Saving Mothers' Lives in Zambia

Headlamps have arrived in Zambia!

2010-06-08T14:46:00.000-07:00

To all the incredible people supporting HLH-Zambia,

I apologize for the delay in updating all of you on the project. However, many interesting developments have taken place since I first asked for your support on this endeavor. First of all, through your efforts and connections I raised nearly $3,000, far exceeding my initial hopes when I sent out the email. Second, the founder of One Degree Solar came across my blog (and plea) and became very interested in supporting the headlamp mission. Turns out I had also pirated his idea, since he had already developed and patented a real 'Headlamp for Health' after working for several years in Liberia. (I knew I should have gone with 'Headlamps for Hemorrhaging'....) Fortunately, he was very excited about the project and more than willing to help. With his engineering background, he developed a headlamp that was more effective for medical purposes and piloted the solar headlamp in rural health care centers in Liberia. He is currently working with several ministries of health in Africa, bringing solar headlamps and panels to many rural health centers. And now Zambia has been added to the list! I tried out the headlamp for a week, asking all friends to come to me with the medical needs in the middle of the night....and after many band-aid applications, I decided it was the best headlamp for the job :) And because of your efforts and generous contributions, I have sent 46 Solar Headlamp for Health kits to rural health centers in Zambia, plus a number of additional solar headlamps that were donated over the past few months from many of you! Here is a link to the news update on the One Degree Solar website: http://www.onedegreesolar.com/blogs/news

Many thanks from both me and all the Zambians whose lives you have (and will) touched through your generosity.

Have a wonderful summer and think of all the women delivering by the light of headlamp when you take your own headlamp on camping trips in the next few months.

All the best,

Headlamps for Health! Update...

2009-12-17T13:51:00.000-08:00

It has been just one day since I first asked for help in raising money to purchase 20 headlamps to send to rural health centers in Zambia. I have had an overwhelming response and want to thank all of you for your support! I am so lucky to have so many wonderful family and friends, as well as many new people who contributed after receiving the email through mutual contacts.

My initial goal was to raise enough money to purchase one headlamp for each health center. We have met this goal and now I am hoping to raise enough money to send a headlamp to each health care provider that participated on the pilot project. This was my original goal, but I thought it was too ambitious. But as the last 24 hours has indicated -- the original goal was not ambitious at all!

Thank you again and keep spreading the word!

Headlamps for Health!

2009-12-16T13:48:00.001-08:00

While in Zambia this summer, I gave away my clothes, shoes, digital camera – basically everything I had brought with me. But the most coveted possession I shared was my headlamp. Spending countless nights in villages with no electricity, the headlamp did more than save me from stepping on snakes in the middle of the night…

Sleeping on the floors of health centers gave me the rare opportunity to see the struggles of the work at hand. Returning after dark one night to the health center, I found a nurse holding a candle in her mouth as she hurriedly flipped through the pages of a medical book. She was trying to figure out what to do for the woman lying on a cot at her side. The wax was dripping on the pages and the flame nearly extinguished every time she breathed. I grabbed the candle and placed my lamp on her head. She turned to me in amazement… and I blinked back at her with constricted pupils – she was unaware that this crazy contraption on her head was blinding me as she stared at me with a huge grin from ear to ear. Needless to say, this story is not unique – except for the part about the musungu blinded by the light in a remote Zambian village. Countless women deliver in the dark or by the dim light of a candle in almost all of the health facilities I visited. If you read my blog over the summer, you might remember some of the challenges of childbirth in rural Zambia that I highlighted – and without light, these complications can go unnoticed. Most of the health centers are greatly understaffed, which makes the headlamp even more ideal, as it keeps both of the providers' hands free to deliver babies and save babies' mamas.

Recognizing the value of a simple headlamp, I committed myself to getting one for each of the health care providers I had the privilege to work alongside while in Zambia. Easier said than done. I have spent the last three months writing and calling companies in hope of securing a donation of solar power headlamps. And not too long ago, I received the last ‘sorry we would love to help you…but we can only support projects in alignment with our mission, like helping women become more active outdoors – you know, hiking and camping’. I laughed the first time I heard this response. My attempts at explaining how the women I met hike to the water pump or how village life is sort of like camping have not impressed folks to action. But lo’ and behold, the last corporate response included a personal note that my story was very moving (not moving enough for them to help), but maybe enough to pull on your heartstrings this holiday season…

And since it is the season for giving, perhaps you would like to give the gift of the light – in the form of solar power or windup headlamp (batteries are very hard to come by in rural Zambia) J I am not much of a fundraiser – as noted by the previous paragraph – and I don’t like asking people to donate to my causes. However, this one is more near and dear to me than most – and I control how the money is spent (only on headlamps – you have my word!). My current goal is to raise $500, which would cover the cost of around 20 headlamps – or one per health center.

How can you help? Donate just a few dollars (right corner) – the equivalent of that beer you were going to buy me the next time you saw me. A team from Venture Strategies (organization I worked for over summer) will be heading back to Zambia in late February and I hope to send at least 20 headlamps with them.

NYT 'Half the Sky'

2009-09-23T23:26:00.000-07:00

NYT "Half the Sky' Contest

“If you educate a girl, you educate a nation”, I read on the front of a school as we made our way out of the rural village in Zambia. I remember laughing at the irony. You see, I was well into my second month of traveling from one rural village to the next, assisting in the implementation of a maternal health program aimed at reducing maternal death from postpartum hemorrhaging with the simple drug misoprostol. I had met countless women since arriving in Zambia - incredible, courageous, intelligent women. But not educated.

At first they were too young to safely walk the long distances to school. Then they were too old to not be married. Somewhere along the way, the possibility for these girls to be something more than a mother was...just...forgotten. So there I was, deep into the Zambian bush, trying to safeguard the one thing they could hold onto - motherhood - using education as my only tool.

I will probably never view pregnancy and childbirth quite the same either. In the US, pregnant women ‘glow.’ They go to the doctor for regular checkups and pack a bag to prepare for the delivery - all well before the due date. In most of the rural areas I worked in, it is very surprising to see any woman above the age of 17 without a protruding belly and another child strapped on her back; no one asks these women how far along they were or if it was a girl or boy. If these women packed a bag, they were packing soap, clean cloths, and an umbilical clamp because these things are not provided by the health facility (however, most women don't get to pack bags at all. It is estimated that 50-75% of women in the rural communities don't even make it to a health facility. They give birth on a dirt floor, perhaps with someone to help if they are lucky).

Postpartum hemorrhaging (PPH) attributes to over one third of maternal deaths - a striking fact since PPH is such a basic complication of childbirth that it's practically unheard of in our world. The deciding factor? A drug called misoprostol that can be easily taken orally immediately after the birth to prevent PPH. For women delivering at home, having the equivalent of aspirin tablet in misoprostol is a life-saving factor.

My last site visit this summer was the weekly antenatal (pre-birth) clinic at the health center. Nearly thirty women were waiting to meet with Sister Hilda, the only trained provider, and I was told this was a "light" day. On average, Hilda will counsel 50 women a week. Now, thanks to the efforts of groups like Venture Strategies, misoprostol education is included in the antenatal sessions. Simply handing out tablets without the education would be pointless. Now, after their individual appointments and screenings, women are given the choice of taking Misoprostol home with them. An overwhelming number agree to do so, tucking the packet into the corner of their chitenge as they leave the facility.

As we seek to empower "half the sky," it's important to remember that it comes in many forms, and always starts with education itself.

Last day...

2009-07-31T06:12:00.000-07:00

Out of breath and sweating in the waiting area for South Africa Airways at Lusaka International Airport, I thought about how my subconscious defense mechanism against teary-eyed goodbyes is packing and leaving for the airport at the last possible minute. This way – I am so overwhelmingly stressed about missing my flight that I do not realize I am actually leaving.

In the case of departing from Zambia, I decided that I needed to leave for the airport at 11am, which to me meant putting off packing until the morning of. After a couple of glasses of wine with friends the night before, I had a later start than expected the following morning. Then I quickly learned the 9 hand-woven baskets I bought were not going to fit in my carry-on bag and I needed to get something to transport them in. I decided I would run to the market and get one of the plastic carriers that all the Zambians use. Most of them are decorated with Winnie-the-Pooh or Disney characters. However, I did see one with the Zambian flag on a previous visit and was hoping to find that one. Although, the thought of showing up in Boston, with a huge pink bag with Winnie-the-Pooh painted across the front was also appealing.

The usual fan club cheered me on as passed them running to Kamwala. Several stall owners were very willing to help me find the Zambia bag as I reached the market. However, I was down to my last kwachas and refused to pay more than 10 pin ($2) for the bag. Musungu price is always quite a big higher – especially for something that could be considered a souvenir. My helpers were quickly able to find a bag, but would not go lower than 20 pin and claimed no one would. I turned down the offer and was about to go buy Pooh, which was selling for 6 pin, when I decided that I might be able to negotiate better if I tried on my own. I ditched my helpers and took off, weaving through the many aisles of the market. I found the bag and used my hard-earned skills after three months in Zam to negotiate the right price . As I sprinted out of the market, now running quite late, I shouted to the helpers, “I got it for ten pin…hahahaha”. They shook their heads and laughed. I could hear murmurs of ‘what did she say’ and then someone mimicking my response, even down to the accent.

The next hour was a whirlwind of making cds for the staff people at the backpackers, shoving what I could into my backpack and giving away the rest. I may have learned to negotiate in the last three months, but I still had learned African time. My friends were due to pick me up at 11am and of course did not show up until 11:30. How could I have forgotten that you have to tell someone to be there at least a half hour before you need to leave, if you want to leave on time? Then we stopped at the bank and for gas. As we entered the midday traffic, I was in total panic mode. I heard, “Stop chewing your nails off” from the back seat and turned to see my friend sipping on a warm beer, probably left from the night before, and smiling, not a care in the world.

