Mwanawasa's Final Return

President Mwanawasa’s body arrived at the airport yesterday morning. Then, over the period of about two hours, he was very ceremoniously carried off the airplane, out of the airport, and down Great East Road to a spot where the body will rest for the next couple of days. Originally the burial was meant to be this coming Tuesday, but it was postponed until next week, September 3^rd. This was partly because September 3^rd would have been his 50^th birthday, and partly to give more people the opportunity to pay their respects. His body will be carried to numerous different provinces over the next week.

After getting home from Kalikiliki, we rushed out to great east road to try to catch a glimpse of the motorcade. Normally, Thabo Mbeki Road, the road that we live on, the road that connects to Great East Road, isn’t that congested. But on our walk, the cars were parked along the road in both directions, almost as far back as our house. From a distance, we could see the masses of people lining Great East Road. We just missed him. As we neared the intersection, it became apparent that everyone was walking in the other direction, towards us.

We decided to walk over to the Show Grounds. While his body won’t actually be resting there, it is the spot that has been designated as a gathering place for mourning. As we walked, we took in the crowd. There were women wrapped in chitenge with Mwanawasa’s face on it, left over from the election campaign of 2006. There were people holding posters and flyers with his picture, asking that he be blessed and rest in peace. There were buses full of nuns, in watching blue and white dresses with little knit white hats. There were trucks driving by, the truck beds absolutely full of people, all singing hymns loudly. The entire country is indeed mourning him.

We were all dressed in the appropriate manner as well, chitenge wrapped over our pants. It’s interesting. As white girls, we get a lot of attention while walking down the road, and it’s normal for men to call out to us. But I think as white girls wearing chitenge, partaking in the tribute to the president, we got even more attention. Everybody turned to stare at the mzungus, we kept hearing “chitenge, chitenge” over and over again. Some people actually stopped to compliment how we were dressed, or thank us for mourning with them.

A group of three women stopped us to say hello. Each was carrying a baby slung over her back. But it turned out that all three babies actually belonged to one of them, and they were triplets. The babies’ names? Kaunda, Chiluba and Mwanawasa, in honor of all three presidents of Zambia.

The Show Grounds certainly had a different feel from the last time I was there, watching the majorettes march across the field with the traditional Zambian dancers behind. This time, there were crowds of people gathered across the field. Some were sitting on the ground, some were sitting in chairs under tents. As they had been on the trucks outside, people were singing, praying. At the other end of the field, big coach busses were pulling up. More tents were being constructed. They were all facing a staging area, where it seemed that a church service was going to be starting. We were the only white people to be seen, and we definitely got more stares, laughs, compliments. On our walk home, we were trailed by a group of children singing spirituals.

What’s really impressed me is how much this has affected the people of Zambia. It seems that Mwanawasa was indeed a liked and respected leader. Or perhaps even if that many people didn’t like him, there is still a sense of duty to show respect. We saw people openly weeping. There has been a peaceful calm to the country, a feeling of unity. Out of respect to the president, there has not been, and there will not be any talk of the election or candidates until after he is buried. I’m hoping it will stay this way.

The Orphans of Kalikiliki

Before arriving in Zambia, my roommate Sarah made a connection with a woman named Dorothy who works at an organization here called CINDI, which stands for Children in Distress. CINDI is not an orphanage, but their mission is to help families who are supporting orphans and they run all kinds of programs in various neighborhoods around Lusaka. This morning we had the opportunity to join Dorothy and her coworker Mike for one of their weekend youth group sessions. They picked us up at the office, and in yet another ubiquitous white SUV with NGO names painted along the side, we drove to a neighborhood in the eastern part of Lusaka called Kalikiliki. We had never been there. It’s not a planned neighborhood, it just sort of sprang up. There is no clinic there. It was almost flattened by the government. It was almost completely flooded when a dam was opened up. Finally, the city government officially recognized it, and now there are international partners working to establish it as a real neighborhood, doing projects like building roads and community centers. To me, it looked much like many of the other compounds- rough, narrow, packed dirt roads lined with haphazardly placed houses. It was there, at the community center, that we met all the children for the morning program.

