Sunday, June 14, 2009

home!


This is probably old news to most of you, but we've arrived back in the States safe and sound after three flights from Zambia, to South Africa, to England, finally to America!  The first thing we all noticed upon exiting the airport in Dulles was the humidity!  I don't think we missed that at all!

Now it's on to jetlag and unpacking and getting readjusted to life as we normally know it.  I'm off to the grocery store shortly and am not looking forward to ALL of the options!

Thanks again for tuning in to this blog, and to sharing this amazing experience a bit with us!  I'm sure your loved one will be more than happy to share their HUNDREDS of photos with you!  A picture is, after all, worth a thousand words!

Thanks again and again to Dr. Thuma and Elaine, and to the wonderful staff at MIAM and the Macha Mission Hospital, and to the beautiful country of Zambia!  We will never forget you all!

Sunday, June 7, 2009

so long...for now


As we expected, the church service that was to scheduled to start at 9 a.m. this morning actually started at 10 a.m.!  But we were there on time, being the Americans that we are!  We were once again treated to amazing singing during the service, and even made a joyful noise ourselves, sharing our one song with the congregation!  It was wonderful to be with our African brothers and sisters in Christ one more time before departing tomorrow.

Tomorrow.  I’ve heard so many of the students today denying that we’re actually leaving!  For most of us, it feels like we’ve always been here and always should be!  It will be difficult to leave tomorrow, that much is for certain!

After lunch, most of us spent the afternoon doing some combination of studying, packing, and napping.  A few of the girls went back to Vera’s to finish their hair-braiding (they look great!).  At dinner we were treated to some of our favorite leftovers, including some of the most amazing rolls!  Here is a picture of Alicia S. enjoying the yummy goodness!

After dinner, we gathered to start debriefing, with each person sharing what was the most memorable experience during their time in Macha, and what they will miss the most.  Here is some of what we will remember:

  • Our gracious hosts.
  • Seeing firsthand the devastation of AIDS.
  • Going on rounds, realizing the lack of proper equipment.
  • Realizing what we have and take for granted.
  • Confirmed calling as a doctor to Africa for some.
  • Realizing how much needs to be done in global healthcare.
  • Recognizing American privilege.
  • The way the sound of voices in song carries for miles.
  • The rustle of the wind through the banana leaves.
  • The bright, warm sun and the lack of humidity.
  • The beautiful, friendly people.
  • Hospitality
  • Seeing the face of Jesus in patients in the hospital.
  • A renewed sense of purpose and calling.
  • Refreshing
  • Recognizing how small I am.
  • Realizing that I am not in control!
  • The roads!
  • Scrubbing in for surgery.
  • The surprising sense of hope.
  • Greeting everyone you pass with a friendly hello, and having them always respond!
  • The huge blue sky during the day, and the incredible starry sky at night.
  • The spaciousness of the land.
  • The laughter and joy of kids.
  • Walking everywhere.

Needless to say, we will remember and miss this place!

The students begin their final at 7:45 a.m. tomorrow morning and have until 9:45 a.m. to finish it.  Then we’ll quickly load up our luggage and ourselves in the bus and we’ll be off to Livingstone, hopefully making the five hour drive in time to see Victoria Falls before the sun sets.  We’ll then enjoy a nice dinner in town and will spend the evening in Jollyboys, where we stayed when we first came over two weeks ago! 

We’ll leave Jollyboys at 6:45 a.m. on Tuesday morning to go to Chobe Game Park, where we’ll be spending three days and two nights on safari with Chobezi Safaris.  If you’re interested in reading a bit more about what we’ll be doing on safari, click this link for more information: 

http://www.chobezi.com/combos32.html

We’ll return to Livingstone on Thursday late afternoon and will spend Thursday night at Jollyboys again.  Friday morning, we’ll have a few hours to do last minute shopping in town or money-exchanging and then we’ll be off to the airport by 11:30 a.m. for our 1:30 p.m. flight to Johannesburg, South Africa.  We’ll have a six-hour layover before departing at 9:20 p.m. for London.  We arrive in London at 7:20 a.m. on Saturday morning and will depart for the States at 10:50 a.m., arriving in Dulles at 1:40 p.m. local time!

