Thursday, August 30, 2012

Gina's Post: Another Week in the Life



Yet ANOTHER Week in the Life

 Every three months or so, I like to journal what I do every day for about a week so folks can get a glimpse of rural life in Zambia.  There is not really a typical “day” as each day presents its’ own rewards and challenges.  The last time I intensively wrote in my journal was from the last week in June to the first week in July.  Enjoy!

Thursday June 28th: Cooking Day
-       I woke naturally with the sun and chickens around 6:30 am.  It’s been nice to not have to use an alarm clock since being posted at our site.  Did the morning chores including watering the garden with our wastewater and fed the chickens.  I drank some green tea from a thermos, which was still warm from last night, and prepared for a big cooking demonstration day at the clinic. 
-       Another volunteer Kelly stayed the night to help with a refresher course I’ve been putting on all week for 6 community health workers and 11 members of the Safe Motherhood Activities (SMAG) group.  Topics covered so far have been: reasons pregnant women should have a clinic delivery, why fathers should accompany their pregnant partners to the clinic, HIV transmission, family planning, and malaria prevention 
-       Scott helped her fix her flat bike tire in preparation for the 2+ hour bike ride back to her village later this afternoon.
-       Scott went to a mud brick church down the road to finish teaching a 2-day workshop for fish farmers sponsored by a local NGO.  He had spent all last evening cutting out paper fish used for an educational hands-on activity as most of the villagers he taught read and write very little.
-        I arrived at the clinic around 8:30 and Kelly arrived shortly after with her newly-fixed bike.  Since all the SMAG’s and CHW’s were actually sleeping on foam mattresses in the clinic for the week (some came walking from faraway villages), breakfast was served.  It came a little late but was tasty: tea with creamer and sugar, boiled sweet potatoes, and roasted peanuts.
-       The workshop started at 9:30 (only half an hour late), and the participants gave a very good re-cap in Lunda of yesterday’s session.  They divided themselves into 3 groups to practice teaching expectant mom’s coming to today’s antenatal sessions about HIV, malaria prevention, and family planning techniques.
-       During this groupwork, one of the course participants who had a stomachache was lying on a reed mat on some grass outside the clinic porch (Lundas like lying in the sun if they feel sick).  She was not bothering anyone, but I went to go get the clinic worker in the next building over to see if she could get some pain killers and oral rehydration solution. 
-       Upon coming back, I saw almost the entire group of 16 participants surrounding the sick one and saying that she was possessed.  Upon seeing that she had an audience, the woman started convulsing and speaking in tongues.  Many started praying and saying that they needed to carry her to the church to get rid of her evil spirits (granted we WERE in a clinic).  Even the in-charge agreed that there was nothing he could do and maybe it would be better for her to go to the church. 
-       Kelly and I patiently waited in the makeshift hospital-room-turned-clinic since almost all the class participants were outside trying to calm the poor woman of her nervous fit.  Finally the in-charge (not a nurse mind you) gave her a shot of some type of tranquilizer and the woman drifted into a deep sleep. 
-       It was like herding goats to get all the CHW’s and SMAG group back into the classroom to talk about this afternoon’s child nutrition session and cooking demos.  We started with drawing pictures of the difference between extremely malnourished and stunted children.
-       Lunch for everyone consisted of nshima, soya pieces, and boiled beef leftover from last night.  During lunch, I received a message on my phone that the guest speaker who was supposed to come from Mwinilunga tomorrow to teach about water and sanitation was not going to make it.  This is definitely not the first time that BOMA officials have cancelled on me!  I guess I’ll just teach all of the content.
-       We had one more short classroom session after the men came back from bathing in the river, and we reviewed ways to enhance children’s porridges to give them more nutrition.  The health workers sorted food into three different baskets: “go, grow, and glow” for carbs, proteins, and fruits/vegetables and talked about foods that make you do each of the above.
-       Then for the fun part!  The groups divided up into 5 co-ed groups, which was fun to see since traditionally Zambian men don’t cook.  They each made a different children’s food: pumpkin porridge, sweet potato porridge, eggs with veggies, soya patties, and pounded peanut and dried fish porridge. 
-       Each group was very proud of what they made and village toddlers (many of whom were malnourished) came from across the road to test.  They liked them very much!  The health workers were encouraged to give them small amounts and to eat slowly.  Even the older kids wanted to eat some, but unfortunately we didn’t have enough and we had to re-enforce that the younger children had priority with the food, which was good role-modeling for the mothers of the malnourished toddlers.
-       As the sun went down, the adults finally got to try their own creations for dinner, and there were mixed reviews, but most of them liked the dishes.
-       I rode my bike 4k home under the half moon, which was bright enough to light up the road as I saw warming fires from the various family compounds. 
-       I got home, took a quick foot bath, re-capped with Scott on his day’s events at the fish farming training, and tried checking my phone messages only to hear that the network was well.  Oh well . . . more time for sleep!

