computer seances

We have been trying to modernize the outpatient records system here at
Mukinge this week with the help of a visiting Yale graduate (class of
96) who lives in Denver. Currently, our files consist of a series of
colored index cards with frayed edges stapled together in haphazard ways
and stuffed into dilapidated filing cabinets; some of them date back 50
years. So, in an effort to locate records more quickly, we decided to
make a computer database that was searchable by various identifying
characteristics to help us cull through some of the records that don't
get used anymore.
Yesterday was our first day of on the job training. Our start was
hampered by the fact that we don't actually have a power outlet in the
reception room of the outpatient department; after several visits to the
workshop, a failed work order, and an pilfered extension cord, we're
back in business. We have two clerks, neither of whom has ever worked
on a computer before this. We have about 10,000 cards that need to be
put into the system. Edson (like the car) sits down in front of the
computer and begins his typing ritual -- he gradually sways from side to
side, staring at the keyboard, not looking at the screen, humming to
himself, until with a grunt of delight he finds the letter he's looking
for, which he pounces on like a mouse and begins the same ritual again.
He'll do all this without looking at the screen, until the whole name is
entered in; then he'll inspect his work. He bites his knuckle and has a
childlike expression of horror and surprise that the computer would have
screwed up his best intentions if there's a mistake, then proceeds to
erase the whole thing and begin again.
Needless to say, it may be a while before we get all 10,000 put in the
database.

african pets

As a dog-lover, I find the state of most dogs in Africa to be a sad one, as the flies constantly harrass them to the state of drawing blood. Most dogs have scars on both of their ears where the fur has been eaten away and the flies bite to the point of bringing blood on a daily basis. In the village, of course, the dogs were working animals, and watching them herd goats was one of the highlights of my day, as the somewhat obnoxious beasts ended up bleating and running around into the pen where they headed to.
Currently, I'm trying to capture a kitten for the Yanjishas to help with their rat problem, and I have also become the somewhat unwilling caretaker of a local cat who doesn't seem to have
many people to feed it. It is occasionally nice to have my legs rubbed against, however, while I'm doing the dishes, especially since physical contact is pretty limited in Zambian culture to handshakes. And I feel safer about avoiding the mice....

transitions, transitions, transitions

Africa is a continent of transitions. The population seems to be
constantly on the move, especially if you are well educated, and the
expats often are flitting about from one site to another as they visit
various projects and evaluate potential areas of need. In Lords of
Poverty, this kind of money spent on "fact-finding" was roundly
condemned as a waste of money that would be better spent on in-the-field
needs, not on westerners flying around to see them. I don't know about
that, but the fact remains that we have had 24 people coming in and out
of Mukinge over the past two weeks. At the hospital, 2/3 of our
administrative staff has left for 6 months to 2 years to pursue higher
education; similar things have happened to our nursing staff. Adult
education plays an important role in career development, and virtually
everyone you meet has future plans to better their education in some way.
In similar veins, AIDS and HIV has a similar impact on the professional
staff. The hospital has lost two personnel that had been there for many
years this past two months, and it has taken a toll on the morale at the
hospital. I have been trying to get one of the staff to get himself
tested for HIV for some symptoms he has been having, and after a month
of cajoling and talking him out of statements like 'I think I might
commit suicide if I test positive' I think we have gotten somewhere, but
those two deaths have made my job that much harder. The statistics
published in the Lancet say that we lose more professionals to HIV than
we do to the 'brain drain' that I referenced back in October.
Clearly we as temporary missionaries contribute to the problem, as I
find that I have to reinvent the wheel for duties and information that
was probably known by previous executive directors and doctors but never
got written down, passed along, and the contacts have all changed due to
the transient nature of things here. And I will probably leave behind a
similar legacy, although you try to improve the system a little bit and
make it easier for people to come in and out. I do feel that Zambia
clearly isn't ready to stand on its own, not from intelligence,
training, or force of character, but simply because resources don't
exist in ample supply to get there. It may be quite some time before
that happens, as well. Until then, I think we have to stand in this gap
with our brothers.

