Women's Group Meeting

Yesterday we went to Mukonchi Rural Health Center and met with about 15 women to ask what THEY would like in a waiting house. When we build this we want to do it right and give them what they want and not tell them the way it is going to be.

Overall they really like the idea of the waiting house, they say that they would like to come about 2 weeks before their expected date of delivery so that they are able to travel more easily. They also feel that they and many other women will be much more likely to seek their help with delivery if they can come 2 weeks early rather than just a couple of days. The whole point of the waiting house is to build a place where expecting mothers can come and wait before their delivery so they will have access to medical care when the big moment arrives.

Then we got asked the tough questions. First, they wanted to know if there would be any transportation to bring them to the waiting house, I managed to dodge the bullet by saying that at this point we weren't sure what else we could offer in ways of transportation. But then the big question was asked by a woman who was very quiet the whole meeting. She raised her hand at the end and simply asked if there would be a way to get them to the hospital in Kabwe if there were any complications. Every woman in that room nodded and was very concerned about this issue. Let me explain why.

If a woman is at this health center and suddenly there is a complication, right now they have to wait for the one ambulance in Kapiri to come get them (which would take an hour, and that is if it was available and had fuel) and then take another 1.5 hours to get to Kabwe hospital. When I asked Marion (our OB) what the standard is in the U.S to get a woman in for a C-Section as soon as a complication is discovered and she told me it was 30 minutes. Now, add in the fact of the matter is that nobody can count on the ambulance and what happens is that the women are left to find their own transportation while they are in labor with complications. This would cost them about $25, which nobody has. So they are forced to sell off their livelihoods (cattle, chickens, goods, whatever they have) in order to save their and their baby's life. And still, it's going to take hours to get them to the hospital as the road is terrible. We timed it out yesterday, took us 1.5 hours to travel 50 km. I believe it's 8 km per 5 miles, so I'll let you guys figure out the math.

I sometimes wonder if would could do more by paving the road instead.

Lazy Weekend

The weekend was a lazy one. Yesterday I took part in the Hash, which is a running club that is unlike any other running club I've ever seen or heard of. They are called the Hash House Harriers. Yes, there was a bugle, lots of shouting, and plenty of beer at the end. That was the most fun I've had exercising since high school softball! I hope to go more often.

I moved into the guest house today in Lusaka, and I'll be up in Kapiri for a few days this week setting up the house. I ran into one of the guys from the MSF (Medecins Sans Frontieres) house yesterday at the big month end market that I had previously met up in Kapiri. We are going to get together this week once I go up, and hopefully he'll give me some more info on the area.

Another Day

Today we decided to look for some alternate housing in Kabwe. It was not that pretty. Our house in Kapiri is now looking a lot more attractive. We hired some guards for the day and night from a security company. We did that the smart way by sending in our driver to get some quotes and he was actually able to negotiate a deal that would save us 100,000 Kwacha/month! I'm sure they would have elevated the prices a bit had I walked in and tried to set things up. I just hope they weren't disappointed when I walked in to sign the papers.

Marion and Jason spent about 3 hours in Kapiri Mposhi Hospital today and seemed to be pretty jazzed about what they saw. I noticed another WFP (World Food Program) truck load outside the Kapiri District Health Office. I wonder how often they are getting shipments, and I wonder where they are getting dispersed to.

I'm starting to really think about how we are going to get women into the rural clinics. Thoughts were to give out incentives for women coming in. The question is whether it is better to get the incentives (let's say a blanket) donated and just hand them out? Or would it be better to get a bunch of the local women involved in making the blankets, and they buying them back from them to give out. It would give a few jobs, some confidence, and maybe spread the word more if women in the communities were actually making whatever it is we would give out. But would that be too difficult logistically to get up and running right away? Would it be better to bring in outside resources and eventually shift to local women making things??

Thoughts??

Beautiful Babies

This is why I'm here. Just look at those cheeks! This woman was waiting in line to have her baby weighed to see how she was doing on the growth charts. This is one thing done on antenatal clinic day. The women were so happy to see themselves and their babies on my camera after I took their pictures. I hope to print them out and bring them with me to the clinic so they can have the pictures.

Looking at all these babies I can't help but wonder which ones will survive. When at Kapiri hospital I was told that 1/2 to 3/4 of the admissions are HIV/AIDS complications. Throw in some malaria, TB and malnutrition and these babies have a lot working against them.

