Wednesday, November 21, 2012

A Memorable Week--Gina's Post


A Week in the Life: September Edition (Sorry it's Late!)

Again I'm on Zam time with getting my blogs posted, but I wanted to give just another little snippet of village life intertwined with transportation stories of some of our travels.   This last series of journal entries dates from September when we were on our LONG journey back to the northwest of the Northwest province from Lake Tanganyika.

September 26th: 24+ Hours of Transport
I don't know if we actually woke up, because I don't know if being on a night bus since 2:30pm the day before counts as sleeping.  But . . . the bus stopped at its final destination, Kitwe at about 2am, letting us fend for ourselves finding onward travel toward Northwest Province in the middle of the night after 12 hours of being on a bus.  I was quite tired myself, and Scott kept falling asleep on the mosquito-infested benches when we heard the call "Chingola, Chingola, Chingola" from the driver of a shared taxi who was able to drop us off at a hitching junction just as day was about to break.  

At the junction, a nice policaman named Felix who usually stop cars to search before the northbound traffic goes to the Congolese border asked us where we were from, what we were doing, and told us he would talk personally to the drivers to help us find a ride.  Sure enough, after about 20 minutes he found us the bed in the cab of a semi bound for Solwezi.  The driver stopped to pick up several other paying passengers, and all I wanted to do was take a little nap at the Peace Corps provincial office in Solwezi.  Unfortunately, the office was closed for a workshop, so Scott and I decided to try to get to Mwinilunga that very same day.  We stopped at a little shwarma shop next to a gas station around 9:30 and took turns watching our bags and going to the market for needed essentials.  On my way out of the restroom, I ran into Sally, a blond Australian in an SUV doing a Shoprite run.  She was happy to give us a lift to the nearest mine where she and her husband work.  She apparently used to manage mines in Australia, but couldn't handle the Zambian men talking down to her, so she quit her management position and "is getting used" to being a housewife like all the other expatriate women on the mining compound.  She was just glad her husband could pull in a good salary here in Zambia and was quite astounded when we told her our Peace Corps stipend.  

After that mine, we waited by the side of the road for quite some time and met Richard, the self-proclaimed neighbor of the Peace Corps house.  He had a passenger in the front, drove extremely fast, and was on the phone the entire time.  I alternated fearing for my life and drifting to sleep.  When he turned off, a super friendly mine worker in a pickup truck named Jeremy gave us a lift in his cab, although he had to turn off at the third mine down mining row.  Just as we were waiting at the corner expecting that our only other options would be the late afternoon bus or a cantor truck, a white Zimbabwean ex-farmer turned mineral prospector after the Zimbabwean government seized seized his tulip farm in 2006 (Mugabe's government re-possessed all land owned by whites, no matter how many generations the land had been in the family) said he could give us a lift until his next prospecting site.  Although he went to Europe for 6 years and just recently returned to Africa, he still visits family and friends in Harare every 6 weeks.  It was about 3:30 in the afternoon, and in the past 24+ hours, we had been on seven different vehicles.  
Now that we were on a desolate patch of tarmac past the mining strip, we were exhausted and our best hope of getting to Mwinilunga was either by bus or cantor truck.  Luckily the next vehicle we saw was a cantor truck with Maggie and Brian, some of our Peace Corps friends, in the back.  We found out that the truck wasn't actually going to Mwinilunga, and we were too tired to look for transportation #9, so Scott and I made the executive decision to camp at Bryan's for the evening and try to find a hitch to our site the next day.  His neighbors looked on and greeted us in Lunda as we set up the tent, and it was nice to hear that familiar language after a week in Bembaland.  Brian was a wonderful host and made a stew of soup mix, pasta, and soya pieces.  He also heated us a hot bucket bath over the brazier and we played Monopoly cards while it started sprinkling lightly as I passed out in the tent, probably before 8pm.  Scott stayed up to play yet another game.

