My First Week in Macha

Hello everyone. Sorry for the delay in a new post. Our internet here in rural Zambia was down for three days. I imagine it may be a not too rare occurrence during my time here. Really, when you think about it, it is quite amazing that I have internet access at all, let alone wireless!  Life is much more luxurious here than in war torn El Salvador in 1990. Water is usually off most of the day, but so far seems to be coming on at night. We'll see if that lasts during the dry season. I have buckets of water in my kitchen and bathroom which I keep filled as back up. It is not uncommon for electricity to go out, especially at night. One night when I was ironing it must have gone out three or four times.

Anyrate, on to bigger and better things. Despite the initial challenges this week of figuring out who my direct supervisor will be, what my orientation will consist of, and what my final job description will be, things are beginning to come together. The nursing officer (head nurse of the hospital staff) was out when I arrived, but was back for a few days at the end of the week so my schedule for this next week is set.  I have started Tonga lessons. So far I have learned to greet people properly, which is a very important part of Zambian culture. I will have my second lesson later today.

Just yesterday I also started tutoring with Mrs. Sitali (the principal of the nursing school here) in preparation for the General Nursing Council exam which I must take at the end of May. Apparently 50% of foreigners fail the exam the first time they take it. Our first session was very informative in regards to how the exam is scored and what expectations there are in the responses. 75% of the score is based on 3 essay questions related to specific patient scenarios. Terminology, including names of diseases here are different than in the US. For example thyrotoxicosis is hyperthyroidism. Also, immunization schedules and other standard practices and protocols are different here than in the US. It's been 25 years since I've taken an exam, time to clear away the cobwebs in the recesses of my brain and refresh my old knowledge and make room for some new information.

On Wednesday of the past week I did outreach with Maternal Child Health (MCH) to the village of Humbbwatu.  Two nurses besides myself, a PMTCT (Prevention of Maternal To Child Transmission of hiv- the area I am focussing on) lay counselor, the data entry person and the cleaning woman from the department all went. I was impressed at how informed and active everyone in the department is in interacting with the clients. We were to leave at 11, we left at 12:20. When we arrived, all the mothers were gathered under a big shade tree by the rural health post and the local lay health workers were providing a short education session on PMTCT.  Soon we were introduced and Mrs. Mabeta, the charge nurse spoke to the crowd and then Granma, the cleaning woman spoke.  This was all in Tonga, so I couldn't understand, but there were lots of questions asked of the mothers to make sure people were understanding the topic. Granma was very animated and got the woman laughing. When the education portion was done, there was a quick market (such a gathering is a good chance for local people to sell their wares). I bought bananas for myself and lusaulo (sp? pronounced rusaro- an "l" is pronounced as an "r" would be in the US) a local root which I was told my Tonga teacher loved.

After this, we divided up in teams. A local health worker weighed the infants under one tree. One nurse and the PMTCT lay worker vaccinated the under 5 kids under the main tree. Inside the health post Mrs. Mabeta and Granma did the antenatal checks on the pregnant women. I went with Vernon, the data entry person, to a small side room to do the PMTCT counseling and hiv testing with the newly pregnant women and their husbands. There is a big emphasis in Macha to get the fathers involved in this area. The pastor of the main Brethren in Christ church here in Macha is actually sponsoring a workshop on the topic for all the men of the church today.

Vernon, myself and the lay health worker sat on the three chairs. The three couples and one woman whose husband didn't come (there was a note presented from  a headman to explain his absence) all sat on the floor around us. I was not completely comfortable with having pregnant women on the floor and myself in a chair,  but it is part of the culture here. There is a definite status hierarchy and places and times when it is not appropriate to question it. Vernon did all the counseling in Tonga and every once in awhile would tell me the current topic.  He tried to include me as he could. The counseling is quite thorough. We all talked together for probably 90 minutes before signing consents and testing. He spoke of hiv (prevention, transmission and treatment), family planning, nutrition, child rearing, hygiene. He asked lots of questions and seemed good at drawing out answers even from those reluctant to participate. The couples were all young, mostly in their 20's. Thankfully the test results all came back negative. After testing, Vernon brought them back in as couples to give them the results. The relief on some of their faces was evident. The women will continue to be tested every three months during pregnancy.

