Day 22: a website

https://www.doctorswithoutborders.org/

Today, I introduce you to Medecins Sans Frontieres (Doctors Without Borders), one of the most well-respected humanitarian organizations on the planet.  To my knowledge, nobody provides disaster relief and humanitarian aid better than MSF.  They have extensive experience, impeccable practices, and they speak out for those who are unable to speak for themselves.

Here’s a little about them in their own words, from their website:

Today, MSF provides independent, impartial assistance in more than 60 countries to people whose survival is threatened by violence, neglect, or catastrophe, primarily due to armed conflictepidemicsmalnutrition,exclusion from health care, or natural disasters. MSF provides independent, impartial assistance to those most in need. MSF also reserves the right to speak out to bring attention to neglected crises, challenge inadequacies or abuse of the aid system, and to advocate for improved medical treatments and protocols.

MSF goes to the most difficult places in the world, the most volatile, the most dangerous, to those with the greatest need.  They go places where no one else can go.  Their website chronicles the experiences of those who serve and calls out those who are responsible.  They hold governments, aid organizations, and individuals accountable.  The develop newer, more effective, cost-saving and life-saving treatments for all sorts of difficulties that they encounter.  They are the NASA of international health care.

Annually, they publish a list of the 10 most underreported humanitarian stories of the year.  This, for example, is the 2007 list.  I bet you didn’t know most of these things were even happening.

TOP TEN UNDERREPORTED HUMANITARIAN STORIES – 2007

  • Displaced Fleeing War in Somalia Face Humanitarian Crisis
  • Political and Economic Turmoil Sparks Health-Care Crisis in Zimbabwe
  • Drug-Resistant Tuberculosis Spreads As New Drugs Go Untested
  • Expanded Use of Nutrient Dense Ready-to-Use Foods Crucial for Reducing Childhood Malnutrition
  • Civilians Increasingly Under Fire in Sri Lankan Conflict
  • Conditions Worsen in Eastern Democratic Republic of Congo
  • Living Precariously in Colombia’s Conflict Zones
  • Humanitarian Aid Restricted in Myanmar
  • Civilians Caught Between Armed Groups in Central African Republic
  • As Chechen Conflict Ebbs, Critical Humanitarian Needs Still Remain

Visit their website, read a little of what is going on in the world.  May it awaken you to the great crises that occur every day in some other place, maybe somewhere you’ve never even heard of where people just like you try to make a way.  I want to grow in my compassion.  I don’t want to remain ignorant.

Day 18: The Most Important Lessons From Residency, Lesson 3

I am to tell you of a time when I felt passionate and alive.  This is how I discovered my calling.  My apologies for the lack of details in this post.  I do have to protect my patient’s confidentiality, even though I no longer care for him or even work in the same city.

A little boy arrived in the city where I trained and was brought from the airport directly to our emergency room because he was so ill.  He had just journeyed from a refugee camp in a small developing nation (French-speaking) where he had lived his entire life.  His family was from another neighboring country and fled because of war.  This boy and his two siblings were born in the camp.  During the process of their immigration to the U.S., this child was diagnosed with a very serious and potentially fatal condition which became active at some point during their journey.  He was admitted to the hospital, thin, fevered, with terribly painful swellings in most of his joints.  I wasn’t working in the hospital at the time, but knowing my interest in international medicine along with my earlier study of the French language, the hospitalist invited me to meet him and his family.  I was overwhelmed by their need, arriving in a foreign culture, speaking a foreign language, attempting to understand the repercussions of having a child with a very serious chronic illness all in a place that is completely unfamiliar in every way.  I stumbled over my French (rusty from over 7 years of disuse), eventually warming up to recall enough vocabulary to speak relatively competently.  I managed to learn some details of this family’s life and communicate a few important details when the staff interpreter was absent.  This boy’s parents shared some of their life with me.  When I asked what his father did for a living, he told me that for the past 9 years, he had begged and searched for food.  When living in a camp, there’s no place to work, no way to sustain a family.  His mother was so worried about E, not sure if he might live or die, unsure whether medications might help or make him worse.  His two younger siblings were happily oblivious to all of this and excited to make new friends.  They loved when we brought ice cream up from the freezer in the ER for them.  I brought some children’s books en francais that kept them occupied during long hospital days.  I burned CDs of French music that I had on hand and brought books from my French lit classes for mom to read and pass the time.  I was honored to have this role, one of friendship and not of medicine.  Since I was not responsible for his medical care while he was hospitalized, I was free to sit with this family and talk.  Poor E was terrified.  He received blood draws, shots, procedures.  He awoke from sleep screaming and thrashing, and during the day, he remained quiet and sullen most of the time.  I thought for awhile that he had given up.  A medical student, James, on the inpatient service made a particular impression on this boy, and I enjoyed so much watching little E learn to high five and wrestle and do all of the things that little boys should do.  James took him outside, played soccer with him and taught him to yell.  James did what none of the rest of us could do.  He brought this little guy’s spirit back.  After his discharge, I had the privilege of caring for this child and his siblings in our clinic along with several other refugee families.  We wrestled with a number of complications, and I relied heavily on discussion with specialists to form treatment plans, but he improved steadily, and by the time I left, he was thriving.