When I arrived at airport, I needed to drop off my camera at the Proflight office. I was giving the camera to my friend in Mfuwe and needed to send it through a flight attendant he knew. The airport was very confusing and I left my bags near the security area, as I could run around in search of the office. I found the office, stuffed the camera in an envelope and then was off again. But by the time I returned to my bags, there were three security guards staring at them. “They are mine….they are mine”, I shouted as I ran towards them. The one guard replied, “Madam you cannot leave your luggage alone”. I smiled and said, “Oh I am sorry, I didn’t know that”, the whole time thinking about the States and the constant code orange warnings that are announced every 15 minutes in the airport.

After making it through security and immigration, I was able to make all the last minute phone calls to say goodbye. I was feeling very proud that I survived without crying. Just as we were boarding, a final text message came through from a coordinator that I spent a week driving from clinic to clinic on the worst roads in Zambia… ‘I will miss you my daughter. Safe journey’. And suddenly, I was no longer so brave.

Gift from MOHZ

2009-07-28T08:22:00.000-07:00

They remembered how much I loved the falls!

Colleagues at MOHZ

2009-07-28T07:24:00.000-07:00

Going away party

Nayonda...(I'm Going)

2009-07-28T06:54:00.000-07:00

The last entry will be written from the plane and posted from the States. I have an affinity for red wine on international flights, so it should be an interesting one...

Thanks for reading,

Musungu

People I will miss...

2009-07-28T01:19:00.000-07:00

Favorite Place Take 2

2009-07-27T07:09:00.000-07:00

My favorite place in Zambia...

2009-07-27T06:09:00.000-07:00

Proudly Zambian

2009-07-27T05:25:00.000-07:00

Goodbyes

2009-07-26T09:09:00.001-07:00

Just a week ago --- I told my mother I was ready to return to the States. But now, with just a few days left in the country, I find it hard to sleep and wake up each morning with racing thoughts. The work is far from done, but is it ever really done? While being faced with a rather impossible ‘to-do’ list contributes to the anxiety – the main culprit is that in three days I will have to say goodbye… Goodbye to friends in Lusaka…goodbye to colleagues at the MOH… goodbye to the many Zambians who have touched my life over the last 11 weeks.

I have been incredibly fortunate to visit 20 rural health centers, staffed by some of the most committed people I have ever had the honor of working alongside. Equally amazing have been the women who have opened up their lives and shared their stories.

I have seen long queues of people waiting for treatment and providers working into the night to ensure all patients are served. I have slept on the floor of health centers, with the hum of villagers singing lulling me to sleep. I have crossed rivers in dugout canoes to reach a clinic and watched the sick transported on oxcarts down long dirt roads. I have seen extreme suffering and pain, only matched with overwhelming courage and strength.

And it is this courage and strength that will remain with me long after I leave Zambia…

Backpackers

2009-07-26T08:39:00.000-07:00

With most of my time spent in rural areas, it made little sense to rent a flat in Lusaka. I instead opted to stay at the Chachacha Backpacker. The nice thing with backpacker living is that you can always find a friend to share a beer and a conversation. The bad thing with backpacker living is that those friends always leave you. Getting left is usually worse than leaving.

Of course there were a few other ‘lifers’ like me. There was Tom from Australia, working tirelessly to set up a school in Misisi Compound. But he left me at the beginning of July. There was Reck, who intended to travel throughout Southern Africa for 7 weeks, only to leave Lusaka for Malawi after four weeks gone. And then Lisa who was interning with the UNDP, but she also left to chase Reck to Malawi. And finally there was Doc, who after four months of living in at tent at Cha, took off for the Congo.

So in my last week at Cha, it was suddenly just me. Well not exactly….30 high school girls from London filled the gap. And boy did they fill it…

I was struggling to find conditioner and a razor. Meanwhile, these ladies came equipped with blow dryers, hair-straighteners, and the biggest offense of all…ROLLER SUITCASES. Um…it is called backpacker for a reason. While I tried my best to inculcate them with the beauty of simple living…they had a different idea of beauty. I returned from a run to find the room cleared, but a stack of Cosmo and Glamour magazines on my bed with a post-it…”You should read these”.

Animals are fun...but health promotion is better!

2009-07-21T05:33:00.000-07:00

Rural health center waiting area.

Poster on wall of rural health center.

Baby weighing station

Low-cost, innovative wheel chair, with tires for dirt roads.

2009-07-21T05:04:00.000-07:00

Guides start out all safaris by asking the clients which animals they are interested in seeing. 'Leopards...lions!', everyone typically shouts in unison.

'Hippos', I cry out when the talk of cats has died down.

One guide, Phillemon, laughed and told me that hippos were the last animal created by God, getting all the leftover parts...'short feet, short tail, big stomach, ugly teeth and wiggling ears'.

Fortunate for me, South Luangwa has the largest population of hippos in the entire world. The cats are pretty cool too....

2009-07-20T06:11:00.000-07:00

I just saw a leopard eating a puku in a tree!
The ultimate camouflage....find the leopard.
South Luangwa National Park
View from the bar at the campsite.
Leopard eating puku (sort of antelope) in tree.

Big Love = Big Mistake

2009-07-20T05:42:00.001-07:00

A certain degree of sacrifice is necessary when spending three months hopping between rural health centers. Although, I am typing this from my laptop,inside a tent with an attached bathroom… Nonetheless, sacrifices are made.

Take for example when I ran out of conditioner. I lasted about two weeks without, but then decided I was losing far too much hair trying to get a comb through the rats’ nest that was developing. I went to the store in one of the rural towns and decided on “Big Love”. Big Love advertised that is was suitable for all hair types….except apparently mine. Instead of just a rats’ nest, I acquired sticky coating to protect the knots…and this coating attracted all the dust and dirt Zambia could spare. Mmmm.

A couple days after chucking the conditioner in the trash, I lost my razor. I returned to a similar store in search of a ‘stick’, as this is what I was told it was called. No one was aware of this so-called stick, so I demonstrated shaving my legs. My charades routine failed…not a big surprise since leg-shaving is probably not a priority in such rural towns. I then acted out shaving my face…which they understood, but they looked at me strangely for wanting to shave my face. The store owner gave me a blade and it was my turn to be confused. What was I going to do with just a blade? He noticed my confusion and said I would have to learn to shave like an African. He then came over to me and tried to demonstrate how to use it on my face. I thanked him – and then tried to once again explain it was for my legs….I couldn’t bear to leave the store with everyone thinking I shaved my face. But then again, they would probably think it was even stranger that I would take the time to shave hair off my legs…

WWJD

2009-07-20T04:49:00.000-07:00

Prologue

This entry could have easily been called TIA (This is Africa) Part II, but WWJD seemed more appropriate. While as you will see, God does make his way into this story, the ‘J’ in this WWJD stands for Jon (not Jesus). Perhaps because my first real travel experience (and many to follow) was with Jon or because we manage to have crazy adventures without ever stepping onto foreign soil or because he is my most loyal blog fan (sorry, Mom), he often comes to mind when I get myself in precarious situations. I wonder, ‘what would Jon do?’ Sometimes I take the path less traveled, as Jon always does…and other times I say, “oh, hell no” and stick with the tarmac. On Friday, I found myself thinking WWJD on more than one occasion, and consequently ended up back on the road with the man size potholes.

WWJD?

After the last epic trip to Mfuwe, I vowed never to return…at least on public transport. But one weekend in the smog of Lusaka made me anxious to find an alternative, especially with only two weekends left in the country. Since Petauke, the most recent and last site visit, was just four hours from Mfuwe, I decided to give it a second chance.

Finishing up my site visit in the morning, the first two hours of the journey were simple, as I hopped a bus to Chipata. However, the only option to get to Mfuwe from Chipata was on the back of a lorrie, filled to the rim with potatoes, beer and mattresses. WWJD? That one was easy…he would take a lift with the cargo.

Turns out I was not the only person with this plan. After an elongated period of packing (and actually the worst packing job I have ever seen, including a piece of rebar jutting out from the back, with the smallest piece of scrap plastic indicating it was there), twenty people appeared out of nowhere and started clambering to the top. It was the shit show of all shit shows. I ran to the truck, threw my remaining backpack to the top and someone how squeezed into the last remaining spot on the vehicle. Fortunate for me, this was on top of a mattress and not a sack of potatoes.

We didn’t even make it out of town before we were flagged by the police. All of the passengers were kicked to the side of the road and the vehicle was impounded for carrying passengers on a cargo truck and overloading (see video). On the side of the road, the other passengers and I debated what was to happen. Would the drivers pay the fine and come back for us? Would the vehicle be released? As nightfall crept closer, I decided action was necessary. WWJD? I conspired with two other local men I had been chatting with and we grabbed a hitch back into town and to the police station. We were informed the vehicle would not be released until morning and we should find a place to spend the night. With only two nights in Mfuwe, sleeping in Chipata was not an option--- I had to leave that night. The driver said that he did not have money to refund us until the morning and my new friends seemed to think the situation was helpless. However, still committed to reaching Mfuwe, I threatened to go in and tell the police and made it just a few feet away from the station door, when suddenly the money appeared. ‘But only money for the madam…’ So I had to once again put on the mean face and demand my new friends get refunded as well.

With our money and packs, we took off for the road, hoping to find a hitch. Unfortunately, it was already dark and no one seemed interested in picking up three strangers at this hour. A taxi driver did pull over and offered to take us to Mfuwe for 350,000 kwacha. Not an entirely bad deal since the 130 km dirt road drive was horrible, but the price was a little steep for the group and my budget would not allow me to make up the difference. However, we decided that if we could shove a few more passengers in the car, we would be set.

At this point the rest of the passengers were following our lead and making their way back to the police station. Two were willing to join our mission, but again we were faced with the task of refunds. The first man left his wife behind to collect the money in the morning (typical). However, the additional woman could not afford the taxi without her refund and she really needed the taxi ride because she had to be at work at 7am in Mfuwe the following morning.

Again my co-conspirators were ready to give up. WWJD? I quickly changed from enraged musungu to charming volunteer and made my way to a police officer. I asked to use the bathroom and as the officer escorted me, he asked how I was doing. At this point, I retold the story, tugging at the heartstrings. He fell for the bait and took on my case. Unfortunately, the driver wasn’t lying this time and really had no money until the morning (his boss had take the stash and ran). To everyone’s surprise, the policeman pulled out 40,000 kwacha to personally refund the woman, so she could get in the taxi with us. He said he would deal with getting the money from the driver in the morning. The entire group looked at me in shock...apparently policemen are typically as corrupt as the drivers and this was completely unheard of. We didn’t waste another moment and ran out the station, hugging and high-fiving, as we piled into the taxi.

