Saturday, June 9, 2012

A much needed update!

May 20, 2012

This afternoon I am writing to you from the CIDRZ house, which will be my home for the next six weeks. At that time, I will be moving again, to another place that has yet to be finalized. There are several good things and several bad things about switching locations. Some of the benefits include being closer to work (AND living in a house with someone who has a car and works at the same place I do). So now I have two options of getting to work, both of which are better than the 1 hour + long commute I was doing from the House of Moses. I am now also closer to a lot of other foreigners who are also interning, volunteering, studying etc. and therefore have more community around me. Another benefit is that it is quieter than where I was before and it also has a pool. Some of the drawbacks are that I am no longer around the House of Moses, the babies and the staff who work there. I now also have to make own dinner, which is sad because it means that I won’t be eating nshima and the yummy relishes that accompany it. The new place where I am staying is owned by CIDRZ, and the yearlong interns stay here as part of the program. It has a main house and small cottage. I am staying in the small cottage and have my own room. It is nice to not be in the main house because it is quieter (not so many people coming and going). However, both the cottage and the house are extremely messy-dishes overflowing in the sink, ants crawling in the food, and the garbage rotting in the kitchen. While I am not always the cleanest person, most of my mess is only at the surface-my place is generally not dirty down deep. In the cottage, the bathroom has garbage strewn all over it. The person in the other room of the cottage will be leaving in the next week or two, and assuming that she does nothing to clean the place before leaving, I will be doing a thorough deep clean. I have to walk this fine line of not offending her by cleaning up her mess but also not living in grossness. Another drawback of moving into the intern house is that they have all been here for almost a year now and are not necessarily looking to develop new friendships. Though the four other people living here are friendly, they are going to be leaving Zambia within the next month and are starting to wrap things up before going. What this means, is that I probably won’t become best friends with anyone I live with. However, on the plus side, I have met some other people who are really friendly. Yesterday I went on a cruise on the Kafue River, which is about an hour outside of Lusaka. There were many people on the cruise, who are from a variety of projects and backgrounds. They were fun to hang out with and we ended up eating dinner together after the cruise was over. We went to a really good Italian place (doesn't seem possible does it?) for dinner and I had some yummy homemade pasta. This same group of people (about 10 in total) is also going camping next weekend, and I will probably join them. I have always wanted to go camping in Africa and I am excited to have my first chance to do it.

I am not sure what tomorrow will bring at CIDRZ. If my department is really moving to a new area, I don’t know if I will get much done or figured out. I am hoping to get set up with the internet early in the week so that I can communicate with friends and family, but I am not sure how much longer that will take. I also have been told that the area my department is moving to is actually closer to the side of town I was just on-closer to the House of Moses. However, the buses are less frequent and I may have to use a few buses to get there. Sounds like an exhausting nightmare if you ask me! I am hoping that isn’t true, but I guess I will find out on Monday!

May 23, 2012

So, my department isn’t exactly moving to the new location. Upon further questioning, the new clinic/office is not ready yet and even when it is, only the clinical part of my department is moving to the new location. This was exciting to me, because the new location is going to be hard to get to. However, to make things complicated once again, I am going to be spending half of my time working with the clinical team and half of my time working with the community engagement team. What this means, is that when the clinical team does move to the new location, I may have to get out there anyway. I am hoping that since the clinic opening is already delayed, that these delays will just continue until I leave, so that I won’t have to worry about it. Today, I was in the office the whole day, editing some documents that other team members had written. I finished those by lunch and then had nothing left to do. I am still waiting for the people I will be working with to send me the official description of what I will be doing for them, and until then I can’t really get started. While I am waiting, I have been trying to read up on different child health measures in Zambia (number of children vaccinated, burden of illness, etc.) and have also been trying to research some different ways that behavior change can be measured. It is not very exciting work and I have to say that I really wish I was out doing stuff because I don’t know that I am cut out for a desk job.

May 24, 2012

Today continues with my “independent research”, which really means that I am doing nothing exciting. I still don’t have the project descriptions that I need to get started with my work and the PAED team doesn’t have any other work for me to right now. However, at this point in time, I only have three more hours of my day left and then I can leave! I have tomorrow off because it’s a holiday, African Independence Day or something like that. For the weekend, I will be going camping with a group of people (the same ones I went on the boat cruise with) to Kafue National Park. I am excited for this and will try to take lots of pictures to post online.

June, 2, 2012

Camping last weekend was amazing!! We camped right on the short of this huge lake and were the only ones there. It took us about five hours to get there from Lusaka (not including stops) and about half of it was on bumpy dirt roads that left me and the driver squealing on a regular basis as we hits the bumps. The trick was to go as fast as possible while not wrecking the car. We did ok on the way there, however, I am sad to say that car didn’t do so well on the way back. The screw holding the window in place had fallen out, so the window was taped up (using some of my leftover medical tape) and then the exhaust pipe broke off just before the muffler and we had to rig it up just to keep it from dragging on the ground. By the time we made it to Lusaka there was also a noticeable rattle from the front wheel too. Oops! Other highlights of the weekend included going to an elephant orphanage and a soccer game in one of the local villages. On the way to the orphanage we had to drive through the national park (filled with lions, cheetahs, and elephants, etc.) and managed to come up on a group of elephants resting in the grass. They must have gotten annoyed that we were watching them because they got up and moved to the woods on the other side of the road and passed right in front of us. It was such an interesting experience being in the middle of the wilderness with no protection without a guide. Once at the orphanage we got learn a lot about who the five elephants are, how they are raised, and what will happen to them in the future. They ranged in age from 2-7 years and the orphanage was last step before they were reintroduced into the wild.

After the orphanage, we stopped in a village called Ngoma to watch a soccer (football) game between a Lusaka based team of expats and the local Ngoma football team. It was a random event out in the middle of nowhere but it was still a lot of fun. I found the village children to be particularly amusing and spent most of time playing with them instead of what the game. They even managed to braid my hair as you can see from this picture.
The rest of the camping trip was nice with the exception of our early morning game drive the next day. Waking up before six and sitting in the back of an open Land Rover for four hours while it was only 40 degrees out was not a lot of fun. It was even less fun to see less animals on the four hour trip than we had seen the previous day for free on our way to the orphanage. The best part though was when we saw some zebras and another deer-like animal grazing together. The driver of the vehicle stopped to let us get some pictures and felt the need to mention to use that the zebras were the striped ones. It was a great addition to a bad game drive.

