Caughtya with 10 Billion Kwacha

Within a short two weeks – some of my frustrations with working in African countries have flooded back – no country is immune to corruption and misappropriation of funds, but it seems to be magnified on this continent.  The big news in the MOH over the last few weeks has been the 10 billion kwacha (2 million dollars) that has disappeared into the pockets of some very high up officials.   Having just returned from four rural clinics with absolutely no clean delivery kits and dropping a woman off at a district hospital without any aspirin to offer patients for pain, I find this even more enraging. 

When I arrived, only one person very high up in HR was implicated, but this week, several more arrests have been made in the accounts and planning departments, including the Director of Planning, who I met with on my first day in the office.  Anti-corruption police are everywhere and the general sentiment is fear in the office (everyone’s personal accounts are being investigated) and retribution in the public.  Even more money is being spent on the investigation and then the court proceedings – people want them locked up without another penny wasted on judicial processes...and frankly, I agree.  Denmark, Sweden and the Netherlands have frozen their aid to the MOH, until the government takes some serious action.  On some levels, I agree with their stance in pressuring the government to act swiftly, but unfortunately, the wrong people will be the victims of these measures and even less supplies will make it to the communities I have visited.

In terms of my work, many of the challenges with rolling out the program have been hold ups within both those department under investigation.  I fear it is only going to get worse in the next few months...especially since the staff has decreased considerably in both those departments, given the arrests made this week.  

As if I don't already attract enough attention...

The energy was intense in Lusaka yesterday as soccer….I mean football…fans from across Zambia prepared for the Barcelona v. Manchester U. game.  I caught the fever and joined a couple of Dutch guys I met earlier in a bar to watch the game.  As they sat with their Heinekens, I gave them a hard time for drinking THEIR local beer and not THE local beer.  Finally, they were sick of hearing of my comments and for the next round, Reuben said they would drink Mosi (my fav local beer), if I would drink a Heineken.  Naturally, I agreed – they were buying J

Like a scene in a movie, after about five sips of my beer, a team of Heineken promoters (I still can’t believe they exist in Zambia) marched into the bar, looking for people drinking Heineken.  Of course, I am the ONLY person drinking it – suddenly a Heineken shirt is thrown over my head and I am given sunglasses with green-tinted lens, as well as a champagne size bottle of Heineken.  All the while, four people were taking photos and videos, and a crowd was gathering, as confused as I was about what was happening.  And then the poor Dutch guys – looking on in disbelief…

The car can go no further -- time for the canoes to take us across the swamp.

Safe Motherhood Action Group members in misoprostol training

I am hiring these guys the next time I move!

Electricity and running water at last!

Abortion -- legal, but not really....

Abortion is legal in Zambia, but only with the permission of three doctors.  There was no doctor in any of villages we visited and I learned that there was only one doctor in the entire district center.  Therefore, legal abortion was not a reality for the women we met…but that doesn’t mean it doesn’t happen, it just means that it is not done safely. 

Halfway through the training of the Ngabwe SMAGs the MCH coordinator was called to check in on a woman who was suffering from an incomplete abortion.  She was in extraordinary pain and in serious danger of death.  However, without a working pontoon, it was impossible to safely transport her to the health center across the river.  We send her to the next closest health center, Mukubwe, which is over 1.5 hours by vehicle. 

By the time we returned to Mukubwe that evening, she had not progressed, but fortunately, she was not worse either.   As I walked into our room, the MCH coordinator was pouring over books, trying to figure out what to do next – with no doctor and limited medicines, there are not many options.  The sad reality for so many women here.

The following day – she still had not progressed and we decided to drive her to the district hospital – a short 6 hours on a bumpy, dirt road.  We dropped her off at the hospital, but with no money I have no idea how she will get back to her village when she is better….

Chase

I quickly learned the universal game of chase was a favorite among Zambian children.  During breaks, I spent hours chasing children.  They would also find me during the training sessions and in a charades-like fashion act out running to signal they wanted to play. The group would usually start out small – maybe 4 or 5 – but by then end I would be chasing between 20 and 25 children, ranging from 2 to 13 years old.  At the end of our play sessions, I always called for a group hug and all twenty-five of us run toward each other and crash in the center. When I would return to training they would wait outside the door, poking their little heads through the cracks, running in place, and I would have to shoo them away until the next break.

