I think you know you’ve been working here for a while, that you’re settled into your projects, that maybe you even really know what’s going on, when you start staying late at the office.
To Zambians, the concept of staying late at the office is totally foreign. The exodus at 5 pm is rapid and complete. Within the period of five minutes, the office goes from bustling to almost silent. The aircon gets shut off, the lights turned down, computer monitors go black. If you peak into the CIDRZ offices past 5, the only faces you’ll see are white.
It’s the same for lunch. Between the hours of 13:00 and 14:00, you can never expect that anything will get done. Even if you have a meeting that starts at 14:00, a meeting you’ve confirmed with many people, including the driver, that you need to leave the office early in order to make it in time and they all say yes, sure, no problem. Inevitably, at 13:45 when you’ve arranged your day to take lunch early and get back to the office and go, the driver will be lounging and just beginning his large plate of nshima. (The pharmacists here have a joke about nshima. The way you feel after lunch, after you’ve eaten a large plate of nshima, it’s like you’ve had nshimazipam.)
Up until now, I’ve managed to be fairly Zambian about my after hours working. Usually if I’m in the office after 5 pm, it’s to use the internet for personal reasons. But all of a sudden, everything is happening at once. The fact that I’m leaving on Wednesday means there’s at least four days worth of work to do before then. Today found me drafting IRB exemption forms for my peer educator evaluation, rewriting an abstract about the OPD-ART integration for a conference, and playing architect as I did a site visit at our newest clinic to be integrated, attempting to draft the entire clinic building layout with a pencil on plain paper (map not drawn to scale). I don’t think tomorrow will be any better. Drafting another clinic, finishing the abstract, submitting to the IRB, presenting data to the drama group on their performances. And oh yeah, packing. I’m going to Cape Town on Wednesday!
Tuesday, December 23, 2008
A morning of medicine
Just in time for all of that public health work to get busy, I finally got to spend a morning doing medicine too. Through CIDRZ, I made a connection to a semi-private clinic that sees only HIV patients. Last Tuesday morning, I was given my very own room and my very own patients. Okay, they weren’t totally my patients. But Dr. Jack let me see as many as I wanted, and spend as much time as I wanted, and then bring him in to teach, explain, agree, sign off. It felt so good to be back, stretching my medical brain, dusting it off, and learning a whole lot in one day.
The nerdy side of me is excited to tell you that I saw Kaposi’s Sarcoma, lipodystrophy, chronic pelvic inflammatory disease and two people failing their HIV treatment. Of course none of those things are good things, but I learned what they looked like, and what to do for them. Each patient is a lesson for the next time. “I remember the time I saw….and we did….”
I’ll remember the look on her face when we told her that she’s failing treatment, that her CD4 is rapidly dropping and she continues to insist she’s been adherent to her medications. And Dr. Jack insists, she’s been on the same regimen successfully for 4 years, one of the original clinic patients, why is she suddenly doing so poorly now? She barely spoke, barely acknowledged us in the room. She stared into space, lost in thought. What was she thinking of? Of that one dose she forgot? Of the person who infected her, now long gone? Of what comes next? To give up or to go on? The last I saw of her that day she sat stiffly on the bench by the lab, waiting to get her blood drawn for a viral load. At home, viral loads are done all the time, certainly part of an initial workup for a newly diagnosed person. Here, they take two months to come back, and they aren’t even offered unless there’s indication of treatment failure. Qualifying for a viral load here is usually a bad sign.
Because of the fact that HIV is at the forefront of all the clinician’s minds when seeing patients, chronic disease is the largely ignored and very real issue here, for anybody who makes it to middle age.
One of my patients was a 50-year-old woman who, back in the states, may have been older, but she was the quintessential lonely older woman who comes to the doctor to talk, hypochondriac, somewhat depressed, but really cheery too. One minute she was crying and telling me about her friend who died, and the next she was smiling and joking. She must have answered yes to every symptom question I asked her on the standardized ART visit form. She had the same long history that primary care docs at home see on a daily basis-high blood pressure, obesity, history of deep vein thrombosis, uterine fibroids, dysmenorrhea. If only she knew how many medications she’s missing out on, how many medications she could potentially be on if Zambia had a healthcare system like the US. For better or for worse, most of that is largely ignored here, or barely managed. And oh yeah, by the way, she also has HIV. But in her case, it just kinda fit in with all her other chronic diseases.
I was proud of my diet and exercise discussion with another obese woman with high blood pressure who had never been told how she could try to bring her blood pressure under control. She seemed like she really wanted to know.
The morning flew by. I almost forgot what it feels like to be on my feet all morning, forgetting if I’m hungry, forgetting if I need to go to the bathroom. Gotta keep going, there’s always more to see. But that morning got cut short, because there was busyness back at the office. When did I get so busy?
I hope to go back on a weekly basis. More patient stories to come, hopefully.
Monday, December 15, 2008
Pictures up!
After a two week long saga, I finally managed to get some more pictures posted to picasa.
For your viewing pleasure....
Canoe Race in Siavonga
Kasanka and Mutinondo (apologies for duplicate pics, I can't deal with it right now)
Holiday decorating
Click on the link on the lower right hand of the page
For your viewing pleasure....