Since that time I have been busy working for CIDRZ on the two projects that I have been given and working with another group at CIDRZ on a survey they were compiling. In the evenings I have gone to ultimate Frisbee a couple times, gone out to dinner a lot (I am discovering a lot of good restaurants in town) and been learning to drive. One of the people I met here is leaving Zambia for six weeks and has graciously let me use her car while I am gone. It’s going to be an amazing experience in freedom that I haven’t known in Zambia before. I have also had the chance to meet up with a friend from school who will be in Zambia for the summer too.

Overall, this trip has been great and I am really enjoying the people that I am spending time with. I am hoping to get back out to the orphanage sometime soon because I haven’t been there in more than two weeks and I miss the babies and the staff there.

The big challenge coming up for me is my work permit. I was supposed to start the work permit when I got here, but I forgot my diploma at home and I have had to order a new one. I am supposed to report to immigration by next Thursday at the latest, and I have nothing to show yet. I am afraid they are going to yell at me and make me go through extra hoops or pay some big fine. I guess we will have to see!

Getting my hair braided in Ngoma

The finished product:

Our camp site on Lake Itezhi Itezhi

Evening boat cruise on the lake:

New friends!

I love elephant smiles!

Baby elephants1

Children from the village:

Sunset over the lake:

An authentic braii (barbecue) at my house with about 10 kinds of meat grilling. 

Friday, May 18, 2012

First week back

May 13, 2012

I can’t believe it’s been two years since I have been in Zambia. For four years in a row, I had travelled to Zambia and it had become my routine. Then last year, I applied for and was accepted in graduate school. With all of the expense and time needed to move across  the country, I didn’t go to Zambia. In some ways it was hard, but in other ways, it was refreshing. However, when the time came for me to search for an internship this summer, Zambia was a logical place to start. By January, my internship placement was finalized, and all I had to do was wait. And wait. And wait. It seemed like forever. But now, here I am one my first layover in Washington, D.C., awaiting my departure to Addis Ababa. This is my first time flying anything other than British Airways to Zambia and I am a little nervous because I have three flights on the way there, and four flights (plus an extra refueling stop!) on the way back. British Airways seems luxurious with only one stop both ways. However, I am looking forward to experiencing the hospitality of Ethiopian Airlines and hopefully getting some really, really good sleep with the help of my friend Benadryl.

Here I am sleepy in the D.C. airport, trying to get stuff done! 

I am sure that some of you are wondering what I am going to be doing in Zambia, where I am going to be staying, and how long I will be there. Well, this summer I will be working for an organization called the Centre for Infectious Disease Research in Zambia (CIDRZ) which is based in the capital city of Lusaka. I first encountered them two years ago when I worked at the pediatric HIV clinic. This organization does a variety of things in Zambia including conducting research, disease surveillance, procuring the country’s HIV medications, laboratory testing, program planning and implementation, health systems strengthening, and more. I will be an intern working on the Rotavirus Vaccination Campaign. The first rotavirus vaccine was given in January and outreaches are occurring through out the capital district to vaccinate all the children in Zambia. Rotavirus is known for causing severe diarrhea and is one of the leading causes of mortality for children under the age of 5. A vaccine like this one is very important in a place like Zambia where diarrhea is common and access to healthcare is lacking. This campaign in the capital district is a pilot implementation of the vaccine so that the kinks and issues and can be worked out before expanding coverage to the entire country over the next three years. Though this vaccine is easy to administer (just a couple of drops in an infant’s mouth) it does need to be kept cold and it requires two doses to achieve optimal protection. These are both issues in a place where there is little refrigeration or electricity and where it can be hard for women to be able to make it a clinic twice. Additionally, it can only be given between a fairly narrow window of time, between 6 weeks and 24 weeks of life.  After that, the risks of medical complications are a little bit higher. As of this time, I only have a vague understanding of what I will be working on, but it will involve going out to the different clinics in the province and talking with clinic staff about issues that are arising, collecting data from their logbooks, and writing reports about the data. I am not sure if I will be working with a team or by myself, and how independent I will be. Too much independence scares me because I don’t really know what I am doing, but I also don’t want to travel this far to sit back and watch other people do the work. So hopefully this will be a good combination of getting enough support and working within a great team, but also getting to have meaningful contributions to the organization. I start working with them the day after I arrive as too much time of doing nothing is going to make me feel more jetlagged. I will continue working there until the end of July. For the first few weeks, I will be staying at the House of Moses (the orphanage where I have stayed previously), and then after that I am not sure. I have a room booked at a hostel, for the rest of my time, but the hostel is inconvenient to get to and expensive. I just found out that there is a space available in the CIDRZ guesthouse for June, which is very close to work, but then I would need to move to a new place in July and I am not sure if I want to move three times in less than three months. We shall see!

To conclude, here is a list of things I will miss and a list of things I am looking forward to doing in Zambia.

I will miss:
My family!
My friends, both in Washington and North Carolina
Convenient food
My cars and reliable transportation
The hot NC sun (believe it or not, it’s going to winter in Zambia and it will be cooler than NC)
Dairy products-especially cheese!
Asian food
Iced Vanilla Lattes
Hazelnut Creamer
Reliable and speedy internet
Getting a lot done in one day
Infrastructure-health care, governmental, all of it!