One day they came with a piece of chalk and said, “Teach”.  Teaching is not one of my strengths – let alone teaching when I had no idea what to teach.  I started out with the alphabet and then went through numbers – working on English pronunciation.  Again the number of students began to multiply at incredible rates.  I went from a class of ten 5 and unders to 50 students ranging from 2-13 year olds, with a group of even older kids peaking through the windows.  I drew pictures of everything I could imagine and wrote the English name on the board until I eventually ran out of chalk….phew. 

   

Musungu drinking mukoyo 

Rural Health Clinic

Misoprostol poster at clinic

My sleep arrangements in health center.

Can't figure out how to delete -- so here I am again :)

Musungu Plots Against the Chief

In the bush, many nights were spent sitting on the porch of clinic, telling stories by candlelight.  Many were stories of black magic or poisonous snakes – and now, thanks to my colleagues, I am afraid to sleep at night because a witch doctor will choke me in my sleep or walk to fetch water, because surely there is the most deadly snake in the world waiting to bite my leg. 

However, one night, we were back to our other favorite topic – men.  Apparently, among the Bemba tribe, the men used to tell the women that they should not eat chicken.  I can’t remember the reason they told them, but the motive was their own greediness for more chicken (not surprising).  Many older Bemba women still do not eat chicken for this reason. 

While, this myth has generally been stifled, it is still a strong tradition that if a woman cooks a chicken and does not leave the gizzard for the man to eat, then “it is not a chicken at all”.  Not serving the gizzard to the man is a HUGE OFFENCE!  And the company that sold packaged chicken, without the gizzard, nearly went out of business.   Which brings us to talking about the Chief again – everyone was still very excited about meeting him.   (The day before it was discussed how the two bodyguards we met were also responsible for tasting the Chief’s food before he ate, to ensure he wasn’t poisoned).  In the talk about the importance of the gizzard, Delphine asks, “Do the guards get to try some of the gizzard?” Apparently not, we learn.  To which I reply, “I guess we know how to poison the Chief then”.  Again shocked faces dissipate into laughter.  Now musungu not only wants the mealie meal back, but she wants to poison the Chief while she is at it.  I decided it was time to get out of the bush before the word got out…   

Musungu Meets the Chief

In route to Ngabwe Village, we stopped at the palace of the chief to pay our respect.  His palace consisted of a concrete home surrounded by several straw-roof round huts.  They were many customary steps that we had to follow in terms of asking the “body-guards” for the Chief, greeting the Chief (kneeling and clapping three times) and then giving him a gift – in our case a huge bag of cornmeal, which one bodyguard could barely lift, even though I had been throwing it up to the top of the Land Cruiser all week.   Hence the earlier quotation marks.  Maybe the Chief is hiring…

Later in Ngabwe village, we ran into a problem.  Our resupply truck did not show and we had no cornmeal to make food for the participants who showed up for the training.  I asked, “Can’t we go back to the chief and get our cornmeal back?”  A group of shocked faces looked at me and then everyone broke into fits of laughter as they realized I was joking.  For the next three days, barely an hour would pass when someone would bring up, “Ahh….musungu wants to get mealie –meal back from the Chief” and everyone would laugh and high-give.

Musungu and the manual camera...

During the lunch break, one gentleman came up to me with a huge manual camera and asked for help loading the film. He had recently bought the camera and had never used one before. I had never used such a beast of a camera before either, but I decided to give it a shot. All was going well, until I accidentally clicked a button that completely rewound the film, making it impossible to use. My heart sunk and I asked if there was anywhere to buy film. Everyone said “no” and I wanted to crawl in a whole. I tried prying the film back out, but of course this was useless. Finally, someone came running in and said they found a shop that sold film and the owner the camera went to buy a new roll. Hearing the news, I chased after the man, pleading to pay for the film, since it was my fault in the first place. Phew – problem solved – a $2 roll of film would allow me to sleep soundly that night.

Ngabwe Health Center

The village of Ngabwe is on the far side of the croc-infested Kafue River.  The pontoon boat is broken and given the remaining small-dugout wooden canoes for transport, I am secretly relieved that the MOH teams refuses to cross.  I was not particularly interested in being a crocodile’s lunch and the loaded, home-made canoes barely sat an inch above the water.

The Safe Motherhood Action Groups to be trained met us on our side of the river instead….which was no easy feat, as the health center was 17km from the river.  The village and health center were not only very isolated, but also very underserved, with only one community health worker to serve up to 70 (yes, 70) patients a day.  Thus, the work of the SMAGs was especially important.  The group of SMAGs was predominantly men, which I found interesting, but learned there has been a recent push by the MOH for more male involvement.  For all the indolent men I had seen in the past few days, these men were extremely committed to the issues of women and I was honored to work alongside them.

