Yes, I do actually work also...

Things here are good. I can't believe I have only about one more week of work! Last weekend I had a nice visit to Lusaka. It was fun to visit with Ben and Jen and I also got to spend two days working at Beit Cure Hospital, a hospital started to treat children with orthopedic and neurosurgical problems. It was a bit astounding how a privately funded hospital could have so many more resources. It was much more like operating at home. We also did some rounds at the University Teaching Hospital which was huge. There were hundreds of patients with seemingly very few physicians and resources. Reportedly many pts get admitted then have to wait several days before seeing a physician. Obviously this is another huge contrast compared with Beit or home. After returning to Choma I went with the District Health Office to rural area to do outreach- primarily prenatal care and vaccinations for kids. I really liked doing that and it was interesting to set up a clinic in the little schoolhouse without electricity.
On a more sobering note, two of the town's nurses died this week and we also did an autopsy on a 6 year old girl who it seems was likely abused (she had a lot of blood in her brain). People here just have so much more death to deal with than we do. Its such a contrast to at home where if someone from the hospital dies it would be a big deal rather than just an ordinary week. Its so different here in that regard Today I opened about 15 emails regarding the death of the Oakland Police, who were treated at Highland and much a part of the Oakland community. Amongst them were people gathering funds for their families, shuttles to the services at the Oakland Coliseum and encouragements for people to get counseling in the aftermath of the traumas. At Choma today a few people said the death of the nurse who died yesterday was a pity and were trying to make arrangements to attend her funeral Monday but nobody was particularly shocked or surprised. She had been in her young thirties, working in the theatre without problems when I arrived and now is dead of unclear causes but it doesn't cause much of a stir. Obviously the cop killings were a very different situation but I guess the timing just made me think even more about the difference. I always find myself wondering in environments with so much death and tragedy if the communities just get numb to it on some level. At every stage of life- from in utero, to childhood, maternal death during childbirth, young adults up to the elderly if they make it that far- there is just so much more death here.

I'm not sure where I'm going with all of this death talk but it just makes me realize that for all of the flaws in the health care system at home, even the poorest in the US have generally more access to care than an average citizen here.

That's it- not many posts left. Hope you all are well!

I'm legal!...and there definitely was a silver lining

Thank you Zambian Immigration office for one of the best vacations yet. I'm back safely and again working at the hospital, allegedly with the correct visa. In the interim, while banned from the country, I got to have some fun cruising around Namibia with my friend Jen and her husband Ben.

After seeing Victoria Falls and having "Sundowners" at dusk on the Zambezi, my friend Jen, Ben and I set out the next day for Windhoek, Namibia. The 18 hour bus ride there was indeed as long as it sounds (actually ended up being 20 hours because of an overturned fuel truck blocking the road)but the bus was definitely the nicest I've ever been on. It felt more like flying with pit stops every few hours. From the minute we crossed the border it was very apparent that Namibia is a completely different world than Zambia despite sharing a border. The immigration office we had to stop in on the Zambian side was a run down house run in a completely chaotic manner. In contrast, the Namibian office looked brand new, was air conditioned and very orderly. All week the three of us were astounded by how good the infrastructure and development in Namibia was- by any standards, but especially in contrast to Zambia.


We arrived in Windhoek which felt much like a German town in the middle of the Kalahari desert. Much to my delight after a month of Zambian food, we stocked up on groceries at a Whole Foods type store then picked up our rental truck and camping gear. Our 4x4 made us feel like we were cheater camping as the tents unfolded on top of the truck. We then drove about 4 more hours out to Swakopmund where we had a seafood dinner looking out at the Atlantic Ocean. Yes, ocean as in beach- very strange after living smack in the center of Africa. Notable events in Swakopmund were Apple Strudel (phenomenal!), riding ATVs in the sand dunes and sea kayaking with literally thousands of seals playing around us.

After Swakopmund we packed up and headed south to Sesrium, our campground at the base of Soussevlei where the largest sand dunes in the world are. The drive out to Sesrium was incredible because we started at the ocean, drove through the desert followed by mountains which turned into canyons with rivers in them, then green rolling hills, more plains, then eventually desert again. This was made all the better by coming over a mountain pass to see an enormous full moon (which my super novice photographic attempts couldn't quite capture).

At Sesrium we pretty much just relaxed, hiked in the enormous dunes and lamented how fast the week had flown by. The dunes were incredible- as always, way more impressive in person than on film but there are pics below.

On 18 hour bus ride round two I managed to wake up enough to plead my case to the immigration officers and was very relieved when they agreed to not deport me. I did get a 30 second lecture that I could have settled all of this on my initial arrival(an even different way than suggested by the previous two immigration offices) but ultimately they smiled and said "We will work with you and want you to enjoy Zambia". So I now have 30 more days to work and then up to 60 days to be a tourist before leaving. This week I'm doing more surgery and also trying to get more involved in seeing other health projects going on locally- I'm going to visit some rural hospitals with the district health office on Friday then hopefully spending some time at the ER in Lusaka next week.