I am excited for:
Nshima!!! And all of the yummy relishes and sauces (okra, pumpkin leaves and groundnuts, beans, cabbage)
Pineapple Fanta
The House of Moses
Getting to see Zambian friends
Travelling outside of Lusaka, getting to see more rural areas
Beautiful sunrises and sunsets
Victoria Falls
Getting to establish new connections and relationships

May 15th
Day 1
I have just completed my first day as an intern at CIDRZ and am excited for what the next few months will bring. I met several people and they were all incredibly friendly and welcoming. My first day was spent mostly in a vehicle with a team of people driving to a couple of rural clinics to assess their vaccine needs and administration-related issues. It was great to get out of Lusaka and see some more of the country. I was also thankful because it meant that I wasn’t sitting behind a desk reading training manuals all day, which definitely is not a good cure for jetlag. Surprisingly, I am not feeling too tired today. Going to bed at 8:00 last night did me some good. Tomorrow, the plan is to stay in the office and complete some of the more administrative tasks including getting set up with an email account, figuring out the duties of my internship, and getting a cell phone. I also haven’t had time to go to the Bureau (“bank”) to exchange my money so that means that I also haven’t had time to buy food to eat. What this also means is that I have only eaten two protein bars today and I will be very excited to eat some nshima tonight for dinner. Even though I was looking forward to eating nshima my first night in Zambia, by 6:30 I was struggling to stay awake. The staff sometimes doesn’t even eat until 8:00 or later and I knew I couldn’t wait that long. Instead of waiting for the nshima, I just planned on eating a protein bar for dinner. However, when I pulled my sleepy self out of bed at 7:30 to go to the bathroom one last time, the night time cook was in the kitchen and informed me that she was going to prepare a plate of nshima for me so that I wouldn’t have to wait to eat with the staff. I was very thankful for this offer and quickly ate some delicious nshima and rape (a leafy green) with chicken. It filled my belly nicely and helped me sleep deeply all night long (well until 4:30 am).

May 16th
Day 2
Today was tiring! Partly because I woke up so early and partly because I used the public transportation system today. Man, I did not miss that! I hadn’t forgotten that it would be hard to ride the buses (especially since very few foreigners do), but what I had forgotten was just how uncomfortable it feels to be the minority and to know that everywhere you go, you are noticed. People may be excited by you, indifferent, or downright hostile, but you can be sure that you are always noticed. In my internship, it’s not as apparent. The Zambians who work there know that they will be working closely with foreigners, and they are more comfortable with it. However, that is not the case in general public settings and definitely not on the buses. The conductor (the driver’s assistant) made a special point to ask me about Saddam Hussein and ask me to call him “Sugar Boy”. It’s hard to know when ignoring that kind of talk will be to your benefit, or when it might actually anger the person. Either way, it’s uncomfortable to feel so powerless. It takes a while to build up a tough skin. And last but not least, I was very thankful that the conductor didn’t buy his bottle of liquor until the stop before mine, which means that he also did not have time to start drinking it before I got off his bus. It’s events like these that make me question why I ever decided I wanted to work abroad. I know that life in the capital is different than the rural areas and I look forward to spending more time in these areas where the attitudes are a little friendlier and more likely to be curious than harassing.
I also continued with my “orientation” at CIDRZ today which included getting a phone, reading a lot of manuals and briefs, and attending a grand rounds style meeting where the different medical personnel in the room had to present on different complicated patients they had seen that morning and described how they diagnosed and treated them according to IMCI guidelines. These guidelines are standardized diagnostic and treatment tools for the most common causes of mortality in children under five years of age. This standardization helps providers determine what the disease is, classify the severity, and then develop an appropriate treatment plan for the illness. This consistency in managing illness is important for timely and effective treatment, helping to prevent delays in diagnosis and treatment.

May 17th 
Day 3
            Today I started my day by attending a research meeting with the CIDRZ staff at one of their additional office locations. The group heard two different research proposals and then had the chance to ask questions and provide constructive criticism about the proposals. It was really interesting to listen to the group’s comments and ideas for improving or strengthening the studies. Though I don’t feel like I learned a lot in biostatistics and epidemiology last semester, it was because of those classes that I was able to follow along with the conversation about bias, statistical power, and confounding. I, myself, would not have been able to think of those things, but once mentioned they made sense. Understanding these conversations was a nice confidence boost, because I have been spending the last few days wondering what I am doing here. Not specifically in Zambia or at CIDRZ, but in public health. I am still very uncertain of what I want to do when I graduate, but I feel like I have put myself on this path towards research and policy development, which is not something I have a passion for. Though I really do love what I am learning in school, seeing the practical application of it (and CIDRZ seems to do it well), I wonder just what is it that I love. Is it the talking about it and the general appeal of international travel and culture? Or is it actually doing it? Maybe I am just feeling discouraged because I still don’t know what I am actually doing for my internship. All I have been doing is reading about the program and watching different trainings and meetings. I have got to say-things look like they are running pretty smoothly. I don’t understand what I am doing here, as the staff are very well trained and the curriculum and objectives are well defined for the program. It doesn’t help that the main person I was communicating with to develop and plan for my internship is out of the country for the first two weeks that I am here. I think I am just frustrated and missing home right now. Once I get settled in, things will get better. On the plus side, I have met most of the other interns working here, and they have been nice and welcoming. I will be moving into the “intern” house this weekend where the year long interns typically stay. There was an unexpected opening so I will be leaving the House of Moses early. Though I like staying here, it has been different this time as I haven’t really gotten to spend any time here. So far, I have been gone until after 6 pm, and I am in bed by 8:30. The time in the evenings I am exhausted and it is all I can do to stay awake. It has been nice to see some of the staff, but so far I have only really gotten to see the night shift, and I am missing out on seeing all of the day shift staff.

I know this is blurry, but this is the scene that greeted me and my lungs on the way home from work today. In Zambia, in the dry season, it is common for them to burn the brush as a way of maintaining it and reducing rodents and pests. However, in addition to the black smoke belching from many of the vehicles, the smoke from this burning does not make for good breathing. This picture is of the highway median, across the street from the House of Moses.

I will also try to take some pictures of CIDRZ and my workspace there. I am very fortunate to have my own desk and chair. I am also very fortunate to not be stuck in some cubicle. Rather, the desks are very open to each other, facilitating communication and interaction.