Friday June 29th: Toilet Inspections
-       This was day 5 of a 6-day course, so there was no time to do many morning chores except wash my sandals, which really needed it!  I did have the lovely experience to waking up to a dead bird and big pile of feathers under the bed that the cat brought in, but no time to even clean it.  I threw the bird outside but to no avail as the cat brought it right back in as a play toy.  Sigh!
-       Scott spent the day getting wall lime from a Peace Corps neighbor’s house, visiting me at the clinic, gardening, and making yummy pumpkin curry.
-       I biked to the clinic with full-fingered gloves and a coat in the early morning chill and brought baking soda and a spatula to make pancakes for the health workers camping at the clinic for their training.  One of my male counterparts enjoyed flipping the pancakes, which was fun to see, and everyone enjoyed eating them.  Anything containing flour and oil in the bush is a true treat.
-       The workshop actually started close to time (9:00) and I had each cooking group re-cap what they made and if it had all 3 food groups.  They said that all the recipes could be used with small children, except for the eggs, since eggs are too expensive and traditionally eaten by adult men only. 
-       The Safe Motherhood group finished up their four days, and they each got mosquito nets and the names of 2-5 pregnant women in their area to distribute directly to the houses of these women while providing health education on malaria prevention. 
-       We were left with the six community health workers, who were able to practice giving a health talk at the clinic where over 100 children under 5 years came to get weighed.  Even though all day’s session was supposed to be about water and sanitation, I couldn’t pass up the practical learning experience.  Everyone helped with both the weighing and tallying of kiddos at two different weighing stations.
-       Unlike a typical scale day where they just weigh the kids like produce and then just send them home without telling the parents if they are underweight, we practiced assessing the growth charts do determine which children actually needed special assistance and helped the health workers formulate how to explain better nutritional practices to the parents.
-       Scott biked to the clinic to join the group for lunch, which consisted of nshima, dried fish, and a tomato-onion sauce.
-       In the afternoon, we went over a list of expectations for all of the health workers to receive a refresher course certificate.  They will have to do different types of health promotion tasks in their villages, and we will have a follow-up course and give out the certificates in November if they have completed the tasks.
-       We then took a little field trip to some different compounds surrounding the clinic to assess various pit latrines.  The first place we stopped was a nearby family whose latrine was completely full (and uncovered at that), so everyone was using the bush, which was dangerously close to the nearby river.  We assessed what would be a good spot to build a new toilet and educated the family on the importance of disease prevention for the entire community.
-       The second compound was strikingly different and a model for sanitation; both male and female chimbushis, both made out of strong bricks and covered with good roofs to prevent erosion in the rainy season.  The toilet holes had covers and were swept daily with ashes to disinfect.  This gave the health workers a good comparison so they could come back to the classroom activity of writing up a checklist of things to look for in a village toilet.
-       For dinner the group had nshima and chicken, which we had just seen squawking moments earlier.   I bypassed this dinner to come home to Scott’s cooking of pumpkin curry just before dark.  As I was arriving our house, there was also a visitor I had never met asking for money for his HIV group.  Most of the villagers know by now that we just don’t hand out money . . . but there are those occasional few!
-       Although I should have been planning for tomorrow’s lesson at the clinic, I was tired and read a few chapters of my book before retiring straight to bed.

