Patient Stories

So, for some time now I have been wanting to write some stories of some of my patients. Some are stories of frustrating struggles that paid off in the end, and some are stories of the lengths mothers will go to for their babies.

HIV here in Zambia, as around the world, still has stigma attached to it, but that is slowly changing. When the ART clinic first opened, patients were allowed to register with false names, and doctors saw patients after hours or at their homes. Over the years, however, led by a few with the courage to share their status openly, the stigma is breaking down. People greet each other in the halls of the ART clinic, share their status with visitors and openly come to VCT for testing. Occasionally you still find the nurse in charge seeing people in an office so the patients don't have to be see waiting in the halls with the other patients or you might hear of hospital staff dying of AIDS because they refused treatment, but not so frequently. There is denial, fear of family or friends finding out, the belief that herbal remedies or faith healing will work better than imported ARVs. A whole host of reasons why people refuse treatment. Luckily in Zambia, there has been lots of training of lay counselors who talk with people about hiv, give them information and encourage them to make wise decisions about their diagnosis, treatment and lifestyle. Many of our counselors are hiv+ themselves, they make the best counselors as they can speak from experience. Recently I was reviewing with some of our counselors a couple cases in which our persistence paid off.

L was a 19 year old with her first pregnancy. She came for prenatal care when she was 5 or 6 months pregnant. We drew her CD4 and it was only 57, (below 200 is considered AIDS and below 350 you are put on lifelong HAART.) Despite this, she seemed healthy and strong, and maybe that contributed to her refusing treatment. Several of us met with her and talked to her and pleaded, but she was fearful the people she was staying with would find out (she was not married). When the CD4 is so low, the viral load is very high and the disease is very contagious. Finally one of our nurses convinced her to take AZT which we usually give to pregnant women with CD4 counts over 350. It was better than nothing, but we didn't think it was enough. It was not until after the baby was born, that one of our counselors who is hiv+ herself with 2 children was able to convince L to start on full HAART. L knew this counselor and her children, and the counselor revealed her own status and that her children were hiv – after she took HAART during pregnancy. Finally L was caring for herself and hopefully there was still a chance the baby would not get infected, but I was doubtful. The baby's first DBS done at 6 weeks came back negative, very good news. Then came the 6 month test, still negative, it was beginning to feel like a small miracle. Just the other day L came in with 10 month old S who is weighing in at 9.8 kg! Quite large by Zambian standards, he looks like he is nearly 2. L and I can't speak to each other, but the way she looks at me, I know she realizes what a good thing it was that she came around for her and her baby, and I am sure she is grateful for all our concern and persistent nagging of her to get on board.

Another story is of a woman who did not come for prenatal care till she was nearly 9 months pregnant. Turns out her husband (a friend of one of our counselors) had been hiv+ for three years but had never told his wife. As we ask women to come with their husbands or partners to their first visit, so they can both be tested, it was probably his reluctance that kept them away so long. They both tested positive and we put mom on AZT while we waited for her CD4 results. They never came back for those, and by the time one of our counselors went to their home to find them, she had already delivered. If a woman delivers at home, but gets to the hospital within 72 hours, she and the baby can still get meds that will decrease the likelihood of transmission to the baby. 5 days had already passed, it was too late. The mom's CD4 was low enough to warrant her to be on full HAART, as was the husband's but he was refusing treatment and she didn't want to start without him. We tried to work with her and encourage her to go on treatment despite her husband to protect her and the baby. At first she refused, but eventually after a few weeks she came in on her own to begin treatment. The baby didn't look so healthy to me, and I was concerned perhaps the virus had already transmitted, so we had mom and baby open files at ART. I am happy to report that this baby also has had two tests come back negative, and mom continues on treatment despite lack of support from her husband.