May 18, 2012
Day 4
I started my morning today by accompanying the CIDRZ medical team to a clinic in Kamwala, a neighborhood of Lusaka. The medical team was completing a training of health care providers from different clinics in Lusaka in the standardized management of common childhood illnesses. The goal of the morning was for these healthcare providers to see children under the age of five and assess, diagnose, and treat any problems that the child is experiencing. During these sessions, the caregivers are given education as appropriate on proper nutrition, oral rehydration therapy, HIV testing, and immunizations. For children experiencing dehydration, the clinic has corner where the children are supposed to drink specific amounts of oral rehydration solution (ORS) before they are able to go home. I liked that this type of system is being implemented in Zambia because it ensures that children are not only getting some ORS, but also that they can keep it down. If they are unable to keep it down, at least the child is still at the health facility for follow up. Today the clinical facilitators had an interesting situation where a mother came because her son was vomiting. In addition to the present illness, he had also been recently released from the hospital after spending almost a month there because of malnutrition. The child was also severely malnourished at this time but the mother was resisting referral to the hospital again. She was severely depressed after recently being abandoned by the father of her children and was unable to properly care for her children. Even after much encouragement and convincing, she reluctantly accepted the referral. Both of the training facilitators were concerned about the wellbeing of the child and were not very convinced that the mother was going to take her child for care. They even provided her with transport money out of their own pocket and obtained her phone number so that they could follow up with the mother. If I hear any more, I will be sure to update you. Below, I have included a picture of the ORS station at the clinic.

The afternoon has been okay, but I have not done anything internship related. After going to the clinic this morning, I was supposed to come back to CIDRZ and then attend a meeting with the community outreach coordinator on a new drama program that is being instituted to teach the community about Rotavirus and the vaccine. However, this meeting was cancelled and the office where I had put my computer before leaving CIDRZ in the morning was locked, thus I had no access to my computer. I also still don’t have access to the CIDRZ intranet and email, so I can’t really do anything on my computer any except write my blog. At least I am getting something done! I am really hoping that next week I will be given a concrete plan on what I am expected to accomplish and specific tasks that will help me get there. Like I have said before, I feel like things are running so smoothly here that I don’t know what I will be able to add to the team or the project.

In other news, I found out today that the CIDRZ department I am working with is moving to a new location next week. It will be in Ibex Hill, closer to where I will now be staying. I am very thankful that space in the intern house has opened up, because it would be a really long commute there otherwise.

Other observations to note:

Zambia now has a KFC, Zumba, and Viagra. Not all in the same place of course(!), but these are continuing signs of an increasing global presence in Zambia. There is really very little that you can’t find here, though sometimes the selection is limited and the prices higher. I am not sure if I think this is good or not, though I do recognize that it doesn’t matter what I personally think. I like some of the progress, like more shops and food choices, but I don’t like the traffic and that more and more Zambians are changing the ways that they eat, dress, and raise their children. I see a growing population of well educated Zambians who are obese, developing diabetes and hypertension, and formula feeding as more Western ways are adopted. 

Thursday, May 27, 2010

Winning battles and losing wars...

Winning battles and losing wars…

This last couple of weeks has been rough. Things have become increasingly frustrating and defeating and have left me wondering how anything gets accomplished here. This isn’t to say that people are lazy or unmotivated. No, that’s not the problem at all. Zambians are extremely hardworking, resourceful and generally want to change things for the better. But it seems like anytime change is possible, there is a whole system of things that comes to bring everyone down and prevent that change from happening. For instance, you try to organize a meeting with the women in your neighborhood to teach them about their health. On the day of the meeting you get a call at the last minute that you must come and work that day (without extra compensation of course) even though it’s your day off. The next time you try to have the meeting, your child is sick so you spend the whole day at the hospital and have to cancel the meeting again. The next time you try to hold the meeting, it rains and your neighborhood floods so no one will come to the meeting. So then you give up. Whether it is employers, friends, family, weather, the busses, money, health, there are extraordinary hurdles to cross to achieve anything. Saving money is uncommon in this culture because as soon as someone knows you have it, they will come to you and ask for it. Staying healthy is challenging because people are sick all of the time, they live in close quarters, usually have inadequate nutrition, and can’t afford adequate health care. So what happens? Life goes on, and each person is a little more defeated than the day before.

Learning these things is part of the reason that I was interested in coming to Zambia for more than just a three week vacation. You can hear about the struggles of people and you can witness them once or twice, but until you live it, it’s impossible to understand. Even I don’t truly “live it”. As an American, I have options. Access to money, health care, advocates, and an escape when things get too tough. Here, it’s a daily fact of life that life is tough. And though it is rare to find people who dwell on the difficulties of life here, it is extremely common to see people held back by them. I have now been here for four months and am starting to understand how difficult life and change is here. I am also beginning to see how the people have to have joy-because it is the only thing that they have and one of the few things in their lives that they can control.

Here are some more examples of how life is difficult here. The patients at the HIV clinic are usually given an appointment for a Tuesday or Thursday to come and see the doctor. The clinic is technically from 2-4 pm on those days, but many patients usually arrive anytime after 8 or 9 in the morning. On Tuesdays we always have a meeting from 9-10 a.m. so sometimes they wait for 2 hours before being seen. If they arrive anytime after 10 a.m., we may or may not get to them before 2 p.m. Because they don’t have actual appointment times, they have no power to ask to be seen within a reasonable amount of time. It’s generally first come, first served. The way we track this is by stacking their patient id cards on the bed that serves as our “desk” in the clinic. Many times the cards get mixed up so you next know who has come first or how long they have been waiting. And it’s not uncommon to have the patient answer to the wrong name without you realizing it until halfway through their examination. Once a patient actually gets into the clinic, the doctor may or may not be there. You may or may not be able to find their file after 20 minutes of searching. If they are lucky, the patient’s records are found and they will be seen by the doctor within 20 minutes of sitting down in the clinic. Many times, the doctor isn’t even there, or when he is, he is seeing patients for the private clinic next door and is unavailable. There is no possibility of privacy, because there are usually other patients and staff members in there to hear everything you say, and even translate if necessary. If you need labs, you may end up waiting another hour and they have to have them redrawn because there was a lab error, they didn’t collect enough blood, or the patients information was incorrect. Or the lab results may never arrive from the central laboratory. Once you have been seen by the doctor, it is up to the pharmacist to dispense you medicines-if the clinic is lucky enough to have the right ones. Many times we have to substitute medicines because we have run out. This adds confusion to an already complicated medication regime and increases the chances that they will take their medicines improperly. And we lack many basic medications requiring the doctor to write one and give it to the patient to go somewhere and pick up. Once you get your medicines, you must see the social worker for counseling. This is a requirement for every visit and usually requires more waiting. This is a process that repeats itself every 2-4 weeks for children, and every 2 weeks-3 months for adults. For each patient to come to the clinic, it becomes a day long affair, requiring mostly sitting and waiting outside with no food or drink.

