Zambia 2007

On June 9th, 2007, I embarked on my first medical mission trip, and my first trip to Africa.  I had prepared, studied Isaiah 6 and Matthew 28, and read Oxford’s Handbook of Tropical Medicine to be sure of every malaria parasite and schistosome I might encounter.  Even so, I felt completely inadequate when I came face to face with the developing world and the presence of my creator there.  Everyone who enters the mission field overseas fully expects to have a “life-changing” experience, but my African encounter has taken me months to digest.

Cultural adjustments met us even before we entered Zambia.  I was shocked to learn that our Ethiopian flights left the ground as they pleased, and not according to any schedule.   We boarded a plane in Addis only to turn around due to an “engine problem.”  Ten minutes later, we were again asked to board the same plane, which fortunately took off uneventfully.  I was also poorly adept at joining the herds of Africans that swarmed ticket counters and security check points.  Even when I patiently waited “in line” for my turn, I was repeatedly cut off by yet another swarm.  No African likes to wait in lines.  After a brief night’s stay in Addis, we expected the airport shuttle to pick us up promptly at 6:30 for our 8:30 flight.  “No problem,” our guides assured us.  At 7:50 that morning, all 27 of us paced impatiently in front of our hotel when our shuttle finally arrived.  I understood better when we arrived at the Lusaka Airport and met Enocent, our Zambian liaison.  Enocent immediately asked to collect our watches.  After working with many American physicians and nurses, he was accustomed to our pacing and wrist-checking tendencies.  He patiently explained, “Here we have the time, just not the clocks.”  The next morning he met us for breakfast and explained the schedule for the day:  “the drive to Kitwe is about eight hours, T.I.A. [This is Africa].”  He used that qualifier often to remind us that inconvenience is common in Africa.  We also invented our own ways to adjust to the pace of Zambian life.  Each evening, our team leader would announce our departure time for the next morning as “7:30-Z.”  Z-time became a running joke with the team, but it also taught us to worry less about time and focus more on the work which needed to be done.

We also met the corruption of the developing world just shortly after our arrival.  Our suitcases filled with angiocatheters, mebendazole, and other supplies were just sliding off the conveyor belt when all of them were confiscated by the Zambian customs officials even though we had taken great care prior to our arrival to ensure compliance with Zambian law.  For two hours we waited outside the airport and prayed while Festus, an Ndola pastor and our personal Zambian guide, battled for the medications.  Finally, he emerged with every bag piled on a single cart.  Even after our departure, we met officials who were anxious to take advantage of us.  During the long drives between Lusaka and Kitwe, Zambian officials stopped our bus at every police checkpoint along the way for reasons as varied as making sure we had a first aid kit and fire extinguisher on board to checking that our driver was wearing a regulation color shirt.  Our guards demanded payment immediately for the “violations,” but our Zambian guides refused to pay outside of a government building.  As they predicted, once we reached the capitol, no records of any violations were found.

Each day in Zambia, we began and ended with devotions and prayer.  One of the first was a focus on Philippians 4:8:

Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things.

This quickly became a theme for our trip.  Our team leader, Bill Bridgeforth, called the verse to remembrance each time we were confronted with difficulties, whether it was the stock of penicillin G which went missing or a flat tire between Livingstone and Lusaka.  Each time a Zambian shrugged, “No problem,” Bill quipped, “Whatever,” thereby minimizing the hassle and redirecting us to the lovelier moments in Africa.  Once while stopped at yet another police checkpoint for half-an-hour, we took pictures of wildflowers and bees along the road.  Enocent agreed, “We have a saying here in Zambia; maybe you’ve heard it:  ‘Hakuna matata.’  It means ‘no worries.’”  In a nation where there are so many real reasons to worry, it was refreshing to encounter a people who always expect the worst but hope for the best.