After we were through, we got to eat nshima and greens brought by a local woman to thank us for coming. Yum! A good way to finish the day. We were back at the hospital by 5 (or 17 hours as Zambians say).

On Thursday I worked with the senior nursing students in the ART (antiretroviral therapy) clinic screening room. We mostly saw patients who had been on ARV's (hiv meds) for several years. We would record their vitals, ask if they had any complaints since their last visit and check to see if they have been taking their meds correctly. Macha uses all the national forms for the ART clinic, but has added their own which measures a patient's adherence (compliance). We review their pill count from their last visit, see how many pills the pharmacy dispensed to them, then calculate the number of pills they should have taken since then. The patients know to bring their pill bottles with them. We then count how many they have left. If their adherence is less than 95%, they are sent for  counseling before seeing a provider.  It is a pretty thorough system that people seem to adapt to well.

In Zambia hiv+ patients do not start on ARVs until their CD4 count is less than 350 (there are some exceptions which I won't go into right now). The CD4 count indicates the level the immune system is working at. However, people who don't yet qualify for ARVs are started on prophylactic septra (an antibiotic) and multivitamins. This gets people used to the idea of taking meds on a daily basis in preparation for taking ARVs in the future. Poor adherence can lead to failure of treatment and resistance. People are not put on ARVs until they can prove their ability to adhere to the regimen.

Okay, this is a lot of info for one post. I think I will stop here for today.

Celebration and Mourning

There has been quite a mixture of joys and sorrows in the community since I arrived.  On Saturday morning I was given a three hour tour of the hospital complex by Felix, the nurse in charge of the ART clinic. I met many people; nurses, nursing students, doctors, med students, pharmacy, laboratory and x-ray techs, the head of the kitchen and housekeeping. Too many faces and too many names to remember, but a good start none the less. It was fun to see that on the adult wards (male and female) all the patients had hand made comforters on their beds. I'm sure these were made by people in North America and shipped here by MCC.

The pediatric unit(under age 6) was in a separate building divided up into many smaller rooms/wards.  I was surprised how full the TB unit was (perhaps 8-12 pts) and the malnutrition unit was similarly full. Apparently if the child doesn't improve after a month of special nutrition, they will start treating them for TB. The rooms were crowded with the beds only perhaps two feet apart from each other and a mother either in the bed with the patient or sitting or standing beside it. After the peds unit, we went next door to the Maternity unit, also in a separate building. We spent perhaps 20 minutes inside reviewing the logs where I would be gathering information for my work. When we exited the Maternity unit, there was wailing outside the pediatric unit. A child had died. I had not noticed while inside that any patient was so near to death. I found out later that the baby had pneumonia and they were considering surgery to drain the lung and place a chest tube.  The surgeon was just checking on staffing in the OR. The wailing could be heard throughout the rest of my hospital tour and it was heart-wrenching.

Later in the afternoon, I was invited to a wedding reception. I went with Mr. Mabeta, the hospital administrator coordinating my stay here, and his wife. The bride was a nurse in the hospital who had grown up in Macha and nearly the whole vilage came.  It was quite the event.  There was lots of dancing!  The child attendants, two boys in dark suits and two girls in white dresses danced in.....they were perhaps 5 or 6. Then the bride danced in with the groom dancing from the front to meet her half way down the aisle. Next the whole bridal party danced in. This was all a long choreographed dance that took probably 20 minutes for them to get to their seats at the big table at the front of the hall. Mrs. Mabeta said they practice for several months ahead of time.  I asked Mrs. Mabeta what would happen if one's friends did not know how to dance, and she laughed and said you would have to hire someone. The joy was infectious with those of us watching shouting and clapping and taking lots and lots of pictures and videos. Sometimes you couldn't see the dancers for all the people taking pictures. Unfortunately the lighting was not good for my camera.