Two babies that I have been following were diagnosed about the same time. A's mom tested negative during pregnancy, but later when the baby was a few months old, he fell sick and entered the hospital. There mom was tested and came back positive. For over a year we have been testing all patients in maternity and peds (the mother/caregiver if infants are younger than a year). So a dbs was performed on baby and it came back positive. Unfortunately, before we got A on meds, he got quite sick again and was admitted for TB and malnutrition. People must be on TB meds for 2 weeks before they can start HAART. I visited A and his mom a few times a week and prayed for little A. This was mom's only child and one of the doctor's told me he had a 50/50 chance of pulling through. He was running a fever and very lethargic. We don't do IVs on kids here, because we don't have machines to control the amount of fluids going in and fluid overload can cause too many problems in small children, so mom's have to work hard at keeping the kids hydrated. A was put on antibiotics, antiparisitics, analgesics and later the TB meds and then HAART. So many meds for this little body. He spent days just laying still, I remember going in one day and seeing him holding a balloon animal someone had given him. He wasn't playing with it, just holding it as he lay in bed and looked at mom. I was unable to speak to mom, but I would bring food and stay for a few minutes, somedays he seemed better than others. Eventually he got better and went home. Mom lives quite some distance away, but thankfully she lives with her parents, so she has some financial and emotional support. She didn't lose all her crops while spending weeks in the hospital with her son. She has had frequent clinic visits over the last few months as A needs to come to both the chest clinic and the ART clinic for meds. He started his TB treatment on 4 meds, now he is down to 2. For HAART he is on 3 plus a prophylactic antibiotic. I can't imagine mom keeping track of all these meds and working on feeding this wee one with all the other tasks in life. One of the meds he is on for hiv is very bitter tasting and lots of babies spit it back out. Mom has been expressing her gratitude to several of us in the clinic by bringing gifts of food. I have received two live chickens, a bunch of groundnuts, some sweet potatoes and a large papaya. Recently she made an extra trip to the clinic for a med refill as there would not have been enough to get A through the long holiday weekend. He had just had his one year birthday, and I bought him some clothes and a little toy car. He is still a bit timid around me (understandable with all the poking and prodding he has been through) but he was quite eager to hold the car and push its wheels round and round. He is still quite skinny, but seems quite long, so I think his growth is picking up.

A's mom tested negative during her pregnancy, but was never retested. We have started retesting pregnant and breastfeeding women every 6-8 weeks, because hiv is most contagious when you are first infected and then years later when your CD4 count starts dropping. We hope to catch women as soon as possible after they are infected to better prevent transmission to their babies.

There is another mother in a similar situation, though her baby M is a few months older, and never got quite as sick as A. However, he was in the hospital and is also on TB meds as well as HAART. Mom and M came into the clinic one Friday for meds. She was two days late for her appointment because she rides 60 kilometers on her bike (with M tied onto her back) to get to the clinic and she had had a breakdown on the way. This would mean finding a place to stay in the nearest village until parts could be found and the repair made. Fridays we don't see patients in the clinic because we do mobile clinics on those days. So if patients show up, it takes us a bit to find a file and then a clinician to see them. As they were waiting, I could here mom talking to M and his playful, happy laughter like that of a healthy toddler. It was quite heart warming.

M's mother tested positive but had a high CD4 count. She received what we call short course, AZT during pregnancy and then 2 other meds during labor followed by the baby receiving Neveripine while breastfeeding. While this course of meds, if administered correctly reduces the transmission rate from 35-40% down to 12-15%, some babies, like M are still infected. As of this year, we have started putting all hiv+ pregnant women on life-long HAART. This reduces the transmission from mother to child to less than 1%.

A and M are doing well, having gotten on treatment early in life, but our goal is to prevent more such cases. With these new methods, we hope to do just that.