Canoe Race in Siavonga
Kasanka and Mutinondo (apologies for duplicate pics, I can't deal with it right now)
Holiday decorating
Click on the link on the lower right hand of the page
I will not miss...
Despite the touching and saddening previous entry, when I reflect on the reasons I’m happy to be here seeing all of this, even if it’s difficult, I’ve got to write this next one. I’ve been saving it up for a long time.
Here are a list of things I will not miss about Zambia.
I want my anonymity back. This includes:
-I will not miss being honked at, numerous times, by every taxi driver who goes by. Partly it’s because this is how taxis drivers find fares, they honk at likely people walking. People don’t often flag down taxis here, they flag you down. But my whiteness makes me a more likely fare, and thus the higher incidence of my being honked at. It becomes particularly obnoxious when I’m physically in the driveway of the shopping center, clearly walking to it (as opposed to away from it). I just want to scream out at them:
“Why the hell would I want a taxi when I’m here?! I’m clearly going here, and here I am, and just leave me alone.”
But I don’t do that.
-I will not miss not being able to walk past a bus stop without being heckled by every call boy who comes within 20 ft of me. Like cab drivers, call boys get passengers for the mini buses. Usually the get off the bus at each stop, run up to pedestrians, every one a potential passenger, “Town madam? Town?” The drivers honk wildly, in case anyone didn’t know they were already there. Sometimes their passenger recruitment is to such an extent that they will drive off the main road, onto the side streets, honking repeatedly as the call boy slides open the door and shouts at passersby, even if they clearly have no intention of getting on a bus. Don’t you want to get on a bus? Surely you do, how could you not? We’ve got one right here! And never make the mistake of getting on a minibus that isn’t full, because you’ll likely sit there at the stop until it is.
-I will not miss being stared out, hissed at, shouted at, sneered at, or even genuinely greeted, by every single person I pass on the street. I think there’s something to be said for that cold Northeastern exterior. I don’t want to know everyone on the street. I don’t want to be approached by every man and get comments like, “Hello, you seem nice, I really want to know you, give me your phone number!”
-On that note, I will not miss Zambian social norms. Here, it is completely normal to have a less than five minute conversation with someone and ask for their number. Zambians really like to meet each other. To us, who tend to be somewhat reserved in that sense, in seems super foreign. I get tired of having to constantly figure out how to tell someone I don’t want to give them my number, I don’t want to tell them where I’m staying (where do you stay means where do you live), and I don’t know how to help them with whatever business or charity scheme they are planning, no matter how genuine they may be.
-I will not miss having to retreat indoors as soon as it gets dark. I will not miss that as soon as it starts to get dark, it makes it okay for men to start talking inappropriately to you on the street.
-I will not miss having women tell me on a weekly basis that I have a stomach. Zambians are dead honest. And I’ve yet to figure out if they’re insulting me, or complimenting me, or just telling it like it is. But there’s no taboo against telling someone they are fat. I adore the nurses I work with at CIDRZ, but they sure do know how to make me feel shitty about myself when they reach out and pat my stomach for no apparent reason. I don’t think they mean to be insulting. I think they don’t realize there are. I think there’s a double standard though. In traditional culture, it’s a positive thing to be fat, because it means you have money and are well fed. But with encroaching western culture, it’s probably not a good thing. So I have no idea where they are even coming from.
-I will not miss the utter disregard of drivers for anybody else except for themselves. I don’t think it’s only drivers, I think in general there isn’t the same sense of courtesy on the street as there are in other places, but here it manifests most obviously on the road. Think of all the places where people say, “Oh drivers are crazy there!” Massachusetts drivers, for instance, who have gained themselves the nick name of Massholes. Then multiply that by 100.
At home, it’s not uncommon to see some guy speeding down a neighborhood street, and you kind of just watch them pass and feel mad and give them a dirty look. But it certainly doesn’t happen every day. Here, it’s the rule rather than the exception. People race down neighborhood streets at highway speeds as if there was nobody else there. And if they see a pedestrian or biker that could potentially be in their way ie walking on the side of the road equivalent to the sidewalk here, rather than slowing down, they honk obnoxiously, speed up and give you the dirty look. And when car accidents happen here, they are bad. People speed around corners, lose control, and fall into the deep drainage ditches. It’s not uncommon to see two back wheels and the rear end of a car sticking up from the side of the road. I try not to think too hard of what the front of the car looks like.
-I will not miss the number of drunk men walking down the street on any given day. Unemployment -> idleness, depression-> drunkenness-> spread HIV-> depression -> drunkenness. Yeah, you get the picture.
-I will not miss having people expect that because I’m white and working for an NGO, that I’m bringing them something. If I have to hear one more in appropriate request (complaint…whine) for refreshments and transport reimbursements, I will scream.
-I will not miss having to extensively greet everyone each morning, and if I don’t, being thought rude. Sometimes I’m in my zone, and all I want to do is go to my computer and start my work day without the niceties.
-I will not miss people trying to sell me things. I’ve never been a good bargainer. So when it comes to techniques that some people use to drive down prices while bargaining, I use them in a sincere way.