The taxi driver drove like a maniac, and the music was blaring, but I didn’t care…we were going make it to Mfuwe! Two of the men only need transport to a village about halfway to Mfuwe. Three of us were left in the taxi. We only made it another 20 km, when the taxi driver began fighting with the two in the backseat. At first, I had no idea what was being said, but quickly deciphered that he was demanding more money. I looked at my cellphone…no service. I looked out the window…pitch black. Shit. WWJD?

I started out with reasoning. He wouldn’t reason. I resorted to yelling. He wouldn’t budge. (Side note: I have never yelled so loud and I even shook my fists). Then I tried to play on guilt…bringing his mother into the conversation. Finally, in a very dramatic finale I said, “In your mother’s eyes, in God’s eyes and in MY EYES…you are thief, a cheat, and a HORRIBLE person.” Then I got out of the car, took a picture of his license plate and said I was walking to Mfuwe, at which point I would report him to the police. The other two passengers looked at me in disbelief. I slung my bag over my shoulder, not knowing what I was really going to do…a huge lump growing in my throat. Within minutes the taxi was trailing me and the driver was pleading for me to get back in. We paid the original price and we sped off…the music once again blaring as we continued to Mfuwe. Ten minutes later, the taxi man had the audacity to ask if he could be my friend. After laughing uncontrollably for a few minutes (I was still calming myself down from the earlier episode), I took the opportunity to explain to him how friends treat each other. As it turned out he didn’t have a lot of friends (at least trustworthy ones) and was orphaned at a young age (which explained why the mother strategy was not effective). By the time we reached Mfuwe an hour later…I probably was the closest thing he had to a friend. And there is no doubt in my mind that Jon would have been too…

Epilogue

My friend, a safari guide in Mfuwe, not at all entertained by my stories, refused to let me take public transportation back to Lusaka on Sunday. He somehow organized a ‘resident rate’ ticket on the one plane leaving Sunday afternoon. And since I did not have to show ANY form of identification at the Mfuwe International Airport, no one seemed to know any better.

Although I love public transportation adventures, I was ecstatic to spend more time with the wildlife and take a one hour flight at the end of the day, instead of a 13 hour multi-leg bus ride.

How do you cross a river full of crocs?

2009-07-14T03:24:00.000-07:00

Is this better Jon?

2009-07-14T02:47:00.000-07:00

Musungu Sings

2009-07-13T23:30:00.000-07:00

I somehow tend to end up in karaoke bars in foreign countries…and Zambia did not let down. Saturday night a crew of us went to one of the 'nicer' spots in town for drinks and to my surprise - karaoke. The restaurant looked as if I clown was in charge of the decorating, and the accompanying music was just a synthesizer playing the famous tunes we would eventually sing. Nonetheless, it was an incredible night. The group desperately wanted me to sing ‘Born in the USA’, but I refused. Another option was a duet. My friend Alex and I find it far too entertaining to refer to each other as musungu (white) and mufita (black), so we thought it would also be very fitting if we sang Ebony and Ivory, but neither of us actually knew the song, so it was a failed attempt. I debated 'Sexual Healing', but finally settled on ‘I Will Survive’, followed by ‘If I Could Turn Back Time’, which the crowd really liked. (Becky – I did my best to impersonate you impersonating Cher).

Missus Compound

2009-07-13T00:58:00.000-07:00

Having spent a year working in Guguletu (Gugus), a township outside of Cape Town, I was very interested to visit one of the compounds in Lusaka. While the compounds are not a result of the blatant separation of people based on race, as in South Africa, they are definitely a symbol of the deeply entrenched poverty in Zambia (also very much related to race). And are a staggering contrast to the rest of the neighborhoods in Lusaka.

With only a few weeks left in the country, I finally convinced a friend, Awiya, to take me into a compound. Most people are not keen on bringing musungus into these settlements, but when he realized I was going with our without him, he decided it was best to accompany me.

Misisi (pronounced missus) Compound is the oldest in Lusaka and used to be a place where the British folk resided during colonial times. One older white woman continued to live there, even after the rest of her kinfolk flocked back home or to different neighborhoods. Everyone referred to her as ‘Missus’… and the name stuck. Oh the legacy of colonial times…(David) Livingstone, Zambia….Victoria Falls…and now Missus Compound.

There is one long, dusty road that stretches through the entire compound. We followed the road from start to finish….which is enormous. I was overwhelmed. I had seen plenty of poverty and desperation in the rural villages, but this was so different and I can’t even pinpoint exactly why. So many people come back from visits to poor areas throughout Africa, saying “they are poor, but they are so happy”. This irritates me a bit, as I feel that it is a way to shake off responsibility to take action…but I can also see their point at times…especially in many places I have visited in the last two months. I didn’t see much happiness here…I just saw children playing in piles of disgusting trash, women engaged in exhausting manual labor, and men drinking shake-shake – the local brew. Community water pumps and toilets were sporadically placed and after an hour of walking, I only saw one school. I asked if children go to town for school and my friend said it was too expensive – most children in the compounds don’t go to school beyond the primary years.

Awiya asked if we had areas like this in the US and I tried to explain the so-called projects and other disenfranchised communities. I also explained the welfare system and our government’s attempts to mitigate the problems. He mentioned that the Zambian government didn’t care about the people in the compounds… ‘And they know that no one cares about them’, he said. ‘Why do you think there are so many churches…the only hope that people have is that God cares about them’. It was true, we had passed by a church on every block….which was usually directly across the street from a shebeen (bar). I thought about if I was living in the compounds….would I have faith in God or faith in the shake-shake to save me? I bought a carton of the shake-shake on the way out.

I don't think you're pretty....

2009-07-13T00:56:00.000-07:00

As I walked to the market on Saturday with Alan, he explained to me how he had finally saved enough money to put a tombstone on his father’s grave, and was going to do so that afternoon. It had been a year since his father died and several years since his mother passed. At age 32 he was an orphan. He talked about how he was in college when his father died, but had to drop out to take on the responsibilities of raising his younger siblings. His story, though very sad, was not unique.

A woman approached as we neared the tracks, the part of town where the poverty becomes much more visible. She stopped Alan and began talking to him in Nyanja. He sincerely listened to her story and then retrieved 5,000 kwacha ($1) from his pocket and gave the money to the woman, no questions asked. Now Alan works as a cleaner at the lodge where I stay – which means he has a job, which is better than many Zambians, but he is by no means making a lot of money. And whatever money he does make is used to support many people, as he had just explained to me.

As we continued walking, I asked him if he was worried that he was being scammed. Two months in Zambia (and five years in San Francisco), I was growing cynical. He told me the woman’s story and said there was no reason not to believe her. (I can think of a few, I thought to myself). I then asked him how he distinguishes if the truth is being told in other situations…I had yet to master this art and was constantly leery of being manipulated. He replied that it was not up to him to question the integrity of others. But is up to him to help those in need…the burden of being more fortunate. (Fortunate? An orphan who had to drop out of school to raise his brothers and sisters….I thought).

We parted ways and I continued thinking about his unwavering trust and faith in the good in people. I also thought about the countless people that I said, “Sorry”, before I even heard their full story. I then thought about the man who threw the sandwich back in my face because he wanted money for alcohol and was not really hungry, as he claimed. Or the homeless woman who said, “I don’t think you’re pretty….no I don’t think you’re pretty at all” as I passed by her begging in Dolores Park. I decided that while Alan was an incredible person – I would continue to help with discretion, but perhaps ease up a bit on the cynicism.

I bless the rains down in Africa...

2009-07-13T00:35:00.000-07:00

Not even a week had passed since my first visit to Livingstone (Victoria Falls) and I was itching to get back. I had also heard that the Falls were open for viewing during the full moon each month – a fact not mentioned in any of the guide books. Locals mentioned that Victoria Falls was the only place in the world where one can see a lunar rainbow. Determined to not miss the opportunity and also doubting such a moon rainbow could possibly exist, I hopped on the six hour bus to Livingstone, barely touching ground in Lusaka since the last trip to the bush.

The weekend was amazing – rafting down the Zambezi during the day, jogging through the town at dusk and dancing at the disco till dawn. I needed to catch an 8:30pm bus back to Lusaka on the night of the official full moon. Fortunately, the park was open for the couple of days before and after the full moon. After a huge seafood meal with friends, we all smashed into a Land Rover and headed to the falls. We arrived about 10:15pm and had 45 minutes until closing. The sky was full of clouds, but the falls were still illuminated by the moon and the sound of the crashing water was even more intense than during the day. We walked the narrow path in the dark…there were absolutely no lights guiding the path or even another person in the park. As 11pm crept closer, I realized that the clouds had ruined my one chance at seeing the lunar rainbow. But I was so amazed by the sight of the falls at night that I didn’t even feel disappointed…

That is until the next day, in which I spent the majority debating whether or not I should attempt to go back to the park one last time before my bus left for Lusaka. The sun set just after 6:30, so this would give me over an hour in the park before I would have to rush back to town to catch the bus. About midday, I decided it was too stressful to chase the rainbow again….at about 4pm, I decided I had to at least try. I convinced Maya to return with me and we set out at 6pm, to ensure we were the first ones through the gate. I again walked the entire path, in search of the elusive rainbow. The wind had picked up, which meant we were absolutely soaking wet from the mist in less than five minutes. Other rainbow seekers stayed at the viewing point closest to the gate to avoid getting wet, but we marched on. Actually – marching is probably the wrong term, since we tripped every other step given the darkness combined with an extremely slick pathway. Safety precautions and railings are nonexistent and with each step, we were one step away from going over the edge…literally. The moon continued to rise as we made our way to the end of the path, but there was no sign of a rainbow. I entered the final viewing point, looking down to make sure I didn’t lose my footing. As I lifted my head and looked out to the bridge from Zambia to Zimbabwe, there it was… “RAINBOW”, I screamed, shocking Maya, who was still struggling with her footing.