There were songs and speeches. Then there was the cutting of the cake with, you guessed it, more dancing. A young boy and young girl, perhaps 11 or 12 danced in holding knives.  The boy came from the front and met the girl half way down the aisle. Then the bride and groom danced out from their places and cut the cake and then presented smaller separate sections of it to the guests of honor and their parents. Then the bridal party again came out and danced the rest of the cakes out of the hall to the kitchen to be sliced. The bridal party was dressed in western attire (men in suits and women in bridesmaids dresses) the women, however, were barefoot, much more conducive to the required dancing than heels! In the midst of all these festivities, people were bringing drinks and plates of food to all the guests.

At one point during the festivities, the master of ceremonies made a call out to all of the nursing students.  I found out later, that this was informing them that a classmate of their's who had been very sick in the hospital had just died.  What a juxtaposition of death and celebration.  I had noticed the bride was not smiling much and was wondering why.  Perhaps she had  been friends with the woman who died. The bride was a nurse at the hospital and the other a nursing student. I imagine they had worked together. How hard to go on with your own celebration, knowing that a friend was dying.

Towards the end, it was time for folks to bring forward their gifts and greet the bride and groom, this of course was done with more dancing! Hundreds of people came forward in along line to greet the new couple and celebrate with them.

The Road to Macha

As part of orientation, we went out to lunch one day and had nshima, the traditional Zambian food staple. It is like tortillas in El Salvador, if you don't have nshima, you haven't eaten. Nshima is a maize based porridge sort of like dry grits.  You break off a golf ball sized piece, roll it into a ball, then make a thumb indentation and use it (again like a piece of tortilla) to scoop your food and eat it. No silverware needed.  It is quite filling.

I also became a millionaire! In kwachas that is. The exchange rate is 5,225 kwachas to one US dollar. They no longer use coins, and their smallest bill K500 is worth a penny. I've heard they are going to update the currency soon, removing a few zeros to make the math easier.

The day before we left for Macha, Kathy took us all shopping for food and household supplies. It is always good to have someone along who knows the products when shopping in a new country. I would say a majority of the products come from South Africa, but there were a few from Europe.  Lucky for me they have a few gluten free products (I found 6 bags of rice pasta and two packages of rice cakes). There are also a few European and Australian products. The markets were full of many nationalities.  There are whites and blacks from Zambian and neighboring countries (South Africa, Zimbabwe etc), people of Indian descent (many with a long history in this country), there were also quite a few Muslims from various different countries by the look of their clothing. We noted at least two mosques in downtown Lusaka. 

On Thursday, a week from the day the Ulbricht's and I arrived in the country, we headed to Macha. With all our stops along the way it took us about eight hours.  The roads were in amazing condition. It was a two lane highway once we got out of Lusaka. We passed many semis carrying heavy loads of copper ore to the ports on the coast.  The road we took is the main highway through Zambia and a major trucking and travel route from southern Africa to the interior.  We passed many trucks from Botswana and South Africa. We passed several buses including one traveling from South Africa to the Congo. In this part of Africa, the borders are pretty permeable.

It is the end of the rainy season, so the elephant grass along the side of the road hides most of the houses and small communities, but you would see concrete signs for government schools and small stalls by the roadside selling different wares depending on the area. We saw chickens, chicken houses, squash, charcoal(lots and lots of this), tonga stools, baskets, sweet potatoes, etc.  We stopped to buy sweet potatoes we got a whole stack (probably 8-10lbs) for $4.

Overall, I find that Zambians are very friendly and laid back. The lack of a recent armed conflict seems to have kept a strong polarization from having developed.  I feel safer on the streets of Lusaka than San Salvador . Though petty theft is a problem, there is not the presence of gangs or armed criminals as there was in San Salvador or major cities in the US. I also have yet to notice an obvious drug use problem. The fact that Zambia is so sparsely populated, merely 13 million people in an area slightly larger than Texas, probably contributes to the absence of major discord in the population.

Only the last 15 km of our journey was on an unpaved road. We arrived safely into Macha and my temporary home (three months or so) was ready to move in. Tonight will be my third night here. I have been sleeping well and figuring out the water and electricity challenges. Soon I will write more of my first impressions of Macha.