I wrote this confession not long after meeting this dear boy:

“I completely fell apart when I got home on Friday night.  My heart is overwhelmed by this family.  I don’t really mind that part so much.  What frightens me is that I think I might want to take care of children like E all my life (French-speaking and all).  I’m not really sure what that means for me yet, but I’m beginning to think I should stay in residency for a few more years.  I have so much more to learn.  Needless to say, I am feeling a little bit too contemplative this weekend.  You didn’t tell me that when I encountered the developing world that it would grab a hold of me like this.”

I’m still working out what this all means for me.  I do want more training.  I completed a 2-week international medicine training course which was phenomenal.  I met so many like-minded individuals there, some who have been missionaries for years, others who are, like me, just beginning.  I still keep in contact with many of the professionals that I met at that conference.  More intensive training will take much more time though, and I don’t know how to work that out.  I’ve thought about pursuing an MPH.  Most programs that emphasize the areas that I am interested in are out of state and available to me only online.  The challenge of getting a masters-level degree while working and parenting two toddlers just feels like too much (particularly with the $36,000 price tag I was quoted for one program).  I’d love to learn some more tropical medicine.  The course I’m most interested is in London and lasts 12 weeks.  How to get to London for 12 weeks with 2 small children and continue working?  I just don’t know.  I’ve studied up on missionary organizations.  I think I may have even selected one, but I still don’t know how to make the transition from this life to my next life to fulfill this calling.

Day Three: The Hole in Our Gospel

I’ve spent my day with Teme at a Children’s Hospital over three hours away from home trying to solve his tummy troubles. I’m not sure I have much more insight than I had before, but I have some hope that he will get well. We also visited a sweet little patient of mine that has been hospitalized there with a very serious diagnosis for the past two weeks and will likely be there for several more. To better diagnose the tummy troubles, our specialist recommended some stool samples, so, to pass the time, we visited a very upscale shopping center across the street until little Teme produced a sample for us. I then had to change his diaper and his diarrhea-soaked clothes and collect 3 jars of poo for the lab in the women’s restroom of this very fine shopping establishment. Anyway, what I mean to say is, I haven’t had a moment to think about all the books I love or adequately consider how to choose one for this post.

I have chosen Richard Stearn’s The Hole in Our Gospel for discussion today. I love books; I am a bit of a literary snob. With the right time and consideration, I could write you a reasonable term paper on some of my favorites. The Hole in Our Gospel happens to be sitting on the shelf near me, and I do love it, so it wins this place of honor today.

This book rattled me. Richard Stearns is the former president of Lenox, maker of fine china and other luxurious but useless items, who became the president of World Vision, one of the leading faith-based humanitarian organizations in the world. He begins by explaining how God called him away from fou-fou collectables to caring for the poorest people on Earth. He has no qualms admitting that he enjoyed his prosperity, living in 10 bedroom home and driving a sports car. Through a series of “too coincidental to be just coincidental” events, he realizes that God desires him to leave his lucrative career for World Vision, and an internal struggle between submission to God and continued prosperity ensues. Ultimately, he chooses World Vision, and he awakens to a depth of poverty and depravity that occurs in more than half of the world’s population that he never knew existed. This book is his analysis of poverty, his solutions to the problems of extreme poverty, and a call to Christ’s followers to join in the effort, no matter the cost to them personally. He calls us to leave prosperity so that others might leave poverty. It is a profound book, one that left me sickened over my own greed and lack of compassion. I am sad to admit that I still live a life of excess, maybe not as much excess, but still excess. I am trying to work this out, how to live in this culture but still be mindful of another. It is sort of romantic to me, the idea of selling everything and moving overseas to live and work in service of others, but the reality is much more difficult. I pray for God to remove my desire for stuff, to enable me to enjoy the blessings he gives but act with good stewardship and give generously. I want to be willing to give him everything, everything he asks. I’m not there yet, but he is working on me.

Returning Home

“Faith today is treated as something that only should make us different, not that actually does or can make us different.  In reality we vainly struggle against the evils of this world, waiting to die and go to heaven.  Somehow we’ve gotten the idea that the essence of faith is entirely a mental and inward thing.”  –Dallas Willard

 

After the 6 hour journey from Kitwe back to Lusaka, we were able to spend some time shopping at the local markets.  In Zambia, the markets operate on a system of bartering and trading, which I don’t particularly enjoy.  I find it silly to work at trying to lower a price for something since I clearly have more than the salesman does.  I don’t want to be swindled, but I don’t want to cheat them of their wages either.  It’s a difficult balance.