Thats it- sorry this got longer than planned. Again.

Have a great week!

Melissa



http://picasaweb.google.com/melclark217/Webalbum3?feat=directlink

Goodbye Zambia, Hello Namibia

Well the visa fiasco, for the pain its been, turns out to have a silver lining. Dr Johnson did some more research and deciphering of immigration policies. While he did get a few different answers, it seems as though if I leave the country for a few days and return with a letter from the hospital welcoming me I should be able to qualify for the required 30 day business visa. The other step, which Dr Johnson is working on, is getting a letter from the ministry of health agreeing to me being here. When I first heard that I had to leave Zambia I was a little unsure as to what I could economically and safely do on my own for a few days. Still unsure of the complete plan I headed to livingstone, zambia (site of Victoria Falls, right on the Zimbabwe border and close to Botswana). I wasn't dying to go to Zimbabwe given the Cholera situation and potentially unstable political environment so figured I would end up in Botswana.

I arrived in Livingstone last night and checked into a great Hostel called Jolly Boys with a pool, lots of young people and several good areas to relax. I woke this morning only to bump into one of my friends from Portland at breakfast! I had known Jen, a med student I worked with at OHSU, was in Africa somewhere but no further details. It turns out she and her husband are doing medical work in Lusaka for the year. They had planned a weeklong trip leaving tomorrow for the dunes of Namibia and kindly invited me along with them. Today we wnt to go see Victoria Falls which was amazing.

So...next stop Namibia! Keep your fingers crossed that immigration is feeling friendly on my return so I can get the business visa and resume working in Choma. There are 2 national holidays this week so we'll se how muchthe ministry of health gets done. Have a good week

Melissa

On a lighter note...

Here's more pictures- not so different than the first set other than I included a few hospital pics at the end. There are a few pictures from a quick day trip I did to a nearby village called Chikuni (Dr Johnson had to do a house call). The Choma girls in the middle of the set were hilarious- they all had about a million modeling poses they wanted to do. In looking at these pics I realized I cut off probably 95% of people at their foreheads, so perhaps next time you'll see some full faces (if you are in the 2 people who aren't totally bored looking at pictures of the same stuff)



If above slideshow doesn't work use address
http://picasaweb.google.co.uk/melclark217/ZambiaRound2

Visa Purgatory

I was needing a bit of time off to recover from the medication side effects and in quite the unexpected twist of events I may have much more time off than I hoped for. Before I came here Dr Johnson, who has been in Zambia for 15 years and knows logistics here well, checked with multiple official-type people about me visiting. All parties assured him I only needed a tourist visa. He has had many visiting students and residents in the last few years also on tourist visas without problems. Yesterday we got a message from the organization that coordinated this
trip that the state department had issued a new alert that all volunteers must be on a work visa rather than a tourist visa. Apparently some Americans volunteers have recently faced huge fines or even jail time for having the wrong visa. (It is unknown what exactly their circumstances were, politics here can be complicated and perhaps they were up to something else suspicious too). Dr Johnson thought this seemed strange since tourist visas have always been well accepted. Initially we thought I could probably just get approval since he knows many officials in town or say that I am visiting him rather than an official volunteer but he went to the immigration officials who confirmed I cannot be in the hospital any longer without a work visa. Apparently getting a work visa requires applying from your home country at least 6 weeks before entering the country. Dr Johnson is driving to the capital today to talk to the ministry of health and immigration to see what, if anything, can be done. I'm going to see what happens in Lusaka before panicking or scrambling to find a plan B. So here I am a bit in limbo now as to the plans. Sara, my best friend, is due to come here April 8 so we can go on safari. I'm already getting bored sitting around the lodge while under the weather and definitely do not see staying in Choma not working until April as an option. I've thought about emailing everyone I know to see what else I can figure out work wise but that won't make the
visa issue go away, so other projects in Zambia aren't really an option. If it was just a fine at stake I would maybe play dumb about the issue but I'm not really dying to see the inside of a Zambian
jail.

So we'll see. I'm not sure if its fortunate or unfortunate timing that this is catching me at the phase of the up and down cycle where I'm not loving things so much. I feel sick, hate the food here so am alternating between nauseated and starving. There is a small part of
me that is so ready to hop on the next plane home but the bigger part of me knows
I'll figure out a plan B to stay. I don't want to feel like I wimped out if there is an opportunity to stay. I'll definitely go travel for a bit one way or another but as far as work that will be the bigger
challenge to sort out. I'm just keeping an open mind to all the possibilities. Either I'll stay and make the best of it or perhaps find another great opportunity. And at the end of it all, if it
wasn't meant to be I'll putz around a bit, see some animals and come home having had a bit shorter but great experience.