September 27th: Homecoming!
We both slept in past 8am, which was much needed, as it would have been hard for us to get back to the village in the dark and exhausted.  We wanted to buy eggs to make pancakes for Brian, but all the little tuk shops were out of the essentials.  I walked about 2k down the road to the school and there was no one selling eggs that side either.   Nontheless, we enjoyed eating breakfast on Bryan’s front porch, including tea, slightly gritty homemade tortillas (since there were no pancakes), jam, and apples.  Bryan noticed that he had chicks hatch the previous night and he placed the new hatchlings in a hawk-proof enclosure he made out of chicken wire.  One chick dropped from the elevated nest to the ground, and I got to hold the little hatchling before giving it back to its mother. 

Unfortunately we were enjoying the morning breakfast and chicks too much, because we heard several vehicles pass by the nearby road toward Mwinilunga from Bryan’s house.  Since there would be no buses passing by until at least 3pm, Scott, Maggie, and I headed toward the road around 9:30 to try to flag down any vehicle that might be going to Mwinilunga.  Maggie waited by the shops while Scott and I walked a kilometer to a scenic spot by the river.  We saw nothing for hours except a few completely full cars.  I read over 100 pages of my current book and we took turns drifting to sleep under a tree by the road.  At least the weather was pleasant.  Finally around 1pm, a family van passed us by, and Maggie was already in it!  Luckily they had space for two more riders.  It was a very generous Lunda family; the father had gotten a job at a mine near Solwezi, while the grandmother and child took turns greeting us in Lunda.  They were only going to a junction before Mwinilunga, so dropped us off there, while first offering us a snack.  We politely declined as it was generous enough of them to take 3 passengers plus all of our luggage!

It was about 1:30 pm, and we waited under a chota near a bar to get out of the midday sun.  Drunken men spoke to us about white people in broken English while women brought Maggie and myself a bench and we exchanged pleasantries in Lunda.  The drunk men proceeded to talk specifically to Scott about Lunda culture, especially adolescent initiation ceremonies.  One of the drunk guys did manage to flag down a vehicle for us since it was hard to see from the chota.  It was a cantor truck packed full with baskets, luggage, huge sacks full of dried fish, and over 15 people sitting precariously on top of everything.  I hung on to a piece of strapping for dear life as the truck plotted along the road in the bright sun while the wind whipped my hair around.  Unfortunately the strapping was coming off of the stinky bag of fish, so I wedged my foot between two of the sacks, hoping the leverage would keep me on the truck!  Maggie dropped at her place, and I immediately climbed down to her spot, which seemed less life-threatening.

We reached Mwinilunga BOMA at dusk and I ran to the post office to find a surprise package from Meredith and Jeff!  It definitely brightened the day of long waits and harrowing transport.  We were so close to home . . . but unfortunately we checked around town and all vehicles going toward our village had already left for the day.  We could either start walking up our road 20+ kilometers toward our village and hope for some type of transport on the rural dirt road, or splurge on a taxi.   We grabbed a quick egg sandwich and meat pie for dinner as well as bread to take to the village and opted for the latter.  It was a boy probably no older than 19; he had never even been up our road before.  A friend of his jumped in “for the ride,” and they were both very grateful for our business, asking us if we had any other work for them.  Of course we had to explain that we were Peace Corps volunteers and us taking a $20 taxi to the village was not a frequent occurrence. 

Scott and I arrived home at dusk after over 3 days of being on transport or waiting for transport.  Ryvus and Ryford had swept the area surrounding our house and even filled the water drum!  And . . . we had hatchlings of our own.  Six out of 7 of Beta Jones’ chicks had survived and were chirping and teetering around with their proud mother.  We laid our bags down, opened our package, and fell straight into bed.

September 28th: 2 Births
We must have slept in, since the chickens were already out and about, and then proceeded to have a delicious breakfast of 5 eggs from our chickens, basil, and tomatoes from the garden.  I spent the morning doing chores including unpacking, tending the garden, sweeping chicken manure, and washing dishes thinking I could spend all day around the house just settling in.  Scott had an impromptu visit from a local NGO vehicle who had enough fingerlings (baby fish) to stock 4 ponds he helped design, including the church pond.  When he came back, we both went to visit the neighbors to see the new well they were digging by hand and their new goat milking stand.  The well is finally functional, and many neighbors are going over there with buckets.  They were proud to show how they had trained the goats to call them by name and have them jump up onto the milking stand.  Altogether, there are 2 pregnant does and 2 young does.  So far, only the very pregnant one tolerated human touch, but at least it’s a start.  The neighbors looked on, impressed that there will be milk in their very own village one day. 