It saddens me that a woman will sell me a piece of fabric in exchange for some hotel soap and lotion.  She didn’t even want the money that I offered her . . . she was delighted to have Orange Ginger lotion to moisturize her skin.  We bartered and exchanged and loaded up our treasures on the bus to head for the airport.

The Lusaka Airport is one of the most inefficient places I’ve ever seen.  There is a security checkpoint at the door (shoes off, pockets empty, belt off, bags x-rayed, no liquids, etc.).  This is followed by a long line to obtain boarding passes and check baggage.  While we all waited to have our boarding passes printed, the airport lost electricity.  The computers were still somehow functional, but nothing else worked.  This meant that baggage couldn’t be weighed (and therefore couldn’t be checked), and boarding passes couldn’t be printed.  After about an hour of standing still in the dark, airport officials began issuing handwritten boarding passes and baggage claim tickets.  This made several in our group nervous, as they were unsure that their bags were being checked through to the correct airports.  This process took about 45 minutes for each passenger.  With 25 people in our group, we weren’t sure if we’d manage to make our flight back to Addis on time.  After receiving the boarding passes, there is a second security checkpoint.  Somehow, we all made it through in time to board the plane.  This particular flight goes in a circular route from Addis to Malawi, to Zambia, and back to Addis, so there were already passengers on the plane when we boarded.  The attendants announced free seating, and the plane was boarded from the front and the rear simultaneously.  This resulted in complete and utter chaos.  Trying to find empty places to stow luggage followed by empty seating was a challenge.  We climbed over each other in the single aisle trying to find enough space for everyone.  Finally, we were airborne, and on our way home.  About 30 hours later, Matt and I were back in Springfield, welcomed with homemade signs at the airport by our pastor and his family.

 

It always takes me a long time to digest all that happens when I travel.  Overwhelmingly, I felt inadequate to really meet the needs of the people in Zambia.  The need is so great that the only option is to help.  There is no other moral possibility.  I was confronted each day with diseases that I’m not trained to heal.  I lacked medical specialists, supplies, and medications that are readily available in the U.S.  Most of all, my patients are the poorest of the poor, and they have no money for medical care and no government to provide care for them.  Even knowing what care they need, they have no money for transportation, food, or lodging.  What do we do with this information?  As Brook Fraser says, “Now that I have seen, I am responsible.”  I really think that I need some additional training.  I’m still not exactly sure what that means for me . . . maybe a few conferences on tropical medicine, a pediatric HIV course, or a public health degree.  I don’t know yet.  I am certain that I belong in Africa, probably more and more in the years to come.  In the meantime, it is absolutely necessary to spread the word.  What’s crazy is that it does not have to be this way. Ten million children do not have to die every year from preventable causes.  We, the citizens of prosperous nations, have the ability to end this if we are simply faithful enough to do it.  Listen to Bono:

“We can be the generation that no longer accepts that an accident of latitude determines whether a child lives or dies–but will we be that generation?  Will we in the West realize our potential or will we sleep in the comfort of our affluence with apathy and indifference murmuring softly in our ears? . . . . This is Africa’s crisis.  That it’s not on the nightly news, that we do not treat this as an emergency– that’s our crisis. . . . We can’t say our generation didn’t know how to do it.  We can’t say our generation couldn’t afford it.  And we can’t say our generation didn’t have reason to do it.  It’s up to us.”

Janna School

“Don’t fail to do something just because you can’t do everything.”  –Bob Pierce

 

One of the highlights of our time in Zambia was our visit to Festus’ school.  His school is a community school, meaning that it receives no government aid.  Festus feels that the very best way to help his country is to provide education to his community.  To understand all this a little better I should tell you a little bit about public schools in Zambia.

 

The Zambian Public School System

Public school is not free in Zambia.  It costs about K400,000 ($80) for a child to attend primary school in Zambia.  It costs about K500,000 ($100) to attend secondary school.  This probably seems reasonable, until you consider that the average family living in the slums in Zambia earns only about K400,000 ($80) per year.  Overall, Zambia reports average annual family incomes at $4000 per year.  Aside from paying tuition to attend public school, families are also responsible to purchase uniforms for their children which cost about K500,000 ($100) per year.  Most families have several children, so if they are fortunate enough to be able to afford tuition and the uniform, they are rarely able to send more than one of their children to school.  Generally, in a public school classroom, there are around 80 children in each class with one teacher.  Public school teachers earn $100 per month during the school year, which isn’t enough to be able to even afford a home.  It costs $150 per month to even rent a house/apartment in Zambia, so these teachers are often forced to rent a single room or live in huts with their families.

