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.
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.
Let me first say how proud your family is of you and what you are striving to do with your life. Reading your blog entries makes me want to go there, but there is no way you would actually get me there. I have heard Africa is hot. I don't like hot weather like all other bears. I am excited to give my students the opportunity to read your adventures and experience Africa through your eyes. It is truly a pleasure to go along with you to the clinics and learn about the culture, issues, and changes there. Thank you for your continued efforts and I look forward to seeing you again soon.
ReplyDeleteThank you for your comments! And, not everywhere is Africa is hot, so you shouldn't rule it out indefinitely. See you in August!
DeleteMy teacher gave me the link to your blog and I just wanted to say that you are doing great work and you are helping so many people.
ReplyDelete