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.

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