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!

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!

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!

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.  

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!  

happy birthday, Tiara!

Wednesday dawned extra-joyously as we celebrated the 21^st 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!

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!

a peanutty Monday

Morning seemed to come extra early this Monday, though I suppose most Mondays usually do, no matter where you are in the world!
Another yummy porridge breakfast followed by some more hospital rounds for some of us, reading and studying for others, and no doubt some sleeping for a few more! 

Another good lunch was followed by a few more hours of afternoon class discussing the different types of international organizations involved in healthcare – government (e.g. USAID in the States), non-government (including private voluntary organizations – e.g. Doctors Without Borders, philanthropic organizations – e.g. The Gates Foundation, professional/technical associates – e.g. Planned Parenthood, and commercial companies – e.g. consulting firms), and inter-governmental organizations (e.g. the United Nations).  We also spent time discussing the purpose and role of the World Health Organization, as well as the benefits and challenges of economic development and healthcare. The United States is only 21st in the world in giving monetary aid (only .22% of its GNI instead of the UN agreed .7%), despite being one of the wealthiest countries.  We are extremely rich compared to the rest of the world and give a fair amount of aid overseas, but not nearly as much as we could (should) give.

And, oh, the acronyms just keep coming! GDP. GNP. GNI. IMR. WHO. UN. UNICEF.  USAID. OECD. PVO.  It’s like texting for the nations!  (But only a few actually know what they all stand for – hopefully including our students!)  The mid-term is tomorrow (that’s what happens when you only have class for two weeks!), so students are cramming these acronyms into their heads along with the other information they’ve learned in the past week!

The major news of the day is that one of Zambia’s few hydroelectric plants is off-line, meaning we are having some significant power shortages.  The national electric company has started load-shedding (shutting off the electricity in rural areas so more can be given to urban areas), so Macha has been without electricity for most of the day.  Thankfully, the MIAM campus has a generator, which apparently has run more in the past two days than it has in the past two months due to the recent outages!  While we’ve been lucky to have power despite the interruptions, we will be without power tonight from 10:30 p.m. to 5:30 a.m. to let the generator rest.  (Some of the students are bemoaning the fact that they do their best studying after 11 p.m. – and will have to do it by candlelight tonight!  Another authentic African experience!)

We’ve also been spending a good amount of time today shelling the peanuts some of the students brought back from their home stays!  I shelled some for about two hours total this evening and my fingers are already aching!  But the roasted peanuts and subsequent peanut butter will be well worth the effort!

Tomorrow will bring surgery observation for some students in the morning, no doubt more cramming for others, and the mid-term in the afternoon.  Another full day in Africa!

they're back!

Each red name is a location where one of our students stayed this weekend!

It was so wonderful to see our students returning this afternoon from their various weekend home stays!  They looked wonderful as they returned in pairs, thanking their hosts for the weekend.  After an afternoon of settling back in, we had another delicious dinner followed by an extended time of sharing about their weekend experiences. 

Here are some of the comments/phrases students made:

• Key words from the weekend: hospitality, humbling, patience, grace, hard-working, simplicity, strength, family.
• Two of the girls were proposed to by the same man!  (Fear not, they both respectfully declined!)
  
• Reading a sign that says, “Don’t panic, needs never end.”
  
• Discussing gender roles in Zambia and the clear distinction between “men’s work” (building, plowing, etc.) and “women’s work” (childcare, cooking, housekeeping).
  
• Some of the unique names of people they met:  Sunday, Clever, Bright, Gift, Brilliant.
• Noticing the differences between how Americans and Zambians observe death – Zambians take a week to intensely (and loudly!) grieve after a loved one passes away, and seem to get it out of their system more quickly than we do in the States.
• Realizing they had very little control over what happens next.
  
• Realizing how much they take things for granted.
  
• Feeling guilty for not earning the hospitality they received.
• SPIDERS!
• Realizing that “a lot of people do a lot of work making my frozen vegetables at home!”
  
• Spending time harvesting sunflowers and groundnuts (aka peanuts).
  
• Very physically challenging – walking A LOT, harvesting, being in the hot sun.
  
• Sleeping in their hosts’ beds while their host families slept on the floor.  VERY humbling!
  
• No electricity!
• Kids are kids everywhere – laughing, playing, teaching them to play games.
• Watching their food die in the form of chickens freshly slaughtered before dinner (an honor to get to eat a prized chicken!).
• Getting to carry buckets of water on their heads from the well.  (Or, trying to!)
  
