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.