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.

Nurse Exam Prep

Not much interesting to report this week. I've been in Lusaka preparing for the General Nursing Council's exam for foreign nurses. I was studying with three other nurses, Rachael from Australia and Esther and Solange from Congo. We studied at University Teaching Hospital where the main nursing school is. The week was a bit challenging for me. It was a busy time at the school, with an international conference taking place and graduation preparations going on. The professors were busy with all that and many didn't show for their sessions with us. It was good to be in the library with access to books and a studious environment. It also was good to be with others in the same situation to encourage study discipline.

Most of what we learned were specifics of how we are expected to answer the questions on the exam. There are very specific requirements like absolutely no abbreviations, and you must give a rationale for every intervention including taking a temperature. The nurses here use this same format all through their schooling, so they are used to it. Foreign nurses have a 50% fail rate largely due to lack of familiarity with this. Seventy five percent of the score is based on three patient scenarios. There is a compulsory pediatric question and then we must choose two of three others (general medicine, general surgery, and tropical medicine). They gave us lots of practice questions and old exams. I also just brushed up on illnesses in general and tropical medicine in particular. It's been a long time since I've taken a test.

Tomorrow I return to Macha for two weeks prior to coming back to Lusaka to sit the exam on May 31st. I will continue to study on my own during this time and ask the principal of the Macha nursing school to look over my answers to practice questions. They say only spend 35 minutes on each question, so practicing the timing will be important also.

I guess one other thing to mention is that I have now driven on the left hand side of the road (right hand side of the car). I actually find it easier than I expected. It's actually less awkward for me as the driver than as the passenger. When you are the driver you are focussed, as the passenger you just glance up and it all looks wrong and your relexes shout alarm.

Time is going quickly. It will be odd to leave for a month in July, so soon after arriving. Between that and the nurse's exam, my time in Macha really won't settle down till I return in August. I'm trying to take advantage of the time I do have there to learn what I can and become a part of the community.

BIC National Women's Conference

This past weekend I spent four nights and three days at the Brethren in Christ Church of Zambia's National Women's Conference. It was held in the nearby town of Choma on the grounds of the Choma Secondary School. The school, like most secondary schools in Zambia, is a boarding school. The month of April is a vacation month, so we had access to the entire grounds. There were over a thousand women there from all over the country. Most of them stayed in the dorms. A few of us stayed on the grounds of the nearby Nahomba guest house which is run by the BIC church. The school is actually also a BIC school, though it is a Ministry of Education school. This seems to be a common situation in this area of the country where the BIC church of Zambia began over 100 years ago with the Macha Mission. I am unsure if other churches perhaps run government schools also. I imagine the situation is similar to the hospital's, started by the church then registered with the government once they had a presence in the area.

The weekend was filled with guest speakers (only one man, the rest women), worship, fellowship, music and even a bit of dancing. The program began at 6am most days and didn't end till after 9pm. Some women stayed longer into the night for more prayer/healing sessions. Most of the weekend was in Tonga, which surprised me because women came from all over the country where other languages are spoken. I learned that the BIC church is known as the Tonga church which can create problems. Apparently a lot of the women from other parts of the country are originally from the Southern province where Tonga is spoken. Usually the speakers were translated (into English or Tonga) but often the announcements, side comments and singing were in Tonga. It was good for my brain to hear it and start recognizing it.

Natasha, Miriam and I rode to the conference with other women from the Macha church. We were to leave at 10, we pulled away from the church around 12 but really weren't on the road till 1 as we had multiple stops to make. A sad thing happened while we were waiting at the church. A woman received a phone call saying that her father had died unexpectedly. She began to wail, we tried to comfort her and reach her family to come and be with her. It was so shocking, one moment she was joyful about attending her first women's conference since 2002 and the next she was crushed by the news. The decision was made that the rest of us would proceed to the conference and likely return early for the funeral. We sang nearly the entire way to the conference. It's call and response and many choruses are repeated multiple times, so even though I didn't understand what we were singing, I could sometimes join in.

Singing continued throughout the weekend. The national choir was there, and two district choirs. Each choir sat together as a group, and they each had a different uniform for each day. One choir would be called upon at the beginning of the day, in between each speaker, after lunch break and at the end of the day. They would sing and dance in procession up to the stage, then perform one or two songs, then sing and dance in procession back to their seats. The choirs compose their own songs, so the words were often new to people, but there was often an easy sing along refrain. When the audience found the words particularly meaningful they would shout and clap and stand up. I was afraid I would miss my Mennonite hymns, but I think I could get used to this music!

One other small thing to mention about the conference. I successfully held my first Zambian baby. I should preface this by saying that on two occasions at the hospital young children have started screaming just at the sight of me. So I was a bit cautious one of the first nights at the conference when the breastfeeding baby next to me started smiling at me. He started reaching for my Bible, and I gave him my hand. He was content to play with that for awhile. We continued to make faces at each other off and on. Later outside, I clapped my hands in front of him and he nearly threw himself out of his mother's arms reaching for me. So I got to hold him for a few minutes. I was quite thrilled, he was such a joyful baby, it was contagious. 

I am currently in Lusaka for a couple weeks of studying at the local teaching hospital in preparation for the nurse's exam I need to take at the end of May. More about that in my next post.