I will never forget that first moment I spotted the rainbow...but it only became more pronounced as we made our way back to the gate. By the time we arrived at the bridge in the path, there was a full rainbow stretching from Zambia to Zimbabwe. The bridge is an incredible viewpoint, but also the wettest portion of the walk. Therefore, I would normally run across as fast as I could, head tucked down to keep the mist of my face. But this night was different. I stood in the middle of the bridge, the entire falls stretching before me, the lunar rainbow overhead and sang Toto’s ‘Africa’ at the top of my lungs with the mist streaming down my face. Now raise your hand if you you think I am one ridiculous musungu (my hand is raised).

It's just a ball...

2009-07-05T02:30:00.000-07:00

I have been in Zambian long enough now that I am starting to revisit the villages. I was quite excited to return to Mukubwe. I visited this site before I became overwhelmed with the challenges at the clinics… the days when I had time to give into-to-English lessons with the roomful of children and followed by hours of chase. A group of the older boys had asked if I could bring them a soccer ball (what they were using barely was deflated and torn to pieces) when I returned. I nearly forgot the promise and had to scramble around town looking for a ball to buy the night before I set off for the visit.

After several hours of retraining the staff (for a third time) on the protocols, I made my way across the field from the clinic to the school, the usual frustration and anxiety taking over my thoughts. Immediately children appeared out of the elephant grass and ran towards me. I knew they recognized me, as all children run away from musungus, not towards upon first meeting. With each hug, my earlier frustrations became less and less urgent and the anxiety dissipated.

I found the headmaster to give him the ball, as I didn’t want to make a scene. I remembered the days in Guguletu in which visitors would bring gifts to the after-school care program and without fail, there was never enough and I would have to deal with the disappointed children. The headmaster was very pleased with the gesture and insisted we deliver the ball to the field, where a game was already in session. Thus, the scene that I was avoiding became magnified. A train of children followed behind me to the field, as if I was playing a magical flute. The soccer game stopped as I approached and the ball was spotted in the headmaster’s hands. The coaches left the sidelines to shake my hand, and the ball was closely examined, passed, kicked and bounced, as grins spread from face to face. Then the inevitable… everyone sang a song for me. The clinic officer said on the way back, ‘you have made everyone very happy today – they will celebrate’.However, I only felt like a giant ass…. the great musungu saves the day with a $10 soccer ball. I wish I would have just left the ball on the school steps with note… I wish I had brought more…I wish I could do more.

I went to bed that night still thinking about all the events of the day, particularly all the challenges at the clinic, and woke in the morning in need of a clinic. It is hard to pinpoint who is to blame. As I look through the pictures from that day, every child had a runny nose and one coach even picked his nose before extending it to shake my hand (yup a folk, that is right— I still shook his hand). Nonetheless, my throat was raw, my nose was running and every bone in my body ached. No time to nurse a cold though. With each pothole on the rural road, my body screamed back at me. We traveled from 7:30am until 12:30am that day, only reaching two clinics. As I stared out the window, feeling bad for myself, I thought of the many women I have described with pregnancy-related complications, in far greater pain than me, who had to make life-saving journeys on these roads and only in a vehicle if they were lucky. Suddenly, my discomfort was not so important.

How does an angry woman get to other side of the river?

2009-07-04T11:36:00.000-07:00

As I have articulated over and over again in my posts, fidelity is very hard to come by in Zambia. The part that I struggle most with is how women accept it as a fact of life. But not all women…

The village that I visited on Thursday can only be reached by a pontoon boat, crossing a river full of crocodiles. I was told a village man kept a wife on one side of the river and a girlfriend on the other side, where he went to fish. The wife caught wind of the girlfriend and set off with her sisters early in the morning to take the pontoon across the river and confront her husband. However, that same day, the husband and his girlfriend were on the other side of the river, hoping to catch the pontoon and sell the fish in the village. In a panicked state, the man jumped in a canoe and tried to quickly paddle around the pontoon to escape his angry wife. But his paddling was no match for the wife, who plunged into the water and swam (or some version of swimming that was apparently more effective than it looks) to the canoe. After throwing all of the fish back into the water, I was told she began to beat him, while everyone watched in shock from the pontoon. I would have asked for her autograph.

What is worse than getting beat by girls in chitenges? (Zamruns Part II)

2009-06-30T02:13:00.000-07:00

Early Wednesday morning, before the journey to Kalomo, I set off on my usual run. The Lusaka teachers had ended their strike and for the first time, children of all ages filled the sidewalks on their way to school. I made a right onto Addis Ababa and continued on the dirt path, parallel to the road. I caught up to a group of school boys, who couldn’t have been older than 7 or 8. At first they seemed surprised to see me and then the bravest starting running alongside me. At this point I remembered the advice Jon gave me… “Don’t forget to spread love and get people psyched around the world with high fives and fist pumps”. As a FPIT (fist-pumper-in-training), I decided to go with the traditional high-five. I held out my palm to the boy, smiling (and clearly not looking ahead). Just as his hand was about to hit mine, my foot caught on something and I was suddenly flying through the air. The flight ended as my body slammed down and slid across the ground, like I was stealing home. At this point, the boy looked at me with a mix of fear and shock. I tried to explain to him that humor was the proper response and that it is OK to laugh when people trip and fall….I mean I do it all the time (the laughing part of course, not the tripping). But he couldn’t stop staring at the bleeding gash on my arm. And I couldn’t stop thinking about how lucky I was that I didn’t take Jon’s second piece of advice to bring my camera on the run…

Ground control to Major Tom

2009-06-30T01:44:00.000-07:00

To follow up an incredible morning of flying through the gorge on the end of a rope, I decided to spend the afternoon flying through the air on a microlight flight. You are probably wondering what the heck a microlight plane is…and apparently I should have asked the same question of the person selling me the ticket, as I showed up in a dress and flip flops. As you can see below, I was quickly given a flight suit to put on over the dress and was told I would have to fly barefoot…which makes the pictures even more classic.

I had a bit of time to wait at the airfield before “Flying Kangaroo” (my Australian pilot) was ready. A friend from the backpacker had joined me to watch and we sat with another American (we’ll call him Tennessee), who was also taking a micro-flight. His Zambian pilot, aka “Likes to Watch Top Gun”, aka probably needs some help coming up with a new tagline, was also not ready. As we waited, Tennessee was trying his hardest to impress us with his attempts at witty commentary. Also, he apparently didn’t see my triumphant face-first jump into the gorge earlier and was convinced I was going to freak out in the go-cart with wings. At one point he said, “We’ll just see who has the wettest panties at the end”. To which I quickly replied, “You wear panties?”A chorus of laughter from everyone (including Zambians who usually don’t get my jokes) around followed… and Tennessee was silent untill Flying Kangaroo was ready for me.

I was strapped into the ‘student-pilot’ seat. Yes folks, that one is going on the ole’ resume. Next, I was given earphones and a microphone to communicate with the Kangaroo. He said, “Karen, can you hear me?” I said, “Ground control to Major Tom”. He didn’t laugh. Apparently the Flying Kangaroo wasn’t a fan of David Bowie.

The pictures from the flight will tell the rest of story. One thing is for sure, I will never forget seeing ‘The Smoke that Thunders’ from clouds above…

Just because you can fit through the hole, doesn't mean you should crawl through it...

2009-06-29T03:47:00.000-07:00

After catching up over late night beers and early morning coffee, the ladies caught a flight back to South Africa and I caught a shuttle to the falls. This was not my first trip to the falls – I had been on the Zimbabwean side in November 2006. However, the falls looked completely different – and not just because I was viewing from Zambia, but because there a significantly greater amount of water (November is dry season and June is still reaping the benefits of rainy season).

I spent the first two hours walking in awe – soaked by the mist, with the roaring water vibrating in my ears. For most parts of the trail, I was the only person in sight. Mainly because walking the path closest to the falls required one to commit to becoming completely drenched. Fortunately, I was wearing a hand-me-down trash bag inspired poncho and Teva sandals. Most others were sticking to the dryer routes.

I finally made it to the end of the trail to find two rainbows and the bridge to Zimbabwe in the distance. As I turned around, I nearly bumped into a young woman wearing a Gortex jacket, pants and hiking boots. Her father laughed, making a joke about how our two very different outfits were serving the same purpose with the same effectiveness. I ended tagging along with them for the next hour or two on the trail. The father was a renowned physician and researcher, while the daughter was about to start medical school in Chicago. In addition to our common health-related interests, they were both from NY and I was appreciating the return of sarcasm to conversations.

We decided that we wanted to cross the bridge to Zimbabwe, which can be done without any special visas, just a bridge pass. We followed a path that was marked ‘To Bridge’, but it ended at a fence and a great deal of barb wire. However, there was a hole in the fence, and lo’ and behold, it was big enough to crawl through. The father crawled through first and as the daughter began to protest, I followed suit and she was left with no choice. In the process of climbing through the fence and young British man on the other side asked if I was trying to break into Zimbabwe. I laughed at the prospect…

However, as soon as we made it through the fence and down onto the bridge, we were greeted by a guard with a carbine, very angry about the offence (of-fence suddenly the word is so fitting) we just committed. I was not worried about being shot or jailed, but I was definitely panicking that we were going to have to pay an exorbitant fine or bribe. Fortunately, the good doctor was a good talker, while his daughter and I played dumb quite well. Before the guard could object, we were all back through the fence and briskly making our way away from the crime scene.

Rejoicing in our freedom, we made our way back to their five-star hotel for some wine and lunch…

Aligning of the African Stars...

