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.