Meeting My Fellow MCCers

I have been in Zambia for 4 days now.  It has been a nice easy landing.  After traveling nearly 30 hours (including a 7 hour layover in Heathrow airport) I arrived early in the am April 5th. I traveled the last leg of the journey with the Ulbricht family. Natasha, Ingo and their sons Tobin and Noah will also be living in Macha. During their one year term, Natasha and Ingo will be mentor teachers in the various schools in the region. The evening of the day we arrived, all the other MCCers working in Zambia arrived to begin a team mini-retreat over the Easter weekend. It was nice to be able to meet our other team members before heading out to Macha.

The Moeller family (Cynthia, Jonathan and their boys Jason, Jarrod and Justin) live in the back half of the MCC guesthouse (where team members stay when they come into town).  They have been in Lusaka for 3 years and just extended for two more years.  Kathy and Eric Fast are the team reps and live in a smaller house on the same property. There are currently four SALTers. SALT is a MCC program where young adults from North America serve one year overseas.  Allison works here in Lusaka. Miriam, Chris and Matt are all working in the southern province near Choma. Miriam is in Macha.We also briefly met Ron and Irma Herr and Elsie and Peter Rempel. The Herrs' are finishing up nine years working with the Zambian Brethren in Christ (BIC) church in the area of HIV/AIDS. They are going home to be near their grandkids. Elsie was just here on a sabbatical doing teacher mentor workshops for three months filling in a gap between a previous worker and Natasha and Ingo. Peter came to travel home with Elsie who is on crutches after a broken leg.

We have had a lovely weekend eating, playing and worshiping together (with a little work thrown in).  We had an outdoor Stations of the Cross on Friday, a footwashing and communion service on Saturday evening and two services on Sunday. At sunrise we had a service with a reenactment of Mary at the tomb.  Then later after brunch we had a full worship service with lots of hymn singing.

It really has been a nice way to get my feet on the ground. I have had time to recover from jet lag (almost there) and get to know my fellow team members. Today and the next few days will be official in country orientation. Then on Thursday the Ulbricht's and I will travel with Eric and Kathy to Macha and settle in. It should be a full and exciting week.

The Seed Was Planted

(complete post, the first attempt was cut short)

The seed was planted for this journey when I read an article in Common Place magazine which I receive as an alumni of Mennonite Central Committee (MCC).
The article was about a center for HIV+ teens run by a MCC partner agency in Uganda.  I thought, wow, what an exciting time to be in Africa!  With the introduction of antiretrovirals (meds to treat hiv) around 2005, the first generation of children born with hiv are moving into adulthood. Since I was between jobs, I decided to check out the MCC website to see what sort of nursing positions were available. There was this position in Zambia. Though I had served with MCC before for three years in El Salvador, I was not sure that I was prepared for living overseas again. However, reading the article and then finding the position felt like it could be more than just a coincidence. Might the Spirit be moving? I inquired and was asked to apply. I went ahead and applied even before I had finished my own internal discernment process. However, as time went on my heart grew ever fonder of the idea. The application process went in fits and starts between the holidays, a big restructuring process at MCC and a three week period I was in a remote location with no phone access.  I applied the end of November. I interviewed February 23, was accepted to the position on February 24, and left the States for Zambia on April 3.

The month of March was full of scrambling for documents,filling out forms, getting cleared medically and outfitting myself with skirts (previously practically nonexistent in my wardrobe) and white nursing uniforms (not worn since graduating from nursing school nearly 25 years ago).

In the 90's, I lived and worked in El Salvador for over 5 years. I have traveled  quite a bit in Latin America and am fluent in Spanish. I have experienced the joys and challenges of living in a culture different from my own. Africa is a new continent for me, Zambia a new culture. I will also be working in a new area of nursing.  I am so blessed for the opportunity to learn and experience so many new things.

Yesterday, quite unexpectedly, I purchased a small sculpture of two people dancing. It was carved out of ebony by a man named Eddie. Once he put it in my hands, and I felt the weight, touched its mostly polished surface, admired the highlights of the grain and the gracefulness of the figures, I didn't want to put it down. I knew I didn't need it, but I wanted it. It is beautiful. I bought it and am pleased I did. I will place it in a prominent place in my new home.