My Second Week of Orientation

Life has continued to be full here in Zambia as I orient to the country, culture and the hospital where I will be working. Last week I spent two days on the maternity ward. I have been in hospitals before in the developing world, but it still sometimes comes as a shock to see the conditions. Open air buildings and unreliable electricity and water just add to the difficulties of small budgets. Macha Mission hospital does its best to use its resources wisely. They overlook some of the cosmetic things (unstained sheets, freshly painted walls, sparkling bathrooms) to focus on the crucial things like medicines, necessary lab equipment, food for the patients etc. There are no disposable instruments or even packaging. Instruments are sterilized in basins wrapped in surgical towels or old sturdy sheets. There was a premature baby (1.1kg at birth) that they were feeding with a syringe because they were out of ng tubes for neonates. When I offered to pull out the iv on a patient being discharged, I struggled to find cotton (they buy sheets of cotton and tear them up) and never found any tape to secure it in place. Bandaids are non-existent. Patients just hold the cotton ball in place till it stops bleeding.

Nurse training is a bit different here. From what I understand, the first level is an enrolled nurse (similar to an LPN or LVN in the US). This is a two year program. The nursing school in Macha is an enrolled program. Next one studies another year to become a nurse midwife. Most deliveries at Macha are done by nurses. Doctors are only called in for complications/c-sections. Then after another year of study, one becomes a registered nurse.

My first day in maternity I worked with Mrs. Simamba. She has been a nurse midwife for 20 plus years and gave me a thorough orientation to their processes and charting. The first patient was born the same year as me, making her 46 or 47. Though we didn't speak the same language, this gave us a bit of a bond.  I was a bit surprised by her age, but they say it is not uncommon for women to have babies into their 50's here. Though there is an automated BP machine and digital thermometers, fetal heart rates were measured by the manual funnel shaped fetoscope put directly to the mothers abdomen, the nurses ear is then placed on the fetoscope and the heart rate is counted for a minute. There are no tape measures. She taught me the trick of counting fundal height and estimating gestational age with my own finger width. She also calculated the gestational age from the last menstrual period on paper (no handy wheel).

The maternity ward is housed in one building. There is the labor room on one end with four beds for laboring patients and two warming beds for newborns. There is an ultrasound room off to the side.  At the other end is the antenatal and postnatal beds partially divided by a wall halfway down the room. The four beds closest to the door are reserved for surgical (theater) patients. There looked to be a total of 20 or so beds. I would say they were two thirds full. There are a few baby cots, but most moms seem to keep the baby in bed with them or in the bed next to them if it is empty. There is a door on the antenatal side that exits outside to the bathrooms. I have learned that a lot of the nursing care is provided by patients' families. Each patient can have one family member stay with them (sleeping on the floor under their bed, or with them). Nurses give meds, do dressing changes and other procedures, but the family, helps the patient eat, bathe, get to the bathroom, change linens etc.

In between the two ends are the nursing station, storage rooms, staff bathrooms,  a procedure room, the cleaning closets/areas, a counseling room and a side ward for staff patients (this exists on all wards, the closest one can get to a private room). There also is a room for premature babies and their mothers. This room has heaters, a warming bed and no visitors are allowed. The door is kept closed and there is a window that looks straight into the nurses station. They usually stay until the baby is 3kg.

My second day in maternity I worked with Mrs. Bakasa. I learned about the discharging process. Most women with normal deliveries and healthy babies leave in less than 24 hours. I was happy to see there is a heavy emphasis placed on patient education. It's done in Tonga, so I can't understand it, but it seems pretty thorough. We had one young mother who said she was almost 15, but didn't look a day older than 13. She is the youngest by far that I have seen. After she left I found out that she was the second wife to an older husband. Polygamy is a tradition in Zambia that is less and less common, but still occurs. We also came across a baby with a 37.7 axillary temp (normal is 37). The baby was bundled to the hilt, but we decided it best to keep him for a few more hours of observation.

I also got a chance to connect with Mrs. Bakasa on PMTCT, the program I will be focussing on which she has been overseeing since it's beginning six or so years ago. We will connect in the future and sit down to talk nitty gritty, but it was nice to have a brief intro to each other. We had only seen each other in passing up till then. She explained all the logs they have there on the maternity ward (inpatient admission, delivery registry and PMTCT log).

When my job description was written, 40% of hiv+ mothers in our catchment area were not getting treatment to prevent transmission to their baby. That is down to 18% in just 4 years. This is good news. We hope to decrease this even more and figure out a system where less people are falling through the cracks. During my day last week in  maternal-child health (MCH) outpatient department, I examined the records of all mothers receiving short course treatment. Short course is given to mothers whose CD4 counts are high enough that they don't qualify for full treatment. If their CD4 count remains high, they will go back off meds a week after delivery. The baby will take an antiretroviral medicine from birth until one week after weaning. During this time, the mom's CD4 count is checked every 3-6 month in case it drops low enough to start full therapy.  The baby is tested at 6wks, 6mos, 1yr and 18 mos to make sure that the virus has not transmitted to them. It seems the medicine is getting dispensed, but according to the records, these follow up exams are not getting done as they should be. This is one area I hope to help reconcile over the next three years.

The ART clinic at Macha Hospital has done great things. It has grown so big though, with over 8000 patients enrolled, that the staff can't keep up with all the little details. On top of that funding has not kept pace, and is even getting cut. I really look forward to being able to participate in improving the care that is being given.