I finally rode my bike to the clinic around 11:30 just to touch base after several weeks of being away.  I didn’t really expect to see many people, since many of the clinic volunteers knock off for lunch around this time.  I couldn’t have been more wrong!  There were 70+ women and their children waiting for under 5 clinic, which is basically to weigh the children to see if they are malnourished.  A different volunteer than usual was manning the scale, and he said the clinic was being audited by people from the district and the daily volunteer was helping show the government officials the records.  Usually I know when government officials are around because of a large SUV parked in front of the clinic, but I guess these three had been dropped off. 

I went in to help them find some papers they were looking for when I heard a knock at the window by Hildah the TBA (traditional birth attendant).  I thought Hildah might just be saying hello, but it seemed urgent, because she said there was an “underweight” baby in the labor room that needed more immediate assistance.  I spoke with the three auditors to see when their SUV was coming back, and they mentioned that one was actually a doctor who could probably help.  He calmly entered the waiting room and saw a baby with good color swaddled in blankets and laying by itself.  “This one looks fine,” he said, and almost turned to leave.  Luckily Hildah opened the door to the delivery room, saying, “not that one, this one.”

The baby was a pasty white, not breathing at all, and sitting like a lump while her mother mournfully looked on.  The child was still attached to her mother by the umbilical cord, which the doctor directed to have cut.  He asked if we had a suction tube in the clinic, and of course we did not.  By this point, the small child was turning blue.  He swaddled the non-breathing baby and did a series of chin tucks and repositions to get oxygen down the airway.  Time stood still and I helped hold the large bag valve mask that was far to big for this little one as years infant CPR courses rushed through my head.  The doctor was trying to get the correct angle for airflow when I volunteered to look in the main clinic building one more time for a simple suction device.

The two auditors were still in the med room, unaware of the emergency out back.  They handed me one of the newly-arrived labor kits, which of course had everything but a suction device.  Back in the labor room, the baby was turning slightly pink and produce barely audible coughs.  There was finally a very weak cry, and I called the mother to come in from the waiting room to see her child, but she would not hold her.  The baby remained wrapped up, alone, barely breathing on the birthing table, and the hospital workers heated up warm water bottles to keep the heat.  Of course I wanted to tell them she needed her mother’s skin-to-skin contact, but I felt there was some unspoken cultural taboo that prevented me from it.  I left the labor room, not being able to handle knowing if the baby continued breathing.

I went back to the main clinic, furious, saying to the auditors, “now you all know exaxtly why our clinic needs a nurse.  That baby in there almost died, and it would have if we didn’t have a doctor here happening to visit.”  They nonchalantly went about their business as if this small clinic’s problems were nothing.  Seeing how distressed I was, the head of the auditing team suggested I write a letter of complaint to the district office about the lack of any trained professional staff at our facility (there are supposed to be two).  I sat down right then and there and wrote a 2-page letter, trying to state my observations about lack of staffing at our clinic for this past year.  I highlighted that I as a Peace Corps volunteer am supposed to do health education, not direct treatment, and I am in no way a substitute for a trained nurse at our site.  I hand-passed the letter to the head auditor, looking at him directly in the eye and giving him the this is serious look.

I really wanted to go back home, but Hildah wanted me to see another live delivery (it would be my 3rd in Zambia), and I was secretly curious to see how the little boy in the makeshift incubator was doing, so I decided to stand in for this next birth.  They had already cleaned the labor table with bleach and water and another mother was on it ready to give birth!  I asked if the woman had brought a green antenatal card just to check for any health information and scanned it for any red flags surrounding the birth.  There was no red mark in the corner like there should be for a high-risk birth, but I glanced to the left in the HIV test column, and sure enough, it was marked “R” for reactive, meaning the mother was indeed HIV+.  I went to the main clinic building to ask the volunteer tester if this was an error, since all women who are HIV+ are supposed to go to the BOMA to start taking antiretroviral drugs that can prevent the virus from being passed to the child while in utero.  He told me that she was in fact positive and after counseling, had declined the referral to the BOMA for treatment, most likely because the 20 kilometer walk was too much, along with the cultural taboo of being HIV+.