We walked into a room lined with children who looked like they ranged in age from 5 to 12 or so. At first, it felt very much like a classroom. A woman at the front of the room had written, “Learning to work together,” on the board, both in English and in Nyanja. But it soon became clear that it wasn’t a classroom lesson. The morning was full of games, many with a teambuilding theme. There was a simon says type game, which caused occasional outbursts of laughter from the entire room. There was a game outside, where they scattered rocks on the ground, one person would be blindfolded, and everybody else had to guide them through by telling them which way to step. It was great to see this group of kids, all of whom are orphans, really having a chance to enjoy themselves. Some of them left impressions on me, and I tried to capture them in pictures, but I don’t know that I managed to do it so well.

After the youth group, we drove a little down the road to a small shop. CINDI is also involved in giving out microloans. The woman who owned the shop was grandmother age, wrinkled, short, wrapped in chitenge of various patterns, hardened from life but with a smile underneath. Age can be deceiving here, I always peg people as older than they are. I think life here takes its toll. She, together with some other women, have been given a microloan to start this shop. They don’t sell much-some cooking oil, soap, some beans, some mealie meal, one single little girls dress. But it’s enough. I think she enjoyed practicing greeting us in English just as much as we enjoyed greeting her in Nyanja.

So our little morning trip to Kalikiliki was interesting indeed. We will be returning. They hold youth groups in other neighborhoods, in addition to groups for widows. Seems like a very fulfilling weekend activity.

More on Gender and Sexuality

At the office on Friday, there was a lunchtime discussion whose topic was announced only as, “Gender and Sexuality.” We had no idea what to expect, but we knew it would be interesting.

An hour later, I came out of the session, head spinning. While in some ways, the discussion was quite explicit and it’s reassuring that these topics are beginning to be discussed more than they were before, it wasn’t exactly a promising discussion either. I think they could use a little dose of Salt N’ Peppa.

The amount of misinformation and unwillingness to be frank, even among much of the CIDRZ staff, was far from reassuring. The most memorable part of the session was when we were broken into five groups. Each group was given large piece of flip chart paper with a topic for discussion and a list to make.

Group five, which included some of my roommates, was meant to present on street words, vulgar words, common words, for body parts that can be considered sensual or involved in sex. The first word on the list was “ears.” When the presenter for the group read it out, he prefaced it by saying, “I don’t really know how that works, but my American group partners wanted me to add that one in.” Same with neck, and navel. It made me sad. When they got to the obvious penis and vagina, they chose the most benign terms they could think of without actually choosing the anatomical name. For penis, they used “Zanako.” Zanako is actually the Zambian National Bank, whose slogan is “Big, Strong and Reliable.” For vagina they used “Boma,” which actually means government, because the government holds everything together. When pressed by the session facilitator for other words, they said they were too vulgar and inappropriate. But that was the point of this exercise, to throw these words out there, be okay with discussing them and why we use them.

Group one was meant to discuss sexual practices that are probably common but that people normally don’t ever discuss, and the misconceptions surrounding them. “What if…I put my mouth on his penis?…I put my mouth on her vagina?…We rub genitals?” A few things we learned from this discussion. If a woman gives a blowjob, she’s a prostitute. If a man goes down on a woman, she’s a prostitute. And if you do any of these things, it means you’re going to have sex, and therefore it’s a huge risk for getting HIV. And he seemed to be saying that oral sex was a big risk factor for HIV, without differentiating it from the risk of any other type of sex. The facilitator’s tone implied that thus, you shouldn’t do any of these things, because it’s uneven power and puts you at risk for HIV. But I don’t think that’s the point at all. The point is, if you can talk about these things with your partner, you will be empowered, and equal with your partner, and safe, and lower your risk for HIV. But that message just wasn’t there.

Group two had to list different sexual practices. The list was quite short. Interestingly, group sex was listed. One timid nurse raised her hand and asked quietly, “What’s group sex?” Want to know the explanation? It’s when more than two people have sex at the same time. “This can be a man and two women or two women and a man.” Apparently there never have been and there are currently no homosexuals in Zambia.