Visit to Nemfwe

It is the dry season now and I am determined to get out on my bike and visit some of the neighboring villages. One Saturday a couple weeks ago I went out to Nemfwe, a village where my co-worker Cliff lives with his family. It took me about 40 minutes each way. Cliff had told me more or less how to get there, and I asked along the way and didn't have too much of a problem finding it. However, when I arrived, no one was home. A neighbor boy named Joseph told me they were probably out working in the field (it is harvest time) and he was able to find two young girls to escort me out there. I was only able to get the girls' names and that they were in 4th and 2nd grade. I offered (in sign language and English) for them to sit on my bike and I would push them, but I don't think either of them could ride and I couldn't get them to understand that I would hold onto them. So we just walked and I pushed my bike. When we eventually arrived at the field Cliff and his family were taking a break from harvesting the maize. I was given a glass of chibwantu (a fermented maize drink with maize chunks in the bottom) and a sweet potato. I was introduced to Cliff's wife Chinyama and we chatted briefly before I joined them for a bit removing the husks from the maize which was drying in an upright pyramid shaped stack.  Soon we headed back home with Chinyama and I biking and the others walking. We arrived back at their home and I met young Mary who is in 2nd grade. Chinyama stoked up the fire in the kitchen, an area with a half wall and a grass roof. She put water to boil (for the upcoming prep of the chicken they would kill on my behalf) and set off to clean the outhouse. As I sat waiting with Mary staring at me, Girl, another daughter of Cliff's also in 2nd grade, came along carrying a bucket with 2 or 3 gallons of water on her head. Her eyes wide at the visitor, she called Mary to come help her lift the water from her head and place it on the ground.  Quite something to see these two spindly girls who couldn't weigh more than 40 pounds each struggling with this bucket of water, but you could tell they were used to it. Girl came and sat briefly with Mary and stared at me while discussing amongst themselves. Soon Girl remembered her task at hand and went back to get another container of water waiting at the nearby pump.  Mary and I sat and fed the baby ducks. We would chew up pieces of maize and then spit them back out for the 1 month old ducks who had been abandoned by their mother. She was still around, but not caring for them. At night they put them to sleep with the baby chickens. During the day the two run around together.



Cliff has a whole collection of animals and enjoys calling them and feeding them. Before he returned, Chinyama had fed the fowl just enough so that Astridah, Cliff's younger sister could grab the chicken we would have for lunch (she succeeded on her first try, I was impressed by her technique). When Cliff arrived, however, the whole brood was fed. Chickens, pigeons, guineafowl (including an albino), ducks, and pigs. They also have dogs and a few cows.

I had brought some papaya (pawpaw) to share and Chinyama pulled out some ground nuts for all of us to shell for me to take home. So I sat with Cliff and the girls and shelled groundnuts while Chinyama and Astridah worked on lunch in between shelling groundnuts. At one point we took a break to eat the pawpaw. Cliff brought out a radio and hooked it up to a small solar battery so we could have some music. A big feast of nshima, chicken with tomatoes, and greens was made. I ate inside the house with Cliff in front of the solar powered TV which was showing a soccer match.



Both Cliff and Chinyama have  12th grade educations. This is rare in rural Zambia. Only around 40% of students continue after grade 7 and of those only another 40% continue on after grade 9. There simply are not enough schools, and so at each of these grade levels, there is a national exam to select those with the highest scores to continue on. Yet, with grade 12 educations, Cliff is working as a general worker/cleaner at the hospital and Chinyama is working as a cleaner at the nursing school. They bike 40 minutes each way to work each day.  The other night Cliff, who works in Maternal Child Health didn't get home till after 8:30pm as they had gone for outreach to another village and returned late. He says he biked home by moonlight.



All and all it was a lovely day in the village. I need to make such trips more often. The hospital compound where I live can become like a college campus, a bit secluded from the outside world.

