Decision 2008, Zambia Style

The campaign is finally in full swing. Election day is October 30^th, which means the candidates have just over a month to convince everyone of their ability to be Zambia’s next president. Except that, from talking with most Zambians around here, that won’t matter much at all. The general feeling is that the election of 2006 was rigged, and that this one may be too.

There are three main candidates, but two front runners:

Rupiah Banda. He was President Mwanawasa’s Vice President, he’s serving as the current acting president. The general feeling, at least around Lusaka, is against him. There have been corruption accusations. The national TV station, ZNBC, is being accused to covering Banda more than the other candidates. The politically independent newspaper The Post is reporting that Banda wants to stop them from speaking out against him.

People say that in 2006, when he and Mwanawa were running for re-election, that the highest population areas, Lusaka and the Copper Belt, all voted for the opponent, Michael Sata. The votes that reelected Mwanawasa and Banda all seemed to come from remote areas of the country. Those votes took days to travel into Lusaka, and the numbers of votes coming in seemed inconsistent with how many people could reasonably be registered in any of those places. So their entire administration is questionable, and people don’t seem excited to continue it. On the extreme end, I’ve heard that if Banda wins, people will again say the election was rigged, and there may be protests. In addition, his opponent is the very person who they say he stole the election from two years ago.

Michael Sata. He was Minister of Health in the 1990s and people say he was able to bring about change. At multiple health centers, I’ve heard stories of him coming on his own, just to spend time at the clinic and see how things were going. People around here really seem to have faith in him. I have yet to talk to a Zambian in Lusaka who is not voting for Sata. On the most extreme end though, I’ve heard that he would almost go the way of Mugabe in Zimbabwe and kick out all the non-Zambians. But most people have explained that he just wants more Zambians running business, and he would not go so far as to kick out NGOs or aid workers and such.

I suspect as the campaign goes on, the claims of corruption will increase. It should certainly be an interesting month.

To reassure all of you a bit, should you be worried, the US embassy is not overly concerned about the elections at this point in time. More updates later.

Kalingalinga

Kalingalinga is probably my favorite neighborhood in Lusaka. Well, not really my favorite at all, but the most fun to say. Say it, Kalingalinga. My theory about why it’s called that:

Kalingalinga is the place to go if you need a large metal gate for the wall around your house, a wooden bed frame, an overstuffed couch or a pile of rocks. That’s right, apparently the entire gravel industry of Lusaka centers around the rock hammerers of Kalingalinga. Drive through at any time of the day, and for blocks and blocks, people sit by the side of the road, under the hot sun, making the sound, “Kaling! Kaling!” as they monotonously hammer rocks into gravel. Old and young alike, they sit on the ground and hammer. Sometimes they even have the little babies wrapped around them while they hammer, perhaps to accustom them to that “kaling” that will be the rhythm of their lives. The children who are old enough to sit and hold a hammer can break rocks too. Imagine being born into a rock hammering family.

It’s actually not a very nice place at all. It’s busy, it’s dusty, it’s hot, it’s dangerous at night. One of my fellow interns has a good Zambian friend she works with who lives in Kalingalinga. She was recently staying there at night. Even though there were bars on the windows of the house, they can’t keep the windows open at night for safety reasons. And the power was out, so there were no fans. So she lay awake all night, sweltering in the Kalingalinga heat. Recently though, I have found its saving grace.

In the past few weeks, the Jacaranda trees have been in bloom. Tall, branching trees alive with a rich purple flower, a sort of opposite of an autumn maple alive with reds and oranges. The Jacarandas, which cover the trees like the leaves, are a beginning instead of an end. They are the kind of flower that you just want to look at in awe and appreciate. That you wait all year to see. All around me, people say, “Look, the Jacarandas are in bloom.” And people who are not here, but who have been here in the past will write to me and say, “I imagine the Jacarandas must be in bloom.”