rainbows before the rain

Okay, that title sounds a little too Disney for the reality of Africa,
but with all the rain that we have here, you get a lot of rainbows.
Here in the southern hemisphere, weather moves east to west, not west to
east, so that in the afternoon, when most of the rains come, you see the
rainbows before it rains, instead of afterwards, like in the states.
When God promised Noah that the rainbow would be a sign that he wouldn't
flood the earth again, I always appreciated it after the rain happened
at home, because it was like a wink and a nod from God, saying that same
thing again. But I'm struck that here, the rainbow is a promise, a
warning even before the rain hits, that this time won't be the big one,
and we don't have to worry. In a place where it sometimes seems that
the next cataclysm could be just around the corner, I appreciate the
reassurance. And it makes the coming rain seem not so bad (although I
still can't get my clothes dry).

Going to court

I thought that after I left the US my court testifying days were over,
but it turns out that that is not the case. I had to go and appear
before a Zambian court for the case of the man who was beaten by a
coffin, ended up in a coma for three days, and eventually pulled
through. I really hate having to testify, the defendants always look so
scared, and here in Zambia few have even a defense lawyer, so they are
pretty much on their own with a 4-5th grade education, usually. You
hope and pray that the magistrate and the court will not abuse their
privilege and provide justice to everyone involved. I'm reminded of all
those verses in Psalms that talk about meeting God at the gates, which
are where the courts used to be in ancient Israel, and how important
justice can be if you're poor.

Back from the village

Greetings to you all!

Yesterday marked my 2 month anniversary here in Zambia, so you could say the moving jitters are over.  I've been settling into my duties at the hospital, which are wide and varied, ranging from ultrasound to obstetrics to nutrition.  I did my first solo amputation a few weeks ago before I left for the village to improve my language skills and get a taste of the culture. Starting next week, WMM has sent out a travelling surgeon for a month to help me and others improve our surgical skills, so I should be in the OR a bit more over the next few years.  The medical work is a mix of struggling against diseases that are too advanced to do much about, preventive care and malnutrition, and tropical disease.  We are in the middle of malaria season here and see quite a few sick children pretty regularly.

I and the hospital will be going through a fair amount of transition over the next few months as three of our docs leave, and we get two new ones for the next year.  It's a bit weird to graduate to the person who's been here the longest after only 2-3 months, but that scenario is common in all walks of life in Africa because of the HIV epidemic and people leaving the country for opportunities elsewhere, in addition to the usual reasons people move jobs.  Thanks for all of your prayers and thoughts over the past few months; we have gotten a little relief with our financial situation, although we still suffer from chronic shortages and crises of basic supplies like IV fluids, tape, bandages, etc.  The nursing shortage has gotten a little better as we have come through the holidays as well.

Personally, I've been enjoying my time.  My personality has been a good fit for the culture here, and some of the frustrations of African life don't bother me very much.  On the other hand, I will be glad when the communication situation improves -- the satellite internet folks are coming today to help set up more equipment, so we draw closer to a modern communication system.  As people get more used to me, there have been more petitions to help out with things that the hospital or others need -- helping a man raise the tuition funds for Bible college, trying to raise money to buy a supply truck for the hospital, organizations to help out HIV orphans around the area, etc.  It's difficult to have wisdom about where to help.  As I have mentioned before, Africa, because the need is so great, can quickly overwhelm your personal resources, and I'm learning discernment on how to help.  If there's anything any of you would be interested in helping with, let me know.

 I put a picture of me and my poking stick with the kids from my host family when we were out fertilizing the fields.  I hope that you are all able to keep up with the blog (www.mattcotham.blogspot.com); I've been intermittent about postings because of the spotty internet access but it gives a good picture of what life is like out here.  If for some reason you can't get on and you'd like me to send you the postings by email, let me know.

Wishing you all the best for 2007.  I'm still getting Christmas cards in the mail -- thanks for all of your support.  I found out I passed my written boards, so I will likely be coming back briefly to take the oral boards at some point for the next year -- perhaps we can get together if the stars align.