 

Janna School, Ndola

Festus started a school at his church.  He named it the Janna School, which means “God Given.”  At his school, parents pay what they can afford to support the school.  If they can afford nothing, they pay nothing.  Their children are welcome there.  Festus has taken great care to minimize the school’s expenses, so he purchases school supplies for $5-$10 per child.  No uniforms are required, so the children can

come in clothes that they already have.  Festus has taken microloans from Americans to help the school, and he has gotten grants from charitable organizations in the U.S. to help purchase construction materials and supplies.  Some of his staff are volunteers from the church, others are paid teachers.  Class sizes are smaller than in the public schools.  Currently, 300 children attend the Janna School, and this fall, they will have grades K-7th grade.      The children attend school for half days 5 days per week.  Since we last visited two years ago, the school has added on a separate building for classes.  Originally, all the students met together in the church building.
Festus, being the wise man that he is, had gathered plans and materials over time to build a school, even though he had no one to build it for him.  A missionary team came to Lusaka last year for a building project, but found no plans or materials.  Somehow, this team came into contact with Festus, who had plans and materials waiting for them.  That team built the Janna School building instead of their original project, which wasn’t ready for them.

 

We visited the Janna School on a Saturday, a day the children aren’t normally in school.  We were a little sad that we wouldn’t be able to see the children, but Festus smiled and said, “We have arranged something for you.”  Sure enough, as we entered the church building that morning, we were greeted with the chorus of 300 Zambian children singing “We Welcome You.”  They sang several other songs for us (my favorite is below, “Make a Melody”), and the older children recited scripture for us.

We had brought trunks of school supplies, soccer balls, and cash donations (for purchase of desks and chairs for the classroom).  All in all, the team raised money for books, supplies, desks, and chairs for the kids at the school.

After we had given them the supplies, we were allowed to tour the school.  It has changed so much since we first visited.  Originally, there was only a church building for all the children to share.  Now, there is the church building, a separate school building that has several classrooms (and glass windows), the beginnings of a real bathroom, and a clean water tap.

While we were touring, the kids were allowed to go outside to play with the soccer balls that we’d brought for them.  They were so excited, and they wanted to talk to us, touch our hair and faces, and hold our hands.

 

Festus considers the school the most important thing that he does.  Festus told me again and again that if change is to come to Africa, it must come through the church.  Festus believes that the government is corrupt, from the highest office to the lowest civil servant.  Over and over, he has seen the government take aid from foreign nations and NGOs and keep it for themselves.  For example, a large organization offered a donation to help

community schools in Zambia like the Janna School.  Originally, the money was going to be distributed to the schools directly, but the government stepped in, saying if money was to be donated to the schools it should be given through the Ministry of Education.  Since then, Festus says that the community schools in Zambia haven’t seen a single cent of that money.  It was all kept by the government.  Festus plans to build reform in Zambia by educating the children and their parents, by providing for those who have less, and empowering the people to take care of each other when the government does not.

 

“If you think you are too small to make a difference, try spending the night in a closed room with a mosquito.”  –African Proverb

Zambian Worship

Church in Zambia is unlike any other worship experience I have ever seen.  Our team had anxiously waited to spend some time with the Zambians in church.  The Zambians knew how much we wanted to worship with them, so they scheduled a special service at Enocent’s church on Friday night.  We all dressed in our Zambian clothes.  The songs, speakers, and the dinner menu were all chosen specifically for us.  The Zambian’s sang several of my favorite songs . . . my newest favorite is “Double Double.”

The first time I heard it, we were just finishing clinic.  I was standing next to Mary (midwife extraordinaire) and one of the church volunteers.  We’d had a particularly busy day.  She raised two fingers with each hand and sang, “Everything is double, double.”  The volunteer responded the same way, two fingers raised, “double, double.”

Mary explained to me, “We had double the people today in clinic.”  I heard it again at church.  The Zambians, the poorest people I’ve ever met, sing “My God is good, oh.  He gives me double.  Everything is double, double.”  They praise God because they receive double portions of blessings from him.  If you are a Zambian and you are in church, you are dancing and singing as loudly as you can.  It is absolutely authentic, and it is more active than any church I’ve ever visited in the States.  Zambian’s believe that praise and prayer requires work, so when church is over, you’d better be exhausted, or you probably haven’t done it right.  After church, the congregation treated us to dinner, a meal specially prepared for us.  All the fresh fruits and vegetables had been washed in boiled and treated water so that they were safe for us to eat.  It was a fantastic meal, and with it I had Orange Fanta in a glass bottle, which is the best way to drink Fanta.  It tastes so much better in a glass bottle.  Any other way, it just isn’t the same.

 

Early the next morning after church, I awoke to Lovely tapping on my door.  She was in search of some antiemetics and antibiotics for her roommate, Carla.  Carla had become sick overnight.  We were anticipating a 6 hour drive to Lusaka that day, and Carla was completely incapacitated, presumably because of something that she’d eaten sometime in the days prior.  Our departure was delayed several hours as our team leader, Festus, and Enocent decided what to do.  Ultimately, they decided that Carla was too ill to travel.  The team was absolutely willing to wait for her, but Bill opted to have Lovely and Carla stay behind with Enocent.  If well enough to drive, Enocent would meet us with Lovely and Carla at the school in Ndola.  If not, they would use the team’s emergency funds to fly from Kitwe to Lusaka to meet us for our departure flight.  This has never happened on another team, and I know it was an agonizing decision for Bill.  Fortunately, Carla was well enough to meet up with us in Ndola.  She still had a very shaky ride (we pulled over several times for her to rest along the side of the road), but we were delighted to have the team intact.