These beautiful trees grace even the dustiest, hottest and most unappealing neighborhoods. Under the Jacarandas, even Kalingalinga looks inviting. Almost. But do let me know if you need some of the finest gravel in Lusaka.

A weekend in Chirundu

For the first time in a month and a half, I managed to get out of Lusaka for the weekend. Much like at home when Boston starts to wear me down and I feel that pull towards the mountains and wide open freshness of New Hampshire, I just had to get out of the city. In this case, the destination was Chirundu, a town to the south, on the border with Zimbabwe, on Zambezi River.

Chirundu is hardly New Hampshire. In her book Don’t Let’s Go to the Dogs Tonight, Alexandra Fuller describes Chirundu as “possibly the hottest, least hospitable, most malarial place in all of Zambia.” Sounds lovely huh? Well actually, I didn’ t remember having read that before I went. I went because I was promised a weekend of camping, relaxing, wildlife and tiger fishing on the Zambezi River, and that’s definitely what I got, although it certainly was hot.

Although travelling in large groups can be challenging, the good thing about traveling with nine people was that we were able to charter a minibus all to ourselves. Yes, there was the adventure of going to the City Market bus station, and having every minibus driver there gather around us to find out where we were going. But it helped having a Zambian friend who came along, and he managed to haggle us a deal, not only did we get our own bus down there but we got driven directly to the camp at Zambezi Breezers (www.zambezibreezers.com). Having our own bus, we were also able to avoid the constant stops, the overcrowded, packed the brims, sweaty, stuffy, fish/live chicken filled experience that it could have been. Within a half hour of arrival at the bus station, we were speeding southwards out of Lusaka. The crowded, traffic ridden city starts to thin out, and then it’s gone. Then nothing but clusters of thatched roofed huts, little one room markets, cinder block structures adverising pay toilets for 500 kwacha (that’s about 15 cents), and dry bush on a dusty plain with hills in the distance.

I also discovered on this ride that Lusaka is indeed at elevation. Eventually we started heading down, some roads with a surprisingly steep incline, nestled between rubbly/sandy/dusty hills. I think it was the wind through the open windows that helped us not to bake under the sun. Chirundu itself is nothing special, a border town, a truck stop. Lines and lines of trucks on their way to somewhere, carrying fish norwards to Lusaka, goods southwards to Zimbabwe. With my mind stuffed full of HIV programs, I couldn’t help but think of all the truckers right there at those crossroads, an important target population. But it was the weekend. Our minibus turned off the main road, up and down the rough dirt road. Past the occasional cinderblock house, turned right at the goats, around the bend at the fish farm with its large concrete tanks, and up to our camp. All along the ride, the theme for me was dirt, dust and hot.

Happily, Zambezi Breezers is a haven from the inhospitalbe dustiness. A narrow oasis along the river. Sprinklers scattered drops of rainbow catching water along a soft green lawn. A small, kidney shaped swimming pool glistened in the sun. A large, thathed roof cabana caught breezes off the river and enveloped them in shade. Down in the river, halfway across, what looked at first to be a cluster of large boulders soon revealed itself to be a large group of hippos. And beyond them, Zimbabwe. Not surprisingly, it didn’t look much different than Zambia. A flat plain with those stereotypical low, branching African trees of paintings, large termite mounds, and some hills in the hazy distance.

I set up my tent on a grassy, tree shaded nook with a view of the river. It was the first time I haven’t set up a rain fly over a tent for as long as I could remember. I haven’t seen a drop of rain since I got here.

For those who know anything about fishing, tiger fishing is a well known sport. People travel to the Zambezi River for miles to have a go at catching them. A blackboard at the cabana proudly announced that Diane had caught the biggest tigerfish of the year there, back in June, at a whopping 7 kg.