I learned from my group that, it is said, that if you have sex when you’re too young any combination of the following things will happen: you will have long fingers, your family will disown you, you will become blind and you’ll be barren.

The snickering and muffled laughs in the room was reminiscent of a middle school sex ed class.

This session and the one about the secrets of Zambian bridal lessons have given me a lot to think about. You ask why there’s an HIV epidemic in Africa? It’s because nobody talks about sex, even partners. They don’t discuss it with each other before, during, or after. It’s dark and quiet. Women are submissive or they’re whores. Men do what they want. There’s no foreplay, there’s very little variety. People hold so many misconceptions that they’re afraid to even think about asking questions, or discuss, or deviate from what they’re taught about how it’s meant to be. Homosexuality is treated as if it does not exist. Men refuse to get tested, even when their wives and children are HIV positive. Some women cannot even go get tested unless their husbands give the okay. Most women have no power to ask for a condom or even negotiate when or if sex will happen at all. It’s essentially acceptable, and expected, for men to have girlfriends and then not discussed. The list can go on.

Certainly, I’ve made generalizations. Certainly not every Zambian relationship is like that. Certainly you can argue that many of these issues are also issues back at home. The gender balance is by no means equal in the States. But it’s certainly better.

I think there is hope here. The Zambians in our office discussion said that the younger generation is more and more willing to discuss. Maybe, for the generation after that, it will be the norm. And for the sake of the people of Zambia, of Africa, and all the other parts of world where the gender balance and sexuality are not discussed, let’s hope that it’s true. Because if they continue to treat sex and sexuality as the completely taboo subject it is now, HIV will continue to ravage through these places and there may be no future generation to be empowered.

The Death of a President

Levy Patrick Mwanawasa is dead. He died Tuesday at 10:20 am, in a Paris hospital. He was only the third president of Zambia since it gained its independence in 1964. He is the first Zambian president to die.

His death didn’t come as a surprise. Back in June he had a stroke. Since that time, there had been little information disseminated about his condition. It was always the same, “Let us pray for our Great President Levy Patrick Mwanawasa.” They always say his full name like that. As days became weeks, the lack of information spoke for itself. The country was abuzz with speculation. They were angry too, but only in speech, not in action. “Why haven’t they told us anything? When will they make a plan for the transfer of power? There’s only so long they can let us go on without a leader.” It didn’t help that parliament has been spending all its time trying to pass through a very controversial pay raise for themselves, especially because they suspected that elections would be happening soon.

All the uncertainty left us interns to speculate as well. What will happen if and when he dies? How peaceful will the peaceful Zambia prove to be? All I could think of were the numerous elections held around Africa in recent years-Kenya, the Congo, Zimbabwe, which proved to be less than fair and peaceful.

When word did come through of his death, I can’t say much became clearer. The government has been in the process of writing a new constitution, but it’s not finished yet. So the old rules still apply, I think. There’s a lot of confusion on the street about what exactly is the procedure from here. It seems that the vice president will continue the temporary power he has had until the funeral on Tuesday, after which the Chief Justice will be sworn in. Elections will take place in 3 months or 6 months, depending on who you talk to.

There was a palpable hush to the office on Tuesday afternoon. Everyone lost in thought. Whether about a leader they loved and respected, or uncertainty about the future. On Tuesday night, we turned on ZNBC, the national station, to find a live tribute show. It was somewhat laughable (however inappropriately) in that it had the quality of a small town public access show, with unsteady cameras panning in and out, focusing on not quite the right area and hosts looking at the wrong camera. But amid all that, there were some nice recollections of Mwanawasa, some touching music, and some fired up religious speeches.

Our Nyanja teacher told us today about what the funeral will be like. The president’s body is being flown from Paris into Lusaka on Sunday. People will line Great East Road, from the airport all the way to the Show Grounds, which represents several miles, to watch the body drive by. Traditionally when there is a funeral, anyone who wants to will come to the house to pay their respects. Everyone removes their shoes. The women sleep on the floor in the house. The men sleep on the ground outside. There is no way the state house could accommodate an entire country’s worth of people who want to pay their respects to the leader. So they decided to hold the funeral at the Show Grounds, where just a few weeks ago, they celebrated Farmer’s Day with the annual agricultural fair.