Kawama Clinic Part 2

After returning from Kafue, better rested, we met for devotions early for our 5th day of clinic.  Bill prayed and asked that the neediest patients would find their way through the gates to us.  Every day after, it seemed that each patient who entered had an urgent need.  My day started with a young lady with congenital heart disease.  I gave her $17 to see a cardiologist in town.  My second patient was severely malnourished with kwashiorkor, and I had several other severely marasmic infants.  We had so many that were sick that a church member arranged to drive them all together in the church van to the hospital.  One mother brought her infant daughter to me with all of her prior health records.  This infant had grown well and nursed well until her mother developed a serious infection in her eye.  She was hospitalized for several weeks, and during this time, she was unable to nurse her baby.

Her father fed her porridge, but the baby lost weight.  By the time her mother was released from the hospital, she had no more milk for the baby.

I met one boy whose mother told me that her son had been normal until just before he turned two.  Then his head began to enlarge dramatically, and he lost the ability to walk.  Since then, his condition has declined, slowly but steadily.

We began keeping a list of patients who could be helped by the Cure Hospital in Lusaka.  We hope that the church will be able to transport families there monthly for treatment.  Mary, one of the midwives from the church, kept a list of our skinny children to follow up for us after we left.  I have some hope for what we do because I  know that the local church is there behind us, trying their best to raise money together to finish the things that we start.

 

The following morning, Bill again prayed that the sickest patients would somehow squeeze through the gates.  My first patient was a 13 year old boy, carried in by his father.  He was completely unresponsive that morning when his father tried to wake him.  He was comatose, and cold.  As it turns out, this boy sleeps on a concrete floor alone.  Generally, the family sleeps together at night, but since he has gotten older, he has wanted to sleep away from his parents and younger siblings. He had no covering, and the temperature during the Zambian winter dips into the 40s at night.  We filled latex gloves with hot water and stuffed them in his clothes and transported him along with 3 other sick patients to the hospital in the church van.  Once he’d received some glucose and warm IV fluids, this boy was doing cartwheels in the hospital halls.  Later in the day, I met a 5 day old baby with ophthalmia neonatorum, a serious infection in the eyes which can cause blindness.

This is easily preventable with eye ointment at birth, but this infant had been born at home.  For another $2, this little one was transported to the hospital as well.  We treated his mother’s infection before she left the clinic.  Carla had a 3 month old baby arrive with severe jaundice and a rock-hard liver protruding from her belly . . . even in the U.S., conditions which cause this are difficult to treat.  Many children with hand and foot deformities came for help; all were added to the list of children to send to Cure.

 

The evening before our last day of clinic, as we drove back to the Lothian House, the van carrying all of the church volunteers (our interpreters) hit a child who ran into the road as they left Kawama.  The driver got out of the van to see if the child was hurt and was immediately encircled and beaten by the crowd that had gathered.  He and the child were taken to Kitwe Central Hospital for treatment.  The church members stayed there with the child’s family all night; she only had minor injuries and recovered well.  In the morning, Mary brought her to the clinic to be sure she was well.  Even after being up all night, the church volunteers arrived in good spirits, singing praises and blessing us as we began our last day of clinic.  The crowds were particularly desperate on our last day.  Several of the sickest people in the

crowd were trampled as the mob stormed the gate; once they managed to break through, and several people ran inside.  Chad, our 6’4” blond security officer, ventured outside to pick up those who were injured in the stampede.  We worked as quickly as we could to see as many patients as possible.  When we finished, we had seen 2826 patients; Matt had given away over 600 pairs of reading glasses.  Even so, there were still hundreds who had not made it through the gates.
Ta kwaba uwa ba nga Yesu

 

Ta kwaba uwa ba nga Yesu

Ta kwaba uwa ba nga Yesu

Ta kwaba uwa ba nga Yesu

Ta kwaba, Ta kwaba ka be

 

Na yenda, yenda

Konse Konse

 

Na fwaya, fwaya

Konse Konse

 

Na shinguluka

Konse Konse

 

Ta kwaba Ta kwaba ka be

There’s No One Like Jesus

 

There’s no one, there’s no one like Jesus

There’s no one, there’s no one like Jesus

There’s no one, there’s no one like Jesus

There’s no one, there’s no one like him.

 

I’m walking, walking

Here, There

 

I’m searching, searching,

Here, There

 

I turn around

Here, There**

 

There’s no one, there’s no one like him.

 

**General translation:  I’ve gone around everywhere searching, but I’ve never been able to find anyone like Jesus.

Kafue National Park

 

“‘I tell you,’ he replied, ‘if they keep quiet, the stones will cry out.’”