Well  . . .  too late now to get this woman to Mwinilunga for a hospital birth . . . her contractions were getting closer and closer together, and the TBA said the child was coming at any time!  We called the doctor was auditing back in to address this 2nd maternal complication, and he recommended a regular delivery and that the child commence drugs at 6 days to prevent HIV transmission through breast milk, if the child hadn’t already contracted the virus in utero or through the birthing process.

The delivery itself went very smoothly.  Like all of her fellow Lunda women in labor, the mother made barely a sound indicating this was probably one of the most painful events of her life.  It’s against their culture for some reason to let out even a cry.  The small head poked out, and then the body, and the TBA used gloved hands to stretch the labia and catch the baby without a single tear in the mother’s skin (a good sign as far as the prevention of HIV was concerned).   I peeked over at the barely breathing baby lying in the bed next door just to make sure he was still alive.  Shouldn’t he be with his own mother? The woman in labor had two of her female village elders in the room to assist with the labor, and the elders and myself jokingly betted whether it would be a boy or a girl.  It was a girl . . . she won the bet!  As the TBA cleaned the area and cut the cord, one of the elders gently manipulated the women’s belly to coax out the afterbirth.  They immediately put the beautiful girl on the scale and she was a healthy 2.6 kg.  One elder swaddled the child as the other elder helped the mother bathe in a bucket next to the bed.  The other women came in to celebrate this happy event.

I went out into the waiting room, and the celebrating women gave me a bowl of raw honey on the comb, which they like to eat straight.  I could only stomach one bite, due to nerves from the previous two events.  The mother of the resuscitated baby was lying alone in the waiting room, clearly NOT celebrating, while her barely breathing child was still swaddled in blankets and hot water bottles in the delivery room.  I insisted that they be together, since that child would surely die if he didn’t start breastfeeding soon.  She hesitantly accepted but was internally already grieving.  The auditors’ SUV came to finally pick them up, but not before I spoke at length with the doctor about helping to arrange a simple CPR course for the clinic volunteers and birth attendants.  He said he would like to come back and teach one of these days, but he has so many clinics to audit, who knows if we’ll actually see him again.

I biked home and Scott had made a delicious salad with produce from our garden that was abundant after several weeks of being away.  As the clouds and thunder started rumbling in preparation for a big storm, I couldn’t help hope and pray for those two infants that just came into this world—pure survival for the small boy, and the hope for a HIV-free future for the little girl.  We brought anything that could possibly get wet inside, and Scott was about to take a solar shower when the sky broke loose and water inundated the carth.  I guess when it rains it pours . . . a good analogy for the crazy day at the clinic!

I heated water over the coals and had a luxurious bucket bath in the pouring rain.  Scott and I had a late-night dinner of onion mushroom soup as the rain lessoned, but continued spitting at intervals for the next three hours.  We didn’t even need to collect it from the roof since our water containers were already full.  I prayed again for the two babies.

September 29th: 2 Deaths
We woke to the fresh smell of rain and damp earth like a new beginning.  I went across the road to keep up with the goat-training project, but someone forgot to close the door of their stick shelter, and they got out overnight and were currently running around happily in the bush. 

I came back home to piles of dirty laundry from several weeks of being gone piled onto three days of riding on Zambian transport, but could only do half of the big bag due to time constraints as well as worrying about limited indoor hanging space in case the rains came again!  Doing laundry in the village consists of squishing and squashing it with my feet in our big plastic tub (almost like stomping grapes!) and then  going through garment to manually remove any stains that are left with a brush.

Scott looked at the sky, waged a bet that it wasn’t going to rain today and announced that he was going to cement the roof of our newly-constructed (thanks to Scott, Brad, Ryvus, and Ryford) bathing shelter before another big rainstorm hit and literally melted the hard work from top to bottom.  His goal is to finish both the bathing shelter and storage room this week. 