Saturday June 30th: First Do No Harm
-       Today is the last day of the refresher course! Although I enjoy teaching at the clinic a lot, I’m ready to be done with 10+ hour days at the clinic that include teaching as well as managing meals and logistics for health workers from remote villages camping out at the clinic.
-       Yesterday the health workers prioritized that they wanted a refresher on basic diseases, so I woke up with the roosters (no alarm clock these days) to look up infectious diseases and make a little matching game. 
-       I was a little jealous because Scott went to the agricultural show in the BOMA that was happening Friday and Saturday only.  I wanted to see it to compare it to the Yakima fair, but alas, it will have to be next year. 
-       I again cycled to the clinic in the morning chill and found that breakfast of sweet potatoes and roasted peanuts were still cooking over the fire.  I prepped for the last day only to find that the markers we use to write on butcher paper on the wall were all finished, so I went back home to get more markers knowing the course would definitely start later than 9am today . . . and so it goes in Africa!
-       I came back and breakfast was ready.  We prayed, ate, and prayed again before the course began.  We re-capped the toilet session and problem-solved how the health workers could address issues of full toilets/no toilets on family compounds in their communities and ended the discussion with six toilet experts!
-       The next topic was weighing children, since many of the health workers are very good at the actual weighing, but many have a hard time looking at the charts to determine if a child is actually underweight or not.  We practiced plotting lines on growth charts and assessing the curve to see if it was going up or down.  It was fun to finally see them “get it” to see if a child is actually underweight for his/her age or not. 
-       Lunch consisted of soya pieces and of course nshima.  Mmmm .  .  . not that I don’t like nshima, but it’ll be nice to have a break when the course is over.
-       The last lesson was called “first do no harm” as these community health volunteers have pain killers, malaria medications, cough syrup, antibiotics and a myriad of other drugs (thanks to generous foreign aid donations) at their disposal.  Unfortunately, their 6-week training six years ago was hardly a substitute for a solid pharmacology background.  Most of these health workers end up working in the clinic quite often since we have had no nurse much less doctor there for over a year.  They often pass out medications at patient’s request, thinking they are doing a good thing by making the patients feel better.
-       This session re-iterated that health workers’ main job was disease prevention, and then went over the side effects of each of the above classes of drugs mentioned above.  We also discussed the concept of drug resistance, which they had never been taught about, and the importance of having a patient finish an entire course of antiobiotics or malaria medications.
-       Many of the health workers had an “ah-ha” moment, realizing for the first time the dangers of side effects of some of these drugs they had been passing out like candy.  Some even admitted, “we’ve been giving too many medications.”  Even though it was only a short session, it piqued their interest enough that they want to learn more about medications from a trained nurse when we re-unite in November.
-       The very last activity was the disease matching game and let me tell you I was surprised by these health workers knowledge of diseases such as measles, lice, and syphilis.   They knew more than I thought!
-       The health workers helped clean up after the week-long course, which involved carrying by hand the church pews we borrowed from the Catholic Church ½ a kilometer up the road.  They got their mosquito nets for distribution, and we ate a last meal of nshima and kapenta (dried sardines) together.
-       I rode home exhausted as the sun was going down and the full moon was coming up.  It was slow-going since I had a small leak in my front tire and brakes rubbing in the back which I hadn’t had time to maintain all week.  But I did have a good sense of accomplishment for a week completed. 
-       I came home to find Scott roasting big marinated hunks of fresh pork over the brazier, which he had bought at the agricultural show.  He liked the show, but said that most of the fresh produce was for display only and not to buy. 