The nine of us rented a boat for the afternoon. First, our driver Robin took us speeding down the river, close to the Zimbabwe side, where we saw several groups of elephants, hippos, and even a crocodile. The nice thing about being on the boat was that we were able to slow down, double back, and get much closer to the elephants than I had at Kafue National Park. They glanced at us briefly, seemed to give it some thought, and went back to rustling through the trees, stuffing clumps of brush into their mouths. From the middle of the river, the hippos continued their loud, grunting calls. They always sound closer than they actually are. At one point in the middle of the night, I had to peek out of my tent to make sure they weren’t standing right there.

The second half the boat ride was dedicated to fishing. We each had a go at reeling out the bait, which in itself could have been a fish worth catching. At one point I felt a tug at my line, it seemed that I may have caught something, and we even moved the boat in pursuit. But I came up with an empty line, hook broken off. We’ll never know if it was a fish or if it just caught on the bottom. In the end none of us caught a thing, but we enjoyed an afternoon out on the water, the breeze and the sun, some cool animals and cold drinks. At several points, we passed by other camps and lodges along the Zambian side of the river, which looked much more luxurious, and I got little panks of missing Mukambi Lodge where I went in Kafue. But our camp was a no frills (=cheap) kinda place, and that’s what we were going for. One of the girls who came along, who doesn’t work for CIDRZ (!) is spending the week in Chirundu, staying on the river in one of those very structures, doing research at an Italian mission hospital with some nuns. Seems like a lovely way to spend the week.

Besides the boat ride, it was a lazy weekend of lounging, by the pool, by the river, under the cabana, reading, chatting. We took a walk down the road to a banana farm, watched some monkeys dart between the trees.

After our banana stroll, we walked by the fish farm. At that point, I was rather hot and thirsty, and decided to return to camp rather than explore. That decision ended up costing me an intereting experience. My friends who did decide to go ended up meeting the old British couple who runs the fish farm, and they turned out to be the parents in the memoir I mentioned above. Indeed, if you turn to the last page of the book, Alexandra Fuller describes how here parents are living on a fish farm in Chirundu, on the Zambezi river, down the road from some Italian nuns. How neat is that? Talk about bringing a book to life. I could not have feigned the ignorance my friends did when they were speaking to the couple, the parents in the books, “Oh yeah? We’ve never heard of the book, we’ll have to check it out.”

I was sad when it was time to head out. Relaxing is addictive. Yet much like I feel when returning to Boston, coming to Lusaka this time felt like coming home, in a way.

The weekend ended with a nice surprise. Our friend Rodney, the plains camp manager, came to visit (we thought he was coming next weekend). The occasion called for dinner at this lovely Italian restaurant called Portico. One of those places you can go and forget you’re in Zambia. Hidden among the green trees, we all dined on caprese salad, homemade pasta and crème brulee, and sipped red wine by the polo grounds (yes, there are polo grounds), surrounded by actual Italians speaking Italian. It’s nice to discover all the other foreigners who are in Zambia too.

I didn’t want all the relaxation to end. I have many busy weeks ahead. But actually, that feels good too.

Some morning harmony

I was sitting in the ART (antiretroviral) clinic registry at Bauleni this morning, getting started on our pre-implementation wait time survey, when I heard this heavenly, harmonious singing, which sounded rather close. Where in the world was that coming from?

“Oh, that’s from the MCH (maternal child health) building, right next door,” they informed me. “Here, I’ll take you over.” With that, I followed one of the clerks out the door to a neighboring building. As I would have expected, I walked into a crowded waiting room of patients waiting to be seen. But instead of sitting packed in, on every available chair and bench, they were all standing, facing a nurse at the front with a proud look on her face, who seemed to be conducting in a way. They were all singing, in perfect harmony. I just wanted to stand there and listen. When’s the last time you saw a waiting room full of patients sing, let alone as if they were in a choir together. The clerk told me that they were singing a gospel song in Bemba, one of the most spoken languages of Zambia. I’m not entirely sure if there was a meaning or a purpore, or perhaps just an insprirational way to start the day, with a long wait ahead and not much to do, fueled by that glow of pregnancy. At the very least, they lent some inspiration to my day. I definitely walked out of the room feeling uplifted.