It’s so hard to believe our time in Africa is coming to a close.  We have truly fallen in love with this beautiful country and its people.  The MIAM staff were absolutely wonderful to us, and it was a privilege to get to study with Dr. Thuma and see the amazing work that is being done here in Macha.  We have truly learned so much from this experience and will no doubt continue to glean from it for months and years to come.  (And, on a completely personal note, I want to be like Elaine Thuma when I grow up!  Elaine – You are a joy and a delight!  It was such a privilege getting to know you!  Thank you for ALL you've done for us, and for just being you!) 

So, thanks for tuning in to this blog!  I’ll post one more entry when we return to the States (probably sometime on Sunday) just letting you know we arrived home safe and sound, though I’m sure by that point you will have already heard from your loved one!  Then we’ll be in the throes of jetlag and readjusting to life in the “developed” world!  Keep us in your prayers as we reenter life as we know it!


Saturday, June 6, 2009

our last Saturday in Africa


Our last Saturday in Africa passed way too quickly and very quietly as we had a “free day” to allow students to begin studying for the final on Monday.  That being said, I have a sneaking suspicion that most students spent the day out and about – going to the market, visiting their host families, getting freshly baked rolls right out of the oven in the village store, buying more citenge’s at Gideon’s or Joe’s, or just relaxing and resting at the dorm.   A few got up super early (5:30 a.m.!) to watch the sun rise at the water tower.  (See the photo at the end of this blog taken by Melina for the beautiful view!) A few ventured out to the children's bible school they hold every Saturday morning nearby.  Larry picked up a bunch of rolls for us to take on our long drive 

back to Livingstone on Monday.  He also once again showed off his new lemonade-making skills, treating us to freshly squeezed lemonade at both lunch and dinner!  (What a gifted professor!)

A few of the ladies in the group went back to Vera’s to pick up their outfits, and a few spent hours having their hair braided African-style!  Here are Tamara and Alicia (who is also wearing a traditional African headdress) showing off their new do’s!

This morning, I met Jillian, a Johns Hopkins University student who arrived last night and will be doing research in Macha for the next three months.  I gave her a “tour” around the village and was amazed at how comfortable and at home I feel here after only a few weeks.  I’ll admit I was more than a little jealous of Jillian for her ability to stay for three months!  I know many (if not most) of us will leave pieces of our hearts here on Monday when we depart. 

We were treated to yet another feast at dinner, and picked up bags of unroasted peanuts that we’ve shelled the past few days to bring home and share with our loved ones.  I think whenever I see a peanut from here on out, I’ll think of Zambia!

Tomorrow morning is a special church service that will “begin” early (on African time that could be anywhere from 9 a.m. to 10:30 a.m.!) and last into the early afternoon.  Our group will be sharing a song with our Zambian brothers and sisters during the service!  While some of us carry tunes in leaky buckets, we can definitely make a joyful noise!  And we intend to do so!  Then we’ll have the afternoon to pack (sob!) after lunch before having our last dinner in Macha (double sob!), followed by a debriefing session on Sunday night, where we’ll start to talk more about what going home will feel like (triple sob!).  Continue to keep us in your prayers as we continue to process this incredible experience!  Pray also for safe travels as we go!

I’ll write one more post tomorrow night (Sunday) and then we’ll be off and without internet access until we return to the States on Saturday, June 13th!  I know that as excited as we are to see our family and friends and share about our experiences, we’re also praying the next week goes VERY SLOWLY!


Friday, June 5, 2009

last day of class!