To culminate experiences like this, when children come in acutely ill and in need of medical attention, we have nonexistent resources to treat them. The private clinic whose building we are in, won’t treat them or give us their supplies so they are usually referred to another clinic. If they need hospitalization, it is up to the second clinic to refer them there. A situation like this presented itself just last week. A HIV+ mother, dedicated to providing care for her HIV+ children, brought her sick toddler to the clinic last week. Boyd was a quiet, two year old boy who was only diagnosed with HIV in February. He had come in to the clinic many times and was doing well on his HIV medications. He was brought to the clinic by his mother because he was febrile, lethargic, and not eating well. With our limited resources, he was seen by a nurse practitioner (there was no doctor available to see him), diagnosed with measles, given a prescription for the mother to fill, and told to go to another clinic for further care. The mother took her child to that other clinic the same day but they were too busy to see her so she went home despite how sick the child was. The next day she brought him back to the clinic and given his serious condition, was told to take him directly to the hospital. No transportation was provided or basic medications were given to the child. On arrival to the hospital on Wednesday he was admitted in critical condition. At the same time, her youngest child, an infant (who had been very sick also though we did not know this), was admitted to the hospital with same illness. The baby died on the same day of admission. Two days later, Boyd died also. Upon arrival to the clinic the following Tuesday I was told the news. The mother was there asking for help with funeral expenses. When I asked to see her, I was told “But if she sees you, she’s going to break down again”. Crying is generally unacceptable in this culture, where life is tough every day. For the clinic staff to see someone crying is an uncomfortable situation that they would rather avoid. Coincidentally I had just been reading a previous volunteer’s blog on this exact situation where a patient had died unexpectedly and she started to cry. The clinic staff quickly became exasperated with her tears as they indicated to her that there was no reason to cry. Regardless of the cultural norm, I wanted to see the mother and give my condolences. As soon as I walked in the room I started to cry. She sat by herself looking dejected and alone. When she saw me she also started to cry and could only say again and again the name of her deceased son. After a few minutes of just sitting and crying with her she started to speak in her native language, nyanja. I couldn’t quite make out what she was saying so I asked her to say it again. The gist of her statement was “I have to buy two coffins. Not one, but two.” The weight and gravity of that statement was hard to comprehend. I can’t imagine losing even one child in a lifetime. But to lose two in the same week, how do you survive such grief? Ultimately I am not going to know what will happen with her. The clinic has moved on after providing her with a measly $50 for the two coffins and she informed them she was going back to her village. As I return to the clinic this week I am sure that life will continue on as it was before and this family will likely not be mentioned again.

And so I will also continue on. Not only on this blog, but also with my work and life. But I won’t be forgetting Boyd or his mother and the grief on her face she cried over the coffins she had to buy and the children she lost.

In other news…the clinic has been approved to receive a large grant from the Elton John Foundation and is going to lead to a lot of changes for the clinic. First, we will be renting space across the street from the clinic where the social work and administrative offices will be located to help free up space in the clinic for the medical side of things. What this means is that patients will check across the street, come over to the clinic for their medical visit and medications and then cross back over the street again to see the social worker and get transportation money. If there are any questions with medications, patient information, or anything else, the social workers will have to come across the street for clarification. I predict there is going to be a lot of running back and forth and a lot of confusion. They are also planning a big kick off even the first week of June which will be held at a graduation party for a large number of soccer camps. The clinic is expected to test hundreds of teenage boys and girls on this day! Yikes….let the craziness begin.

At the House of Moses we have had several visitors come and go. Some have stayed for just a few days and some have stayed for a few weeks. It always add some excitement to life to have new visitors and come and join us “long termers” here. There are 5 of us who are staying here for a long time. Sandra is the one of the directors for the organization that runs the orphanage where I stay. Don and Jane are here this year to manage and organizes and visitors/teams that come and stay. Kevin is a Canadian who has been here just as much as me and is planning on staying for a full year. He does construction and IT things here. I am counting down the days now…only 23 left until I leave. From each moment to the next my emotions waver between sadness to be leaving and readiness to go back to the culture and people I know. I am also still working on the medical records revision (my ONE accomplishment here) and might have them finalized and printed by the time I go. I guess it would have been good to have the project completely finished, but I guess you can only do so much.

I have also been staying busy with church and bible study. In addition I can usually be found several days a week at the Murray’s house nearby. They are the American missionary family who I go to church with and who always feed me amazing food. I am usually there to tutor their gardener who, though he is older than me, is just completing his 7th grade course work. I was asked to help him with math and English. I am definitely not the best English teacher as I am usually having to learn what he is working on at the same time as him, but the math part is fun and I am actually seeing him make progress! I am also going to plenty of movies (at $2.50/each it’s a great deal!), got to see a Michael W. Smith in Zambia, and am continuing to read a lot of books.

And to end on a happy note…my friends, Dave and Stefanie, have arrived from America to adopt a baby! It has been great to see them spend time with each potential child (they have narrowed it down to just a handful or so) and to picture them as that child’s parents…any of the children here would be lucky to have them. It’s a blessing to get to witness this experience though I don’t envy the tough decisions they are having to make or the headache they will encounter trying to maneuver through an inexperienced Zambian adoption system.

As I have written before, the internet has stopped working on my computer, so it is extremely difficult for me to post blogs. I am hoping to send one more before I go, but be assured that if that doesn’t happen I will send a “final” farewell blog on my return home.

Best wishes to you all…and may you find joy even on the most difficult of days.