For instance, I’m at the Sunday crafts market, looking for something very specific. I’m examining a carved wooden bowl. It’s not exactly what I’m looking for, a bit smaller, not the greatest paint job. And the salesman keeps asking me how much I’ll pay for it. And I keep saying I’m not sure I want it. I say this because I really mean it, I’m not sure I want it. But to him, that’s my bargaining technique. He won’t even let me put the darn thing down. I have to move away from him, set it down and essentially run away to get away from him. And of course, as I leave his stall, every other shop owner wants me to enter his, “Madam, come look, looking is free!” while shoving the same old kitchy knick knacks in my face and all I want to do is run away. Being obnoxious to people doesn’t make them want to be your customer. Or maybe I’m just no good at this stuff. Businessmen are businessmen the world over.
-I will not miss the literality with which people think. The lack of critical thinking, of thinking outside the box, sometimes utterly amazes me. Or maybe I take for granted how I’ve been taught to think critically and creatively. Even some of my Zambian colleagues at CIDRZ cannot read something over, give a presentation or think about something above and beyond what is written on the page. And if it’s written, then you have to read it. Meetings can last hours longer than they are meant to, because people will take the time to read every single word of a protocol, out loud, together, rather than having prepared it before hand, or skimming it, or speaking about the gist of something.
The TB-HIV peer educators, who I sometimes love dearly, are great in so many ways, but most of them cannot think outside the box. I have redesigned my monthly reports several times to most accurately reflect what they are actually doing in clinic. And I get their feedback and input, and we go through the questions over and over again. And they say it makes sense, they say they get it, they helped me design it! And then the next month’s report comes in, and they’re still answering some of the questions not really how I wanted/expected. They take the most absolute literal meaning of the question, one I didn’t think of because it was, perhaps, too obvious. It’s a lesson for me in how to word things, at how words can have so many meanings, but I also wish they just thought about it a bit harder. If they did, they’d realized that they way they answered didn’t really make sense in the context.
I think a lot of it stems from the standard system of schooling here, of a large room full of students, repeating back word for word what the teacher says. I don’t mean to be overly critical in this respect, we have issues with our education system too, and there are surely many children in the states who can’t think critically either. But it’s a daily challenge, and time sink.
-I won’t miss being seen as the boss just because I’m white. I’m not the boss. I’m here to work with them, to learn from them. Once again, the peer educator Mary illustrates this. I went to meet with her and Dennis at the clinic one afternoon, and when we were through, I was waiting for transport to go back to the office. She insisted on waiting with me, even though she was done for the day and I told her she should feel free to go home numerous times. So I just saw it as a courtesy, really nice of her to wait. But then, when her phone rang, she mentioned in the subsequent conversation that she had to stay at work “with my boss.”
I hate being seen that way. I am here to help, to mentor, to make things sustainable for them yes, but I’m also here for me, to learn, to experience, and certainly not to boss anybody around.
But there’s no hiding from my skin color. Everywhere I go, I am mzungu, whether or not it gets verbalized (though it often does). And on some level, no matter what I do, people will never see past that and give me a chance otherwise.
So I yearn for my anonymity. The freedom to put on my hood against the brutal Boston winter wind, keep my head down, plug in my headphones, stay in my own little confined world, and not be expected to acknowledge anyone or anything, and not have anyone want anything from me, all the way from the door of my apartment, through central square, to the T, through the streets of Chinatown to my school. I want that unwritten, unspoken, separation. I want the harsh northeastern coldness, if only for a little while. Friendliness if overrated.
Here are a list of things I will not miss about Zambia.
I want my anonymity back. This includes:
-I will not miss being honked at, numerous times, by every taxi driver who goes by. Partly it’s because this is how taxis drivers find fares, they honk at likely people walking. People don’t often flag down taxis here, they flag you down. But my whiteness makes me a more likely fare, and thus the higher incidence of my being honked at. It becomes particularly obnoxious when I’m physically in the driveway of the shopping center, clearly walking to it (as opposed to away from it). I just want to scream out at them:
“Why the hell would I want a taxi when I’m here?! I’m clearly going here, and here I am, and just leave me alone.”
But I don’t do that.
-I will not miss not being able to walk past a bus stop without being heckled by every call boy who comes within 20 ft of me. Like cab drivers, call boys get passengers for the mini buses. Usually the get off the bus at each stop, run up to pedestrians, every one a potential passenger, “Town madam? Town?” The drivers honk wildly, in case anyone didn’t know they were already there. Sometimes their passenger recruitment is to such an extent that they will drive off the main road, onto the side streets, honking repeatedly as the call boy slides open the door and shouts at passersby, even if they clearly have no intention of getting on a bus. Don’t you want to get on a bus? Surely you do, how could you not? We’ve got one right here! And never make the mistake of getting on a minibus that isn’t full, because you’ll likely sit there at the stop until it is.
-I will not miss being stared out, hissed at, shouted at, sneered at, or even genuinely greeted, by every single person I pass on the street. I think there’s something to be said for that cold Northeastern exterior. I don’t want to know everyone on the street. I don’t want to be approached by every man and get comments like, “Hello, you seem nice, I really want to know you, give me your phone number!”