Just the other day I got a brief glimpse of Mizinga, another nearby village when I helped an older woman haul some water to her house. She walked with a major limp, scoliosis or a short leg would be my guess, and she was struggling with a five gallon bucket on her head which, although it had a lid, was still spilling down her back due to her limp and one of her hands being otherwise occupied carrying another jug of water. I just happened upon her on my way home, and offered to help. She readily accepted. I merely took the smaller jug, but this freed up her other hand to help with the load on her head. We were walking on a slight incline and the ground along the path was not even. I could hear her breathing hard, so slowed my pace to a near crawl. Slowly we made our way with frustratingly minimal conversation as my tonga is just not coming along. I could not believe how far she walked to haul this water. After a good kilometer or so, we came to her village as night was falling. All the neighbors were shouting at her about her “beenzu” or guest. As it was quickly getting dark, I carried her water into her house and then she escorted me back to the road where I could more easily find my way back rather than on the paths we had taken. The next day I asked some co-workers who live in this village about water supply there. I was told there is one bore hole for 1000 people and you have to wait in line 2 or 3 hours for water. One of my co-workers said she has to pay someone to wait in line for her. This rather large village, with no electricity and only one water source for 1000 people, where people still cook over open fires and use pit latrines is located just just a few minute walk from the hospital compound. Granted, we aren't living as one does in the first world, but we have electricity 90% of the time and water about 50% of the time which allows us to fill up water storage containers for bathing, washing dishes and clothes and flushing the toilet when the water is off. Next door to our compound is the Macha Research Trust compound where they have electricity all the time (they have a generator when there is a power outage) and running water all the time (including hot water!) I guess we are a little microcosm of the world with our differing economic levels living side by side. Many of the people who work at the hospital come from the villages nearby. They bring their phones to work to charge them (as do the patients for that matter!).

Finally an Update

Wow! Two months without writing. What can I say. It has been a busy time. I have worked on a post that I hoped to have up by now, but it requires some approval by other people and we haven't coordinated yet.

My work at the hospital has been overwhelming at times and with my personality I am having troubles drawing boundaries and learning to say no. My physical and emotional state are suffering, however, and I have been forced to make some changes. I recently had my annual review, though with very minimal input from the hospital.  With the MCC reps I have decided to take Monday and Friday afternoons "off". This really means missing a total of 5 hours a week on the slowest patient times. It will actually just serve as comp time for all the work I do from home on weekends and evenings. We also agreed I will try and find someone to provide me with some spiritual direction.

A friend loaned me a book by Brennan Manning entitled The Relentless Tenderness of Jesus and I have found it a Godsend.  I am working my way through a Compassion Fatigue workbook that a visitor from the Meetinghouse BIC church in Canada sent to me. I also just finished The Uncertain Business of Doing Good; Outsiders in Africa, which is a frank discussion of some of the concerns I have about what I am doing here. Africa is a continent that for a long time the West has seen as a place to meddle, be it as colonialists, missionaries, aid workers, entrepreneurs, researchers, scientists or government consultants. Not all consequences of this are good even when intentions may be.

So, this is not to rain down doom and gloom to you all, but only let you in on a little bit of what I have been going through and why posting to the blog has been such a challenge of late. This has been a time of growth for me, just not always so pleasant.

Two recent pleasant things were Easter weekend, a 4 day break from work. After a stressful Holy Thursday when I was told to spend nearly $5,000 before the end of the day (end of the fiscal year in the US where our PMTCT monies come from), I attended Good Friday services. The phone network was down for nearly 48 hours and my internet was down for almost 24 which really only helped me to have a reflective weekend. On Saturday, a whole group of expats hiked to the top of the closest thing we have to a mountain in these parts. Then on Sunday morning we had a sunrise service at the dam followed by brunch. Later in the day after church I got to visit with four young women from Choma (two with MCC and two with BICWM) who had come to Macha for the weekend. Then there was another full day off work.

Just last weekend, MCC held its spring retreat at Lake Kariba. It was almost a full day's drive each way, but our time there (2 days and 3 nights was restful). We even got to swim in the lake which I was told you couldn't do because of crocodiles and bilharzia (a waterborne disease carried by snails). It was nice to see another part of the country.