However, the training did not happen as planned because our resupply truck from the district center did not arrive at 11am, as it was supposed to.  Without any form of communication with the district, given our isolated location, we just sat and waited all day long with the disappointed SMAGs who traveled 3 hours to reach the training that wasn’t happening.  Finally at 4:30pm, we gave up waiting and left, planning to drive 7 hours back to the district and hopefully return the next day.  As we packed up the truck and readied to leave, the SMAGs looked so disheartened….not sure whether we would return or what would happen. I felt horrible and held back tears as we drove away. 

About twenty minutes down the dirt road, we saw another Land Cruiser racing towards.  Lo’ and behold – the supplies have arrived.  We turned around and it was all smiles as we unloaded food and training supplies.  I have never seen people so happy – this was even given the fact that they would spend the night on the hard concrete floor, waiting for us to arrive the next day for the training, since it was too late to start. 

We arrived the next day and the training went smoothly, even though 15 bodies were cramped in a small, extremely hot room.  We kept the momentum going, wiping sweat from our foreheads every few minutes, and finished with only one glitch…

Chilwa Island Health Center

After two more hours down dirt roads, passing straw-roofed huts and waving children, we arrive at the swamp.  Chilwa Island Village and Health Center is a one hour canoe ride across the swamp, followed by 1.5 hours on foot.  MOH staff will not cross the swamp, so the training is held on the side where we arrive.  17 Safe Motherhood Action Group (SMAG) members arrive for the training.  The SMAGs will be in charge of outreach to community members – sensitizing women to misoprostol as well as other safe motherhood initiatives.  I helped with setup and logistical details and then they organized for someone to take me across the swamp – I also convince Peter to join.  Our escorts used a long bamboo stick to push off the bottom of the swamp and keep the canoe moving.   While one of the boatmen was very shy, the other one was quick to tell me that there were snakes similar to anacondas in the swamp.  Even though he had never seen one and could not report knowing anyone that had seen one – he promised they existed.  I tried to explain the Loch Ness monster to him, but something was lost in translation.

Later on, he had two wives – one on each side of the river.  I am not sure whether or not he was telling the truth, as he had a mischievous grin on his face as he explained how he spent one week on one side and one week on the other.  Either way – when I gave him money at the end of the trip, I said in Bemba (after having Peter coach me) “Thank you for the ride.  Give this to the madam – I mean madams-- and do not spend it all on beer”.  He laughed for a good five minutes and I could tell that he told all of his friends when we arrived back at the village. 

I arrived back at the village for the second half of the training – since it was conducted in Bemba, I was not much use, so I continued labeling misoprostol packets.  The participants understood a great deal of English and so I introduced myself and explained the purpose of my visit – to check in on the work they would be doing in the next couple of months.  They asked how I would collect the forms they were responsible for filling out.  “Look at her”, the woman in charge of the health center said and pointed at my feet. (To get to the boat, I have to do some wading through mud and my feet and ankles were beyond filthy).  “She is willing to cross the river and she is willing to come to Chilwa Island to check in on you”.  Everyone just stared at my disgusting feet and smiled.  Later, a man came up to and said that he was looking forward to my visit and that he lived 38 km from the shore where the canoe would drop me off. 

Makubwe

After 7 hours, five of them on a very bumpy dirt road, we arrived in the village of Makubwe, where we would sleep for the night.  I had never seen so many stars in my life – no need to worry about light pollution here, because the only lights were those of burning candles and my headlamp – a genius invention for this type of situation.  We were shown our room for the night – one of the clinic treatment rooms with a few mattresses on the floor.  Most of the ceiling was missing because it was bat-infested and an obvious health hazard for a clinic.  It still smelled so strongly of bats, that I slept with my blanket over my head each night and reminded myself that bats are better than mosquitoes.  I also slept in every piece of clothing I had brought because it was so cold.  This health center was our home-base as we traveled each day to a different village and health center.  Every two days, we would be given a bucket of hot water in which to bathe and every night we return in the dark to a meal of ishima (traditional staple food) and cabbage.  By the end of the week, we trained 4 Safe Motherhood Action Groups about the uses and importance of misoprostol, so they could do outreach within their communities.

Thank God I'm a Country Boy

As I walked into the office last Tuesday morning, the TB department was very busy – imagine respected Zambian public health ministers and directors in suits and spectacles, staring at computer screens…and tapping their shiny shoes to the blaring “Thank God I’m a Country Boy”.  True story.  