2009-06-29T03:17:00.000-07:00

With Kalomo, district of last site visit, only being a two hour bus ride from Mosi-o-Tunya (The Smoke that Thunders in Tonga), otherwise known as Victoria Falls, I had no choice but to make the journey. I hopped on the bus and arrived in Livingstone close to 6pm. The first backpacker was full. A group of three recent college grads from Texas offered me the fourth spot in their four-man tent, but as tempting as it was to stay in a tent with three smelly boys who had been driving across the continent, I had to decline. I hauled my pack to the next spot that was recommended and found plenty of space – however, they suggested that I stay at their affiliate backpacker down the street. (There is a reason for all the details – I promise). I bought a beer and sat by the pool, waiting for a lift to the new spot. A half hour or so later, my ride was leaving and I went to collect my bags in the bar area. There was another American woman at the bar asking about her money that was locked in the safe. She looked familiar…

(Now a little more background…. Two very close friends from SF (Debbie and Carolyn) were traveling through South Africa and Namibia for three weeks in June. We had tried our best to make a plan to meet somewhere, but given my crazy schedule and their limited time in Africa, we weren’t able to make it happen. Debbie’s good friend from college, who I had met ONCE in January, was the third travel companion.)

Anyways, I figured I was wrong, but decided it was worth a shot to ask…. “Ashley?” I said. The woman turned to look at me and said, “Karen?” Then we both screamed. Turns out they were evacuated from a 6 day hike along the coast in South Africa because the swells were too high. In a very last minute decision, they bought flights to Livingstone to see the falls. Debbie knew I was out in the bush and therefore couldn’t be reached, so she didn’t bother emailing the last minute change of plans.

Deb and Caro were outside in a shuttle that had picked them up from a sunset cruise and I charged out the door of the backpacker bar and banged on the window. Screams, jumping and hugging quickly followed….I was shaking for a good twenty minutes afterwards. I don’t think I was aware of how much I was in need of a familiar face.

I never speak of fate or destiny – but truly the stars aligned to make this reunion happen, as they were far too many necessary pieces for it to be pure coincidence.

Who needs coffee to wake you up?

2009-06-29T01:16:00.000-07:00

Adrenaline junkies from across the world make their way to Livingstone, as it is just falls short of beating out Queenstown, New Zealand for the adrenaline capital of the world title. With that said, I had no choice but to get my lifetime adrenaline fix on Sunday morning…

After a night of dancing with the locals (in a town with more white people than anywhere I have been in Zambia, I still ended up in the bar with ONLY Zambians…perhaps because I went out with the staff at the backpacker, instead of the other guests), I woke up early to head to the famous Gorge Swing, which entails a 53 meter free fall in 3.5 seconds. I had heard from most people that it was even scarier than the bungee jump off the bridge, but of course I only chose it over the bungee because it was half the price.

I arrived at the swing with 5 Canadian volunteers, four Brazilians and Montana (the nickname I bestowed upon him b/c I couldn’t remember his name). One Canadian refused to jump and all of the other females paired up for tandem jumps. There were a couple options for the swing…step forward and make the decision to jump or go backwards and have the guides make it for you. In this position, they strap your feet together and the guy holds your harness, as you are lean back, and then he releases you. Most people prefer this option because you don’t have to look down.

All of the tandem ladies went backwards, but only after a great deal of freaking-out/nearly backing-out antics on the platform. Montana and I watched, discussing how we would do our single jumps. We both decided on face-first because it seemed more intense. Montana went first and I had his camera ready to capture the jump. “1, 2, 3, Go”. But nothing. He was still standing. Before I could even set down his camera, he was turning around and getting his feet strapped together.

I had no choice but to still go face first – I had been chatting up the guides all morning and couldn’t let them down, right? As I looked down, toes curled over the edge of the platform, I thought I was going to pass out. “Karen, are you ready?...1, 2, 3…” and suddenly I was free-falling for the longest 3.5 seconds of my life. I have never experienced that kind of adrenaline surge and not sure if I care to ever again….

After hiking back up the gorge, I was awarded a nice cold Mosi for my star performance. Take a look at the video from the platform.

Mosi-o-Tunya...'The Smoke that Thunders'

2009-06-27T11:58:00.000-07:00

More pics and stories to come (was accused of sneaking into Zimbabwe by at man with a machine gun) when I have time to update...but here are a few from the weekend at Victoria Falls...

Back to the bush...

2009-06-23T02:24:00.000-07:00

After a brief, but very busy two-day stay in Lusaka, I am back on the road tomorrow, making my way to the Southern Province and Tonga people. Hopefully, the site visit will be followed by a quick visit to Victoria Falls over the weekend...

The irony of enouraging women to deliver in facilities...

2009-06-23T02:16:00.001-07:00

As previously mentioned, there is a strong emphasis on delivering in a facility in Zambia. However, in many cases, the clinics I have seen leave much to be desired, and I wonder whether women are not better off in their home. I have seen decrepit delivery beds, covered in black mold. I have seen blood splattered on the walls and sterilization buckets without any bleach. I have seen women lying on cots in dark rooms, without anyone comforting them or coaching them through contractions. And women chastised for not bringing a cloths, soap and an umbilical clamp because the clinic had nothing to offer. Life’s risky start is not confined to home deliveries…

Childbirth is not easy in the village...

2009-06-23T02:13:00.000-07:00

The number of expected pregnancies in the community and the number of facility deliveries per month are standard questions I now ask during site visits. It is not surprising to see a large discrepancy between the two estimates. In one clinic, situated in a community averaging 54 births a month, only 9-10 took place in the facility.

The extreme distances women have to travel, coupled with nonexistent infrastructure are largely to blame. Most babies also arrive quite unexpectedly. In reviewing forms at a clinic, I noticed that the expected delivery dates were recorded as entire months (i.e. November 2009). It is no wonder that babies are born on the roadside, to mothers in route to the clinic.

In addition, there is a grave shortage of providers in the rural areas. In some clinics, staff members typically responsible for maintenance and facility upkeep (no medical training) are taking on clinical duties to compensate. In other clinics, the sole provider is male, which results in cultural and gender-based barriers to facility deliveries. Consequently, many women choose to deliver the baby at home, with a trusted, yet often untrained traditional birth attendant.

Several maternal health programs in the rural communities are emphasizing ‘birth-preparedness’. Women are advised to have a plan for getting to a facility to deliver and set aside money for transportation. However, men are the decision-makers in the family and subsequently crucial players in determining whether or not women deliver in facilities. Therefore, these programs must go hand-in-hand with initiatives that push male involvement. During site visits, I have met plenty of incredibly supportive husbands and male community health workers. But I have also heard numerous stories of women dying from severe complications in home-deliveries, while husbands deliberate whether or not to organize money and transport to take them to a clinic. Even worse are complications that require hospitalization. For many villages I have visited, this means a five-hour ride on a horrible road to reach the nearest hospital. Since transport beyond a bicycle or oxcart is generally unavailable, an ambulance or district vehicle will first need to drive to the clinic and then return with the woman.

All of these delays limit chances for survival. Take for instance a home delivery with complications… first the complications (emergencies) must be recognized, which can be challenging if there is no provider or the provider is untrained. Then the husband must decide to seek facility care and organize transport, yet another delay. Then the woman will need to be transported to the facility, which could be as far as 30 km on a dirt road, usually traveling by bicycle or oxcart. Finally, if the complications are severe, it will take an additional 10 hours for the woman to reach the hospital by ambulance (and this is dependent on whether there is money for fuel). It is no wonder that the maternal mortality rate is so high…

Honest Musungu

2009-06-23T01:51:00.000-07:00

Through the site visits, I am not just learning about rural healthcare, but also the rural economy. Each trip is laden with purchases from local producers. The prices are considerably cheaper than Lusaka, so the team I travel with goes out of their way to purchase whatever is available (It can be rather ridiculous at times). But everything must be bought in large quantities. I came home from the first site visit with 13 eggplants, 9 cucumbers, 17 green peppers and 20 tomatoes.

Each province specializes in different crops, insects and rodents. Mice were the specialty in the Eastern Province. In the Northern Province, location of the most recent site visit, the hot items were cassava, groundnuts, rice and caterpillars. I had no interest in buying caterpillars or rice – especially the minimum of 100 pounds – but I was suckered into purchasing groundnuts (peanuts, shelled and fresh from ground). For a whopping 10,000 kwacha ($2), I returned to Lusaka with at least 6 pounds of groundnuts. As for cassava – I had no idea what it was…

It so happens that this very popular starch is in fact a root. We stopped at a cassava farm on the last day. After the purchases were made, the owner of the farm suggested I try some. She brought out a plate with large chunks of raw cassava, which had been soaking and softening in water. I took a bite and nodded approval. Then our team of four hopped in the truck and we continued down the road. They all kept watching me take small bites and finally one asked, “So what do you really think?” “Well… I think it tastes horrible...” Relieved that I no longer had to pretend I liked it, I chucked what remained out the window. Everyone laughed, agreed, and threw theirs out the window as well. It turns out that while the rural folks have an abundance of cassava, the city-folk are better at preparing it – I heard stories of roasting, buttering, and salting cassava for the next 20 minutes. (It also so happens that while the rural folks are incredibly lean and healthy, over 30% of people in Lusaka are considered obese).

We continued our journey from the farm. Once we reached the main town area, we stopped at a health provider’s house because I was hoping to retrain her on some of the technical aspects of the project. The provider worked and stayed at the rural health center the majority of the time, but occasionally visited her family in town, which was the case this day. Unfortunately, her daughter informed us that we had just missed her and she was already heading back to the rural health center. As we drove down the road from her house, we almost ran over a drunken man who was stumbling towards us. A colleague explained that it was her husband and that he was always drunk, had to stop working as a result, blah, blah, blah. The conversation then turned to how everyone was surprised that she went back to the rural village on a Saturday night, instead of staying in town until Sunday or Monday morning.

“If he was my husband, I would go back on a Saturday night too”, I commented.

“Musungu – you have made me laugh today”, I heard from the front seat.

Musungu's Music

2009-06-23T01:43:00.001-07:00

12 hours on the road to reach the Northern Province meant a great deal of gospel and country music (yes Dolly and Kenny Rogers both accompanied me on this last trip) …the two favorite genres of the national coordinator (Rabecca), who I travel with. However, halfway through the journey we stopped at a fuel station where several young men were selling dubbed cds and Rabecca bought five new ones to add to our collection. Since Rabecca is the epitome of church-going grandmother, you can imagine my surprise when the first song to play on her new cd was “Sexual Healing”. I teased her for the next couple of days, but somehow the joke evolved, so that each time the song played, everyone would comment that it was my favorite song, which was a bit embarrassing as new people were introduced to the vehicle. It also became customary for everyone to look at me as I sang the lines, “Wake up, wake up, wake up….let’s make love tonight” invoking my best Marvin Gaye impression. Yet another significant contribution I have made in my attempts at a cross-cultural exchange.