-On that note, I will not miss Zambian social norms. Here, it is completely normal to have a less than five minute conversation with someone and ask for their number. Zambians really like to meet each other. To us, who tend to be somewhat reserved in that sense, in seems super foreign. I get tired of having to constantly figure out how to tell someone I don’t want to give them my number, I don’t want to tell them where I’m staying (where do you stay means where do you live), and I don’t know how to help them with whatever business or charity scheme they are planning, no matter how genuine they may be.
-I will not miss having to retreat indoors as soon as it gets dark. I will not miss that as soon as it starts to get dark, it makes it okay for men to start talking inappropriately to you on the street.
-I will not miss having women tell me on a weekly basis that I have a stomach. Zambians are dead honest. And I’ve yet to figure out if they’re insulting me, or complimenting me, or just telling it like it is. But there’s no taboo against telling someone they are fat. I adore the nurses I work with at CIDRZ, but they sure do know how to make me feel shitty about myself when they reach out and pat my stomach for no apparent reason. I don’t think they mean to be insulting. I think they don’t realize there are. I think there’s a double standard though. In traditional culture, it’s a positive thing to be fat, because it means you have money and are well fed. But with encroaching western culture, it’s probably not a good thing. So I have no idea where they are even coming from.
-I will not miss the utter disregard of drivers for anybody else except for themselves. I don’t think it’s only drivers, I think in general there isn’t the same sense of courtesy on the street as there are in other places, but here it manifests most obviously on the road. Think of all the places where people say, “Oh drivers are crazy there!” Massachusetts drivers, for instance, who have gained themselves the nick name of Massholes. Then multiply that by 100.
At home, it’s not uncommon to see some guy speeding down a neighborhood street, and you kind of just watch them pass and feel mad and give them a dirty look. But it certainly doesn’t happen every day. Here, it’s the rule rather than the exception. People race down neighborhood streets at highway speeds as if there was nobody else there. And if they see a pedestrian or biker that could potentially be in their way ie walking on the side of the road equivalent to the sidewalk here, rather than slowing down, they honk obnoxiously, speed up and give you the dirty look. And when car accidents happen here, they are bad. People speed around corners, lose control, and fall into the deep drainage ditches. It’s not uncommon to see two back wheels and the rear end of a car sticking up from the side of the road. I try not to think too hard of what the front of the car looks like.
-I will not miss the number of drunk men walking down the street on any given day. Unemployment -> idleness, depression-> drunkenness-> spread HIV-> depression -> drunkenness. Yeah, you get the picture.
-I will not miss having people expect that because I’m white and working for an NGO, that I’m bringing them something. If I have to hear one more in appropriate request (complaint…whine) for refreshments and transport reimbursements, I will scream.
-I will not miss having to extensively greet everyone each morning, and if I don’t, being thought rude. Sometimes I’m in my zone, and all I want to do is go to my computer and start my work day without the niceties.
-I will not miss people trying to sell me things. I’ve never been a good bargainer. So when it comes to techniques that some people use to drive down prices while bargaining, I use them in a sincere way.
For instance, I’m at the Sunday crafts market, looking for something very specific. I’m examining a carved wooden bowl. It’s not exactly what I’m looking for, a bit smaller, not the greatest paint job. And the salesman keeps asking me how much I’ll pay for it. And I keep saying I’m not sure I want it. I say this because I really mean it, I’m not sure I want it. But to him, that’s my bargaining technique. He won’t even let me put the darn thing down. I have to move away from him, set it down and essentially run away to get away from him. And of course, as I leave his stall, every other shop owner wants me to enter his, “Madam, come look, looking is free!” while shoving the same old kitchy knick knacks in my face and all I want to do is run away. Being obnoxious to people doesn’t make them want to be your customer. Or maybe I’m just no good at this stuff. Businessmen are businessmen the world over.
-I will not miss the literality with which people think. The lack of critical thinking, of thinking outside the box, sometimes utterly amazes me. Or maybe I take for granted how I’ve been taught to think critically and creatively. Even some of my Zambian colleagues at CIDRZ cannot read something over, give a presentation or think about something above and beyond what is written on the page. And if it’s written, then you have to read it. Meetings can last hours longer than they are meant to, because people will take the time to read every single word of a protocol, out loud, together, rather than having prepared it before hand, or skimming it, or speaking about the gist of something.
The TB-HIV peer educators, who I sometimes love dearly, are great in so many ways, but most of them cannot think outside the box. I have redesigned my monthly reports several times to most accurately reflect what they are actually doing in clinic. And I get their feedback and input, and we go through the questions over and over again. And they say it makes sense, they say they get it, they helped me design it! And then the next month’s report comes in, and they’re still answering some of the questions not really how I wanted/expected. They take the most absolute literal meaning of the question, one I didn’t think of because it was, perhaps, too obvious. It’s a lesson for me in how to word things, at how words can have so many meanings, but I also wish they just thought about it a bit harder. If they did, they’d realized that they way they answered didn’t really make sense in the context.