Funeral Invitation

Dr. Lois was disappointed to hear that I would be traveling on Wednesday and not able to attend a funeral with her…  Dr.: “Don’t worry, honey – plenty of people will die before you leave and as long as it isn’t me, I will make sure you go to the funeral”.   Me: “Um, thanks?”

Musungu Learns Nyanja

Given how much time I spend in the car with Peter (MOH Driver), we have decided to make use of it with Nyanja lessons.  He first explained that musungu meant “white person”, but this I did not need translated, as 4 out of 5 people say this word as I walk by.  In South Africa I was mlungu and in Zambia, I am musungu.  However, my favorite new word so far is yeweo, which means “yes”.  

Four days in and I already found a running partner!

The trip to Kipiri Mposhi was delayed until Tuesday, which meant day 2 in MOH. I have taken up walking to work – although – not without problems, as I walked a good 15 minutes in the wrong direction before getting assistance. In asking for directions, I also gained an escort to the office…although a 30 min walk took 1.25 hours, so I think he took me on a tour. Either way, at some point the conversation turned from our appreciation of walking versus riding in the crammed mini-busses to our mutual running interests. Turns out he runs for 2.5 hours, several mornings a week! Imagine that – not only did I find someone to run with, but someone who likes to run for a long time. He is well over 6 feet and legs like a giraffe, so I am not so sure how this arrangement is going to work.
I will also have to turn on my filter for our long runs. At another point during our walk – remember 1.25 hours long – he began telling me about his family situation and how he is not married. I asked if he had a girlfriend – “you know, dating without the commitment of marriage”. “Oh – a girl who is my friend –yes”, he replies. “Well not really just friends – more than that, but you don’t have to marry her”, I try to explain. At this point he makes the noise that Tim Allen used to make on Home Improvement. At this point I nervously laugh, realizing I have overstepped in trying to understand the culture here – “Uh, it must just be something Americans do”.
Or maybe it is just what Zambian men do after they are married. As the next conversation of the day was with a MOH driver, who explained to me that he had a wife and a girlfriend, as do ALL the men, according to Peter. I will spare the details, but I am sure you can imagine where I took this conversation. Ever the feminist.  Poor guy has to drive me three hours in to the bush tomorrow too. I have a feeling he is going to be one of my closest friends, though.
Other news…
I attended a huge concert on Saturday – geared towards HIV awareness. Turns out a contact I made before leaving the US is the Chief Advisor to the National AIDS Council in Zambia, so I had VIP treatment all day long. Something I am still getting used to… I have been in more Land Rovers in the last four days than I care to count. I have thought about starting a picture blog in which I pose in front of Land Rovers, emblemized with UNFPA, UN, WHO, USAID and the list goes on. There is an incredible amount of foreign aid in this country – and yet huge health challenges persist. Hmm…..
And my self-appointed Zambian mother turned into the evil step-mother at some point between Friday and Saturday. (Her daily accommodation rates were also more than my rent in Berkeley!) I quickly moved over into a more reasonable accommodation—equipped with a pool and bar – and very friendly neighbors. All day long I am greeted with, “Kareeeeeeeeeeeen from Caliiiiiforniaaaaaaaaaaaa”.

With that so said, so long for now…….promise the next report will have more news from the field…
KarEn from californiA

Feet on African Soil

After six movies, a manic Structural Inequalities paper writing stint in London and two full days in transit, I arrived in Lusaka – excited, exhausted and not knowing north from south (oh wait – I never know that—the plight of the directionally challenged).

Rabecca – my MOHZ contact – picked me up at the airport and dropped me off at the house of Ms. Constance Daka – my self-appointed mother while in Zambia. She showed me to my room and I proceeded to sleep the afternoon away, only to wake up for dinner and a staring contest with her grandson – then back to sleep for another 10 hours. I feel adjusted, but as I sit here typing on my laptop, I am reminded that while my watch says 11am, it is only 2am in CA.

Upon arriving at the Ministry this morning and getting connected to internet – my gmail inbox greeted me with messages from friends in South Africa and Zimbabwe saying “welcome home”. Oddly enough -- I did feel of sense of homecoming as soon as I landed in Jo'Burg. Having been away from the continent for almost three years now, I thought my sentiment would change. Although, when asked if I have spent time in Africa before and I mention living in South Africa, I am told it is not Africa, except for in name. Apparently Zambia is the “real Africa”, so stay tuned; I haven’t had to fend off any lions yet…

I leave on Sunday for the first site visit to Kipiri Mposhi – a district several hours outside of Lusaka. Will be there for about a week and will be in touch soon after.