Village Boreholes

2009-06-23T01:12:00.000-07:00

While there is no electricity and we sleep at night with a candle stuck to the floor to ward off black magic (yes – I would agree – major fire hazard), there are plenty of boreholes (wells) throughout the villages. I enjoy hanging out at the boreholes, as this is where you can find most women and children. One day, the well was empty, except for some boys and men standing around. A jug of water was set on the head of a small girl, barely 3 years old. Her little arms stretched up to hold the jug and the man let go. She immediately started crying loudly…the jug was clearly too heavy, but she wouldn’t let go….just stood there, with tears streaming down her face. I went over, picked it off her head, dumped some water out and put it back on her head. She then slowly walked home by herself….not spilling a drop, which is more than I can say for myself when carrying a cup of coffee across the kitchen.

2009-06-22T07:40:00.000-07:00

My favorite game...

2009-06-22T06:39:00.000-07:00

Another video...(be sure to watch the first one -- scroll down)

2009-06-22T03:20:00.000-07:00

10 very pregnant women came to the clinic to meet with us during the site visit. The least we could do was give them transport back. I have up my spot inside the car, so that the two most pregnant women could have a proper seat. I was in the back with 8 others, 1 small boy and four 50kg bags of rice. The pickup was very small too, so the 30 minute pothole laden ride was lots of fun for all.

Pics from the Pickup

2009-06-22T02:30:00.000-07:00

1 month in the bush versus 15 years... I gave him some kwacha to buy shoes. He also was quite small for his age...I was told he probably suffered from stunted growth from malnutrition.

Riding in the pickup truck with 8 very pregnant women and four 50 kg bags of rice.

Must Watch This!! Musungu Leaving the Village...

2009-06-22T01:04:00.000-07:00

My last site visit was in the Northern Province. It took 12 hours to drive from Lusaka and each village was at least another 4 hour drive from the district center. Given these distances, the villages are rarely visited, especially by musungus. During a meeting with the health providers, people of all ages kept trying to cram into the small room to get a glimpse of the musungu. My colleagues were concerned that the village headman would think we were holding some sort of political meeting because of the commotion. We kicked everyone out, but as we proceeded speaking with the health providers, I noticed hundreds of eyes peering through the crack and holes in the wall. The video above was taken as we were departing. I was sitting in the back of a pickup truck because there was no room in the cab.

2009-06-16T02:56:00.000-07:00

Typical Zambian food.
Antenatal Clinic

2009-06-16T01:30:00.000-07:00

German friends, cycling from Cape Town to Nairobi.
The usual -- dancing in circles with village women.
Women singing a coming of age song to me.
Little girl who sat on my lap for majority of 6 hour bus ride, while her mother slept.
Roadside stop in route to Lusaka.

Zamruns

2009-06-16T01:26:00.000-07:00

There is a great deal of pride in this country. They eat Zambeef for dinner, Zamloaf for breakfast and plant Zamseeds in their fields. This is probably because the majority of products in Zambia are imported from South Africa…thus, they need to emphasize the few that are produced here.

While in the bush, I have told the villagers that we should change the name of guineafowl to Zamfowl. I have also coined my morning runs through the towns and villages as Zamruns...

The roads and paths are busy as soon as the sun rises, so it is impossible to avoid traffic. During the Zamruns,I cut in and out groups of school children…occasionally joined by a pedestrian (both children and adults) who takes an interest and runs alongside me for a few blocks.

I have been running in Lusaka for nearly a month and subsequently people are beginning to remember me. The man who sells talk time on the corner of street calls out, “You – I see you…strong heart”. A lorry drives by honking and the group of men sitting in the open back move their arms in a running motion and give a thumbs up sign. The taxicab driver comments that he is surprised I am not running to my destination. Naturally, I start to feel like a celebrity….

Then…on recent run through a village, two twelve year old girls in chitenges and sandals started running behind me. I turned around and made some comment about running. As they followed, step for step, they laughed hysterically and called out “running…running” in a voice mimicking mine. I figured they wouldn’t last long...but they continued to run and laugh, as I continued to get more out of breath. I was nearing the area where I loop back and decided to challenge them to a sprinting finish. There I was – $120 running shoes, fancy lycra running top and a high-tech sport watch, clocking my every step – schooled by two girls in flip flops and skirts. Celebrity status deflated, I high-fived the girls and jogged back home.

If I knew then...

2009-06-16T00:48:00.000-07:00

As we discussed some of the extreme challenges associated with reproductive health in rural communities, a colleague commented that if she knew then what she knows now, she would never have had any children. Her first delivery was in a rural health center, similar to the some of the facilities I visit. She shared a cot in the labor ward with two other women and had to walk 7 miles back home the day after the baby was born. Her second child was born in the ‘private’ health facility and even though the doctor did not make it in time for the delivery, he didn’t miss the chance to still make her pay high out of pocket fees. The third delivery was prolonged, and without proper medical care, she suffered irreversible damage and was seconds away from a fistula.

It is no wonder then that when we raced into the health center to warn the staff that an extremely ill woman was being carried by her appendages (no such thing as a stretcher) from the backseat of the truck, that they would assume it was pregnancy related. However, the woman from the oxcart was more likely a victim of malaria.

It was as we were making our way to the final clinic visit in Masaiti, that we first passed by the oxcart. It careened off the road to make way for our Land Rover. I glanced in their direction to see what they were carrying. It was then that I thought I noticed a woman lying in the middle, most likely surrounded by her daughters and sisters. Maximo hadn’t noticed and swiftly passed the cart, leaving a trail of dust behind us. I yelled that he needed to go back. I wasn’t sure what I saw, but I definitely wasn’t going to continue without checking. (While the oxcart is able to transport people who are unable to sit or stand, it is by far the slowest form of transportation on the bumpy dirt roads).

While waiting for the woman to stabilize, I spent some time chatting with her daughter, the mother of William. She was 25 and William was her third child. She actually had left the village and was living in Lusaka, but was called when her mother became ill. She had to arrange for her own transport from Lusaka to the village and then she needed to organize the money (15,000 kwacha or $3) for the oxcart to get her mother to the rural facility, all the while the woman’s health was deteriorating because of the delay. “You see, everyone gives money for the funeral, but will do nothing to prevent death in the first place”, the daughter explained to me.

As we continued talking, another young woman joined us. At first I thought she was child, but she was introduced as the wife of a man working at the clinic. I inquired about her age and was told she was 13…a child after all. In the afternoon, I heard of another young woman who was 11 and with child. I would rather not think about this than to comment. Later, as we drove on the dirt road away from the village, I noticed a painted sign on a school that read, “If you educate a girl, you educate a nation”…

2009-06-15T02:29:00.000-07:00

William's grandmother was brought to clinic on oxcart/ambulance below.

Cross-Cultural Exchange

2009-06-15T01:01:00.000-07:00

I am slowly becoming more acculturated to Zambian life. During our long journeys to rural health clinics, I have learned to tell the driver that I need to ‘wash my feet’ when I need to go to bathroom. I have also learned how to do this without actually needing to wash my feet afterwards J

I have learned that when you ask someone to do something, you need to be very direct about the timeframe. Instead of ‘Maximo, you need to get directions from Angela so we can find the last clinic’, I need to say, ‘Maximo, you need to get directions NOW’ or ‘Maximo, Angela is ready for you to get directions from her NOW’.

I have learned that when someone trips when walking or drops a glass on the floor, I should say ‘sorry’, but when the MC to an event arrives 2 hours late, I should not expect him to say ‘sorry’.

I have learned that it is inappropriate to ask someone how old she is, but completely acceptable to ask how much she weighs.

I have learned that every culture blames someone else for their problems and in the case of Zambia, the Chinese are guilty…. “selling faulty electronics, administering bad medicines and doing karate all day long” they are clearly to blame.

I have learned that no one understands what public health entails and everyone thinks that I am a doctor, no matter how often I explain I am not.

And finally, I have learned that even in a country with barely enough blondes to count on one hand, everyone seems to know the difference between a blonde and a mosquito…

Now I imagine you are wondering about the exchange portion of this cross-cultural experience. I have tried my best to impress new friends and acquaintances with stories of the American culture. However, the only thing that seems to catch their fancy is the culture of divorce.

“Karen, tell her what you do if you don’t like your husband anymore”.

“You get rid of him and find a better one”, I say smirking.

“Wow – that is really nice – I like that”.

(Not a big surprise….given my impressions of Zambian men so far)

2009-06-14T02:26:00.000-07:00

2009-06-14T02:12:00.000-07:00

Site Visits

2009-06-09T06:01:00.000-07:00

Rural Women's Health

This is Africa

2009-06-09T04:53:00.000-07:00

Pictures

2009-06-09T00:24:00.000-07:00

Antenatal Clinic visit - Petauke

Life's Risky Start in Zambia

2009-06-09T00:13:00.000-07:00

The more time I spend in this country, the more I realize how truly fortunate I am to be a woman in the US – and for once, this statement is purely based on access to health care – all other observations and ranting aside. I will probably never view pregnancy and childbirth quite the same either. In the US, pregnant women ‘glow’ or so I hear people say – they go to the doctor for regular checkups, and pack a bag to prepare for the delivery, well before the due date. In most of the rural areas I have visited, it is very surprising to see any woman above the age of 17 without a protruding stomach and another child strapped on her back. No one asks these women how far along they are in the pregnancy or if it is a girl or boy. If these women pack a bag, they are packing soap, clean cloths, and an umbilical clamp because these things are not provided by the health facility. However, most women have no need to pack a bag… it is estimated that 75% of women in the rural communities don’t actually make it to a health facility ….their children come into this world as they lay on a dirt floor, perhaps with someone to help if they are lucky.