I think a lot of it stems from the standard system of schooling here, of a large room full of students, repeating back word for word what the teacher says. I don’t mean to be overly critical in this respect, we have issues with our education system too, and there are surely many children in the states who can’t think critically either. But it’s a daily challenge, and time sink.
-I won’t miss being seen as the boss just because I’m white. I’m not the boss. I’m here to work with them, to learn from them. Once again, the peer educator Mary illustrates this. I went to meet with her and Dennis at the clinic one afternoon, and when we were through, I was waiting for transport to go back to the office. She insisted on waiting with me, even though she was done for the day and I told her she should feel free to go home numerous times. So I just saw it as a courtesy, really nice of her to wait. But then, when her phone rang, she mentioned in the subsequent conversation that she had to stay at work “with my boss.”
I hate being seen that way. I am here to help, to mentor, to make things sustainable for them yes, but I’m also here for me, to learn, to experience, and certainly not to boss anybody around.
But there’s no hiding from my skin color. Everywhere I go, I am mzungu, whether or not it gets verbalized (though it often does). And on some level, no matter what I do, people will never see past that and give me a chance otherwise.
So I yearn for my anonymity. The freedom to put on my hood against the brutal Boston winter wind, keep my head down, plug in my headphones, stay in my own little confined world, and not be expected to acknowledge anyone or anything, and not have anyone want anything from me, all the way from the door of my apartment, through central square, to the T, through the streets of Chinatown to my school. I want that unwritten, unspoken, separation. I want the harsh northeastern coldness, if only for a little while. Friendliness if overrated.
The Hidden Face of HIV
To me, the face of HIV in Lusaka is every face on the street. It’s the young guy strutting along the side of the road, in his baggy, wrinkled, second hand clothing, wishing me a good morning in his ever so cool and suave sort of way. It’s the businessman in his suit headed to town for work. It’s the woman at the clinic, chitenge wrapped baby on her back, another child at her feet, clutching her white ART treatment card and waiting patiently for hours to be seen. It’s the callboy shouting at passersby to get passengers for his bus “town madam, going to town!” It’s the uniformed lady working the register at Shoprite. It’s the woman in the power suit, in the corporate office, in the tallest building in Lusaka.
But one face of HIV I never saw, until today, is that of the babies. Some of them are infected themselves. And others are the face of HIV because HIV has left them without parents. But these children, thousands and thousands of them, live in the orphanages all over Lusaka, the lucky ones do anyway. Today we went to the Mother Theresa Orphanage, on the other end of Kalingalinga (as you may recall, one my least favorite neighborhoods, though my most favorite to say), to visit some of these children. As we first stepped into the complex of buildings, we found ourselves in a courtyard, filled with children from about 4-12. As soon as they saw us, they began to sing, in perfect unison, a song of welcome and thanks. I have begun to believe that Zambians are born with perfect pitch and perfect voices, for on so many occasions- piled on the backs of trucks going to a funeral, shouting out of cars in a wedding procession, at the maternity clinic in the morning, on the school bus, harmonious, uplifiting songs can always be heard. It was no different for these children. You would have thought they’d been rehearsing for days, in anticipation of our arrival, a welcome song finally sung to its recipients, instead of just on the fly.
I don’t know if their clothing was the result of large donations of identical outfits of similar sizes or a true dress code of sorts, but it seemed that each age group/gender had on the same clothing. Most striking were the 5-ish to 8-ish year old girls in bright red, tafetta and gauze party dresses with gold trim. A Christmas gift perhaps? After our welcome song ended, we found the sisters and went to visit some of the tiniest residents of the orphanage.
The room had 25 cribs, lined up in three rows. They were little rolling cribs with short sides rather than proper large cribs, almost like larger versions of the plastic rolling baby carts they use in the hospitals back home. In each one sat a toddler. They all looked at us as we entered the room. 25 pairs of eyes that had probably only been looking at each other and at the Christmas tree in the corner for most of the day.
It only took a quick hello to a couple of them to fall in love. Those large smiles. Those reaching hands. That desire to be held, that willingness to hold on. I thought of the power of touch, and how much it means to be hugged, to know that someone is there. I thought of all the people who loved me when I was that age, of all the songs people sang to me, of all the games they played with me and I wanted to give all of that to them. In a whirlwind tour, I sang “Itsy Bitsy spider,” “open shut them,” “this little piggy,” and “patty cake.” I thought of all the stimulation we give our babies at home, of the little brains watching and absorbing and making connections, and how mostly, these babies just sit and just watch each other.
One little girl, probably a little older than a year, wore a dress I probably would have worn for a family portrait- a yellow and white striped sailor dress with a large white collar. She happily listened to my songs and held my hands and swung them with me.
Her crib neighbor, whom she would crawl over and visit every once in a while, was probably my favorite. In his smart blue striped shirt, he won my heart with his charming smile and his delight at my spinning him around.
After a bit of play, it was time for them to eat. The women who worked there expertly carried two toddlers at a time to the miniature dining hall, the low benches with divided chairs for each child, the baby sized tables, to go with the baby sized bowls of nshima and stew. I checked in on them periodically and got a big, nshima smeared smile from both of them.