Wednesday, May 5, 2010

Cape Town blog

Traveling is fun and it’s a blessing. But at times it can also feel like a curse, especially when things don’t work out right. And this is often the case when there are so many details, restrictions, and schedules to consider. So when I decided to finally take the leap and get over my fear of traveling alone, I started to make plans to visit Cape Town and see a little bit of a different kind of Africa than Zambia. Of course, my internet is rarely working and then when it did, the website that I tried to use to purchase airline tickets kept jumping the price up by almost $300. Feeling that maybe this trip wasn’t meant to be, I mentioned my troubles to a friend who has a friend who works at Zambezi airlines, one of the major airlines that flies to South Africa from Zambia. When he offered to try and arrange my tickets for me, I agreed. Two days later I get a call that my flights are booked, but payment was due at the airport….immediately or I would lose my flights. And it had to be paid in cash, not by credit card. American dollars to be exact. Unfortunately, it was 4 pm on a clinic day and I wasn’t even going to be back to the House of Moses until later that evening. In addition to this, I didn’t know how much money I had in American dollars, but I knew that I didn’t have enough. So I had a friend dig through my stuff to find my “secret stash” at the House of Moses to find out just how much I had, then I went to an ATM by the clinic. After withdrawing the money in kwacha, I then went to the change bureau to switch my money back to dollars. Anybody will realize this penalizes me twice-first, the ATM fee my bank will charge me for a foreign transaction and then the poor exchange rate the bureau charges to change the Kwacha back to American dollars. Ouch. But after all that I had enough money and was able to connect with lady at Zambezi airlines who booked my ticket for me. She lives near me in Lusaka and agreed to drive me to the airport to pay for my tickets when I returned home that evening. After picking me up she took me to her house, where she told me that she had already secured the tickets without payment and it was okay to wait until the next day to take the money to the airport, but I didn’t need to be there for that. All I had to do was give her my money and she would take care of it the next day. I was a little worried about giving so much money to a complete stranger, but as an employee of the airlines I was going to be flying on, I figured it was okay.

So then I started to plan…what would I do, where would I go, and most importantly-what would I eat???? My friends had just gone to Cape Town two weeks before me and had many great recommendations about where to stay, where to eat, and where to great coffee. They even loaned me their guidebook. Friday morning, I woke up nice and early to catch my 8 am flight. After taking off from Lusaka late, I arrived in Johannesburg late which reduced my layover time from 1 ½ hour to just an hour to take the shuttle from the plane to the terminal, pick up my bags, go through customs and check in at the other airline I was going to use to fly from Jo’burg to Cape Town. I arrived at the check in counter 10 minutes before it closed (thank goodness my bag was one of the first off the plane, and the passport line for me was short and quick) and made it the rest of the way without difficulty. I arrived in Cape Town on a beautiful and sunny day. Once I checked in to my hotel, I took a long walk down to the Victoria and Albert waterfront. I walked around a little bit, but it was starting to get dark by then so I had to make my way back up to the hostel where I was staying. Along the way I picked up some delicious shrimp pad thai for dinner, cookies, and wine and then holed up in my room the rest of the evening watching a movie and reading a book.

The next day I went and had a delicious mocha at a local coffee shop here and then took a taxi to Canal Walk, Africa’s largest mall…It’s not quite as big as the Mall of America but I still managed to spend 6 hours there shopping without stopping, and could have spent more time there if I had it. I managed to pick up some clothes for the cooler weather in Zambia as winter approaches as well as some other things that friends from Zambia requested. Dinner was an amazing avocado and bacon pizza…yummm.  I could have eaten the whole thing if I hadn’t forced myself to stop. Seriously.

On Sunday I was hoping to find a church to go to in the neighborhood where my hostel was, but the only one I found was an Afrikaans speaking church and I figured that wouldn’t be very helpful for me. Instead, I went back to the coffee shop and had another delicious mocha and spent some quiet time reading. After this I walked back down the Victoria and Albert Waterfront and did some shopping down there. My greatest find was a store down there called Melissa’s which had the greatest looking food and goodies…I had to buy a few things there just because they had my name on them =). After shopping for a bit, I then headed out to Robben Island, the prison where Nelson Mandela, Robert Sobukwe, and other political prisoners where held until the 1990’s. For such a touristy kind of thing, the trip out to the island was well worth it and I actually enjoyed the experience. It starts off with a 20-30 minute ferry ride out into the harbor, then a bus tour around the island to show you the different parts of the prison and other buildings there, including a leper’s cemetery, followed by a walking tour of the main prison itself led by a former political prisoner. The views of Cape Town and Table Mountain were also beautiful from the island and we were able to get some great pictures. After returning to the mainland I headed back to my hostel for the evening.

Monday was spent on a day long tour of the wine country. I (along with 7 other passengers) left around 8:30 in the morning and headed into the Stellenbosch region of South Africa, which is like Napa Valley in California. We arrived at our first winery around 9:30 in the morning and sampled 7 different types of wine and champagne as we were taking on a tour of the facilities and the grounds. It’s fall here in South Africa so the leaves on vines are turning pretty orange and red colors and the air was cool and crisp. Our next stop was at a newer winery that was only about 10 years old. It was a very beautiful place and had great views. At this winery we were able to sample chocolate, olive oil, and kalamata olives in addition to 5 or 6 wines. I picked up a delicious white wine to bring back to America with me. Our next stop was lunch where I had the most delicious mushroom risotto and a full glass of wine. From there we went to two more wineries that were so pictures            que I was tempted to move here for good…The scenery is made of up vineyard after vineyard on rolling hills made up of golds, greens, reds, and oranges followed by the stark contrast of the mountains behind. At the last winery we went to we were also able to try many different types of cheeses-like brie, goat cheese, and gouda…I was in heaven. For all that I love about Zambia, they seriously don’t know what good cheese is. By the end of the day we had sampled 25 wines, and I had purchased 3 bottles to try and take back with me to Zambia.
Today, I am sitting in the airport in Cape Town as I wait for my flight to start boarding. Arriving here, I found out that my flight had been cancelled and rebooked for an hour later. Which thankfully works out just fine because I had a five hour layover in Jo’burg on the way back to Zambia. If the rest works out well, I should be arriving Zambia around 9 pm tonight.