With misoprostol, these women are at least given a fighting chance. Maternal mortality is somewhere between 591 and 729 deaths per 100,000 live births. Post-partum hemorrhaging (PPH) is the leading cause of maternal death. Among the benefits of misoprostol is that it can be orally self-administered immediately after the birth of the baby and prevent PPH. For women delivering at home, misoprostol can be life saving.

During my last site visit in Petauke, it was the antenatal clinic (ANC) day for two of the health facilities. One day a week is designated for antenatal education sessions and individual counseling for pregnant women. Nearly thirty women were waiting to meet with Sister Hilda, the only trained provider, and I was told this was a light day. On average she will counsel 50 women a week. Now, thanks to the efforts of Venture Strategies, misoprostol education is included in the antenatal education sessions. After their individual appointments and screening, women are given the option of taking misoprostol home with them. An overwhelming number agree to do so, tucking the packet of three tablets into the corner of their chitenge (traditional skirt) as they head back to their homes.

After spending some time with the women, questioning them on what they learned during the ANC, I left the maternal ward of the facility and gave Sister Hilda a hug, thanking her for her incredible commitment to the women and the community. As I rounded the corner, I passed by another line of general treatment patients. Men, women and children were all crowded on to the porch of the front of the clinic, trying to avoid the beating sun. Sister Hilda has an assistant to help with the screening, but eventually she would need to treat all of these patients as well.

I left the site visit feeling frustrated and sad, even though it was evident that the project was going well. I believe in the importance of the work at hand, but in reality, it is just a drop in the bucket, given the incredible amount of need in these communities. I started feeling a bit more optimistic by the third clinic visit. It was a very impressive facility, with a new addition built in 2007…this indicates progress, right? I glanced up at the ceiling of the new building and noticed the asbestos…

This is Africa

2009-06-08T07:30:00.000-07:00

Part of the excitement of travel is the unexpected and in Africa, it is best not to have expectations at all. Rather than getting overwhelmingly frustrated every time something goes awry, the most weathered travelers will say “TIA”….this is Africa.

Friday, June 5

Our team returned from the final health facility visit in Petauke at noon. I made a last minute decision the night before to not return to Lusaka with the group and instead hop on a bus and head to Mfuwe, home of South Luangwa National Park….supposedly one of the best game parks in Africa. The map made it look like a relatively easy journey – I had heard a two hour bus ride to Chipata, followed by another 2-3 hour mini-bus ride to Mfuwe. However, most musungus fly into Mfuwe, so I didn’t have much to go on and when you ask locals, they always seem to underestimate the time and distance.

After the final site visit, I had the driver drop me off at the junction where the buses to Chipata passed through. I sat on my backpack under a tree with a group of men, who were also waiting there with coolers of drinks to sell passengers as the buses passed through. I asked how soon till the next bus to Chipata and was told very soon…

After the first hour of waiting, and a countless number of people asking if I was Peace Corps (apparently Peace Corps volunteers are the only other musungus to make it to this part of Zambia), two German friends from Lusaka rode by on bicycles. These guys are riding from Cape Town to Nairobi to raise funds for an orphanage, which one of them started. They have definitely made the top of my list for coolest people I have I met in Lusaka. I jumped up yelling, “Emmanuel” and they both steered of the road, equally surprised to see me in this town so far off the beaten path. We chatted for a bit and then they proceeded, leaving me to wait for the bus that would nearly run them off the road shortly after….

Anyways, two hours after being told “very soon”, the bus arrived. I shoved into a seat near the front and waved goodbye to all of my new bus stop friends as we drove away. This first leg of the trip was rather uneventful, except for the unfortunate incident in which we ran over a rather large pig. Because of my front and center position on the bus, I was able to see the play-by-play of Wilbur’s demise.

Given our later than anticipated departure, I was pleased to find a minibus to Mfuwe “ready” to leave. The dirt roads in between the two towns, with notorious potholes and a propensity for animal visitors, are not recommended to travel at night. However, since it was only 4:30pm and the man who sold me a seat promised we would be leaving in five minutes, I figured I was in the clear. But then again, TIA.

Over an hour later, we finally rolled out of the parking lot. I glanced at my watch, quickly calculating how many minutes of daylight were left – not enough. In addition, with each revolution of the tires, the entire vehicle sounded like it was going to fall apart. They had also piled so much weight on the roof that it actually started to sag in the middle and only one door was functioning. (It was all starting to make sense why most musungus fly). We didn’t make it more than 500 meters and the driver pulled into an auto shop, claiming he needed to quickly fix our spare tire. After 30 minutes in the shop, I phoned the lodge where I had made a reservation to inform them I would be arriving later than planned. At this point the men were take turns hitting the tire with a sledge hammer. While I am no mechanic, their method seemed counterproductive. TIA.

They finally got their fill of hammering the tire and put it back in the vehicle. It was 6:30pm when we left the auto shop and what little trace of daylight remained was wasted when the driver decided he needed bread for the journey and made yet another stop.

When it was clear that we were on our way, I relaxed, well sort of; my knees were smashed into the seat in front of me because they had added another bench to the minibus to maximize passengers, consequently minimizing leg room to that only fit for a child. Needless to say, it was probably the most uncomfortable position I could have possibly been in for a 3 hour pot-hole ridden road trip. I turned to check in on the family behind me…a mother and her three small children, who I had spent some time playing with during the long waits. The mother sat with one child on her lap and the second nestled into her side. The third, a boy around 4 or 5 years old, was left with very little room and was trying to rest his head against the window. Being a chronic car sleeper – I am familiar with all positions and the “head against glass window on bumpy road” is probably the worst. While, I had no leg room, I did have a bit of space next to me, so I signaled to the mother that the boy should sit with me. She couldn’t understand my signals, but didn’t protest as I lifted him over the seat. However, he stared at me with bulging eyes. Everyone else in the minibus was also staring...something that would become quite commonplace by the end of the journey. Nonetheless, once I convinced him to lay his head on my lap, he was asleep in 30 seconds.

About 1.5 hours into the drive, the vehicle died. I nervously glanced at my fellow passengers and in unison, we all checked our cell phones for reception…and of course, there was none. (cue horror film music) The same three stooges who were using the sledge hammer on the tire earlier, attempted to fix the vehicle in a similarly asinine way, running around and banging things. Again, while I am no mechanic, it can’t be a good sign when someone starts to hit the dashboard in an attempt to get the car to turn on. It was at this point that I also noticed that they had been starting the car all along by touching two wires together. TIA.

Two other cars passed us on the road and no one made any attempt to flag them down. Deciding that I was not going to be complacent anymore and needed to be ready when the next car drove by, I started to make my way out of the vehicle. Since I had no close access to a functioning door, this required elaborate movements over the backs of seats and heads of people. Finally free and standing on the road, I noticed all of the other passengers eyeing me weirdly from inside. I then noticed headlights in the distance. As the car approached, I ran out into the road and flapped my arms like a crazy woman. As it came closer, I realized it wasn’t slowing down and was in fact racing towards me. I threw my body into the ditch, simultaneously yelling “stopppppppppp” as it zoomed by. Now all of the other passengers had their faces pressed against the window glass and shaking their heads.

Brushing the dirt off my pants, I looked up to see the vehicle moving forward. I had to run and catch it, but all the while, I was yelling “woohoo……wooooooo”, and punching my fist in the air.

The next three hours of the journey, albeit bumpy, were without interruption. We dropped off passengers along the way, with finally just the family I mentioned early, a young guy and me remaining. We arrived at the family’s home and I had to gently wake my sleeping friend. The children, still half asleep were deposited on the side of the road, meanwhile their father, who came to meet the minibus, was having a heated discussion with the driver. I figured he was probably angry because they were so late in dropping off his young children and wife. However, the driver was actually demanding more money and refused to give them their luggage unless he was given another 10,000 kwacha ($2), explained Chilufya, the other remaining passenger. However, the father did not have any more money and had paid the price negotiated, which the driver was now denying. The father looked very worried and the children looked exhausted and scared. I searched for my headlamp, found the 10pin in my bag, and handed it to the driver. As for what happened next, I can only say that my thinking was clouded by all of the earlier events and while I am not proud of my behavior, it seemed completely rational at the time. So anyways, I handed the driver the 10 pin and then I asked Chilufya to translate, “Take the money, but you should know that I think you are the biggest asshole I have ever met and I have met a lot of assholes. I wrote down your license plate number and I am going to report you and this piece of shit bus to the police. And if they don’t do anything, I am going to call a friend up north, who knows just the right person to take care of you”. (Through stories from colleagues, I knew that everyone was afraid of the black magic in the north). Chilufya shook his head and mumbled something to the driver and his minions. I don’t think he told them what I said because Chilufya is clearly far smarter me and recognized that I still needed to be dropped off safely.

Which they did at the fueling station in Mfuwe and I was then ushered into an open-air safari vehicle by a guide from the lodge who had been waiting over two hours for my arrival. The camp where I made a reservation was 5 km off the tarmac and situated right outside the official park. However, since there are no fences separating the park from non-park, animals roam freely between the two.

As we turned off the tarmac, I was already well into grilling the guide about his life, dreams and aspirations… He was so caught up in my interrogation that he nearly ran smack into an elephant. The sleeve of my shirt practically brushed the elephant’s behind. He slammed on the breaks and I looked to the left where eight huge elephants were eating leaves, all within reach of my outside arm. TIA.

We finally made it to camp and I was given my own chalet, with a porch that looked out to the Luagwa River, home to more hippos than any other place in Africa. Finally, at midnight I crashed into bed and fell asleep listening to hippos call across the water.

Saturday, June 6

Before my alarm could do its job five hours later, I was jolted awake by the sound of very fast running. Heart racing, I peered out the window, but saw nothing. I made my way to the main lodge and Andrew, the safari guide, asked if I heard the four lions running by a half hour earlier… TIA!