–Luke 19:37-40

 

Knowing that we had a long journey ahead, our team loaded the bus for Kafue National Park at 5:00 am.  During such early hours, there isn’t much traffic, and we sailed through each checkpoint between Kitwe and Lusaka.  When we arrived in Lusaka, Festus took us to the newly-built Cure Hospital.

Cure is a non-governmental organization that operates all over the world.  Their hospitals specialize in orthopedic and neurosurgical problems.  After a few negotiations, we were allowed a tour, but no photographs.  They have beautiful facilities.  The floors are clean tile, the walls are freshly painted (the children’s wards have murals), and some of the wards have private rooms.  As we met the patients (mostly children with brain tumors and hydrocephalus), I thought, “I could work in a place like this.”  I’ve often wondered if I could really work in Africa long-term.  Am I too spoiled by American healthcare?  I don’t really think I could work day to day at Mulenga or Kawama.  The resources are too few in the clinics for me to be effective . . . but a hospital, a real hospital . . . that’s something I could handle, even with fewer than American resources.

 

After our tour, we stopped at a local hotel.  We borrowed their courtyard for a church service.  One of our major disappointments in the longer journey to Kafue was missing church with the Zambians.  We managed to have a nice, sunny, American-style service.  We hoped we’d be able to join the Zambians for worship in a few days.

 

After church, we drove for about 2 hours on a paved road, then turned off onto a narrow dirt road.  We had no signs, no directions except for asking the occasional Zambian walking along the road.  Our bus lurched along, brushing trees and bushes on either side for two hours.  Dust swirled in the back of the bus, and I dispensed zofran and phenergan to several team members.  The Bible says, “Narrow is the road that leads to life,” and I think we may have taken it.  Finally, we arrived at the Hippo Lodge after dark.  The lodge has no electricity, so it was lit with candles, lanterns, and a campfire.  Matt and I won the Honeymoon Suite (Matt is quite good at number-guessing).  It is a stone house with screened windows, a hot shower, and a cushy mattress, a Zambian paradise.

After we each had our accommodations, we were fed tender steaks, peppers, onions, and rice.  For dessert, our hosts served grilled bananas filled with sweet cream.  All the cooking is done over an open fire, and it was fantastic.  Matt and I slept well for the first time in days.  We awoke to a tapping on our door at 6 am for a sunrise safari.  It was dark when we went to our room the night before, so I was surprised to find a river immediately in front of our porch when I awoke.  The hippos lounge in the river all day; from the lodge we could hear them laugh.  Occasionally, we heard a lion growl, though we never saw one.  We snuggled together in the back of the land rover and watched the mist hovering over the river as the sun rose.  We saw puku, impala, kudu, water buck, bush buck, jackals, elephants, monkeys, and warthogs.

We followed some lion tracks, but found none.  We returned to the lodge in time for breakfast (homemade granola, eggs, bacon, grilled tomatoes . . . yummy).  One of the lodge owners, Bruce, made me a fantastic cup of tea (with warm milk and sugar).  Matt and I enjoyed our view, napped some, sat in the sun, took an afternoon boat ride on the Kafue river, watched the sunset.  After dinner, we headed out for a night safari ride.
At one point, our guide turned off the land rover and we sat in the most profound and dark silence I have ever heard underneath the brightest night sky I have ever seen.  The Zambian wilderness is very secluded, and at night it’s a little bit like looking at the sun through a dark screen.

Kawama Clinic Part 1

“The need of the hour, as far as I’m concerned, is to believe that God is God, and that He is a lot more interested in getting this job done than you and I are. Therefore, if He is more interested in getting the job done, has all power to do it, and has commissioned us to do it, our business is to obey Him … reaching the world for Him and trusting Him to help us do it.”  –Dawson Trotman

 

Our team got up hopeful that we might have our medicines back to us by the afternoon.  Festus had been told that the proper officials would release the drugs from customs at around 8 am, so, surely, we would have them in the afternoon.  Bill started us off that morning by reading to us from Dawson Trotman’s “The Need of the Hour.”  He read a section of the essay about the Mar Thoma Church, which is the largest Christian Church in Southern India.  It traces its origin back 1900 years to the work of Thomas, the disciple of Jesus.  When Bill had finished reading, one of our team members, Lovely Philipose, raised her hand.  She said, “I am a product of that church.  My family is from that part of India, and my family is Christian because of the church that Thomas started.”

 

Dr. Bill set us to work sorting last year’s leftover supplies.  Usually, there are one or two bags of supplies left over from the previous year’s team.  This year, we had nine bags left over to sort through.  Dr. Bill told us that at the end of last year’s trip he thought it was odd that there were so many leftovers . . . it was certainly a blessing since we had no other supplies at the time.  We spent the morning counting out analgesics and cough

drops, and by lunchtime, we had counted all the medicines that had been left over.  We headed for clinic that afternoon, a half-day late and short on drugs.  Festus still hadn’t arrived with our supplies.  The crowds at the gate were overwhelming, and the people were obviously frustrated at our delay in getting there.

