A Letter from Zambia

1. A Letter from Zambia Wanda Thuma-McDermond 1/16/11

2. Sunday, January 16, 2011 Hi to all. I decided to write this as a “real” letter that I could attach to an email. That way I could give more detail perhaps that will not be on Tara’s blog. We arrived safely last Sunday so we have had one full week so far, with another to follow. All went well coming through Livingstone last weekend with no hiccups or problems at all. The road between Livingstone and Choma is completely tarred and still in great condition. Now there is also a new tarred road from Choma to Namwala so the dirt and potholes have been reduced to about 15 km (6-7 miles) from the Namwala Road turnoff to Macha itself. The main problem with the rainy season so far has been that lightning hit the internet tower and so access has been spotty. Most evenings I take my laptop to the dorm for the students to try and get access, and it has been better now towards the end of the week.

3. Today is rainy – again. It is a slow steady one compared to some of the thunderstorms and driving rain that have come through in the past week. The mile’s walk to church will be a bit muddy this morning. I will wear my chitenge wrapped around my skirt so that I can get there without too much mess. It is embarrassing how scruffy I feel compared to the Zambian women who can still arrive fresh and spotless. I think the students have had good learning experiences so far – from the hospital to the market to outreach to just being here. I haven’t heard too many screeches in the night so the spiders must be scuttling out of everyone’s way. You can see their long legs poking out from behind pictures or mirrors on the wall. Leave them alone and they will eat mosquitoes!

4. Yesterday’s rounds are something of a typical example for the week. I assigned the students to follow the doctors or “medical licentiates” (equivalent of PAs) on the men’s ward, female ward, pediatrics, and maternity. The men’s ward is emptying out so I shuffled some of the students around since female ward and pediatrics were busier. So far we have not gotten to see any deliveries in maternity, which is a little disappointing.

5. After assigning everyone and making sure that all was going well, I was accosted by a female ward patient who has some obvious psych issues. I’d heard her earlier in the week hanging out of a women’s ward window, yelling away. Most times the Tonga are a very subdued, quiet-spoken culture in public. Students on rounds in that ward earlier in the week had noticed her wandering around, trying to take another women’s baby. Staff gently removed the baby and took her back to her bed. She tried to take Tara’s umbrella one day. Yesterday, the psych patient was wondering around the walkways and open grass areas between the wards. Minders from the hospital and family watched from a little distance but then redirected her when she tried to go into the other wards. At one point, I greeted her as she was trying to walk into the maternity ward - and then she wanted my bag that I carry – kind of grabbed it. So I walked with her back to her ward, greeted her parents (an older couple I suspect – the patient could be 20-30s), and got out of the situation. I then hid out in the chapel area which is an open-sided building in the middle of the complex. From the men’s ward came the sound of women wailing. One of the “RVD” (RetroViral Disease) patients had just died. Some of the patients on the men’s ward had looked very debilitated and basically were on palliative care. The psych patient was wandering around singing loudly from the opposite direction. Visitors and workers around were murmuring gently in Tonga. The rounds in Peds had started some babies crying. So it was an interesting sound picture I heard as I sat there watching the butterflies on the flowers and the lizards running up and down the poles. Then as rounds ended and patients were discharged, especially from Peds and Maternity (a set of preemie twins had finally gained close enough to the magic number weight of 2 kg), mothers bustled by with babies snug on their backs and big bundles on their heads.

6. NOTE: the Messiah students said after rounds that the woman with a possible psychosis diagnosis will have to go to Lusaka (the capital city – about 4-5 hours drive away) for further treatment/care at the only psych hospital in country. That doesn’t mean there is medical transport or anything like an ambulance. Her family will have to figure out how to get her there, maybe even on a public bus. I think the only medication available to her here is Haldol. Tough decisions to make.

7. On Friday, five of us had the chance (at the last minute) to go on “ART mobile” to Mapanza Mission – a neighboring Anglican mission. This is the outreach from the HIV/AIDS work at Macha; peds to adult. We helped with weights (bathroom scales in the middle of the floor of a crowded room – which got more crowded as the rain started and poured in the broken windows, and the people on the waiting benches shuffled and scraped their way towards the middle) and then vitals – BPs for adults but axillary temps for all with 2 mercury thermometers and one digital. I shook down the mercury and explained to the MC students that the yellow mercury thermometers were axillary compared to red (rectal) or blue (oral). The students got back to work and I turned around to find someone had popped the thermometer into a mouth! Fortunately I had a couple alcohol swabs in my pocket to clean things off so we could carry on. The Zambian woman patient laughed about it. (No incident reports here!) In the meantime, the real bottleneck was the “compliance” table so I rooted around in the transport boxes and found some cardboard for a makeshift tray, covered it with some paper HIV file forms, and we set to counting tablets for those waiting in line. Then at the table, they could do the calculations quicker. It really is amazing how well people take their ARVs. Unfortunately we had to head back to Macha at that point for the driver’s schedule – about a 20-30 minute drive. However, I was thrilled with even the short time because I always enjoyed visiting Mapanza as a child. They have an historic church (St. Bartholomew’s – locally pronounced “Bar-toe-lay”) that must be over 100 years old now. From the beginning they used local material and local art and their pictures of a black Jesus in a village setting always made sense to me.

8. The worst crisis so far was the village dog, more puppy size, which fell into the compost pit (about 4 foot deep) beside the garden yesterday afternoon. It was howling piteously! Phil, Elaine and I went out to see how to get it out. Phil tried some boards for a ramp. My suggestion of throwing a blanket over it and trying to pick it up (without getting bitten since none of these dogs have rabies shots) was vetoed since 1) Elaine was not going to sacrifice a blanket and 2) the pit was so muddy and smelly, none of us wanted to get in. As it was, the sides of the pit are prone to crumbling under one’s weight so we were tip-toeing around the edge. Then Elaine remembered a broken plastic porch chair that we lowered in carefully so the dog could jump half way on to it and then on out. By this time the dog was shivering in a corner so we left it. More howls! I took out some left-over “Tennis biscuits” that were in pieces and tried to leave a trail on the chair and up on the top sides of the pit. Elaine and I gently tried to edge the dog that way with other pieces of wood (like chopsticks from the edge of the pit – making sure we didn’t fall in ourselves). We probably looked rather ludicrous, especially as my chitenge kept slipping around my knees. Finally gave up. Tara and the students came back from their walk (for icecream – see blog) a little while later and announced the dog was gone. I went out to check and sure enough, there were muddy paw prints all over the plastic chair – and not a single cookie piece left either.

9. We are well and not going hungry: the meals have included a lot of fresh corn on the cob, zucchini, cucumbers and salad, although the cooks forgot a dressing – but obligingly mixed one up quickly. Salad dressing is such a Western concept to them it’s easily overlooked when setting up the meal. To fill in the gaps, there is a little shop that sells “Eet-Sum-Mor” – shortbread-like biscuits that the students quite like with a cup of hot sweet milky tea from the teashop. We have tried to get some exercise since we walk everywhere but I’m not sure we will lose much weight this way. Hope you are all well too. Wanda