Andrew and I set off for the morning drive, accompanied by an aunt-niece duo from Oregon. This was their 11^th drive of the week, so Andrew asked if there was anything I wanted to see in particular. I told him I liked everything… However, the duo really liked everything and suddenly we were stopping for every damn bird in the park and having a full discussion about its mating and nesting behaviors. I know I should appreciate birds, just like I know I should appreciate modern art – but I don’t. Sure we saw plenty of elephants and giraffe, and even a herd of 200 buffalo, but we seemed to be stalking robins and love-birds, and I really wanted to see some lions. I had given up hope, tuning out the discussion about the physiology of the woodpecker, when Andrew abruptly threw the truck into reverse. He pointed to the right….and there, basking in the sunlight, were 6 lions, all within spitting distance of the safari vehicle. He explained how the women do all of the hunting and provide for the pride…….I told him it sounds like the rest of Africa and he laughed, agreeing. Andrew situated us even closer and I spent the next twenty minutes getting a lion’s share of photos for the day.

After the lion encounter, we had tea in a field of impalas and set off for the journey back to camp, passing elephants, giraffes and zebra along the way. I had a five hour break between game drives, so went to hang by the pool, which was near the river, which was full of hippos. TIA.

The night drive was even more incredible. The two other passengers spoke only enough English to say they wanted to see a leopard (a very elusive animal), which left lots of opportunity for me to talk to Phillemon, the guide and Mago, the spotter. The drive started early enough for a couple hours of daylight, sundowners in a picturesque location, followed by two hours of spotting nocturnal animals with a spotlight. Five minutes into the drive we passed a field with antelope, warthogs, baboons and a variety of other animals. It seriously looked like a scene out of the Lion King and I am embarrassed to say that I started singing circle of life without even realizing it. There was nearly a full moon, which Phillemon said made it even more difficult to spot a leopard….we saw plenty of hyenas though, definitely one of the ugliest animals out there. Just as the night drive was winding down and Phillemon pointed out the Southern Cross, lo’ and behold, Mago spotted a leopard. It was absolutely amazing – creeping through the grass, stalking a nearby impala. While we wanted to wait for the kill, we were ruining the leopard’s game by sticking around.

Returning to camp at 9pm, I was able to get a few hours of sleep before catching a 2am bus back to Lusaka. This time my alarm was intercepted by the sound of a hippo munching on grass. I peered out the window and it was nearly on the porch...fortunately, it had returned to the river before I needed to exit. I had been warned not to startle a hippo. I jumped in a safari vehicle and was escorted back to town, passing several hyenas on the way. We had heard lions howling in the night, as well as the alarm calls of puku and baboons. Now with hyenas in the area, it was clear that the lions had found dinner in the camp during the night. TIA.

Back in Lusaka

2009-06-08T01:02:00.000-07:00

A very fruitful site visit in Petauke last week, followed quite an adventure in the bush over the weekend (take a close look at my friends in the background of the picture). Lots of updates to post...will try to catch up tonight before leaving again on Wednesday.

NYT: Where Life's Start is a Deadly Risk

2009-06-03T04:58:00.000-07:00

Where Life's Start is a Deadly Risk

Childbirth in Tanzania

Back to the Bush

2009-06-03T02:07:00.000-07:00

Leaving the chaos of the MOH and heading back to the bush (Petauke) for a site visit. There is a game park very close, so I might try to sneak a game drive in....

Not sure when I will return, but will post more pictures. Have been sorting out camera issues for the last week.

Musungu Goes to a Wedding

2009-06-01T01:11:00.000-07:00

With Tracy’s in August, weddings have been a major source of conversation in the Weidert family. Therefore, I couldn’t pass up the opportunity to see an official Zambian wedding on Saturday night, when my friend Oliver extended an invitation one hour before showdown. I cancelled my dinner plans and put on my finest dress, which is not saying much, but interesting enough, even though it was a floor length Roxy bohemian dress, most of the Zambians thought I was wearing a traditional dress. Bonus points for musungu.

We arrived late, which was rather awkward, as we walked through the entrance just as the bridal party was making their grand entrance. Not to be mistaken for the traditional announcing of names done in American weddings… these bridesmaids and groomsmen had been rehearsing a dance for several weeks leading up to the big day. Little did I know that this was just the first of a series of dances, including several costume changes. Even the cutting of the cake was the accompanied by a bridal party performance. Thinking about my upcoming role as maid of honor and my propensity to get pulled aside in dance class for remedial help, I realized I would never be a very good Zambian bridesmaid. However, I have to say that there was one part of this ceremony that I especially appreciated. During the initial dancing entrance, guests would run up to the different bridesmaids and groomsmen and stuff money down their dresses and into their pockets I asked the purpose and was told it was to show appreciation. What do you think, Tracy? This could fund ‘Spring Break 2010’.

After an extremely long rant by the MC (not entirely sure what he was saying, as it was in Nyanja and only some was translated, but everyone was laughing), even more speeches began. All the while, I kept staring at the bride because she seemed rather unhappy for a newlywed. The first orator (her new uncle) said that ‘they hope to see a better version of her, now that she married his nephew. If she has problems, she should no longer go to her family – they are not her family anymore.’ Then the minister stood up and started talking about ‘if your husband says he is gone on ‘business’, it is not your place to assume the worst – you just have to assume that he is just providing for your family’. (Easier said than done – remember all the extramarital girlfriends I mentioned in an earlier blog?). The MC stood back up and made a joke about husbands and prostitution, and then it was the father of the bride’s turn. He went on to describe what a wife was…’wise, industrious, financial and economical’. Industrious was a reference to the work she would do to take care of the home, and the financial and economical referred to how she wasn’t supposed to spend a lot of money. Then he began with husband…’honorable, understanding, supportive’….and then I rolled my eyes and tuned out. Needless to say, the bride’s disposition began making a lot more sense.

During the final speech, crates of beer suddenly appeared and the real celebration began – this was very reminiscent of weddings at home – the men were just much better dancers.

I should also mention that the mother and father of the bride were in beautiful matching dresses. I laughed to myself when I first saw them, thinking about how my father wouldn’t be caught dead wearing a gown, let alone one that matched my mother. Then I was inspired…Mom and Dad – I am getting some custom-made. Do you have color preferences? I am thinking blue to compliment your eyes.

Caughtya with 10 Billion Kwacha

2009-05-29T02:01:00.000-07:00

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...

2009-05-28T00:52:00.000-07:00

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…

2009-05-27T04:31:00.000-07:00

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....

2009-05-27T04:28:00.000-07:00

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

2009-05-27T04:22:00.000-07:00

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.

2009-05-27T03:42:00.000-07:00

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 :)

2009-05-27T03:31:00.000-07:00

Musungu Plots Against the Chief

2009-05-26T06:23:00.000-07:00

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

2009-05-26T06:22:00.001-07:00

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...

2009-05-26T06:21:00.001-07:00

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

2009-05-26T06:17:00.000-07:00

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

2009-05-26T06:15:00.000-07:00

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

2009-05-26T06:13:00.000-07:00

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

2009-05-26T06:09:00.000-07:00

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

2009-05-26T06:07:00.000-07:00

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

2009-05-26T06:04:00.000-07:00

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!

2009-05-18T05:04:00.000-07:00

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

2009-05-15T02:32:00.000-07:00

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.

Project Overview

2009-04-17T21:15:00.000-07:00

On May 12, I will be turning in my last paper and heading to the airport...literally. After two days of travel and nearly 24 hours in the air, I will arrive in Lusaka, Zambia -- my home for the summer.

As a summer intern with the Bixby Center for Population, Health and Sustainability, I will be working working in collaboration with Venture Strategies and the Ministry of Health, Zambia (MOHZ) to implement a formative midterm evaluation of a misoprostol pilot project that was rolled out in January 2009, aimed at reducing maternal death from post partum hemmorhaging (PPH). Based at the MOHZ, I will also be traveling to the five districts where the project is being piloted. During the three months in-country, I will be collecting data and assessing all areas of the project implemention, from the project management at MOHZ to the distribution of misoprostol within rural communities, then writing project recommendations upon completion of the evaluation.

Why misoprostal?
The generic drug misoprostol has been very successful in both the prevention and treatment of PPH. As a low-cost, easy-to-administer uterotonic with a long shelf-life, misoprostol has the potential to reduce death and morbidity from PPH in home-deliveries without a skilled birth attendant. Recognizing misoprostol’s life-saving potential in low-income rural areas with limited access to formal health care, Venture Strategies is working closely with MOH in several countries to determine the best methods and routes for making it available. (Global Misoprostol Registration by Indication)

Misoprostol Pilot Project, Zambia
The goal of the Zambia project is to save mothers' lives by preventing PPH at home births with misoprostol tablets for women who are unable to reach a facility to deliver. The Zambian Pharmaceutical Regulatory Authority approved misoprostol, a simple tablet that can effectively prevent and control postpartum bleeding, for PPH prevention and treatment in May 2008. To reduce the number of women who die due to excessive bleeding at home births, this project will distribute misoprostol tablets at antenatal care (ANC) visits to women who cannot reach a facility to deliver.

The pilot project will provide evidence to inform policy decision makers on the use of misoprostol at home births dispersed through ANC visits, and can serve as a model for other regions of Zambia where most women deliver without a skilled attendant. The project aims to assist the Ministry of Health in developoing a distribution strategy that can be integrated into existing maternal health initiatives and scaled up to increase impact.

Why is this project so important?
The risk of maternal death from childbirth represents one of the greatest inequities in global health. Women in developing countries are more than 40 times more likely than women in developed countries to die in childbirth (1 in 61 women in developing countries versus 1 in 2,800 women in developed countries). Obstetric hemorrhage is the world’s leading cause of maternal mortality. Postpartum hemorrhage (PPH) is the most common type of obstetric hemorrhage and accounts for a quarter of maternal deaths worldwide -- in Zambia PPH attributes to over a third of maternal deaths. Maternal mortality in Zambia is 750 deaths per 100,000 live births (WHO, 2000). Women who carry a pregnancy beyond 20 weeks' gestation are at risk for PPH and its sequelae.

Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Developing countries lack the necessary drugs and skilled attendance during home births to manage PPH cases. In addition, the high prevalence of anemia among women in developing countries predisposes women to PPH-attributed mortality, as even the modest blood loss after delivery can be life threatening. To effectively manage PPH in resource poor settings where most women deliver at home, technologies such as misoprostol are the only available alternative. Thus, the need for empirical data to support community-based distribution and use of misoprostol is urgently needed.