We started our last day of class early this morning – 7:30 a.m. – perhaps a first for these college students!  We continued our discussion on HIV/AIDS.  Zambia is considered a “high” prevalence country based on HIV testing done in different populations.  In 2008 there were around 40 million people in the world living with HIV (up from 2 or 3 million in 1986).  There are about 14,000 new HIV infections a day.   More than 95% are in low and middle income countries.   Almost 2,000 are in children under 15 years of age.  Sub-Saharan Africa bears the greatest burden of HIV in the world.  Life expectancy in Zambia at birth is estimated around 34 years old.  Thankfully, deaths from AIDS have declined, largely due to free ARV drugs paid for by the Global Fund and PEPFAR, President Bush’s initiative to help with the AIDS crisis.

In Zambia, instead of saying this is “the tip of the iceberg” they say it is the “the ears of the hippo” because most people here don’t know what an iceberg is!   There is nearly a 10-year gap between being infected and being symptomatic.  Therefore, there is a huge population of asymptomatic people who continue to transmit the virus because they feel fine.  Of all the people infected, only about 10% at any time have recognizable AIDS.  This is part of what makes this virus and disease so insidious. 

I’ll be completely honest and say that today’s class included a lot of microbiology terminology (e.g. protease, nucleoside-like, transcriptase, to name just a few!) and diagrams that I could barely make sense of (being the one non-science person in the group!).  Suffice it to say, the HIV virus is very complex and nasty.

Our class was broken up into two different sections today due to some prior commitments Dr. Thuma had to attend to.  During our mid-afternoon break, many of us wandered back into town, some spent the entire time shelling peanuts, while others got a head start on studying for Monday's final.  When class resumed in the late afternoon, we continued our discussion on HIV/AIDS and its causes, presentation, and treatment.

After yet another yummy dinner, we spent the evening playing that old youth group game “four on a couch” and then watched “As Good As It Gets,” a movie most of us found hilarious, others not so much (ahem, KENNY!).  But it was still very fun to spend a relaxing evening together.

Tomorrow is our last Saturday in Africa!  Many of us are happily living in denial, wanting to never leave.  

Thursday, June 4, 2009

food and drugs

This is the point in the trip when people start talking about the foods they are missing back home:  french fries, ice cream, brownies, and potato chips have all made the list.  We continue to be fed VERY well here, so this is in no way a reflection on the wonderful food we’ve been served, but rather of our own culture shock settling in a bit deeper. 

I think a bit of the shine has started to wear off of our new, exciting experiences and we’re starting to be forced to come to terms with the expectations and assumptions that are being exposed underneath.  This is a good and integral part of the learning process, but not nearly as fun as the “Oh!-Look!-Shiny!-Exciting!” first few weeks in a new culture.  I would say we are now learning more about ourselves at a deeper level, as well.  Unfortunately (or fortunately, depending on your perspective!), we’ll be leaving before a lot of the really difficult culture shock sets in, when it’s no longer exciting and unique (almost “quaint” by our Western standards) to have power outages every day, to shell even more peanuts, to eat the same foods almost every day.  Soon we’ll have a bit of reverse culture shock and the huge supermarkets at home will no doubt overwhelm many of us!

We have so very much to learn, and we can only really begin to scratch the surface of it during our three weeks here.  Regardless we are VERY thankful for the privilege of the lessons we have learned in these few short weeks!  In fact, one of the greatest lessons I think we’ve learned (or been reminded of) is that we are extraordinarily privileged indeed.  What are we going to do with our newly understood privilege?  That will be a topic of on-going conversation during the next week as we begin to prepare to leave this beautiful place!

Speaking of food and privilege, we were extremely honored to be invited to eat lunch at Vera the dressmaker’s home this afternoon.  All 23 of us were welcomed eagerly by our vibrant hostess as we squeezed into her cozy living room.  A number of students modeled outfits they ordered (see the end of this post for a few examples!), and Vera made notes for some slight alterations on a few.  Then, the feast began!  Vera treated us to an amazing array of delicious foods – from Zambian basics (cornmeal and cabbage) to American foods (mac and cheese that made Kenny so excited he almost cried!). Everything was so good!  Then she brought out the fruit salad (this almost made me cry: fruit salad!!!) and cake.  We walked away full – not just physically but also emotionally as Vera invited (nearly begged!) us all to stay in Zambia!  Oh, that we could!

