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.