Birthing Center

This is another photo from Mukonchi rural health center. This is the room where women who come to the center give birth. It's such a far cry from the sterile, plush rooms we see at any of the hospitals in Boston. We are so lucky. I haven't seen any actual births yet, but I have walked by a couple of women who I missed the big moment by only a few minutes. The one thing I noticed is how quiet they all are, and how alone.

The other photo is of Marion, Jason, and I with Juliet, who is one of the greatest midwives I've ever encountered. She runs the OB ward at Kabwe General Hospital.

Today we are back up in Kapiri getting the house ready. The landlord is using the rent money we paid him to fix up the house to "white people standards." Meaning, we would like hot water, insect screens to keep the malaria--I mean--mosquitos out, and showers. We are also getting a fence put in for security, otherwise it doesn't really make sense to have a guard if they can just run in when he's not looking. Our big debate is over the water storage tank. Yes, the water only runs in the am and evening, so if we want water all day we have to set up a tank so that it will hold it for use when the city shuts the water off. The water was quite yellow when I saw it coming out of the tap and in the bathtub, so I'm really curious as to what we will need to do to make is safe for us "white people."

Wow, the rain is starting to come down again. I find myself constantly watching the sky as it is so big you can just see various storms all over the place with areas of sunshine scattered. I've never seen anything quite like it. It will rain, but maybe only for a few minutes or an hour, and then stop as quickly as it started. Rarely is there thunder but today there is plenty.

Here is a picture from Mukonchi Rural Health Center. These women are in line waiting to get their children weighed.

Mwapoleni Mukwai

Mwapoleni mukwai. I just said hello to you in a formal way in Bemba, which is the language spoken in the area around Kapiri. The m’s at the beginning of a word are pronounced the same way the letter m begins the word in “moo” if you were trying to drag out saying the word and sound like an actual cow. (Admit it, you’ve rolled down a window at some point in your life and moo’d at unsuspecting cows while driving by and know EXACTLY the m sound I’m talking about.)

We checked on the house as it is being revamped to make more of a regular living situation for us. For instance they are putting in a hot water heater, as well as a tank for storage so we’ll have running water all the time and not just during the morning and evening which is when the water is turned on for the city. Lots of houses have these tanks set up in their yards for that purpose. Also walked over to the MSF house and also saw their heavily guarded office. I’m not sure of all the work they are doing in the area, but I’ve seen their advertisements painted on walls in the city of Kapiri for VCT (HIV Voluntary Counseling and Testing) as well as some of their stickers out in a rural clinic. I have a feeling I’ll get to know the people working there. They were kind enough to invite us over for dinner tonight but we couldn’t stay.

I still am struck over the number of people here doing aid work, all the Toyota Land Cruisers driving by with various NGO (non-governmental organization) logs on the side. With all the people doing aid work and all the money flowing into this continent, why can’t we get it right? Why is there still so much corruption and so little trickling down to the people of Africa who need it? I encourage anybody who is interested in these very questions to read “The Bottom Billion” by Paul Collier. Great book. When I read it I just wish I had a better understanding of economics so I could get more out of it, however, I still found it fascinating.

Here is a picture that I took of a family waiting outside the pediatric ward at Kapiri Mposhi Hospital. I couldn't help but notice the Harvard University sweatshirt, and once I asked to take his picture the whole family wanted in.

Kapiri

Today we are up in Kapiri Mposhi. It’s a sad little town that seems to have been forgotten. But the main road (one of two main roads in all of Zambia, one runs North and South, the other East to West) passes through. It is about 60 km North of Kabwe, which is an old lead mining town. Kapiri has a train from Tanzania that stops here, so that is one reason it exists. Kapiri is also building a new district hospital. We took a trip to the site today to check things out, and Jason (one of the visiting OB’s) being the brave one went up to the guards and asked for a tour of the unfinished place. He got the scoop at the same time. Turns out that construction began on the hospital in 2005, but it seems that the contractor wasn’t all that…well, shall we say honest, and so was terminated. Nothing had been continued until the new contractor was hired recently and they resumed construction only last week. They are hoping to have some buildings up and running by March, but it doesn’t look like the whole hospital will be functioning until October of this year. That’s if all goes well from here on out.

A funny story today was stopping at the tomato stand on the side of the road. Marion took out her camera to take a picture and all the women and children working their stands scattered and hid in record time; It looked exactly like what fish do when you get too close to the tank! Our driver said they had some “silly beliefs” which is why they don’t want to get their picture taken. I didn’t feel it appropriate to press any further with questions and find out what those “silly beliefs” are. Maybe someday I’ll find out as I’m quite curious. At least they were giggling a bit while running, nobody was screaming and crying so I guess whatever their reason it can’t be that bad. It was funny to watch.