I rode my bike to the clinic and was running what I thought was late for an 8:30am appointment with an HIV counselor to talk with the woman who delivered yesterday about preventing HIV transmission to her newborn child.  When I arrived, there were no clinic workers . . . just the typical 5-10 patients with various ailments and their family members cooking.  Waiting is just part of their daily lives. 

I went across the road to Hildah, the TBA’s house, and she stated that there was a death of an “old man” early in the morning just up the road.  She and her husband were just walking back from the funeral.  She also plainly told me, with no emotion, that the baby who needed resuscitation died in the middle of the night.  The mother had already taken him home to be buried.  He had not received a name, and the mother did not go through the formal grieving process as she would if she lost an older infant of child.  There would be no funeral for this little one.

The clinic worker was also walking back from the old man’s funeral, and we discussed the baby of the HIV+ mother.  Together, we decided that it would be best to test the baby to see if she had already contracted the disease in utero before we contacted the counselor.  This would enable him to figure out exactly how to best support the mother.  While he went to the clinic to give the HIV test, he asked me to go to the old man’s funeral where I would probably find both the counselor and the baby’s father seated with the group of grieving men.  I asked if it was appropriate to just call them out of a funeral and he said it was quite alright as these things usually last several days, and people moved in and out to pay the bereaved family respects.

 As I arrived at the funeral, I expected to find little circles of men gathered around fires and little circles of women cooking on the other side, as is typical in Lunda culture.  There is no memorial service per se, just circles of family and neighbors chatting and comforting the bereaved.  This was happening to an extent, although most of the men were in a shelter in the back.  Never before had I been to a funeral before the body was buried (apparently this man had died in the wee hours of the morning), and I could see inside the small mud house that there was a body inside the doorway and some women caring for it.  I went around back to the men's sitting area, but couldn't find either the counselor or the child's father that I was looking for. 

I felt very awkward interrupting this intimate ceremony for a dead man I didn't even know when I was invited to sit with some of the women outside of the house and wish them my condolances.  As always in funerals I have attended, there was very little talk about the departed one and much attention on me and my Lunda speaking abilities which Zambian foods I ate and if I could cook nshima and how many children I had.  I did manage to find out that rather than an "old man" this man was a well-respected middle-aged farmer who tends cows.  He collapsed and died suddenly without any signs of illness.  He had two young children and his wife was expecting a third.  All of a sudden, I could hear wailing and crying inside and one elder woman signaled me to take my stool inside the house. 

The body was lying on a reed mat in the middle of the empty front room, covered head to toe with a blanket.  Several women worked to remove the blanket from the man's face, and there was much discussion in Lunda about how he should best be positioned.  A man came in with a jar of Vaseline and started rubbing the departed's hands and feet to keep range in his joints.  Almost on command, the wife of the dead man and several other women began a series of ululations that were a combination of wailing, crying, and singing in a chorus.  Others either joined in the familiar mourning song or just sat on stools around the body and watched the body preparations. 

When the man finished with the range of motion, a group of five men (I assume brothers and close friends) came in the room poking and shaking the body.  They were play-acting, as if making sure the person was actually dead.  They then started the man-song of deep wailing and moaning and they did what I had yet to see a Zambian man do: cried.  The men were ready to put talcum powder on the body, so I took that as my cue to leave.  I gave some money to the family as custom at Zambian funerals so they could help feed the swarms of visitors for the upcoming 2-3 days.  I imagined that this viewing would be only several more hours since of course there was no embalming fluid, but was told that the vigil would go well into the night. 

I rode my bicycle back to the clinic with a sad heart from the unexpected funeral end discouraged that I didn't find either of the two men I was looking for.  I spoke with the volunteer HIV counselor and the day's news didn't get any better: the baby girl born yesterday was tested HIV+ as was her 6 year-old brother who had reported to the clinic with flu-like symptoms during the birth of his sister.  The baby girl had contracted the virus in utero.  I spoke with the clinic worker at length about how the clinic HIV counselors could have possibly prevented this transmission if they encouraged the mother to go to the BOMA to take her antenatal drugs back in April when she found out she was positive during routine antenatal testing.  We made a plan: find the other counselor and meet at 16:00 with the mother, father and child to discuss treatment options.  This was the first time I was involved so intamitely in a case, but felt like I should follow-through with a family who otherwise might not seek further treatment.