• Harvesting, grinding, and pounding flour and peanuts.
  
• Picking sweet potatoes.
• Goats, ducks, dogs, and other animals always wandering about the homestead.
  
• Learning to dance Zambian style!
  
• How challenging cross-cultural communication can be.
  
• Women are known by their firstborn’s name – “Mother of Joe” (or "Bina Joe" in Tonga) instead of Janet.  They are also often renamed after they get married.  (Janet used to be called Mary!)
  
• Many were with polygamist families.
  
• They were all treated like royalty, by people who have little, but gave much.
  

Needless to say, the students had incredible weekends and no doubt will continue to process their experience in the weeks (and months!) to come! 

Tomorrow brings the beginning of week two of class…hello June!

a quiet day

I can imagine it's starting to sound extremely redundant to say that today dawned bright and beautiful, but it's just the plain facts!  Today was another beautiful day, though it got a bit hotter than it has been recently.  The sun shone brightly and there seemed to not be a cloud in the sky again.  Absolutely beautiful.

It was odd waking up and not almost immediately seeing our students!  It's been strangely quiet without them bustling about.  They've been in my thoughts and prayers all day long as I imagine them at their home stays, experiencing Zambian life a bit more up close and personal!

Larry and I started the morning with a walk into the village (or "town" as we call it, though Elaine laughs every time we say it - our definitions of what constitutes a town obviously differ!).  Early in our journey, we found this HUGE beetle, by far the largest I've ever seen.  I had recently watched "A Bug's Life" (it's how I detox from grad school and work!) and recognized him as one of the stars of that movie!  Larry tried to make him fly by flinging him up in the air, only to have him crash land on the ground.  That didn't keep Larry from trying again, flinging him even higher this time, only to have him thud even more loudly on the solid dirt upon re-entry to earth's atmosphere!  I told Larry if he could fly before, he definitely couldn't fly now!   We watched the beetle walk back into the bush, and I imagined him hurrying back to his ant and other insect friends, telling his harrowing story of being flung around by some giants!

We walked down to the market, and then stopped by the MIAM lab and chatted with one of the employees there for a bit who had just returned from visiting family in Zimbabwe.  We then stopped by the local library/craft store where I pretty much blew my wad getting some beautiful pieces.  (I'd rather spend my money here, where it goes directly to the artist, than in a place like Livingstone, where I'm not sure exactly where it's going!)  There were some lovely pieces, and it was hard to choose!

We arrived back at the Gobelo House to find Andrew returned from his home stay early, suffering from some yuckiness.  While Larry continued exploring the surrounding area by foot, Andrew and I spent the rest of the day together at the house - he resting, I making sure he was hydrating in between enjoying a good book on the porch, soaking in some of the beautiful sunshine.  (Andrew is improving, and I continue to thank God for the miracle of antibiotics!)

Larry plans to attend a local church plant in the morning, and I will join Phil and Elaine for worship at the Macha Brethren in Christ Church again as it's "Women's Sunday" and I'm excited to experience an African worship service lead completely by women!  The students will arrive back on campus around 2 p.m., I'm sure bursting at the seams to tell their stories!  We'll have time tomorrow (Sunday) night to process their experiences together before starting week two at Macha!  Time is going by so quickly!

I realized that I haven't posted a picture of where the students are staying, so here it is!  The dorm is the building on the right, and our cafeteria is the building on the left.  They are beautiful buildings, only recently constructed with monies from a USAID grant.  (It's wonderful to see our tax dollars being put to such good use!)  It has served our students very well!  We all continue to feel very privileged to be here!

home stays!

The students just left for their two day home stays in the surrounding villages with MIAM employees.  Most were a mixture of excited, nervous, and overwhelmed to be heading out two by two to experience "real" Zambian living!  But they all had wonderful attitudes as they went! They will quite obviously be out of internet range until Sunday night, so fear not, friends and family, if you do not hear from them for the next few days!  Rest assured they will be very well cared for (pampered even, by Zambian standards!) and, if troubles arise, Dr. Mylin and I will be the first to know!

Here are the students as they left with their hosts for the weekend:

Alicia B., Kay, and their hostess Patricia

Chelsea, Alicia S., and their hostess Edith

Hallie, Ashley, and their hostess Flora

Marlaina, Tamara, and their host Gift

Malina, Jennie and their host Petros

Merrion, Naomi and their host Bright

Sarah, Liz, and their host Nervis

Sharon, Alex, and their hostess Noreen

Tiara, Laura, and their host Stembridge

Kenny, Brandon, Andy and their host Ivan

Keep them in your prayers this weekend!  I'm sure the students will be bursting with stories to tell when they return on Sunday afternoon, and I'm sure we'll all looking forward to hearing them!  I will keep posting a blog a day while they are gone and will take the opportunity to show you some of the other sights around the village! 

health - public and private!