It’s actually not uncommon to hear Zambians singing. Especially on the way to funerals, when they pile onto those trucks. It’s as if they are born with perfect pitch and ready to harmonize. I think we could all do with a bit more Zambian gospel singing in our lives. Bet you never even realized you were missing it.

Garbage

After living in Lusaka for almost two months, I’ve become quite familiar with the smell of burning garbage. Take a drive at night, and you’re bound to see groupings of small fires set in fields, along the side of the road, dry brush burning, fueling the attempted disposal of cardboard containers, plastic bottles and bags. Sometimes we’ll pass small fires early in the morning, while we’re out running, and I curse it for the oxygen it deprives of my hardworking lungs.
Occasionally the fire will grace us a flurry of ashen snowflakes. Even in our living room at night, if the wind blows just right, we’ll get a whiff of that tangy, almost suffocating, thick smoke.
Part of the problem is the lack of municipal garbage collection. Garbage pickup is handled by private companies. If you can’t afford it, then another option is to burn it. Or dump it. Empty pieces of land, and by empty I mean land that doesn’t have a house sitting on top of it, tend to accumulate vast carpets of wrappers and bottles. From the office to the Arcades Shopping Center, there is a dirt pathway cut perfectly through a field of the last vestiges of long ago enjoyed Orange Fantas and Eet-Sum-Mores biscuits. It’s hard to tell if the garbage, or the path, came first.
Today at lunchtime, I took an uneventful walk over to Arcades along that very path. When I returned, I saw thick smoke from across the main road. In the short time I was gone, somebody had set the largest garbage fire I’ve seen so far in the field across from CIDRZ. Under the heat and haze of the midday sun, the smoke burned especially thick and black, and the dark red flames jumped up what seemed to be several feet in the air.
I cringe every time I am not able to recycle a glass jar, a plastic bottle, a tin can. I want to yell every time an old minibus goes by coughing massive amounts of black exhaust into the air, but I’m too busy choking. On a regular basis, we open our front door, and even early in the morning, the smog and haze have already descended. It’s sort of like those pictures of LA at the height of its air pollution, only worse.
Lusaka has been growing by leaps and bounds. I’ve heard that even in the past year, the number of vehicles has exploded and traffic has visibly worsened. Roads are being paved. Intersections will back up for blocks, especially during rush hour. Buildings, houses and shopping centers are under construction in every corner of the city. But all that growth and development come at a price. It seems that it’s growing too fast for its own good. The battles that have already begun to be fought at home have not yet begun here.
I’m reminded of that Shel Silverstein poem “Sarah Synthia Sylvia Stout, Would Not Take the Garbage Out,” which he wrote way back in 1974…

Sarah Cynthia Sylvia Stout
Would not take the garbage out!
She'd scour the pots and scrape the pans,
Candy the yams and spice the hams,
And though her daddy would scream and shout,
She simply would not take the garbage out.
And so it piled up to the ceilings:
Coffee grounds, potato peelings,
Brown bananas, rotten peas,
Chunks of sour cottage cheese.
It filled the can, it covered the floor,
It cracked the window and blocked the door
With bacon rinds and chicken bones,
Drippy ends of ice cream cones,
Prune pits, peach pits, orange peel,
Gloppy glumps of cold oatmeal,
Pizza crusts and withered greens,
Soggy beans and tangerines,
Crusts of black burned buttered toast,
Gristly bits of beefy roasts. . .
The garbage rolled on down the hall,
It raised the roof, it broke the wall. . .
Greasy napkins, cookie crumbs,
Globs of gooey bubble gum,
Cellophane from green baloney,
Rubbery blubbery macaroni,
Peanut butter, caked and dry,
Curdled milk and crusts of pie,
Moldy melons, dried-up mustard,
Eggshells mixed with lemon custard,
Cold french fried and rancid meat,
Yellow lumps of Cream of Wheat.
At last the garbage reached so high
That it finally touched the sky.
And all the neighbors moved away,
And none of her friends would come to play.
And finally Sarah Cynthia Stout said,
"OK, I'll take the garbage out!"
But then, of course, it was too late. . .
The garbage reached across the state,
From New York to the Golden Gate.
And there, in the garbage she did hate,
Poor Sarah met an awful fate,
That I cannot now relate
Because the hour is much too late.
But children, remember Sarah Stout
And always take the garbage out!