Matt

A life well-lived

As I spent time in the village, I couldn't help imagining what Mr and
Mrs Yanjisha would be like if they had grown up in the US. I think the
thing that continually strikes me about Africa is the limitation of
opportunities for people who live here. Mr. Yanjisha, who works as hard
as anyone I know in the US (certainly it would take me some time to get
strong enough to be able to do what he does day after day) has a goal of
saving $300 over the next five years. And that is dreaming big for the
village -- most of the people live with their thatched huts; one man
whose house burned down 3 years ago has still not rebuilt. Mrs.
Yanjisha, for the women's club to help the AIDS orphans, works an entire
field with the other 7 women, planting and weeding about 2 acres by
hand, in addition to helping to take care of their own fields, take care
of three grandchildren, haul water, cook, do the washing by hand, and
keep house. Not many charitable gestures in the US include 6 months of
daily back-bending manual labor -- volunteers would be few and far
between, I think.
But despite the limitations of opportunity, I think that they have a
life that is full. 5 or 6 people would stop by just to chat or get Mr.
Yanjisha's opinion about matters every day. Laughter marks their
getting up and going to bed. Justin, their 6 year old grandson, spends
most of his time singing and dancing around the yard. Certainly much of
that would be lost if they had been raised in the US. Although I am
sure they would have more material security, I don't know that Mr.
Yanjisha would get the respect that he has earned here in the village.
And as I sat under the mango trees and strove to achieve the
conversational level of the village idiot, Daka, who would come to talk
with me every day, I wondered about what God will value when I get to
heaven and look back on things. I think there will be a lot of people
like Mr. Yanjisha who I have never met but who excelled with the gifts
that they were given. And it becomes less about limitation of
opportunity and more about making the most of your opportunity and
living well. I have more choices that the Yanjishas, but it is
incumbent on me to do well with them.

War and Peace and Everything Else

Apologies to U2 for the backhanded plagiarism -- I figure Bono would be
in support of me working in Africa anyway....
Just got back from the village, where I spent two weeks trying to learn
some Kikaonde, working as a 'peasant farmer', as one of the men called
himself, and generally getting sunburned. I made it through 800 pages
of War and Peace in between working in the fields, fetching water, and
so forth. I couldn't help think about the contrast between the last
time I read it in a hot, overheated Yale Russian literature class, and
my life this week, poking holes in the ground with a sharp stick to put
down fertilizer and cutting sweet potato shoots to transplant to a new
field. Yale, and western civilization, thinks that it knows all there
is to know about philosophy and life, but few of my literature
professors would have had a clue what was going on in Lubofu. Tolstoy,
on the other hand, I think would have had a good grip on where my host
family was coming from.
I stayed with the Yanjishas, one of the more respected families in the
village of Lubofu. Every morning, I'd awake with the family around
daybreak (6-ish) staring through the mosquito net gauze which makes the
room seem half-dreamlike when you wake up. Usually I'd be awoken by the
rooster crowing or the three skinny dogs chasing away some would-be
intruder. Most nights the rats and mice would wake me up once or twice
(one memorable night they tried to crawl into bed with me -- I objected
to that) as they bang around in the room where they store their corn. I
am struck again by Paul Brand's discovery in the 50's during his work
with leprosy patients that many patients were losing fingers to the rats
at night, and the introduction of cats as part of his medical treatment
for leprosy. The Yanjishas are quite bothered by the rats, but the cat
that they had was killed by some dogs, and when they poison the mice,
new ones from the surrounding fields and grassland move back in within
the month. I'm going to try to find them a new cat, but they are
strangly scarce here in Zambia. In the meantime they make do, like they
do with many other things -- old fertilizer bags picked apart for
string, melted plastic bags to patch the hole in the bottom of the pot,
reusing tea bags until they won't make more tea.
I asked them to treat me like they would treat one of their own family
when I got there, wanting to do what they would do. I quickly learned
that 'family' means something very different to me than it does to them,
as they took me around the village, introducing me to their neighbors,
who it turns out were all family in some way or another, including the
mysterious relation who was their 'brother, but different father,
different mother." After awhile I decided to simply accept the fact
that they were all members of the same loose family and stopped trying
to untangle the threads. Needless to say, they didn't treat me like
family, they treated me like a king.
The Yanjishas only were able to have two children, but they have since
taken in 3 of their grandchildren, who they are raising as their own, as
well as their uncle, as well as another young man who they hired to help
with the oxen and with the fields. Every member of the village seems to
have tragedy lurking in the background in some way, in some ways similar
to America, although since it is a small town, everyone knows each
others business in a way that we don't have in the cities at home.
Their cousin's husband died of pneumonia a few years ago, and she has
seven kids, so they have taken the two eldest to put them through
school. The hired young man's father was killed by one of the coffin
incidents I wrote about before just two months ago. The village has
been hit hard by HIV. Mrs. Yanjisha is a member of a woman's club who
helps to take care of HIV orphans -- 8 of them to take care of 100 kids.
At church, it's great to watch children being passed from one mother to
another during church, no reserves about how you would treat anothers
child. Commonly we'd feed several kids from around the village for
lunch or dinner as they would stop by. People know that they are
looking out for each other. Community is stronger and more important
than anywhere else I've been.