Stay tuned...

language barrier, religious adventures and more whining

27 Feb

I feel a bit silly with the smile and nod routine when trying to communicate with my patients so I’m resolving to learn a little Chitonga. English may be the official language of Zambia but the vast, vast majority of people speak primarily their tribal language. There are 72 languages in Zambia. In this region that is called Chitonga or Tonga. The men are much more likely to speak English as they have generally received longer education (girls rarely go beyond 7^th grade and even that is not common). The kids love screaming “I am fine”, “hello”, etc but that’s about it. I keep wanting to revert to Spanish when my English is failing miserably, but somehow I don’t think that would help much. So you lucky readers get to learn Chitonga with me. Read below for some very common phrases which should come in handy.

Twalumba- Thank You

Mwabuga buti- Good Morning

Ndili mweembezi mubotu- I am a good herdsmen

Hena basokwe balayoowabasiluwe- Are baboons afraid of leopards?

2 March 2009

Obviously still so glad I’m having this opportunity but am afraid I’m entering the fully anticipated “what the heck am I doing here?” phase of the journey. Hopefully it will just last a couple of days and I’ll be back to rose colored glasses. Kevin, the boyfriend figure, asked me last week what I miss most about home. At the time I just rattled off a few people and otherwise nothing came to mind. Of course since then I’ve come up with quite the comprehensive list, 97% food related, 3% brainless TV. Is it bad I’ve been here only 3 weeks and I’m already fantasizing about what to eat when I get home? Not helping the issue is the fact that, after an HIV exposure in the operating room last week, I decided to bite the bullet and start taking HIV prophylaxis. I work with HIV patients pretty frequently at home without giving it any thought. Here it’s just a bit harder to feel safe given the limited resources for personal protective gear. Gloves are thinner and generally the wrong sizes, surgical gowns aren’t waterproof and aren’t worn for anything except major procedures and faceshields aren’t available in the theatre. Thank goodness I wear glasses at least! For those of you who are non-medical, the good news with an occupational exposure is it is a very small less than 0.03% chance of contracting the virus even without meds (and even lower with taking them). The bad news is that I have to take 9 disgusting pills every day for a month that make me feel totally nauseated. So I’m in a little pickle as I probably will be nauseated for the next month or so and the only available foods I don’t hate here are fried chicken and French fries. Not exactly in the jello, ginger ale, saltine family. I suppose it’s time to learn to love Nshima.

Food and nasty pills aside this is a very nice culture. People in the community here are extremely friendly…and very religious. This combination has lead me to receive about 7 or 8 different church invitations so far. I think inviting someone to church is the Zambian equivalent of “let’s meet for coffee”- a safe, public, socially acceptable invitation. Other than 2 people, who seem to be exceptions, everyone here I’ve met goes to church every Sunday. Without saying too much about what I do or don’t believe, let it be said Sunday mornings at home are generally reserved for listening to KFOG’s acoustic sunrise and searching for the perfect brunch. This weekend I got a double glimpse into the religious subcultures in Choma. Experience #1 was Saturday morning after rounds I went with Dr Johnson to the final vows of a woman becoming a nun. Not being Catholic I wasn’t quite sure what this entailed. I ended up having a great time and got to witness some beautiful Zambian singing and dancing at the ceremony. Afterwards there was a reception at a local school for children with disabilities. At home this would have likely consisted of grabbing cake and saying congrats. In true Zambian fashion (or so I’m told) the reception included a very elaborate program- with an emcee, numerous speeches from various community members, a procession presenting gifts to the new sister, a luncheon, several songs by the school’s phenomenal choir of blind children and a cake cutting ritual of a teenage girl dancing for about 7 minutes with the cake knife.

Religious experience number two of the weekend was going to church on Sunday morning with the people who run the guesthouse I stay at. When they said it was a Pentecostal church I somehow had an idea it was different than anything I’d ever been to in the past but wasn't really sure. When I walked into the church there was a pretty much empty sanctuary with a very small enclosed area. Behind the wall was what sounded like about 20 people screaming wildly and singing. Eventually the room filled up with people attending service. The people behind the wall turned out to be the choir. Things started out pretty standard protestant service (except with great African music and more dancing). Then after a few songs things became a little more free form with people yelling out various songs, prayers or whatever else. Being someone who gets self conscious singing Happy Birthday, I didn't have much to contribute to the mayhem. The sermon was quite heated- lots of hallelujahs, amens, and talking of demons and satan. Subsequently they sang some more songs while about 30% of the people fainted,

appearing to be having seizures or speaking in tongues. Had I been in the hospital lobby I would have probably called a code if I saw people collapsing like this, but I suspected all was well and decided to stay in my seat. Everyone recovered just fine and then wished each other a good week and headed out for tea. I returned to the hospital to round then needed a nap. We'll see what's on tap for next Sunday