I managed to spend some time with some of the older children too, although that was equally overwhelming in a different way. Imagine being the focus of attention of everyone in the room, instantly on arrival. As soon as I stepped back into the courtyard, I had no less than five little boys and girls glued to me- on my lap, on either side of me, tapping me, pulling my arm, making excited declarations in Nyanja that I wish I could understand. And of course, since children will always do what you don’t want them to, I had quite the time keeping them from reaching into my bag with my water and phone.
Towards the end of our visit, when the toddlers had made it back to their cribs (in a seemingly random fashion, for I found neither of them where they were before), surprisingly clean after such a messy meal, I went to find my little friend. I could just feel his need for affection. He was quite the snuggle bunny. I must have held him for half an hour, just held him, and when I had to put him down to leave, he cried. And that’s my final burning image of the orphanage for the day. This is country full of children just like them. And what will happen to them all? Who will survive? Who will grow and thrive? Who will go on to opportunity, health and love, and who will set out at 16 with no job prospects, nothing to do and nobody to care? Just to think of them all is so overwhelming and so sad.
This week we’re holding a Christmas party for them. With the loudest, funnest toys you can think of, and the saltiest, crunchiest, most artificially colored snacks you can imagine, it’s going to be a blast.
But one face of HIV I never saw, until today, is that of the babies. Some of them are infected themselves. And others are the face of HIV because HIV has left them without parents. But these children, thousands and thousands of them, live in the orphanages all over Lusaka, the lucky ones do anyway. Today we went to the Mother Theresa Orphanage, on the other end of Kalingalinga (as you may recall, one my least favorite neighborhoods, though my most favorite to say), to visit some of these children. As we first stepped into the complex of buildings, we found ourselves in a courtyard, filled with children from about 4-12. As soon as they saw us, they began to sing, in perfect unison, a song of welcome and thanks. I have begun to believe that Zambians are born with perfect pitch and perfect voices, for on so many occasions- piled on the backs of trucks going to a funeral, shouting out of cars in a wedding procession, at the maternity clinic in the morning, on the school bus, harmonious, uplifiting songs can always be heard. It was no different for these children. You would have thought they’d been rehearsing for days, in anticipation of our arrival, a welcome song finally sung to its recipients, instead of just on the fly.
I don’t know if their clothing was the result of large donations of identical outfits of similar sizes or a true dress code of sorts, but it seemed that each age group/gender had on the same clothing. Most striking were the 5-ish to 8-ish year old girls in bright red, tafetta and gauze party dresses with gold trim. A Christmas gift perhaps? After our welcome song ended, we found the sisters and went to visit some of the tiniest residents of the orphanage.
The room had 25 cribs, lined up in three rows. They were little rolling cribs with short sides rather than proper large cribs, almost like larger versions of the plastic rolling baby carts they use in the hospitals back home. In each one sat a toddler. They all looked at us as we entered the room. 25 pairs of eyes that had probably only been looking at each other and at the Christmas tree in the corner for most of the day.
It only took a quick hello to a couple of them to fall in love. Those large smiles. Those reaching hands. That desire to be held, that willingness to hold on. I thought of the power of touch, and how much it means to be hugged, to know that someone is there. I thought of all the people who loved me when I was that age, of all the songs people sang to me, of all the games they played with me and I wanted to give all of that to them. In a whirlwind tour, I sang “Itsy Bitsy spider,” “open shut them,” “this little piggy,” and “patty cake.” I thought of all the stimulation we give our babies at home, of the little brains watching and absorbing and making connections, and how mostly, these babies just sit and just watch each other.
One little girl, probably a little older than a year, wore a dress I probably would have worn for a family portrait- a yellow and white striped sailor dress with a large white collar. She happily listened to my songs and held my hands and swung them with me.
Her crib neighbor, whom she would crawl over and visit every once in a while, was probably my favorite. In his smart blue striped shirt, he won my heart with his charming smile and his delight at my spinning him around.
After a bit of play, it was time for them to eat. The women who worked there expertly carried two toddlers at a time to the miniature dining hall, the low benches with divided chairs for each child, the baby sized tables, to go with the baby sized bowls of nshima and stew. I checked in on them periodically and got a big, nshima smeared smile from both of them.
I managed to spend some time with some of the older children too, although that was equally overwhelming in a different way. Imagine being the focus of attention of everyone in the room, instantly on arrival. As soon as I stepped back into the courtyard, I had no less than five little boys and girls glued to me- on my lap, on either side of me, tapping me, pulling my arm, making excited declarations in Nyanja that I wish I could understand. And of course, since children will always do what you don’t want them to, I had quite the time keeping them from reaching into my bag with my water and phone.
Towards the end of our visit, when the toddlers had made it back to their cribs (in a seemingly random fashion, for I found neither of them where they were before), surprisingly clean after such a messy meal, I went to find my little friend. I could just feel his need for affection. He was quite the snuggle bunny. I must have held him for half an hour, just held him, and when I had to put him down to leave, he cried. And that’s my final burning image of the orphanage for the day. This is country full of children just like them. And what will happen to them all? Who will survive? Who will grow and thrive? Who will go on to opportunity, health and love, and who will set out at 16 with no job prospects, nothing to do and nobody to care? Just to think of them all is so overwhelming and so sad.
