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!

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.

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.

New Girls Hostel

Yesterday was a big day for the community of Macha. It was the official opening of the girls hostel at Francis Davidson High School. Unlike most high schools in Zambia which are boarding schools, Francis Davidson is a day school. The students who come from far away must find their own lodging, and this leaves the female students particularly vulnerable and their enrollment and academic performance are much lower than the male students. Also, their drop out rate (often due to pregnancy) is much higher. The teachers, students, church and parents have all expressed the need for a place for the girls to live for years. Typically this is not the type of project that MCC helps with, but they kept asking, statistics were produced and the female students wrote letters about their experiences and their need for a dorm. The funding was raised from three groups of people.  A large BIC church in Canada called The Meetinghouse, several BIC churches in Pennsylvania and friends in Winnipeg. The project was finished on time and within budget. The PTA made all the bricks locally in the community. You could sense the ownership of this new building.

Lots of government and church officials were present for the several hour ceremony. A tent was even rented for the guests of honour to sit under. Parents and teachers found shade under a few trees, but most of the students were out in the sun. There was singing, traditional dancers, many speeches, a ribbon cutting ceremony and a tour of the hostel. When it was all finished they served all the guests lunch. It was an exciting day.

There are still some finishing touches. The outdoor kitchen needs to be built for the girls to do their own cooking. A house for the matron needs to be built and a good water supply connected. Mattresses and curtains are still missing, but some of the girls are moving in on Monday. The entire hostel which will house nearly 60 girls (only three toilets and three showers to share amongst them all!) cost $40,000.

Over the last few weeks, as I have mentioned the opening of the hostel to people in conversation, several of them, especially women leaders in the community would comment on how needed this hostel is and what a benefit it will be for the girls. There are over 200 female students at the school. The girls had to apply for a place in the hostel and a committee of about 6 people (teachers and church leaders) chose the most needy (usually those from farthest away with no family locally to live with). Hopefully the benefits of this new hostel will be sensed soon, you can already sense sighs of relief.