On every international group experience I’ve participated in over the past thirteen years, the topic of conversation inevitably eventually turns around to stool.  So was the conversation at breakfast this morning as we discussed the consistency and constancy of our bowel movements. Ah, the bonding experience continues!  Fear not, though some of us may be slightly afflicted by this traveler’s malady, we are all still doing well, having the proper medicines and processes in place to keep us – or return us – to health! (Plus, we have the privilege of a resident doctor with us in the good and wise Dr. Thuma, so we are in good hands!)

The outdoor thermometer read 53 degrees when we awoke this morning, and Elaine had built a cozy fire in the fireplace of the Gobelo house where Dr. Mylin and I are staying. We also have the privilege of a lovely fire at our group meeting last night as we debriefed from our time with the traditional healer and discussed etiquette for the village stays this weekend. While many in the group are a bit anxious, I have no doubt their experiences this weekend will end up being a highlight of their trip! They will all be staying in surrounding villages with MIAM employees who Dr. Thuma and Elaine know quite well, so they will be in safe and trustworthy hands!

In class the past few days, we’ve continued our discussion of epidemiology and public health. Yesterday, we spent time discussing the United Nations’ Millennium Development Goals, which 189 nations affirmed in 2000 to be reached by 2015. For those interested, here they are:

1. Halve extreme poverty and hunger;
2. Achieve universal primary education (less than 50% of Zambia children go to school);
3. Empower women and promote equality between women and men;
4. Reduce under-five mortality by two-thirds;
5. Reduce maternal mortality by three-quarters;
6. Reverse the spread of diseases, especially HIV/AIDS and malaria;
7. Ensure environmental sustainability;
8. Create a global partnership for development, with targets for aid, trade and debt relief.

We spent time specifically discussing the three health-related goals (#s 4, 5 and 6) and how MIAM and the Macha Mission Hospital are doing on these goals. (They are doing very well!) We also discussed and will discuss (between today and yesterday) the causes and signs of protein energy malnutrition (PEM), iodine deficiency in China, the role of public health measures, and health and the environmental setting.

I’ll post more, including some photos, later today after the students have left for the homestays. So stay tuned!

reflections from an African porch

I can still see my breath hang briefly and vaguely white in the air as I sit around 8 a.m. in the screened-in porch of the Gobelo House where Dr. Mylin and I are staying.  (“Gobelo” in Tonga, the local dialect, means place where wise decisions are made and Dr. Mylin and I like to think – or hope! – that we’re worthy of residing in such a place!)

After another wonderful breakfast of warm porridge, toast with PB&J, and papaya, some students are off to do rounds with the physicians in the Children’s Ward at Macha Mission Hospital, while others have climbed back into bed to steal a few more hours of sleep.  Others are sitting quietly in the warm sun with their own thoughts, or are studying, or reading.  I’m sure a few have wandered into the village or taken a leisurely stroll down to the dam.  Some have gone to the dressmaker’s house to survey the progress of their order.  And I steal a quiet moment on the screened-in porch, continuing to soak in Africa and marvel at God’s handiwork in this corner of the world.

Groups of children happily walk by on the road a few hundred yards away, chatting and giggling to each other as they make their way to wherever they are going.  There go a few village women, citenge’s wrapped tightly around their waists, water jugs balanced expertly atop their heads, obviously having made their morning visit to the local well.  One of the beautiful women who works at the MIAM campus walks up the path, her hands full of colorful blankets and towels, slightly curtseys as she greets me, then enters the house across the way.  Her quiet, yet brilliant, service is easily overlooked, but keenly felt as she, and so many others, cares for us so expertly, and so humbly.

I hear the sound of cowbells in the distance and can imagine a herd crossing to some field, or some village, or some roadside as they make their way to wherever they are going.  The roosters continue their crowing (they never seem to stop!) and are joined by a chorus of birds chirping their good-mornings.  A gentle breeze picks up and the banana tree waves hello to the lemon tree while the bright blue sky greets the morning sun.