During class this afternoon we discussed the complexities and challenges of drugs (and drug companies) in the developing world.  We learned that there are over 60,000 marketed drugs in the United States versus only 2,000 in Norway/Sweden and 15,000 in India.  Why ever do we need so many drugs in the US?  What is the role for traditional herbal medicine?  Of the 25,000 to 75,000 species of plants being used in herbal medicine, only 1% have been evaluated for efficacy.  We also discussed tuberculosis (TB) and its huge burden in the world.  Two billion people are infected with primary TB, and around 8 million develop the active disease annually, causing 2 million deaths per year.  TB is also often the cause of death in HIV patients, whose immune systems cannot fight the disease.

We had the privilege of hearing from someone this evening who is living with HIV in Zambia. Through her inspiring story, she reminded us that every single family in Zambia has been affected in some way by HIV or AIDS.  There is a saying about HIV here in Zambia that goes, “You’re either infected, or you’re affected.”  When the Macha Mission Hospital opened their ART Clinic for HIV/AIDS care and research about five years ago, they expected the number of patients coming through the doors to eventually slow.  That has not been the case.  There are well over 4,000 people in the Macha area living with HIV, and more keep coming to the clinic every week.  (And there are, no doubt, many who have not yet come to the clinic for fear of the stigma of having HIV.)  While ARV drugs have helped people with HIV live longer, this entire area has obviously been very affected by this terrible virus and disease.

For those interested in further reading on the subject, I’m almost finished reading “28 Stories of AIDS in Africa” by Stephanie Nolen and highly recommend it.  It is disturbing and unsettling in all the ways a book about the devastation caused by AIDS should be.

It is nearly impossible to believe that tomorrow is our last day of class!  The students will then begin studying for their final exam on Monday, and then we’re off on safari for a few days before flying home at the end of the week!  




Wednesday, June 3, 2009

happy birthday, Tiara!


Wednesday dawned extra-joyously as we celebrated the 21st birthday of our very own Tiara Heisey!  There was much celebrating at breakfast, lunch, dinner (including Tiara's favorite - carrot cake!), and even post-dinner, as we capped off the day of celebration with a movie (“Secondhand Lions”), cold sodas (or “minerals” as they call them here!) and popcorn.  Happy birthday, Tiara!  We’re so glad you were born!

After breakfast we loaded back onto the MIAM trucks and took another dusty, bumpy ride down more bumpy, dusty African roads to visit a rural health post and a rural health clinic.  The staff at both locations met us with warm greetings and took some of their precious time to explain what they do.  We first stopped at the rural health post, where we met members of one of the Neighborhood Health Committees that exist in villages and give input into the rural health center, as well as do health education in their communities. We also met many of the community health workers (including one midwife) who work tirelessly to keep their villages healthy.  The staff who man these important posts and are the first line of defense against disease in the communities.  Dr. Thuma later explained that it is often very challenging to find a balance between volunteers the community trusts and someone who has technical training in healthcare.

We then went to tour of one of the rural health clinics, a large, nice building about an hour (by car) from Macha.  The gregarious staff gave us a tour of the facilities and explained what each room in the clinic was for.  Children from the surrounding villages peaked around nearby tree, giggling and waving at us when we caught them looking!  Everyone we meet continues to be extremely friendly and generous, welcoming us at every turn!

After lunch, we spent the afternoon in class.  Students received their graded mid-term tests and did very well!  The average grade was in the 90s!  (We have a very smart group of students!)  We then spent the majority of class discussing malaria – a disease very near and dear to Dr. Thuma’s heart!  (Remember, we are studying at the Malaria Institute at Macha!)