There are murmurs of conservation efforts here, but only if you go looking for them. They’re directed more towards preservation and the national parks. I wonder if that type of thinking is somewhat bewildering to people here. After all, there are villages bordering on, in the middle of, national parks. So what really is the difference between one person’s little piece of land, and the land across the road, which, though it looks exactly the same, is actually a piece of land to be preserved and protected.
I wonder how long the garbage will have to pile up before they decide to really do something about it. With all the other issues the government has to worry about right now, sanitation does not seem to be priority.

Ends and Beginnings

Cue OPD-ART Integration Part II. The setting, Bauleni Clinic. Countdown to proposed integration date: 48 days. May seem like a lot of time, but there is much to do.

Unlike Ng’ombe, Bauleni is a good drive from CIDRZ and pulls its clinic population from some of the furthest edges of Lusaka. Ng’ombe is densely populated. Step outside the clinic walls and you find yourself in the thick of the community, along a narrow dirt road, with the crowded marketplace to your left and rows of closely set houses in every other direction. Bauleni, on the other hand, sits along a main, paved road, at the edge of a large cemetery, with fields and sparsely place houses across the way. You have to drive a ways down the dirt road behind the clinic to get any sense of where most the people live. It’s one of the last compounds on the southwest road out of Lusaka. Beyond it is the upscale, spacious, neighborhood called Leopard’s Hill, home to the American School, farms and estates.

Some thoughts about the cemetery. It’s the biggest one in Lusaka. Drive by, and you keep on driving, and just when you think you’ve reached the end, there’s more. Groves of trees shield it from the road in some places, but in others there’s a clear view of the rows and rows of gravesites. Some have the traditional western tombstones, some have more Latin American style elongated colorful blocks, and others are just mounds marked by flowers. This cemetery is a part of Lusaka that’s well known to most of its residents. If you get a glimpse on any weekend, and you’ll witness not just one gathering but 5 or 6 or 7, and that’s only within the five minute period that you drive by. Sometimes I look around a room full of Zambians, and think about the fact that statistically, 1 in 5 of them is HIV positive. Despite our best efforts with ART scale up, that many Zambians living with HIV translates into many of them dying with it. Funerals have become a normal weekend activity. I’ve been told by numerous ex-pats at CIDRZ that I am bound to attend at least one funeral this year, if not more.

Families and friends will often go out to the cemetery together, fitting as many as possible onto the flatbed of a truck. They sing hymns as they drive, in beautiful, unrehearsed, harmony. At the edge of the cemetery, they pile off the truck, and form a long procession to the burial sites. Before I ever went to Bauleni, I would pass the cemetery on the way to play ultimate Frisbee at the American School, and reflected on all that mourning as I was on my way to have an athletic upbeat afternoon. Now I think about the different sort of contrast created by a health center on the edge of a cemetery. Maybe it’s the extra reminder we need of what we’re all working to fight.

Part of that fight is reducing stigma, and that’s part of what integration is all about. T-shirts are a big deal here. Whenever a new program happens, or an event like world AIDS day, t-shirts are made and distributed. You had better not get in the way of somebody getting their free t-shirt, such a trespass won't be forgotten. The t-shirts help spread messages, stir up excitement. The integration shirt depicts a pair of hands shaking and a message that declares, “It Starts With Us.” Tentative word from the ministry is that they're happy with the progress of Ng'ombe, and they're thinking of integrating two more clinics, Matero Main and Kamwala, next year.

Indeed, Ng’ombe and Bauleni are the start of something big.

