borders are kind of arbitrary. In his father's tribe, the lineage is passed through the father, in his mother's tribe (Tonga) lineage is passed through the mother. So, for example, when the current Chief Macha dies, his successor will most likely be one of his sister's sons, not one of his. I teased Tiza that whereas he now belongs to two tribes, if it was the other way around and his father had been Tonga then he would be tribeless. It doesn't really work that way though. We spoke of imperialism and foreign aid and how history books are written. I told him about some books I thought he might be interested in. His interest is peaked so I am bringing him some books from the MCC library to read and may look for some used books in the US to bring back.

On Sunday I went to Lupata with Esther and John Spurrier for church. I would say it is probably 1 1/2 miles away in the opposite direction of Maliko. It was a nice walk, through the fires and the market up onto a plateau where you could look around and try and figure out which builidings or water tanks or banana groves you could see in the distance. We saw a lot of birds, I wished I'd brought my binoculars. We crossed the Macha river (now completely dry, though women were digging down into the sand to get to clean water). We wandered a bit and got a bit lost, but made it to church at the end of Sunday school.

Apparently Lupata is where a lot of the support staff for the hospital live. The small BIC church has only been independent for about three years. The lay pastor, who is also the head administrator at the hospital, was away this Sunday, but I was impressed with how well the service went. The youth led it, with one presiding, one translating (into English for the few of us who don't speak Tonga) and one who preached. The ushers made sure things ran smoothly, the chairman made all the official announcements and welcomed us guests. The music was fantastic and both the youth and the women's choirs were decked out in matching outfits. The youth in black trousers/skirts and pink shirts, the women in royal blue chitenge suits with red and yellow circles. I wished I had brought my camera. Apparently it was the third attempt at a church plant in this village, but I would say it was done right this time. You could feel the sense of ownership. Esther had not been there in 1 1/2 years and the letrines and kitchen were new structures on the ground that hadn't been there when she last visited.

They had been advised we were coming, so after the service we were told to hang around a bit. They had made us lunch, but since the sermon had been shorter than normal, it wasn't quite ready. The youth had a meeting in the meantime, but when our meal was ready, they went outside to practice. The three of us ate with the chairman, and what a feast it was. We had nshima with village chicken in a wonderful sauce and "vegetables" (what we would call greens in the states). More bwate was served as a drink. Before we ate, one of the women came around to us one by one with a pitcher of water and a basin for us to wash our hands.

After lunch we were told to wait "ashonto" (a little bit). As we waited, our cooks, most in there royal blue choir outfits came and sat on the bench along the wall to talk with us. They had carefully waited outside till we were done eating. This was when I really wanted my camera. They were all there, laughing and smiling and joking with us with their beautiful dresses and headscarves. Eventually a woman showed up with three rugs that they make together once a week (kind of like quilting circles) out of old feed bags that they hook colorful scraps of material through. They picked the best two, made a few snips here and there and then presented one to both Esther and I.  These rugs are great for getting the red Macha dust off your shoes/feet before entering your house. I will keep it new till I get my permanent house. It felt like an early house warming gift.

I really was touched by the genuine warmth and generosity of the people at this small church. I think I will try and make it there at least once a month.

The Healing Power of Children

I was down most of this past week with an infected bite that quickly turned systemic causing 102 fevers, headache, nausea and malaise. I am finally getting my energy back with the help of my third antibiotic. The first one didn't work, the second one I had an allergic reaction to (first allergy to medicine in my life). I am not a very good patient, but there is nothing like a few days in bed to make one aware of how wonderful everyday good health is. It also serves as a good gratitude test........what else do I take for granted each day that I need to be more consciously grateful for?

I had numerous adults around me both in Lusaka and here in Macha who were very gracious in caring for me, but in reviewing the week, it was children who kept the spark of joy, awe and gratitude alive for me in various ways.

There have been numerous kids stopping by the house to ask to pick some guavas from the tree out front. They are very polite, some even come inside and visit before getting around to the heart of the matter. One afternoon Oswald and Humphrey two 6th graders came in and played a game of UNO with me, glanced through some books, taught me a little Tonga and just visited. I gave them a few cookies I had on hand.

On Friday, just my second partial day back at work, Miriam, the nursing officer and myself ran over to theater to talk to Dr. Spurrier about my schedule for next week. There was a skinny little boy (perhaps 5) laying alone on a gurney with a sheet covering the lower half of him. One leg was laying flat the other with knee bent and foot flat on the mattress. He was obviously in pain, but not crying just moaning a bit and moving his head back and forth and taking deep breaths. It was as if we weren't even there because the pain was too distracting. Dr. Spurrier said his leg was full of pus. He was waiting all alone, parents/family were probably outside, but not allowed in with him. My heart went out to him.


On Saturday I was in the hospital to find a couple friends. The three of us (myself, a Canadian and a Scott) were speaking English to each other when I noticed two boys sitting on the bed behind us just giggling away with their eyes on us. I noticed they both had bandages on and so were patients. They may have been about 10 and 12. When I looked again, I noticed that the older boy's bandage was covering a partially amputated foot. Here he is, most likely in pain, having lost part of a foot, and yet he was finding such joy in listening to us talk.

A bit later as I was walking home with Fiona, she told me a heartbreaking story of a young girl brought in last weekend who was very sick with hiv. Apparently she was a double orphan and staying with extended family.  These children are often taken in but neglected.  Neighbors had found her and brought her in not knowing how long she had been sick. I don't know the details, but this little girl died in just a few days. Her guardians had apparently not been bringing her in for her meds and some secondary infection killed her. Her suffering has ended.

Today is Sunday. This afternoon there was a "popcorn party" in my backyard. This is an informal Sunday school class for kids in the neighborhood. Two of the youth from the church work with these kids (ages 3-10). The kids arrived before the adults and were hanging out on my back porch. Eventually they got up the courage to knock and I went and talked with them. Once their teachers arrived, class began. I had quite a bit of fun singing along with their songs. There was even one silly one where each verse you added some awkward positioning of your body. The last verse we had thumbs up, elbows out, feet apart, knees bent, head to one side, tongue out and we were turning around! They got quite a laugh out of watching me do it also. They continued on with quoting Bible verses and then a Bible story/lesson and then we all got koolaid and popcorn.  They all waited patiently in line with their bags and plastic bottle to be filled.

So these are some of the kids who touched my life in some way this week. I pray for them all that their lives may be blessed.