The rainy season is officially over. The rains ended a bit early this year, so the people who planted late will not have a good crop, but those who planted early will be ok. Everyone is eating mealies (fresh maize on the cob before it has been allowed to dry and harden). I have joined my friend Mulenga and her sister Bwalya (here on school break from university) several nights roasting mealies on the brazier in her back yard.

I now have a fence around my garden and Titus has planted green beans, peas, lima beans, carrots and strawberries so far. He has a nursery going of green peppers, tomatoes and cabbage. Watering is a bit of a trick as right now I only have water in the evenings and he works two mornings a week. I help him out a bit.

I had planned a camping vacation to see some waterfalls in northern Zambia, but not enough people signed up to make it work. So now, at the beginning of May I hope to take a few days at a nearby lodge located in an IBA (Important Birding Area) and conservation area/game farm. Some friends were recently there and highly recommend it.

I include three recent photos of God's amazing creatures. A moth (or butterfly) that spent three days in the same spot on my back porch. My first ever chameleon (Zambians have very strong negative cultural beliefs about chameleons so one has to be careful when wishing to handle them) and a camouflage frog able to turn white. The last two were seen on retreat at Lake Kariba a large lake that was formed when a dam was built in the 50s in order to create hydroelectric power. Tens of thousands of Tonga people were displaced. I read that all the power is sold to Zimbabwe.

Changes in My Work

Since the beginning of this year, I have branched out of the Maternal Child Health department where I was devoting most of my time and have embraced two other areas of my job description.

First I am working more in the ART clinic. I am helping implement some changes to hopefully improve our care and tracking of pregnant women who attend ART clinic and their exposed babies. Some of this work involves what we call DBS (dry blood spot) testing. Most hiv testing involves a simple and inexpensive antibody test that involves a finger prick and a test strip. However, young infants may carry their mother's antibodies in their blood stream up until a year of age. Therefore, an hiv antibody test on an infant may give a false positive. Early infant diagnosis is done via a DNA test where they test for the actual presence of the virus and not just for the antibodies.  The testing procedure is similar to the PKU tests done on infants in the US. A heel or toe is pricked and drops of blood are applied to circles on a paper card which is allowed to dry for 3 hours before being packed and shipped to the lab (in our case to Lusaka) where the test is performed. The turn around time for us is usually a couple months by the time we gather the sample, take it to Lusaka, then return a month or so later to pick up the results. The Ministry of Health is implementing a text messaging system whereby they will send the results to us by phone which hopefully will get them to us quicker.  I am the point person to get this new system off the ground in Macha, try and work out the kinks etc. I just dropped our first batch off at the lab a few days ago. We will see how soon the results come.

We started performing DBS tests at Macha in 2008. A spreadsheet was designed to keep track of all infants who a test was performed on over the years and the long term outcome of the patient (died, started on ARVs, transferred out, file closed after being confirmed hiv-, or lost to follow up). Over the years, with the quantity of work at hand, the spreadsheet has not always been top priority. There was also some erroneous shifting of data which has created problems in the accuracy of the information. I have been working on getting this spreadsheet up to date and accurate. It is a bit tedious, but it will allow us to better track the trends of different treatment protocols and tell whether or not our care is improving the lives of patients or not.

Another aspect of my job description which I am finally getting a chance to attend to, involves visiting RHCs (rural health centers) out in the villages. Macha Hospital has a catchment area of 160,000 people. There are 14 RHCs (including our outpatient department (OPD) and maternal child health department (MCH) which make up what is called a HAHC (hospital affiliated health center). Each one of the RHCs in turn has several smaller health posts affiliated with it where they go for monthly outreaches to do health education, hold under 5 clinics (weight and immunizations), antenatal clinics, and family planning clinics all in one day. For example, the HAHC here at Macha has 9 health posts under it. The MCH staff visits each one of these health posts once a month.

Some hiv+ pregnant women come to the ART clinic for care, but others are seen at the RHCs. Since these RHCs provide many PMTCT services (antenatal  care, voluntary counseling and testing, labour and delivery, and care of exposed babies) we want to improve our coordination with these centers to help improve the quality of care to hiv+ moms and their babies in our coverage area.