This week we’re holding a Christmas party for them. With the loudest, funnest toys you can think of, and the saltiest, crunchiest, most artificially colored snacks you can imagine, it’s going to be a blast.
Saturday, December 6, 2008
Batfest 2008
There is life beyond the boundaries of
Lusaka, thank goodness. The extra long Thanksgiving vacation time allowed us to go find this out. This past weekend, nine CIDRZ mzungus set out northeastwards in 2 Land Rover Defenders, affectionately named The Green Machine and The Beige Beast aka Bubba aka Short Bus, outfitted with refrigerators, cooking utensils, chairs, tables, stoves and roof tents. At about 5 am on Thursday morning, Batfest 2008 began.Kasanka National Park is one of the smallest national parks in Zambia, located in the northern part of central province, almost on the body of the Zambia butterfly shape, if you will. It’s heavily wooded, with a river and some lakes. It has its share of antelope species, birds and crocodiles, but it’s not particularly known for any of its large game. What it is known for is the annual bat migration. Each year, from November to December, millions of gray fruit bats, upwards of 10 million to be exact, descend on Kasanka. Biologists aren’t even sure where they all come from. They don’t all come from the same place, some are in different stages of the gestational cycle than others. They know that some of them go to the Congo in December, but where the others go is a mystery. Yet somehow, each year, word gets out in the bat community about the Kasanka bat convention, a family reunion perhaps, and do they ever come.
There is a particular grove of trees where they like to roost. I heard some statistic that the weight of the bats in the trees is comparable to some ridiculous number of elephants, like several hundred. Each evening, at dusk, the bats begin to stir and prepare for their nightly hunt for food. As we approached the grove, with a quickly darkening sky in the background, we saw some flecks of black in the air, flying above the trees. But soon the flecks became clumps, and then more and more until the entire sky above the grove was filled with bats, as if mud had been spattered all over a window between you and the tree. In large groups they would fly off in each direction, but just as fast as they could fly away, more would ascend from the trees to fill the air space the others had left behind. We lay there on the ground, watching them fly above our heads, until the crowd thinned out, and it was too dark to see them anyway. Then, in the early morning, when we peeped our heads out of our tents at first light, we looked up, and there they all were, flying back to the very same grove.
The morning viewing was even better. It takes them quite a long time to settle down for the evening. They settle on a branch, fly up again, settle down on another. They crawl up and down the tree branches, clean themselves a bit, do some more crawling. They like to sleep in clumps, rather than spread out on the branches. Is it for the warmth, the comfort? Do bats know the bats they choose to sleep with?
The park has built tree houses, hides, way up in the trees. In the early morning light, we climbed to the platforms to get a better look, a closer look, at the settling down. And every once in a while, if something scared them, a huge mass of bats would fly startled up into the air, scurry round and round for a bit, and then settle down again. New sleeping clumps or old ones? By the time the last few stragglers finally settled down to sleep, there was another Kasanka treat to be seen.
The elusive situtanga, a type of antelope. But unlike the ubiquitous puku, lichwe and kude, the situtang are few, and hide in the marshlands in the early morning. From our tree hide, with the help of binoculars, we caught glimpses of them through the marsh grass, large rears in the air, heads bent down in search of food, tails constantly flapping the flies away.
And if you look even closer, even smaller, there are countless species of birds and insects, including the longest and brightest millipedes I have ever seen.
So distracted were we by the fabulous morning wildlife, and then by a flat tire, that we were late for our canoe rides (as if we hadn’t gotten enough of canoes recently) on the other side of the park, a good hour’s drive. But that way okay, because, darn, we had to sit under a thatched roof by the river for several hours, lounging and eating lunch, before we could go out in the canoes in the afternoon. And unlike the choppy waters of Lake Kariba, this river was calm, and the soft, silent gliding motion of our canoes across the water, with the rhythmic splash of the paddle as it plunged, lulled me into a thoughtful trance. One thing that came to mind was how close I was to the Congo border at that very moment, and all the poor people who are suffering there, and how here I was, in this beautiful forest, on a calm river, soaking in all the beauty.
After we’d had our fill of the bats, it was time to move on to waterfalls and whalebacks. We piled into The Green Machine and Bubba and continued heading north. First we stopped off at Kundalila Falls. Ilse Mwanza, the loud tough old German woman we met at the Busanga Plains camp, the one married to a Zambian man, wrote a book about little known waterfalls in Zambia. Kunkalila Falls is one of her favorite. It was worth every kilometer of the bumpy dirt road to get there. Seeing the falls requires hiking down into a gorge, with breathtaking views of the landscape along the way, a landscape I’d never associated with Zambia before-granite hills, denser, greener, taller trees. There were even trees with red leaves here and there, so you could almost imagine you were looking at an autumn landscape in New Hampshire. Once you begin nearing the floor of the gorge, you get your first glance through the trees, to massive and tall jets of water falling from above. Hike a bit further down and you see both streams tumbling into a large pool below, and then to a smaller cascade, and into a quieter pool. There was very little time between arrival on the rocks, removal of shirts and shorts, and taking the plunge into the delightfully chill water. This watering hole had already been discovered that day by a group of 10 Peace Corps volunteers, celebrating Thanksgiving. There was plenty of space to share. And once again, with a little talking, we were reminded how small the Zambian expat community is. You always run into people you know, or people who know the same people you know.