Itchfest 2007

I seem to have some dermatological disagreement with Africa, which was not helped by my peeling sunburn after this week.  More insights into my two weeks in the bush:
As I mentioned previously, I asked them to include me in what they were doing during the week, a thought which stretched their ideas of hospitality.  However, both cultures bent a little and we met in the middle, with me going to work in the fields for a few hours while they tried to spare me from the hard work, and after two or three hours reached their tolerance limit about what I would be allowed to stand.  Ba Yanjisha works very hard, taking care of three fields with the help of his children, wife, and hired hand.  We hoed weeds out of one field, put down fertilizer, and cut and planted sweet potato shoots in a third.  Like my dad, Mr. Yanjisha has back problems, which I am amazed that more Zambians don't have, considering that all of this work is done bent over half-way, either bending down to hoe, or pull weeds, or put down fertilizer.  I was glad I had brought some extra Ibuprofen to share with him while I was there.
Because he's worked so hard for the last several years, he managed to put a tin roof on his house this past year, which took him five years to save up for (total of around $330 US).  Their place is very well-to-do by village standards, with 4 rooms.  There's a "VIP" toilet out back (as the peace corps workers put it) where the flies rise to greet you like the bats out of Carlsbad cavern.  He's made plans to try to build a separate storeroom for the maize which will hopefully help a little bit with the rat problem in the future.  And the next 5 years or so he'd like to buy a solar panel, so they could have electric lights at night.
After a few hours of work, during which I still managed to get a few blisters and sunburn despite the Yanjisha's careful watch on me, we'd come back to the house, where the rest of the day would consist of me memorizing Kikaonde vocabulary on a language program that I invented through the week, eating a few mangoes, and sitting outside the house in one of the deck chairs that they reserved for special visitors.  Time moves slowly, marked less by the ticking of a clock than by the thud of the mangoes as they fall and hit the red dirt yard, but it is a pace that allows you to greet everyone as they come by, and indeed it would be rude not to.  As an American, it was hard to get used to the idleness; in fact, Tolstoy puts it well:

'Fallen man, too, has retained a love of idleness but the curse still lies heavy on the human race, and not only because we have to earn our bread by the sweat of our brow but because our moral nature is such that we are unable to be idle and at peace.  A secret voice warns that for us idleness is a sin.  If it were possible for man to discover a mode of existence in which he could feel that, though idle, he was of use to the world and fulfilling his duty, he would have attained to one facet of primeval bliss.'