I think of privilege, of temperature, of peace and quiet, of spaciousness and solitude, of joy and laughter, of pain and struggle.  I think of how seemingly simple and easy this beautiful place is in so many ways, yet how devastatingly complex and difficult in others.  I think of home, with its lists and bustle and noise and I wonder what it will be like to go back there – to that place and pace.  I stop myself and settle back into this quiet moment, back into Africa and her hard yet welcoming arms.  And I thank God for the diversity, complexity, and beauty of this world and of this place.  I pray we all continue to soak in it, to splash its dirt on our arms, to let its sun kiss our faces, and its people fill our hearts, learning the lessons it wants to teach us, while doing the work of actively participating in its beauty.   Dear Lord of Africa and America, let it be so!

the dusty healer

We began the morning with class, discussing the role of epidemiology (the field of medicine concerned with the study of epidemics) in understanding healthcare, especially the importance and use of statistics.  We learned that 98% of child deaths occur in developing countries; however, in wealthy countries, 1.1% of girls die before their 15th birthday, compared to 22% in sub-Saharan Africa.  Epidemiology is an extremely useful tool in assessing disease burden and very helpful in recognizing changes in disease patterns.  We also discussed morbidity and mortality, with Dr. Thuma continuing to pepper his lectures with stories from his work in Zambia.  He told us today that he has never treated a Zambian with a heart attack, perhaps mostly attributed to their healthier diet and daily exercise, with many people walking several miles to work each day.

At lunch, we were privileged to sample the local beverage of choice – ibbwatu – a slightly sour drink with chunks of corn meal served in every traditional Zambian home.  (It’s the first drink we’ve ever had to chew!)  In the picture to the above right, Sarah samples her first bit of ibbwatu!  While it seemed to be an acquired taste for most of us, it was good to have a sample prior to being offered some during our home stays this weekend!

After lunch, we set off in two trucks (with seven of us piled in the back bed of each – fear not, parents, it’s not illegal here in Africa!) to drive through the bush to visit a traditional healer in one of the surrounding villages.  Everyone we passed waved hello, some in what is quickly becoming my favorite wave – the two-armed, two-handed, near-full-body wave, where the person doing the waving looks as if nothing in the world is more important at that moment than enthusiastically greeting you with both hands outstretched above their head, hands waving and arms swaying.  After another bumpy, extremely dusty ride, we arrived at the healer’s village and were immediately surrounded and greeted by him and his family.  There were children of all ages running around, dogs wandering in and out of sight, roosters strutting about, and mothers nursing their children.

We were invited to sit down and listen to the traditional healer tell of how the spirits teach him how to treat people in his dreams.  We heard him sing the praises of the Macha Mission Hospital and Dr. Thuma, while at the same time repeatedly requesting that the hospital send more referrals his way!  He then showed us the tools of his trade – old, used plastic water bottles filled with different types of ground herbs, oils and liquids, a tortoise shell, an old plastic phone, which he demonstrated using to call and consult the spirits.  We were introduced to his apprentice, a young man learning the tricks of the trade.  He also showed us the stone behind his hut where he has people lay over night to cast out spirits and save their lives.

At the end of his talk, we mingled (or, more accurately, were nearly mobbed!) by his family who wanted to have their pictures taken.  Some of us also bought beautifully woven baskets that some of the women in the village had for sale.  Before we knew it, it was time to head back to the MIAM campus, so we loaded back up in the trucks and were on our way, with the young children of the village running after us, waving the double-armed, double-handed goodbye with all their hearts.

After a few short minutes on the road, one of the trucks had a flat tire, which momentarily sidetracked us, but soon we were watching the sun set as we flew down the dirt roads, again greeting everyone we passed, trying not to think too much about the incredible amount of dust those of us in the open back were inhaling!  However, the gorgeous sunset and scenery, in addition to the cool breeze and speed of the vehicle, made for an exhilarating and memorable ride home.  (Though those of us in the back felt like Pig Pen from Peanuts when we arrived back on campus in our very own personal clouds of dust!)

We were joined at dinner by three Dutch graduate students who are doing research at the Macha Hospital for a few months.  Many of us will gather after dinner to watch the “European Superbowl” (the soccer equivalent of the United States event!) in the dorm, as the Dutch students are excited to cheer on their favorite team.

Another full day is done.  Tomorrow brings hospital rounds for some students in the morning, class in the afternoon, and further discussion on the role of traditional healers in the villages in the evening, along with some cultural etiquette lessons as students prepare to go out to their homestays this coming weekend!  It’s nearly impossible to believe we’ve almost been in Africa one week already!  Time certainly does fly when you are having fun and learning a lot in the process!