Among the many interesting facts we learned about malaria were these:  Prior to 2003, the Macha Mission Hospital had between 1400-1700 cases of malaria spread over three to five months of the year – about 15 new cases a day, with an average of 3 to 5 deaths a day due to malaria.  In 2004, the new drug Coartem started being used in Zambia to fight malaria.  Due in large part to this new drug (but also due to the expanded use of bednets, insecticides, and education), the number of malaria cases drastically dropped after 2004 to less than 40 cases a year by 2005!  2009 is tracking to have the lowest number of malaria cases in Macha in past 25 years with an estimated 25 cases this year!  Zambia has had a 60% drop in malaria cases in the past few years, while Macha’s reported cases have dropped 95%!  This is in part due to the on-going excellent work Dr. Thuma and his staff continue to do to treat and prevent malaria.

Students are working to finish their major papers on an infectious disease of their choice by 5 p.m. tomorrow.  Many will spend tomorrow morning working away on this, while others will go on hospital rounds.  We’ll have class again in the afternoon, followed by an evening session hearing from a person whose life has been touched by AIDS.

For many of us, the time is going much too quickly!  It is very hard to believe tomorrow is Thursday already!  Apparently, time flies particularly quickly when you’re in Africa!

Tuesday, June 2, 2009

midterms and marriage

The mid-term had begun and Drs. Thuma and Mylin were quietly discussing the source of the chocolate selection that had just been passed around to give the students that little extra “oomph” to get them through the mid-term! All of the sudden, a chorus of “ssshhhhh!!!” rang out from the students directed toward our little table of leaders. Oops. The test had already begun!

The morning had been quiet with studying students, the loudest sounds were of groups of students quizzing each other on the material, or the rustling of pages as students reviewed their own hand-written notes and textbook, or the clicks of mouse pads as students studied the lecture notes posted online. Most students were very anxious to get the first major test out of the way, particularly given the fact the power had gone out at 10:30 p.m. last night, impeding some of their prime study time! A few courageous students spent some of their precious morning hours observing surgery at the hospital. Most found a quiet corner to cram in!

The collective sigh of relief is almost audible when the last mid-term is turned in and students quickly begin comparing notes. After a brief
 break, we continue class discussing a case study on preventing diarrheal deaths in Egypt, have an introduction to primary health care background and basic concepts, and watch another clip from the PBS series “Rx for Survival: A Global Health Challenge” discussing the need for clean water and proper sanitation systems.

This evening we were privileged to meet Edgar and Grace, a young Zambian couple who work at the Macha Mission Hospital, and who talked to us about traditional courtship and marriage in Zambian culture and how it is currently changing. Edgar and Grace come from two different Zambian tribes, each with their own unique traditions, making it even more challenging for them to navigate between the two. Because they are of the younger generation, they don’t adhere to all of the traditions of their tribes, but still work very hard to honor their families. Though traditionally, Zambian families chose mates for their children, Edgar and Grace were friends before wanting to get married and shared that this is becoming more the norm in the younger generations. However, they are still very limited in their interactions prior to marriage. For instance, a Zambian woman should never cook for a man who is not her husband. That is something that should be reserved for marriage!

Family and community are central themes to both courtship and marriage in Zambia, with a person’s family and upbringing playing a huge role in their lives throughout courtship, and as a couple. Edgar and Grace told us about the brideprice a groom and his family must pay for a bride, explained the process a groom must go through to obtain a woman’s hand in marriage from her family, and how a couple is considered married after that price has been paid, even if they have not yet had a formal ceremony. We discussed traditional gender roles in Zambian culture, with women serving men (and never vice versa!), but with men being responsible for paying for everything (even if a woman has her own job – that money is completely hers to do with what she wants!). We also discussed the almost complete lack of public displays of affection in Zambia (a huge difference from our American culture!). Edgar and Grace also asked us a number of questions about our American cultural traditions on marriage and courtship and were quite shocked, I think, at how very different these are in our two very different cultures!  They are a delightful couple and so graciously willing and able to give us a glimpse into this unique aspect of Zambian life. 

Tomorrow we will be visiting a rural health center in the morning in one of the surrounding villages, followed by class in the afternoon. Another wonderful day in Africa!