One key part of PMTCT care which the RHCs cannot do is assess pregnant women for the staging of their hiv disease in order to properly treat them. Access to a lab for CD4 counts (to show the extent of the disease and its response to treatment) and tests to assess and monitor kidney and liver function (which can be adversely affected by the arv medicines) is a big limitation for providing full care to HIV+ women at the level of RHCs. The RHCs must resort to referring their patients to us. Then there is a communication break down as far as getting info back to the RHCs regarding the patients they refer. There can be finger pointing on both sides with the ART clinic saying the RHCs aren't doing a good job of following their patients and the RHCs saying the ART clinic is stealing their patients and not sending back info on the referrals they sent our way. By visiting these RHCs and building relationships with the nurses there, I hope to facilitate conversations and plans about how to improve this situation so as to better serve our clients.

Change can be a hard thing to implement especially when there are so many players. I hope we can be successful over the next couple of years to get a system into place which is sustainable with the resources at hand.

So, work can be tedious and not very rewarding on a daily basis, but occasionally there are those bright spots which lighten ones heart. Just the other day I got to hold a bubbly 4 month old baby named Arnold. He was born to an HIV+ mom and they were in for a med refill for Arnold. He was babbling and trying to stand and weighed in at a hefty 6.4kg. It is so nice to see a healthy happy baby anywhere, but to see a healthy happy baby born to an HIV+ woman in rural Zambia is just that much sweeter. To know that the regimens we are implementing are giving Arnold a chance at a life without HIV and his mom the chance to parent a healthy baby are very rewarding indeed. I was able to hold and play and laugh with Arnold before putting him on his mom's back to be wrapped for the trip home.

The New Year

Blessings on your new year!  For some, including a few dear friends of mine back home, this year has already brought challenges in the form of physical illness or injury. Whatever joys and challenges may come your way, may you all have the grace, strength and support to face them head on.

My 2012 was filled with more challenges than I expected, many of which I did not share in my blog. However, things are shifting and 2013 is already feeling more sustainable and satisfying especially in regards to my work. At the beginning of each year, the hospital shuffles staff. Though it is sad to see some co-workers leave, I'm excited that my friend Mrs. Bakasa (who I work closely with on PMTCT monthly and quarterly statistics) will be returning to the in-charge position in MCH. She was previously in charge for 6 years, then was pulled to Maternity this past year. She is organized, hard working and committed to the patients. Her presence in MCH will allow me to focus more in ART clinic and out in the villages.  I have had recent good conversations with my supervisor and other higher ups regarding my plans for the year in regards to some changes in my work.

I also recently moved out of temporary housing and into what should be my home for the rest of my time here. I am still acquiring furniture and figuring out the best place for things, but it feels like home already. I'm working on getting screens built for all my windows. So far only the bedroom ones are finished, so I usually close the rest of my windows when I am not home, and at night when the lights bring in the insects.

It is rainy season which adds a different element to life. It is hard to dry clothes. Heavy rains flood rivers and keep people at home. The dirt roads get rutted and turn into small lakes in places. Carrying an umbrella becomes a must. Learning which paths are low lying or engulfed in tall grass is important. So far, I have not fallen in the mud, but I did buy a pair of rubber boots in town the other day to make walking to work less stressful.

I've been enjoying sweet corn and green beans from the garden and bananas from the yard, but in general it is a rough season for garden vegetable growing. Everyone is busy tending their maize fields. My neighbor has a plot which is towering over my head already. Sweet potatoes are also being planted here and there. The school year started this past week, so the students are getting back into their routines.

I miss the snow more than I thought I would. If you have some where you are, romp about a bit in it for me!

I include some random pictures of life in Zambia; the bus station in Lusaka, hospital laundry drying on the line and some of our nursing students prepared to go out to the village for outreach.

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!