While it was a nice treat to get away from Lusaka for a weekend and I loved seeing the water again…this detour has reminded me just how short my time in Zambia is. I only have 6 weeks left and that makes me incredibly sad. I already wish I could stay longer but I know that this isn’t an option. And the thought of leaving my baby behind really breaks my heart. He has just been released for adoption which makes me wonder again why I didn’t go through the adoption paperwork before I came. But at the end of the day, I trust that God had a really good reason for telling me that it isn’t my time to adopt.

Well, I guess that’s all for now. I hope to send off one or two more updates before I return. Until next time…


Sunday, April 18, 2010

Another blog post!

Wow! You should all be so proud of me-I am blogging again and it has been less than two weeks! Things are getting progressively busier here-I am consistently spending 3 days a week at the clinic, 2 days at House of Moses, am tutoring 2 afternoons a week, plus church, bible study, meetings, etc. It’s great! I love to be busy and even though the definition of busy means something different here-I like having something to do everyday.

The clinic is changing again-one of the volunteers has left to continue her medical student elective in Denmark before returning home to New Zealand. She was a great volunteer who was smart and fun to hang around with. I am definitely going to miss working with her. And then this week the other volunteer has gone on vacation to South Africa so I am the only volunteer at the clinic until she returns. On the plus side, she is letting me house sit for her while she is on vacation so I have cut my commute short by about 2 hours a day! She lives within walking distance of the clinic in a cute little apartment. The clinic work is continuing to get better all the time-I am getting to know and recognize more of the patients as they come back for repeat visits. I had a lot of fun this morning playing with a little girl whose name was Alice. She is an orphan who is being cared for by an extended family member. Last week she was so sick-her whole body was swollen and covered in a rash and she a really high fever. She could hardly move. In America she would have been quickly admitted to the hospital for treatment but there are limited resources for that here, especially when you go to a free, government run clinic. She was given massive amounts of medication and when she came in this morning for a follow up visit she was back to her normal smiling self. The rash and swelling were still present but they had improved so much over the previous week. She spent half of our visit playing with my hair and kissing my hand-it was cute and rewarding to see the improvement in her condition.

Yesterday I got to take a 13 year old to the eye doctor for a follow up visit. Zelia has had HIV her entire life and when she was younger her treatment was not managed properly and she got very sick. One of the illnesses she had was an eye infection that was not treated and led to blindness in her right eye. The eye has a cloudy appearance to it and looks different than her other, normal eye. Last year one of the other former volunteers from the clinic arranged for her to be seen by an American eye doctor and they arranged for Zelia to receive a contact that would cover the cloudy area over her pupil. Unfortunately the other volunteer left before the contact arrived, and the orphaned girl did not return to the clinic for the contact. The American doctor is leaving Zambia for another country and contacted my clinic to see if we could bring her in before he left so I volunteered. I got to spend the day with Zelia and one of her caregivers as the doctor showed her how to use her new contact. She was excited to see the difference. Here are some pictures for you to look at.

This Friday, I will be going with another girl from that same orphanage back to the eye doctor so that she can be fitted with a prosthetic eye. Teresa is 8 years old and was abused by her stepmother. When Teresa was 6 years old, her stepmother punished her by “removing” the eye. I am not sure that I want to know the rest of the details but I will be excited to see her receive a new eye and for both girls to be given the chance to feel as normal as possible. I will try to take pictures and post them for you also.

The House of Moses is also undergoing a lot of change-many new caregivers have been hired or switched around between the other houses for the older children as a way to help distribute the skilled caregivers and new caregivers. This means that I miss seeing some of my friends, but I also get to make some new ones. We also have had a husband/wife team arrive this week and they will be here for the next month. So now there are 5 Americans at the orphanage. The next visitor arrives in one week, and then more arrive in May. The home is slowly filling up and will soon be bursting at the seams with visitors. My baby, Matthew, is doing well also-he is walking most of the time now and is putting on a lot of weight. Pretty soon he is going to be a really chubby baby! The other children are also great as well-I just discovered that one of my other favorite babies can walk-although I don’t know how because never moves from wherever we put him. But the other day he just got up and started walking it was so great to see. He is also a very skinny baby so he doesn’t even look like he could be strong enough to stand. We have also taught him how to blow kisses. So when you walk in the room he will put his hand to his mouth and go “bwa!” with a big smile on his face. I will try and get a picture for you also.

Well until next time!


PS-Here is the link to my photo album on facebook I just posted some new photos!

Friday, April 2, 2010

The month of March

Hey All! I can’t believe that it has been so long since I blogged last. Yikes. It’s crazy how time goes by. I have been here now for two months and am still going strong. I have acclimated to the weather, food, people, and even the buses. The hour long bus rides (each way of course) aren’t so bad any more. In fact, it’s a great time to think, pray, people watch and do Sudoku. I have been doing a lot of Sudoku lately and am getting better at it. And many Zambians are used to seeing me on the buses and streets so I am not getting as many people yelling at me as I pass them. In fact, I probably only got called Mzungu 5 times today and maybe only 5 times the previous two days. When I first got here, it wouldn’t be unusual to hear comments that like 10 or 15 times a day.

The clinic has been a bit of a struggle lately-there have been two new people who have started: a new clinical officer (like a physician’s assistant) and a new nurse practitioner. When you add this to the already existing clinical officer and 3 volunteers, it adds up to a lot of people to see just a few patients. Adding to that has been some very slow clinical days and a lot of outreach cancellations. This has led to more downtime than anticipated which isn’t so good for the other volunteers who are only working at the clinic two or three days a week. I am lucky to have the House of Moses to keep me occupied.

Two weeks ago I had the chance to visit Livingstone and Victoria Falls again. I went with one of the other volunteers, Rebecca who is from New Zealand. She is a medical student spending 6 weeks in Zambia trying to get some good clinical experiences before returning home. We took an overnight bus after clinic one day and arrived in Livingstone just before 3 in the morning. We went straight to our hostel and fell fast asleep. The first day we went and did the gorge swing (like bungee jumping except at the bottom of the descent you swing sideways instead of bouncing up and down), saw the falls and then went on a sunset cruise on the Zambezi river. This is something I have done on every trip to the falls (this was my third time) and it’s my favorite thing to do. That evening we had a delicious dinner at the hostel and just relaxed. Saturday morning we had breakfast on Livingstone Island which sits in the middle of the Zambezi River and even got to swim on the edge of the falls. It was quite exhilarating and refreshing. That afternoon we went on a game drive and got up close and personal with a solitary male elephant. The rest of the day was spent relaxing, swimming, and eating great Western style food. Sunday we returned to Lusaka on the bus.