I felt Tolstoy's curse heavily and tried to work to learn some language, but after I shifted my chair twice to follow the slowly moving shade from the mango trees, I would make an excuse of headache and return to reading or watching the baby goats or playing uno with the kids.
Much like my skin seems to be reacting to the alien African humidity or insects or whatever it is, I couldn't help but feel that my presence upset what was a well-functioning social equilibrium while I was there.  My well-intentioned gestures, like bringing rice and flour with me, seemed out of place, as the white rice was less nutritious and took longer to cook than the usual nshima, the maize porridge that we ate for most of our meals.  I left behind a wake of bloody chicken carcasses as they kept buying and sacrificing their and the neighbors extra chickens (I wasn't sad when the rooster went under the knife, however -- 15 minutes of extra sleep for me, and a delicious drumstick on top of it all).  I hoped that that was maybe the usual state of things, until most of the people that stopped by commented on how many chickens we were eating.  Already feeling my fair share of white guilt (after living there, I can't even imagine the violence that the slave trade did to these families) the chicken slaughter didn't help matters much.
However, the generosity and welcome that they gave me kept me from feeling those things too much.  And as much as it strained my cultural values of independence to accept their sacrificial generosity, they strained to meet me in my independence.  At the junction is where friendship forms, I think. 

The termites are coming! The termites are coming!

Although I fear that I have missed the great termite migration of the rainy season, when they come up from the ground so thick that it looks like it is raining upward, and people congregate around your outside lightbulbs to collect the dead carcasses to eat, they have still managed to make some inroads on my place.  At least there are no marching army ants coming through my front door....

Gary

This is Gary (I hope the picture came through).  That's also me sporting my new Zambian haircut -- I think it makes me look pretty old, but I am assured that I look very 'smart' by the nurses around.  Gary has some kind of tumor of his left cheek.  We don't think it's a Burkitt's lymphoma, which is one of the pediatric tumors that we can cure here with chemotherapy.  We do chemo although it's a little bit scary without all of the capability of monitoring blood counts closely, etc.  We had hoped that Gary's tumor would respond to the Burkitt's regimen, but he had some unusual parts of the history for a real Burkitt's and it doesn't seem to be responding that much.  He came in because it was hurting so much; that being said he is doing better from the pain and really likes my yo-yo tricks.  So I try to make an effort to make it by his bed and walk the dog and around the world, etc. every day.  Hopefully he'll have some time before the pain comes back and it grows too big to keep him from breathing.  You just want to make the time that he has as good as you can; I'm glad the yo-yo can help with that.
JB Phillips translates one of the beautitudes as "Happy are they who bear their share of the world's pain: In the long run they will know more happiness than those who avoid it."  When I see Gary every day, I hope that that is true.

leave of absence

Hey to all my loyal readers -- starting this week I will be staying in the village for 2 weeks getting to know the culture better and learning some Kaonde.  Should be fun, if the rats aren't too bad.  All that to say, I won't be bringing my computer, since there wouldn't be anything to do with it anyway, so I'll catch up with you at the end of January.  Here's a picture of where I'll be staying:

sounds of Mukinge

There's always a fair amount of sound at my place, although the weird African birds seem to be relegated strictly to the capital, Lusaka.  As I've mentioned before, my front door opens up onto the bus stop for the hospital, and the buses usually run around 4-5 am, so there's a fair amount of traffic noise early in the morning.  I am amazed at the perserverance (or confusion) of the crickets here; there is a 24-7 buzz around my house of crickets; it's very soothing, although a bit creepy when you think of the sheer mass of insect life required to make that kind of noise.  Also adding to the background hum is my refrigerator, which is on its 3rd or 4th life (like many things here, it's been patched together) but still rattles along.  You do have to be careful about touching it, however, because the lower edge is electrified for some reason and you will get a big shock.  My neighbor is also quite fond of music, so there's usually something upbeat playing next door.  African music is very happy -- even in church, they are not big on the introspective songs that we seem to like here in the states.  And I am working my way through my iTunes library to make sure I've listened to every track at least once; I'm working backwards and am up to the 'D's so I should be done soon.  I also get a fair amount of guitar playing in, which always turns the heads of the people walking by.
The noise I don't like, however, is the wailing when someone dies in the hospital.  Especially for the kids, there are usually several family members who will come out in front of the hospital and keen and howl for awhile.  This may happen in the middle of the night, and often wakes me up from sleep.  I still can't help feeling guilty and little sick to my stomach every time it happens, which is about every other day, on average.  By the next morning, there is usually just an empty bed, freshly made, where they used to be, but everyone knows what happened, and you move on about rounds, helping those you can.
My back door:

Happy Birthday Zambia!