Sunday July 1st: Water Day
-       I slept in until 7am, which is a near record for the village considering the sound of roosters and people working that usually wakes me up.
-       I helped Scott fill our large drum of water with our neighbors, which is a 3-4 person affair involving 1-2 people at the well raising buckets of water on a rope and 1-2 people biking and dumping the buckets into our drum.  I took advantage of the bounty of water to soak the garden. 
-       I had every intention of going to church, but because there was so much to do after being gone for 6 days, I decided to stay home for some laundry and cleaning.  We ate a simple breakfast of sorghum porridge and canned guavas, and I started scrubbing away at our clothes by hand as a local high school student put dried grass on an extension of our outdoor kitchen right above me.  We blasted music on our mini AAA battery speaker and the Zambians loved it.  A few neighbors came over just to hear the music. 
-       Crispin helped Scott dig a foundation for our new bathouse/bikehouse.  Although the villagers make these mud structures all the time, they got a kick out of a chindelli (white person) doing it.  They especially liked seeing him use the level. 
-       I did some gardening/weed pulling and picked some tomatoes, basil, and lettuce from our yard.  This was my first fresh salad from our garden in about two weeks.  Also some bike maintenance including jerryrigging the back brake until I have time to replace it. 
-       I rushed to the clinic, thinking I was late with a follow-up meeting with the clinic in-charge and two of the course participants.  The in-charge said he didn’t want to meet because he was tired and only one of the participants.  Had I known, I would have finished fixing my brakes.  So is life. 
-       I got home to make dinner of boiled sweet potatoes, some the size of a small football (took an hour to cook), and granola with fresh local honey.   Scott made collard greens and cooked up the pork he had been marinating all day VERY throuroughly as there’s no fridge around here.
-       Evening consisted of tea, journal, and bed by 8!

Monday July 2nd: A Baby Named Scott
-       Today is some Zambian national holiday that I don’t remember the name of because these holidays really mean nothing to the village workers.  They still go to their fields, pound cassava and build bricks like they would any other day.
-       I went to get drinking water at a spring about 1 kilometer away. Usually there are kids or women around, but this time I got to enjoy the tranquility of the hills and trees by myself before lugging 10 and 20L jugs back up a hill to my biked parked at the top. 
-       Chores today included a deep clean of the bedroom floor, including removing termite trails, the beginnings of ant hills and the remnants of Hop’s scuttle with the bird a few days back as well as starting sweet potato bread.
-       I went to the clinic to make the re-scheduled clinic and the in-charge said he was going home for lunch and gave me the keys to the clinic.  I started counting money leftover from the refresher course (originally provided by the district health office) because we had to account for every single kwacha spent and writing a repot for the district. 
-       We did have some leftover money, and when the in-charge and a course participant finally returned, I asked what they thought we should do with it and they automatically said “bicycles for the clinic volunteers.”  We debated this as the clinic had two bicycles for this very purpose just a year ago, and they mysteriously disappeared.  Better to get something more practical like benches and shelves so patient charts didn’t have to sit on stacks on the floor.
-       We moved all the mosquito nets to the locked pharmacy room to make sure that only community health volunteers had access to them to distribute to pregnant women. 
-       I went to the labor room building, and saw the latest delivery—a male.  I asked what his name was and the mother said that I should name him (this has happened on at least 3 other ideas, so if anyone has any name suggestions . . . ).  Before I could even open my mouth, the traditional birth attendant piped in, “Scott.”  The mother and father both approved, so the name stuck. 
-       I rode back home and worked on the bread, which turned out more like flatbread.  Scott cooked up some leafy green veggies and we had some pitas.  The full moon rose and the night was eerily quiet for a full moon . . . no sounds of children playing and no neighbors huddled around their warming fires. 
-       Scott started burning our trash, and by 8pm we heard what sounded like a procession of people singing and then yelling.  We didn’t know what it was but thought it might either be a funeral procession, a witchcraft trial, or some type of church event.  We had a treat of dark chocolate and dried cherries sent from the States . . . yum!

Another Week in the Life!

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