Changes

Forgive the long delay in entries. When internet servers fry, communication slows down. Life without internet is actually pretty amazing. You should try it. On to the post...

Seasons are turning everywhere. Back home, they were bittersweetly) celebrating the last official weekend of the summer, putting on sales at Staples and dusting off the big yellow buses. Soon the hot, humid summer days of Boston will be a faint memory. But here, summer is yet to begin. Only six weeks ago, I was wearing sweaters nightly, sleeping under a thick blanket and keeping a shawl with me daily. But if I thought it was a bit chilly at times, Zambian women were cold. The older women wear plaid blankets as shawls. The fashion for the younger women with babies is to wrap a fleece blanket around themselves and the child on their back, over the tightly wound chitenge that actually hold the babies in place.

In case you wanted a fast lesson, here's how you do it. 1) Lean forward at the waist. Make sure chitenge is within reach. 2) Lift up baby/child and swing them around onto your back. This is the part where you have to balance them there so they don't tumble off. 3) Fling chitenge around you back so that it rests over the child and you. 4) Be sure to tuck it under the child's bottom. 5) Bring both ends of the chitenge around either side of you, and tie them together, slung across one shoulder. Voila! You have yourself a convenient sling in which to carry your child on your back, now completely arms free. 6) Bonus step, when it's cold, wrap additional fleece blanket around you and baby, tying in front, so that baby is now merely a fuzzy hat clad tip of a head peeping out from all the fabric wrapped around you.

These blankets, may I add, are high fashion, and often feature teddy bears, hearts, or cartoon characters. Sometimes if I walked into work in only my short sleeves, the Zambian would shiver just looking at me, “Aren’t you cold?!” they would exclaim. But really, the Zambian cold season is ideal weather for me, sunny, warm, breezy days and delightfully cool nights. Now, though, it’s hard to remember being cold at all. Last weekend was the first official pool weekend here at McMansion.

At the Sunday crafts market last week, the noonday sun burned with enough intensity to drive us inside. At home, we turned on our fan for the first time. Even when we have an overcast day, it’s just a tease. There will be no rain until November or so. Morning clouds always burn away. Zambia has but three seasons- cool, hot and wet.

There’s change at CIDRZ too. On Monday and Tuesday, the long awaited TB/HIV Peer Educator training finally took place. Although I haven’t struggled through the entire two-year process of getting the okay to start this pilot, I felt a definite satisfaction at the start of Monday’s session. Over the course of the two days, the more time I spent with the four new peers, Mary, Stephen, Dennis and Elizabeth, the more I was inspired. By definition, peer educators must be HIV positive. Through this training, through this job, they are making the most of their situation, and their HIV positive status. I thought about this during the opening prayer, when Stephen expressed repeatedly and heartfeltly how grateful they were to be there, gaining this knowledge, learning to help others. During the session on HIV/TB coinfection and drug side effects, I thought about how they know these effects first hand. At the end of the first day, one of them got scolded for having been late that morning. She went on to describe how little she sleeps, how there’s a health problem with her husband, who is positive and on second line medication, and how her children are positive, and how all of them are taking medication every day. I almost wanted to cry right there, for her, for the unfairness of it all. I thought about the courage it takes to not only face their status every day, but immerse themselves in a world of people who share that status, to talk about it, educate, support. I wonder if I could do it myself.

Trainings are a big deal here. When the peers were asked on the first day what they hoped to get out of the training, one of the goals they stated was, “To get my HIV/TB coinfection training certificate.” They did indeed get their certificates, ceremoniously. I almost felt as if I was at a graduation. Each peer got to come up to the front of the room, shake four hands, and receive their certificate. The TB portion of the training was only two days, but they have been through almost three weeks of peer educator training. This indeed was an accomplishment. They have been given the tools-basic medical and medication knowledge, counseling training, health education training, training on clinic flow and understanding of the referral systems. With all of that, as well as with the logbooks I so carefully designed for them to keep track of patient numbers, I’m eager to see how it all goes.