 

Kawama is much larger than Mulenga was.  We had ample space for pediatrics, a generous though mosquito-infested room with 6 cribs, each with one side lowered for use as an exam table.  This worked well for babies and small kids, but our adolescents were a bit cramped.  The clinic’s usual healthcare workers were strangely absent.  The medical assistant who met us on our arrival informed us that the healthcare workers in Zambia were on strike, negotiating their salaries and benefits with the government.  Every hospital and clinic in Zambia was essentially shut down because all of the nurses, medical assistants, lab techs, and x-ray personnel were on strike.  Only a few doctors stuck

around to attend to duties in the hospitals.  Many people walk for miles just to reach the Kawama Clinic, and Kawama is staffed by nurses, not physicians, so many of them hadn’t had an opportunity for healthcare since the strike began, two weeks before we arrived there.  We arrived at a critical time.  Patients had been discharged early from the hospital, and others had simply been denied care because no one had come to work.  Shipments of the clinic’s regular supplies had also been delayed, so there were no reagents for routine lab work, and medications that we typically buy in-country (anti-malarials, anti-parasitics, etc.) were in short supply.  Our first afternoon, I treated children with pneumonia, malaria, ear infections . . . I enjoyed practicing my few Bemba phrases on my patients and listening to them practice their English.

This is worthwhile work.  I found joy in this work.  In some sense, I felt relieved to be working where I had been called.  I sometimes feel like the past two years have only been anticipation and preparation to return to Africa.

 

By the end of the day, our medications had still not arrived.  They were finally released from customs at 4 pm.  Festus had planned to take a city bus with our things to Kitwe, but since it was going to be getting dark, he was worried he wouldn’t be able to recognize and protect them from theft on the long way there.  He had to hire a private car to take him with the bags back.  All of this took some time, and he finally arrived in Kitwe at about 4 am.

 

June 25, 2009–On our first full day of clinic, we were short on interpreters, so clinic work was slow-going.  I met several families with children with severe developmental delays, children who have never spoken or children who are unable to sit up or walk.  It’s hard to know how to help them.  Zambia has no physical therapy or speech therapy.  I don’t have any medications that can change this.  Sometimes there was an explanation.  One child had survived meningitis as an infant.  Another child had kernicterus from

severe jaundice at birth (this is almost unheard of in the U.S. with available treatments).  Other times I had no reason for a child not to develop properly.  All I had to offer these families were vitamins and prayer.  I also saw my first child with kwashiorkor (a form of malnutrition), and I tended to several severely marasmic babies (a different form of malnutrition).  Each was sick enough to go to the hospital.  I gave each mother some soy flour, vitamins, ORS, and bus fare and prayed that they wouldn’t be turned away from the hospital because of the strike.  As the clinic was winding down for the evening, a woman arrived in active labor with her first child.  Lovely, our family medicine resident, delivered the baby.  During the labor, Mary, a Zambian midwife, asked for a bottle of orange Fanta.  Bill looked around but only found a bottle of water.  Mary set her jaw and repeated, “No, FANTA.”  When Mary asks for Fanta, Mary gets Fanta.  Apparently, Fanta supplies all the energy a laboring mother needs to give her baby life.  Mary

checked the baby’s heart rate periodically with the fetoscope and assured us that everything was fine.  Bill and I helped resuscitate the infant, a baby girl. Everyone else crowded outside the delivery room, peeking in to catch a glimpse of the birth.  Zambians don’t usually name their babies for several days, so I don’t know this child’s name.  She is probably the most photographed newborn in all of Zambia.  After the baby was dried and weighed, we gave the mother a bag of ibuprofen for her pain, and she put her baby on her back and walked home.

 

June 26, 2009–The following day, we worked almost non-stop.  I spent most of the day on my knees examining the kids.  We were overwhelmed with malaria, pneumonias, and malnutrition.  I had a little girl with an elbow injury.  No x-ray was available because of the strike, so Bill helped me make a sling from a torn sheet to protect her until she heals.  Before lunch, a second baby was born.  The mother asked the “nurses” who helped her during the delivery to name the baby.  After listing lots of Biblical women, they settled on Rachel.

 

Matt and I ate lunch with James and Dan, two of the Zambian pastors.  Recently, James traveled to the Congo to help with a mission there.  He told us he saw many miracles there.  Sick people were healed, and many came to know Christ.  While he was there, he was arrested and beaten because the local government felt threatened by his work there.  In one day, the case was taken to the high court in the Congo, and the charges were ultimately dropped.  James was able to stay in the Congo, and he witnessed many more miracles while he was there.  James doesn’t get paid to be a pastor, and he didn’t have the benefit of attending seminary, but he is committed to what he believes is the most important work that he can do.  James believes that there is so much corruption in African government that the only way to help Africans is through the church.