Zambia is called “the Real Africa,” and I had no doubts about Zambia’s authenticity the day we arrived at the Mulenga Clinic.  Our bus had lurched down a long and winding dust road pulling our trailer filled with suitcases of medicines and supplies.  The whole way, we were facing backwards watching the trailer to be sure no wandering individual would help himself to the contents.  As we pulled up to the clinic, the trailer became caught in the uneven road, and we could go no further.  Already, there were long lines outside the clinic gate.  As we descended the bus, we were swarmed with Zambians, each with an individual ache, pain, or spasm to soothe.

I set up my personal pediatric office in one of the clinic’s back rooms.  My examining table was a desk with a dusty mattress slid on top.  Bill and I examined the children from two families at a time, making use of every inch of our four chairs and single table.  We often kneeled on the red-wax floor to examine infants and toddlers in their mother’s laps, as evidenced by the ruddy dust-stains on our scrubs.

Our clinic days were long, and after the end of the first, I sided with Job:

Does not man have hard service on earth?
Are not his days like those of a hired man?

Like a slave longing for the evening shadows,
or a hired man waiting eagerly for his wages,

so I have been allotted months of futility,
and nights of misery have been assigned to me.

One of my first patient’s was a four-year-old boy with fever.  His pale nailbeds, his white gums, and his spleen tip poking through his abdomen showed me that malaria had again returned to him.  He had already taken Coartem, our anti-malarial of choice, so my only thought was to send him to the public hospital where he could receive IV quinine and perhaps a blood transfusion.  I met countless other children with nighttime coughs and wheezes.  Most live in huts with dust floors heated by lumps of gray charcoal; curing their itchy eyes and swollen air passages would be nearly impossible.  Armed only with oral albuterol instead of inhaled steroids and nebulized mist, I prayed in frustration for their safety, knowing that in my country asthma is carefully controlled with precise steps to prevent life-threatening attacks.

It is easy to look at an entire continent stricken by poverty and disease and feel great pity, but I quickly learned that though the African people suffer greatly, they have been granted an overwhelming portion of grace.  I was comforted when I realized that God himself is unhappy with the circumstances which exist in Africa.  Isaiah reads:

In all their distress he too was distressed, and the angel of his presence saved them.  In his love and mercy he redeemed them; he lifted them up and carried them all the days of old.

Three-month-old Blessing was immediately recognized by our Zambian nurse who worked with us in the clinic.  She told us that when his mother was in labor, she became frightened when her doctors told her she would need a cesarean section.  She jumped from a third story window to avoid the surgery.  The physicians were able to deliver the baby, but his mother died from her injuries.  His grandmother named him Blessing because she felt it was a great blessing that he had been born.  Confronted by tragedy each day, I was overwhelmed by the faith and thankfulness I saw in the Zambian people.  I felt fortunate to meet an eight-year-old girl and her five-year-old brother who were brought to the clinic by their grandmother to be sure that they were well.  They were each growing tall with plump cheeks and strong white teeth.  Each was overjoyed to receive a toothbrush and a packet of vitamins.  They held the toothbrushes up to the light and looked through the pink and blue handles.  I complemented their grandmother on how she had raised the children so well.  She pressed her palms together and lifted them heavenward.  She answered me, “Thank you my daughter, but I did not raise them.”  She again raised her hands.  She continued, “Out of my poverty, I took them in when the boy was only 4 months old.  It was God who gave me the strength to raise them, and look at them now.”  Each day at the clinic, the Zambian volunteers insisted that we begin and end our day with prayer and singing.  “Ta kwaba uwa ba nga Yesu/There’s No One Like Jesus” quickly became one of our favorites.  The Zambians sing in spite of their arthritic joints and chronic coughs.  Most have no access to over-the-counter medications like ibuprofen and Robitussin, yet they rarely complain.  Fifteen-year-old Francis was no exception; he suffered a broken leg three years ago.  His wound became infected, and his leg stopped growing.  He hops hunched over on a short pole that he carved himself from scrap wood.  Francis had no complaints, but when asked, he admitted to having frequent pain in his hip from his poor posture.  We were able to give Francis some pain medications and a pair of crutches to help him ambulate standing tall.  In Zambia, I was honored to meet families who seemed to understand what Paul expressed from prison, “I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want.”  Many of the Zambians seem to have found contentment, but I continued to struggle with frustration over the gap between my knowledge of medical technology and my patients’ realities.