From Sunday until Tuesday, his body will lay at the Show Grounds, and some people will camp there the entire time, sleeping on the ground, partaking in the house of mourning. After the burial, nobody knows what to expect. The campaigning will begin. It’s not expected that there will be any serious unrest or violence. But it may also be best to steer clear of the compounds during the campaign because if anything were to happen, it would happen there.

Forget Obama and McCain. No doubt, experiencing a Zambian political campaign firsthand will be a memorable experience.

Olympic party

The other intern house has been attempting to have a weekend get together every weekend since we've been here. In honor of the Beijing Olympics, we held our own games. The teams: such fine countries as Palau, Togo, Turkmenistan and Fiji. The events: relay races, badmitton, nshima spoon fencing, monkey bars, garden hose jump rope and of course, limbo. Let the games begin!



Nshima spoon fencing. Take that.


And that!

Preparing for the three legged race

And they're off! Sarah and Mackenzie in the lead!

Doubles garden hose jump rope event

Or quadruples

How low can you go?

Pictures from Sarah K.'s 30th Birthday Party 80's style coming soon!

On language and miracles

Last Thursday we had our very first Nyanja lesson. Nyanja is only one of the 72(!) tribal languages spoken in Zambia. In Lusaka, it’s probably the most useful language to know, next to Bemba. It’s tricky though, because even Nyanja has multiple forms-the form spoken in Lusaka and the form spoken in Eastern Province. Not to mention the fact that we’re learning somewhat formal Nyanja and many people use slang all the time. This means that an introductory dialogue that we learn like this…

A: Muli bwanji?
B: Ndili bwino. Kaya inu?
A: Ndili bwino pang’ono

…could just as well go like this

A: Muli bwanji?
B: Bwino. Muli bwanji?
A: Bwino.

And that’s only a short example. Having both Nyanja and Bemba spoken throughout Lusaka also means getting them confused. Some days I’ll come home from the clinic, proud that I’ve picked up on some new words, and then find out that it’s Bemba. But really, most people in Lusaka know both, so if I mixed them, it wouldn’t be terrible.

Our language teacher also incorporated cultural aspects to the lesson. He asked us to make a list, off the top of our heads, of all the impressions that we as Americans, and Americans in general, had of Zambia/Zambians before we came and also now that we’ve been here. At first it was a rather benign listing of phrases such as: Africa, safaris, colorful clothing, nshima (traditional food), and friendly people, but as we went on, we added things like: HIV/AIDS, malnutrition, poverty, famine and mud huts. Then he pulled out a list that he had compiled: what do Zambians think of Americans.

It’s truly a love/hate relationship. On the one hand we are viewed through the eyes of Hollywood and movie stars, we are viewed as these people who can work miracles, who can come in and make anything happen. He used the word “better,” but better in the sense of our opportunities and quality of life. But on the other hand, we are seen as devil worshippers, as immoral, and that we brought HIV/AIDS to Africa to kill off black people. It was a very interesting and frank conversation, and I’m glad, because it shed some light on two separate events that have happened to me recently.

The first occurred several weeks back. I ran across the street from the Ng’ombe clinic into a little convenience store to buy more talk time for my cell phone. The owner of the store was clearly very excited to see me, almost as if he thought I was somebody very important. He proceeded to tell me about the proposal he had written up, and that he wanted to share it with me. In my rush to get in and out of the store because my ride was waiting, I agreed to read it. He gave me a printout about 15 pages long describing a poor compound in the Eastern Province, near Malawi. Essentially, it was a proposal outlining a plan for this community to develop itself, through job training and microfinance type projects. It’s a solid plan, one that would help any community in the developing world. Of course, they are seeking funders and he was hoping I could make it happen. I suppose you can say networking is networking. He thought it couldn’t hurt to show it to me, you never know who you are going to meet. But now I really understand that my whiteness alone meant to him that I had a better chance of getting it done. I’m a miracle worker.