In other news, Sandra has arrived from America. Sandra is one of the founders of the orphanage where I stay and she comes every year to manage the teams who visit from America and to implement new projects and such for the orphanage. This time she brought with her a friend. Rebecca is 18 years old and from New Jersey. She will be here for 6 weeks and will be working with some kids from the House of Martha (for the older children) on reading comprehension. So far life has changed a lot in the last week with the new additions to the house, but it has been great to start talking about the changes and new projects that are coming this year.

Well, I hope that you are all well with everyone back home!


Here is the link to some photos that I have posted on facebook. Enjoy!

Tuesday, March 2, 2010

Tales from the home front…

Well here is blog entry number 3…4…5? I don’t remember any more although I do know that it has been two weeks since I wrote last. Which I didn’t think you would mind because not much happened the week before last, unless you count me getting pink eye for the second time in a week immediately followed by food poisoning newsworthy. All I did during this time was read and lay in bed…The first day was hard and I really missed home, questioning why I was supposed to be here. While I have never doubted that God specifically called me to come to Zambia, I haven’t felt like the rest of the details were as obvious-Things came together really easily when I was planning my trip, but as far as my day to day activities here in Zambia…I feel like there has been less direction and inspiration. I am having a great time but I often find myself asking “Did I really need to come all this way just for this?” or “What is so important about what I am doing that God guided me here?” I also thought that I would be a lot more connected with God because Zambia has been a place where I have traditionally been so encouraged and uplifted, but I am also finding that it takes work here too, just like at home. I wasn’t expecting that and I am adjusting slowly, slowly…

            So after five days in bed, I jumped up ready to be active. I was with the clinic that day and we did an outreach in Kanyama. Kanyama is the poorest compound in Lusaka and also the biggest. It also has a bad track record for flooding and big, deep puddles covering the already poor roads, so after getting lost several times on the way and driving through some really deep puddles I was excited to reach our destination. The excitement was short lived though, because we quickly realized that we had forgotten all of our supplies at the clinic…Oops! But have no fear because the time was spent wisely as Anna, Sabrina, and I got a good lesson on the differences between friend relationships and dating relationships in Zambia. For example, if a guy in Zambia is just friends with a girl, it is not uncommon for him to hold her hand as they cross the street or for the them exchange text messages that say things like, “I miss you. When can I see you again?” So the next logical question is what would a guy do if he liked a girl. Simple, according to Justin and Fernando: You simply stop hugging her, holding her hand, and sending her sweet text messages. Instead your behavior becomes more formal and polite. And that is how the girl will know you like her. Hmmm…Needless to say to Anna, Sabrina, and I were laughing at the contradictory messages these actions send. It took awhile for the supplies to return from the clinic, but once we got started the outreach went fairly quickly. We only tested about 40 children and then went home for the day. Thursday was another clinic day though I don’t actually remember what happened…

Friday was a busy, busy day. In the morning the head nurse, Irene, and I, went to the Bill and Betty Bryant Nursery in Garden. This house holds the toddlers from about 1 ½ years of age though 4 years. I went there to learn more about their routine, structure, needs, and record keeping systems as I continue to modify their existing practices. It was so nice to see some of the kids that I have known and seen for the last two years. Although it is also remarkably sad to see how many remain. I wonder what the future holds for them…I wish that there was more literature available written by orphans so that I could read about their experiences. I know that it is exists, so if anyone can recommend any good books that would be awesome. In the afternoon I went to a coffee shop to meet with Dr. Sue Gibbons. Sue is a psychotherapist and had given a 5 or 6 week class to the caregivers for Christian Alliance for Children Everywhere two years ago when I was visiting. She was generous enough to give me her research, outline, notes, and powerpoint slides! So sweet and helpful…now I really need to get down to business though. I am supposed to give the first presentation in like 3 weeks and I will have to admit that I am lack motivation and discipline to get the work done. It is a lot easier to just read, go to the clinic, or hang out in the nurseries instead of working on a slow internet. Then on Friday night the House of Moses held an overnight prayer meeting in the new Bill and Betty Bryant Nursery that will be finished in a few weeks. I didn’t get to bed until 5 am Saturday morning…

Waking at 8, I got ready and made my way to Dr. Tim’s house for the retreat that was scheduled that day. More kids from the clinic came and had another great day with skits, dancing, puppets, swimming, and talking. This time the discussion was on sexual health and it was a good discussion on the basics. I also got to meet Dr. Tim’s parents who had just arrived from Minnesota. It was Dr. Tim’s parents who started the charity clinic I am working for in Lusaka.

Sunday morning I went to church with Alice and really enjoyed it. The choir was great and it was a very nice blend between Zambian and Western church styles. I look forward to going again. That evening I missed the opportunity to talk with friends back home because the internet was down but was excited go to dinner at Dr. Tim’s house.

Monday I was at the House of Moses, looking through the information that I was given by Sue and then rounded out the day watching the movie “It’s Complicated” for $2.50. Zambia is not always a cheap place, but for movies it top notch!

Tuesday was another clinic day, and was met with the arrival of a new volunteer. She’s really nice and is from New Zealand, so she brings a fun accent to spice things up. The downside is that not there are 3 volunteers all trying to do stuff on each patient, not including the clinical officer’s and pharmacist’s duties. It isn’t necessary to have all of us there doing the same thing so I am hoping that we find a good way to distribute the work that we are all eager to do and still manage to stay busy. We can only do so much with each patient…

Tomorrow is another outreach day in Kanyama. Thursday is another clinic day, and then Friday I am back at the House of Moses.

Other than that, I don’t have much to report. With the exception of the day I talked about at the beginning, I don’t miss home much. People some, but not really much else. I really do like it here. There are definitely things that I dislike and will never get used to, but overall it’s not bad here.

Well, I am super tired and ready for an early bed time…so until next time. I hope that you are all well and having lots of fun!