Knowing isn’t half the battle in Africa.  Over and over again, I knew the scientifically supported remedies for the maladies I encountered:  phenobarbital for seizures, fluticasone for asthma, griseofulvin for scalp ring worm.  Even so, without any of these medicines available in Zambia, it was difficult to know whether we were making a difference at all.  One evening, half way through our clinics, one of the medical students on the trip gave a devotion that changed my outlook immediately.  He reminded us, “Now faith is being sure of what we hope for and certain of what we do not see.” As we each recalled our patients, a deaf child, a school teacher with cavitary tuberculosis, an infertile couple, and our hopes for each of them, our faith grew just a little to match the Zambians.  Over the next few days, some of our faith became sight.  We met a young woman who had developed terrible scarring of her eyes from Steven Johnson Syndrome after having had the measles.  Her photosensitivity was so severe that she was unable to open her eyes in daylight because of pain.  Our only thought was to find some sunglasses for her to block out the brightness.  One of our pharmacists donated her sunglasses, and this young woman left the clinic seeing.  The following day, I met Kenny.  He came to the clinic with abdominal pain from parasite infection.  His grandmother was a Jehovah’s Witness, so she instructed him to take the medicines and leave quickly, making sure that no one would pray for him.  I told him that if he ever wanted to hear about the true Jesus, he was welcome to come back to the clinic anytime.  Kenny walked halfway to the door before pausing and turning around.  Returning to his chair across from me, he asked me about the true Jesus.  I explained the fall, the sacrifice, and grace.  Afterwards, Kenny asked me if he could know Jesus.  After leading him in prayer, Kenny told me he was proud to know the true Jesus.  Faith is a choice, and after meeting many more patients in our clinics, each of us decided to offer the Zambians faith in our hopes for them.

My husband was fortunate to work with Dan, a young Zambian pastor, for most of our stay in Kitwe.  Dan explained that he teaches the gospel to his congregation, but it is difficult for them to see from day to day where God is at work.  Each of them knows poverty more intimately than grace.  Each of them lives on less than $1000 per year.  Each of them knows someone dying from AIDS.  They all know the thousands of orphans living on the Kitwe streets.  Confronted daily with this reality, it’s easy to see how faith can be challenging.  The church members were able to see God at work in the Mulenga clinic, just as we were.  My husband acted as the local optometrist (though he had no formal training), distributing reading glasses to over 500 people.  One woman came offering praises because she had prayed that someone would give her reading glasses.  She put on her pink frames and read from the Bible in English, “For God so loved the world . . .” We were able to provide crutches to the lame, clean dressings for abscessed wounds, and penicillin for pneumonias.  I realized that it is a privilege to be an answer to prayer.  Even if I had nothing else, I gave each child I saw vitamins and prayer.  Our pharmacist worried for days that we would run out of vitamins, but on the last day she remarked, “each time I slid my hand into the bag, there were just a few more.”  Like the widow’s oil, our supply of hope for the Zambians never ran out.  On the last day as we closed the clinic doors, one woman who had not been seen called through the clinic window, “Even if I have not got the medicine, you people are God’s people. You left your country just to come and do this generous work for us? God bless you.”  By meeting their needs, we were able to demonstrate God’s love for the Zambian people.  As some remarked in the New Testament, “We no longer believe just because of what you said; now we have heard for ourselves, and we know that this man really is the Savior of the world.”