I could have spent all afternoon at the falls. But sadly, we had to move on, to get to our camp in the Mutinondo Wilderness, a good three hours away, before dark.
Northwards once again. Through the small roadside villages with their colorful mud huts, past the stands with ladies selling piles of tomatoes and onions, past the children selling mushrooms at least 12 inches in diameter, strung on sticks. It’s mushroom season and this part of the country is known for them. We had an interesting conversation about whether the rather extensive ditch digging along the side of the road was for water drainage or related to telecom. Both seemed equally likely. The most developed buildings around seemed to be the schools. There was at least one in every village we passed. When it seemed that the sun might in fact beat us to our camp site, we reached the turnoff for Mutinondo. Another 25 km down a dirt road, and we indeed found ourselves in a wilderness, a lovely, wooded, hilly wilderness.
One of the most distinct features of the landscape are the whaleback, these narrow, steep hills that you could almost imagine to be the back of whales plunging out of the earth. Another distinct feature of Mutinondo is the fact that there really aren’t any big game, and it’s privately owned rather than a national park. Both of these things mean that it’s okay to hike and wander on your own, and wander we did. It was so refreshing to be able to just walk around on our own, and really really walk far, without a guide. Our wandering brought us to a small river that connected a series of small waterfalls, one of which was perfect for lunching, relaxing, swimming, and even using an inner tube to float down the falls. There were also whirling deep pools of water, crevices in the rock carved by countless years of falling water. There were ledges perfect for sitting beneath the falling jets, good for a head massage of sorts. Even after hours of frolicking in the water, I’m not sure any of us were quite ready to leave the river. Except there was horseback riding to do. And dinner at the lodge, as a treat for having made ourselves dinner three nights. And a morning jog/hike up the top of one of the whalebacks, in time to watch the sun rise and reflect across the totally human-empty, tree-filled wilderness.
Another illustration of just how small the expat community is here. At the lodge at dinner (8 hours from Lusaka), we met an Australian man and his son on holiday, traveling around the world, literally, from Sydney to Africa to Europe to the US to get back to Australia. A couple of days later, back in Lusaka, we ran into them in the grocery store.
It was not enough time. I want to move CIDRZ to that part of Zambia. I want to hike more hills and play in more waterfalls and eat more mushrooms and see more village life. But somehow it was maybe all just enough. Despite the 12-hour ordeal getting back to Lusaka (there were some car issues with poor Bubba), I arrived incredibly relaxed, refreshed, ready to get back to work. And it’s only 3 short weeks until I go to Cape Town for the winter holidays.
Three short weeks to finish my work plan for my peer educator program evaluation and begin preparing for integration of ART and OPD services in another two clinics. Sometimes it feels like things happen very slowly here, or perhaps the amount of work that gets done on any given day is small, but the parts add up quickly. I’m going on 4.5 months now. In some ways it feels like I’ve been here forever, and in others, I can’t believe how quickly the time has gone by.
Friday, December 5, 2008
Thanksgiving
Even far away from our families, I think American expats all over the world find special ways to celebrate Thanksgiving, albeit a bit early in our case. Due to our upcoming Great Zambian Batfest Road Trip 2008 on Thanksgiving itself, we declared the Sunday before to be Thanksgiving. With a little organization, I managed to get people to volunteer to make all the dishes you’d expect- turkey, stuffing, mashed potatoes, sweet potatoes, green beans, pumpkin pie, cranberry sauce and lots of non-traditional things as well. With over 30 people gathering at McMansion for the event, it was a dinner to almost rival the years of Alum Thanksgivings at pika. We set up extra tables and chairs all around the house, and covered each with a colorful chitenge cloth and candles stuck in wine bottles. With jazz playing quietly over our satellite TV radio, it felt like some fusion of a romantic restaurant and a college café lounge type place.
It was a grand success. There was plenty of food for all, and everyone commented on how nice the house looked and how well coordinated the food was.
I think for me, the best part was at the very end of the evening, when everyone else had gone home, and it was just the four of us, sipping wine on the front stoop, in the chilly night air, and Liz made a toast to all of us, to our Zambian family, to the family we’ve made here, despite all being so far from our true families. And indeed, I am thankful for so much…for the opportunity I’ve been given to be here, for the people I’ve met, for all the things I’ve been able to do and see while I’m here, for all that I have learned and hopefully what it can add to my career and my ability to better serve my patients in the future.
James Bond comes to Lusaka
Yet another event held by the Environment and Wildlife Conservation Society, a gala event for the premier of the James Bond Movie. They rented out the whole room of the theater. There was a cocktail hour before hand. We all got dressed up in our finest, or the finest we could throw together here anyway, without having brought any gala type dresses myself. Stu, one of the other interns, who ran the James Bond fan club at his university, even made a bowtie for the occasion, observe. Perhaps the movie itself wasn’t so great, but the evening was a blast.
Subscribe to:
Posts (Atom)