The second occurrence was just last week, also at Ng’ombe. I have worked there a couple of times with a Clinical Officer student. We had a conversation about how he loves psychiatry and his dream would be to go to medical school in the United States. He asked me a lot of detailed questions about how medical school works there and how much it costs. At the clinic this past Friday morning, he told me he wanted to have a long conversation with me about it. But I had to leave midday, and he was still seeing patients. He seemed mildly annoyed by this, and wanted to meet up with me over the weekend to discuss it, phone no good, email no good. Suffice it to say I wasn’t super enthusiastic to make special plans to meet with him on the weekend, and I didn’t. I don’t really know what he wants from me or thinks I can do for him. Because I am white, I must be able to find him a scholarship, a sponsorship as they say here, to come to the US to study. I don't mean to sound harsh, but sometimes my patience for this wears thin.

I constantly find myself shifting back and forth, between enjoying meeting the friendly people here, and getting so exasperated that many people seem to talk to me because they want something and they think I can make it happen.

On the street, there’s a pervasive sense of entitlement that because I am white, it means I’m rich and thus I have to give people what I have, because they have so little. People have no shame in approaching me and straight up asking for money, more than pocket change. Even our guards feel they have the right to steal our laundry soap (we won’t be leaving that in the laundry area anymore) or knock on our door at 8 am on a Saturday morning to nonchalantly ask for tea.

It’s true, they have very little, depressingly little. For people enrolled in ART, there’s a program similar to food stamps, whereby under a certain income, you qualify to get free soy protein every month. Last week I found out what those income qualifications are. You thought the poverty line in the US is unrealistically low? Here, you only qualify for free soya meal if you make less than 50,000 kwacha per month, that’s roughly $15. That’s nothing! Right now I probably have four 50,000 kwacha notes in my wallet. Especially in Lusaka, you can easily drop that much on a few items at Shoprite in one shopping.

I continue to redefine how people see me here, what my role is and what it can be. I struggle with the dichotomy between my life within the walls of my home, with my satellite TV, swimming pool and plentiful western food, and life as soon as I walk through my gate- trucks belching thick, black smoke, bed stacked four deep with men being driven to their jobs that pay them less than $1 a day, children running in tattered clothes and women sitting by the side of the road, wrapped in colorful chitenge, selling small bags of beans for 500 kwacha.

Okay, this entry is probably already long enough. But I’ll end with an impression, a thought, a question. Last week my roommates and I watched that Mel Gibson movie The Patriot which happened to be on TV one night. In all its gore and glory, it showed how an army of essentially rebel soldiers, were able to gain independence from the British and establish a functioning, stable country (until the Civil War anyway). It really got me thinking, it was a freaking miracle. Really, how did they do it? Sure, in its youth, the US had its share of growing pains. But they put together this system that worked, overall.

What is it about all these African countries? Why can’t they do it? They too gained independence, through rebel armies in many cases. Many of them have been free for 40 years or more. But I suppose the long history of colonialism and oppression was too much. The poverty and corruption are pervasive. I am here to help with a tiny part, health, the only part I know. I’d like to think my little part will contribute to the overall plan to better this place. But sometimes it’s hard not to think that it never will get better.

What else can I do but go on with my job? Each morning I take a deep breath, walk through my gate, and muster a smile and a muli bwanji to all the smiling Zambian men along the side of the road who want to greet the white chick, miracle worker.

Oh yeah, I have a job

So I’ve been here almost a month now, and you’re probably wondering, is she actually working? Didn’t she go all that way to do research? And yet here she is, busy writing about safaris and fairs and dances as if she were on vacation? Have no fear, the work has begun. I thought I’d write some more about it, just so that you all know what I’m really doing.

Project #1

OPD-ART Integration

I think I’ve already written a bit about this, in relation to the street drama I attended. This is week number four of the experiment that is the new, multi-purpose, integrated ART and regular outpatient clinic at Ng’ombe. In some ways, it’s going well. The file problems of last week have been worked out this week. Some of the staff is getting better and more efficient at the new system. But in other ways, it’s rough, and we’re far from finished. Change is never easy, but I think that’s particularly true here. From talking with my roommates, it seems that workplace dynamics here are very different than they are at home.