Every moment in Zambia, we relied heavily on volunteers from the Zambian church to provide transportation, communication with Bemba speakers, and our daily meals.  Our first night in Zambia, we had the opportunity to have dinner with several pastors from Lusaka.  We were greeted with warm handshakes and a homemade dinner.  The tweed-clad gentleman across from me was a 54-year-old pastor from Lusaka.  He credits his current profession to some young American women who came to his home and took him to school when he was a child.  There were no seminaries in Zambia at that time, so he was trained for his future by these Americans.  Now he trains pastors who will one day take his place in the church.  Although Zambians have no textbooks or commentaries on religious studies, they rise sometimes as early at 2 am for prayer and Bible study.  They give sermons in English and Bemba to reach their congregations.  I have never encountered a worship experience in the United States that compares to one in Zambia.   Worship begins early on the Sabbath, as a call to those who have to walk long distances.  Zambians sing in 12-part harmony; they have no instruments to accompany them.  For hours, the Zambians sing and dance until the entire congregation arrives.  The churches meet in corners of musty warehouses or outside in fields.  Our pastors cited many challenges to their work.  Spiritist religions are still quite popular in Zambia; many parishioners combine their Christian faith with traditions of the occult.  Because of this, Zambian pastors are accustomed to diagnosing demon-possession, and exorcism is a common practice.   Some spiritists pronounce curses upon the church; others offer money and food to parishioners who will denounce their faith.  All of this contributes to the labors of the church.  Zambians believe that authentic faith requires work, and this is especially reflected in their prayer lives.  Zambians believe that prayer should be an exhausting experience.  While Americans simply bow their heads and close their eyes, mimicking sleep, Zambians pray out loud together, pacing, dancing, and shouting their intercessions to God.  Our clinic had an intercessory room for patients who wished to have prayers said for them, and a casual passerby might confuse the prayers of the faithful for a rioting mob.

Throughout our stay in Zambia, veterans of the trip warned us that even close family members may not understand or want to understand the significance of our Zambian experience.  Few Americans want to hear of street orphans, malaria, or HIV-infected children.  Over and over, we felt people responded to us with “why would anyone want to go to Africa” or “better you than me.”  My husband and I have a very different perspective.  We feel that caring for the African people is both a responsibility and a necessity, but even more, we feel the Zambian people taught us more about faith, charity, and contentment than we ever could learn in our iPod, BMW, and Sony-filled nation.  Since returning from Zambia, I have a greater appreciation for immunizations, well-child care, and the readily-available sedatives we routinely use for invasive procedures.  Admittedly, I have less tolerance for parents who complain about half-hour waits in the office or their children’s stuffy noses.  After hearing so many “no problems” in Zambia, waiting a few more minutes for a lab result or calling my patient’s at home who’ve missed their appointments doesn’t seem as much of an inconvenience.

Since I’ve been home, I’ve also been struck by my own comfort level with sharing the gospel.  In Zambia I thought nothing of praying for each patient I encountered.  Two months after returning home, I realized how much I still struggle with witnessing in my hospital.  In September, I met Erick, a 9-year-old refugee from Gabon, who was admitted upon his arrival in the United States due to a debilitating arthritis and complications from HIV.  Erick speaks only French.  Since I speak French reasonably well, I immediately became involved in his care.  During rounds one morning, I thought nothing of witnessing to Erick and his family in French (in front of my non-francophone colleagues), although I have never thought to do the same for my American patients.  I continue to care for Erick and his family in my clinic, and I love taking care of them.  He and his two siblings, Mérosiane and Rayann, always smile for me, and they are eager to share new English phrases they have learned.  Following Erick’s CD4 counts, catching up his immunizations, and monitoring his antiretroviral medications challenges me, and I love the opportunity he gives me to practice my French.  After working in Zambia and caring for Erick over the past few months, I am seriously considering long-term missions work in Africa in the future.

I am still surprised each time that I see the developing world in my daily life.  My advisor is Venezuelan.  Her stories of her family’s daily challenges including her grandfather’s broken hip that was too expensive to be repaired and her premature nephew who died just hours after his birth always leave me aching.  The developing world is not simply an unfortunate collective; each of my Zambians tests my compassion.  I am anxious to return to Africa, to see how Blessing has grown and to find out if Festus has completed his pastoral training.  Each of my Zambian patients deserves the opportunities that Erick now knows in the United States.

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