 

In the afternoon, I saw a little girl who was unable to walk after having meningitis as an infant.  Her mother has lost her last 5 babies during the 6th month of her pregnancy.  I prayed for them both.  I also met two month old HIV positive twins.  They need anti-retroviral drugs, but the government won’t dispense the medications until the babies have baseline labs done.  The labs can’t be done because there are no reagents because of the strike.  Ridiculous.  I also met a 15 year old girl who I think has tuberculosis.  I wasn’t able to confirm it because there were no supplies to collect and analyze a sputum sample, and without confirmation, she can’t have treatment.  I drained an enormous toe abscess in a little boy.  He didn’t appreciate it much.

When I made the incision, pus sprayed everywhere, including on my clothes (I was lucky to have gloves; no gowns or anything else available).  I gave him sunglasses to make peace when I was done, but he still wouldn’t smile for me.

 

June 27, 2009–Early in the morning, Chad (our security officer) spotted a baby in the crowd that he brought to me immediately.  Evaristo Kasonde, a one month old baby boy, hadn’t nursed in two days.  I knew immediately that he was sick.  He was in obvious respiratory distress, and his soft-spot bulged outward on the top of his head (which shouldn’t be, considering how dehydrated he was).  His mother told me he’d had fever at home.  He whimpered and whined.  We tried to place an IV but we were completely unsuccessful.  I gave him an IM dose of Rocephin, and someone from the church drove them to the hospital.  I gave mom $2.00 to get back home once they were released and $5.00 to gain emergency admission to the hospital.  In an emergency, you have to pay extra.  Imagine knowing that your child is in desperate need of medical attention, and travel to the hospital costs you two days’ salary, and to be seen in a timely manner, you have to pay a whole week’s income.  That is a desperate situation.  I still don’t know what happened to him.  Later in the day, I saw 11 month old twins who weighed 6 kg (about 13 lbs).  They each had the developmental skills of a 3 month old.  I wanted to test them both for HIV, but of course, the lab was closed due to the strike.  They only ate breastmilk and porridge.  How in the world can I change that?

 

We finished 3 1/2 days of clinic frustrated, exhausted, and looking forward to a few days rest.  We learned that night after dinner that the travel that was supposed to take about 4 hours to get to the national park was actually going to take about 9 hours . . . just one more bump in a rough Zambian road.

The First Leg–Transit in Addis Ababa, Ethiopia

Our flights:  Springfield, MO –> Dallas, TX –> Washington D.C. –> Rome, Italy –>Addis Ababa, Ethiopia –> Lilongwe, Malawi –> Lusaka, Zambia (this takes about 3 days)

We arrived in Ethiopia a day late, but earlier in the day than usual.  We were greeted as we entered the Addis airport with roses and letters of apology from Ethiopian Airlines.  We settled in at the Beshale Hotel for the night.  I had time

for a hot shower before dinner and a team meeting.  I couldn’t seem to drink enough water.  In the morning after a breakfast of Ethiopian Cocoa Puffs and hard boiled eggs, I sat on the steps of the Beshale Hotel, waiting for our airport shuttle, and thought, it smells like Africa.  It smells like soaps and cooking spices, exhaust fumes and dust.  It’s rather distinctive, but it brings up all kinds of good feelings in me.
After two uneventful flights, we finally landed in Zambia.  Festus, who has been our personal Zambian guide for every team that has come, greeted us at the airport with smiles.  His wiry frame is smaller than two years ago; I think two of him might fit in my scrubs.  We all crowded around the baggage claim looking for bags with bright yellow tags. . . strangely, very few of our bags circled on the belt.  A few began to panic.  What would we do without our supplies?  Dr. Bill, our fearless leader, made a few inquiries, and he found that mysteriously, all of our bags had arrived in Lusaka ahead of us, and they were all locked up safely in the airport.  We grabbed carts and took turns wheeling the baggage back to the group.  This trip has never occurred without at least one person’s bags getting misplaced, but this time, every bag arrived ahead of schedule.  By African standards, this is nothing short of miraculous.  We knew that customs is always difficult in Zambia, particularly when carrying a large quantity of drugs and supplies.  We had packed meticulously, checking expiration dates and filling out packing lists to avoid any trouble with our medications.  We were allowed to take our personal baggage through without any problems, but our supplies were immediately confiscated and searched.  Dr. Bill and Festus stayed with our bags, and we went outside the Lusaka airport to wait and pray.  We waited for hours,
and as the Zambian afternoon turned to evening, we sang songs together, photographed the sunset, and hoped the officials would see the goodness in our plan and let us have our medicines.  They didn’t.  Finally, Festus urged us to go ahead to Kitwe.  It is about a 6 hour drive, depending on police checkpoints and bathroom stops, and it was already quite late.  So, we left Lusaka, without our medicines and without Festus, hoping he would meet us in the morning.