I'm trying to post some photos on the blog, but having difficulty. I'll keep researching.

Week 1

I can't believe I've been here for a week already. I'm finally adjusted to the time difference and starting to feel good about the location. The map has been helping, and I'm ready to try driving. I think I'm going to wait to learning how to drive the stick until I'm used to the other side of the road!! I think both right away is a bad recipe.

Thank you for all your emails and well wishes, it is truly wonderful to hear from you all. This project is really getting into my heart and I'm enjoying the opportunities it is presenting. Just the other day we walked into the Ministry of Health and spoke to some of the head ministers about some stuff we want to work on. Getting that kind of access to people like that is just something that would never happen in America. I'm also getting used to the slower pace and the frequent power outages. The rain isn't wearing on me at all.

Next week we are going to start spending some serious time up in Kapiri, I can't wait for the house to be ready so we can move in. I still have a lot of logistics to figure out for the house, but I'm hoping the people at MSF down the road will be able to help me figure some of that out.

On a side note, today I went to check out getting internet access for our office in Lusaka. It is quite expensive! The set up fee was 3.6 million Kwacha (at a 3,800 Kwacha per US dollar) which is over $900 just to set it up. Then it's going to be another 881,000 Kwacha a month, which is over $200 a month, just for internet. Forgive me if my math was wrong, but MAN is that a lot of money. Needless to say I'm still shopping.

Greetings From Zambia!

After two very long overnight flights I arrived here safe and sound. Zambia is beautiful and the people are quite warm and friendly. I'm very much enjoying the time in Lusaka.

Yesterday we took a ride up to the Central Province to look at the Mukonchi Rural health Center. The workers up there were really devoted which was nice to see. MSF is also doing some work at the clinic, so there were some trained community workers there teaching about HIV/AIDS to first time expecting mothers and what to do while pregnant. I heard from the clinic director there, Matthew, that the HIV rate is about 17% in Zambia, and newer data should be coming out soon. There was also an under 5 clinic for children that day and moms were lined up to get their children weighed and measured. I took some photos but don't have the means to post them right now but I will as soon as I can. The women seemed to enjoy getting to see pictures of themselves holding their children. But I still felt odd and a little out of place taking them.

It's the rainy season here and mosquitos can be seen trying to fight their way into the house at night. Malaria season has begun.

Why MIHI?

I've been asked many times why I chose the project I did. It took a long time to find something worthwhile, and I spoke with many interesting and charitable people along the way.

Upon receiving the fellowship I immediately imagined myself in a refugee camp somewhere dangerous and exciting. After dangerous was crossed off the list by my fiance along with any country where Americans were kidnapped frequently and/or a major armed up-rising took place in the past year, I was left with exciting. Time to re-think what I could do. I contacted previous fellows, called all of their contacts and really started to think about why I wanted to do such work and how I could possibly do the most good in the short time I have available.

At this point I started to really think about the nature of aid and the whole teach a man to fish philosophy. It was during the HSIR course I took in September through the Harvard Humanitarian Initiative that I really learned how damaging aid work could be, and how one way to do it well was by helping them help themselves. I wasn't going to step in and be super-nurse-save-the-day because what happens when I leave? Nothing changes. My work is forgotten. Being forgotten after giving six months of my time isn't quite what I had mind, and neither was doing more harm then good. The only answer for me was to do a project that was sustainable. The work was going to be able to be maintained at a certain level indefinitely after we left. I had to find a project who's mission was teaching and education with full support for the community workers so they could do the work themselves. Quite simply: helping them help themselves.

In walks Thomas Burke, MD of the MGH Center for Global Health. I received a phone call from Donna Perry who is the Associate Director of the Durant Fellowship and was told to call Dr. Burke as he might have something for me. A few hours later we are having lunch, and two weeks after that we were signing the contract. It was a perfect fit.

Now that the time is here to step on that plane I am finding myself thinking about what my goals are for the time I'm away. I hope to make a difference. I really want to see a decrease in mortality and complications, and I really want to see the change be sustained. I'm committed to doing anything I can to help. Nurses have always been good at creative solutions and I hope to bring that to the project.

Post #1

Welcome to the new blog. I will be posting here about the time spent in Zambia while on my Durant Fellowship. I hope you will enjoy reading about my exciting adventures while I am trying to do some good in the world.