I rode home and Scott mixed concrete and had almost finished topping mud bricks on the bath-house.  We ate a simple lunch of tuna sandwiches.  I rode several kilometers past our house to a surreal sight: yesterday's rain had brought out swarms of flying termites.  Kids were catching them with their hands by the side of the road, and hawks circled their evening meal from up above.  I found two volunteer counselors who said they would meet at the clinic at 16:00.  I also stopped by the house of a headman down the road who was washing clothes in the dambo (shallow lake area) behind his house.  He was washing his best clothes as birds were circling in the afternoon light.  I told him that the workshop I invited him to had been moved up a day and would actually start tomorrow, and we both hoped his clothes would dry.

I bought eggs at a small stand at the road, but no one was selling bananas, so I biked toward the river, hoping to buy an entire bundle of them straight from a farmer.  I met my smiling Zambian friend, who said he had few bunches left except one of about 30 bananas (vs. the usual 70-30), so he threw in a free papaya and sold it all to me and said, "you are my customer, name your price."  I paid him 4 pin (US 80 cents), which is actually above the going rate.  I also gave him a bag of dried bananas from our solar dryer, and he says he loves them and wants to learn to dry them himself.  We exchanged cell phone numbers, because his last phone dropped in the river.  That way he could call when more bananas were ready!  I rode back home up the hill, started the charcoal brazier, and put on some lentils for tonight's dinner.  Scott kept working on his concrete project . . . luckily the sky stayed clear.

One of the counselors for this afternoon's meeting rode his bike to my house and together we cycled back to the clinic for the meeting with the newly-diagnosed children.  The father, mother, and two relatives were there, as well as two community volunteer HIV counselors.  We kept any attention away from shaming the parents and focused on the positive aspects . . . including treatment options for the two children.  The family members asked a lot of good questions, and agreed to support the mother by accompanying her and her children to the BOMA for treatment next week.  The family was very grateful for the education session, although the mother was distant/passive and definitely still grieving.  The counselors agreed that the meeting was a success, and they would like to have more like it with newly-diagnosed patients.

I rode home at dusk and took a lukewarm solar shower in the still-drying outdoor bath shelter.  I thanked Scott for all his hard work as he took over dinner and also fried some eggplant given to us by some neighbors while I was busy at the clinic.  We sat in our chota, drinking tea into the darkness, and watched the full moon rise and then hide and show itself luminously among the fast-moving clouds intermittently as the kitten ate spiders.  Life can be cruel.  It was moments like this that put things into perspective.

- We randomly met Sally the Australian again at a restaurant in Lusaka.  Small world!
- Stripe, one of the female goats across the road had two does and we are now collecting milk from her.  Some of our villagers like it while some do not.
- Miraculously, all 6 baby chicks survived into adulthood--5 hens and a rooster.  We kept our alphabetical theme going and named them after states: Hawaii, Idaho, Jersey, Kentucky, Louisiana, and Georgia.

- Our clinic finally got a nurse 3 weeks ago, after over 15 months without a single professionally trained staff.  He had been away at school studying midwifery, so hopefully maternal and child health will improve quite a bit.  Unfortunately due to inadequate housing, he still rides his motorbike back and forth from the BOMA and doesn't come on days that it is broken or out of fuel.
- We're in the process of training our Safe Motherhood Activities Group, and a CPR class is definitely on the agenda for all birth attendants!
- The family with the two HIV positive children did go to the BOMA for treatment, accompanied by one of our volunteer counselors.  The mother and son still have a high CD4 count and don't yet need to commence antiretroviral drugs.  The baby girl's health is being monitored.
- We're working on a drama group to educate villagers regarding issues related to HIV/AIDS, since it is still an issue that is very taboo to talk about.  The idea is to get people with HIV diagnoses to get treatment without shame or fear.
- The kitten is still catching spiders, the moon still rises, and life goes on!

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