Here’s the glaring example. Understandably, the staff at Ng’ombe is stressed, and somewhat bitter, about the new system being tested out on them. It involves a lot more work and dedication on their part. New systems and clinic flow needs to be ironed out. Patients wait longer. Staff needs to stay later. But instead of sticking with it, of continuing to try and be the pioneer, the leader in this change, they decide they want no part of it. Since Thursday, there have been absolutely no, that’s right, none at all, medical officers (MOs) or clinical officers (COs) at the clinic. They have all called in with the excuse that their children are sick. ALL OF THEM. But really, I believe, all of them have decided they just don’t want to show up and deal with the stress of the new systems. So then what happens? All of the nurses are left to care for the patients as best they can. There are some things they can do, and some things they can’t. If a patient shows up at 7 am, and waits until 4 pm, and the nurse cannot help with his ailment, he has little choice but to go home and hope there may be an MO or CO tomorrow. Then the staff gets even more bitter and more helpless with the new system. My heart goes out to the nurses who stick with it. My heart goes out to the poor patients who wait all day long to see no doctor at all. I wish there was more I could do. At this point, I’m too new to know who to contact, or how to tread carefully, or how not to step on anybody’s toes. Our CIDRZ supervisor is away in Mexico City for the International AIDS Conference. Hopefully, when she gets back, some of this can get sorted out. But it highlights this pervasive feeling that people will not do any tiny bit more than their job description or what they are paid to do. And often, they do less.

What’s so frustrating is that we are working out the kinks. Last week it was the clerks and the filing system slowing down the patient flow. This week they are wonderful. But the MO and COs aren’t there to see it.

We’re planning to set up integration of another clinic in October. I think we still have a lot to figure out.

What I want all of you to take away from this current state of affairs is this: the next time you show up on time to your doctor’s appointment and are forced to wait 30 minutes because they’re behind schedule, don’t complain. Be thankful there’s a doctor to see. Be thankful you have more than 4 minutes to spend with them.

Project #2

TB/HIV Peer Educators

Over the past few years, as the number of ART clinics has grown, the number of people taking ARVs has grown as well, and there is a need for more and more personnel to help treat and monitor all those people. There have never been enough nurses and doctors, and the number of new patients only exacerbates the problem. Yet much of the work that needs to be done can be done by people other than healthcare workers. In addition, this massive HIV epidemic has required creative approaches to help get it under control. Enter, peer educators (note: certainly not a novel idea for HIV treatment, peer educators have been used for years for all types of public health problems).

The community branch of CIDRZ has a strong HIV peer educator program. The peers are all Zambians, all members of the community, and are all living positively with HIV. They are trained in all aspects of HIV- etiology, medical issues, treatment, management and most importantly, counseling. The thinking is, that because they are going through it themselves, they are in a unique position to guide and counsel their newly diagnosed peers. In reality, they often end up taking on more responsibility than their job description entails. They encourage those to test who have not, they counsel those who receive a life altering positive test, they run support groups. They have been fabulously successful in increasing testing rates.

So here’s the TB part. Many people with HIV develop TB. Many people with TB are found to have HIV. Our goal is to make sure that testing and diagnosis goes both ways. Almost every clinic has what’s called a TB corner, the area of the clinic where patients go to get their TB treatment, as well as education and support. At this point, we’ve gotten pretty good at ensuring that all patients at TB corner are tested for HIV, or at least counseled to test. But many people who test positive, for many reasons, never actually enroll in HIV care. We want to fix that.

My project, which has been two years in the making, is to monitor and evaluate a pilot program to train new TB/HIV peer educators. The ministry has given us the okay to train four educators in two clinics. We have to prove, through a thorough programmatic evaluation, that they really make a difference and hopefully scale up the program to more than two clinics. Will more people from TB corner agree to get HIV tests at their clinics? Will more people enroll in HIV care? Will the peer educators be satisfied with their jobs and feel that they are making a difference? Ask me in April and hopefully I can give you the answer.