Few people in Zambia actually know their birthday.   In general, people's concept of dates and the calendar is loose at best, so when they are admitted to the hospital, most of the time their age is based on the year of the birth, and no effort is made to figure out the actual date.  So everyone gets to be a year older on Jan 1st!  And everyone plays along with the fiction, correcting me on patient's ages when I see them on the wards, etc.  Maybe next year I'll plan a birthday celebration...

a shout out to my accountant parents

As the son of two accountants, I can't help but be completely mystified
by the fee schedule and revenue sources for our hospital. Our monthly
budget is around $20,000/month, as I think I've mentioned before, which
is supposed to cover salaries, drugs, supplies, transport, etc. The
government, despite lack of funds to back up the policy, several years
back decided that health care should be free to the people. Referral
hospitals like Mukinge were still allowed to charge fees, but only for
specialty services/lab work etc. This, of course, cut into our funds a
bit. Below is a sample list of the current prices for people in the
hospital. Keep in mind that the conversion rate is around 4000 kwacha/1
US dollar.
Visit to outpatient clinic: 4000kw
Admission: free
Hospital stay/day up to 21 days: free
Minor/major surgery: free
Delivery: 5000kw
Family planning surgery: free
Dental extractions: free
Circumcisions: 10000kw
Police reports: 10000kw (we recently raised this price from 5000)
Requested ultrasound: 15000kw
Routine XR/US: 7500kw
HIV test: free
most lab work: 1000kw/test
Perhaps it is no surprise that with little private donation funding, 1/2
the government funding because we are a missions hospital, and limited
reimbursement on even these fees, we struggle at times to make ends
meet. Thanks again to all of you who have been so willing to help out.

old yeller

I had my first case of rabies that died yesterday. It was a 16 year old
kid who had been bitten by the family dog a month before, and came in
for his rabies shots, but after the first round of injections (the first
time you come, you get 8 shots) he stopped coming. There are supposed
to be a total of 4-5 rounds of injections. The family told me that they
had had enough shots, so they didn't come back. Rabies is uniformly
fatal, even in the US, but completely preventable with the right meds
and timely treatment.
We find that despite working here for over 50 years, there is still a
fair amount of distrust of the muzungu medicine among the rural poor.
We have moms pull out their severely malnourished child's feeding tube
because there is a perception that we are choking their child, only to
have the child then die of malnutrition. We have a mass exodus from the
hospital when we have a death on the table in the OR because they think
we're trying to kill them. Every time there is a death on the ward,
since everyone is right next to each other, people get antsy and want to
leave to get away from the bad vibes/spirits etc. Of course, many
people get it and are grateful and get better, but not everyone.
I couldn't elicit from the family of the kid with rabies whether they
hadn't returned because it was too hard to get back, or they hadn't
understood the regimen of shots and thought they'd had enough, or if
they didn't like the idea of all those injections and thought we were
trying to harm them. I'm not sure which answer makes me sadder, but
seeing 16 year old kids die is always hard, especially when you were so
close to saving them -- just a few more visits for a few small injections.
It makes me worried for the future of the anti-retroviral program in
places like this, but fortunately, like I saw on my previous trip out to
the bush, it is couched in Zambian terms by Zambian workers, and
hopefully that will bridge some of those barriers, to mix metaphors.
Certainly it would be less well received by me, although I apparently am
good to hand out certificates. :)

Kamakechi certificates

I thought I would try to describe my experience today with our local AIDS program.  Yesterday I was talking with one of the assistant directors (Lason) about being interested in the program, and wanting to see some of their hands-on activities, and he invited me to a 'graduation ceremony' in Kamakechi, a town about 70 kilometers away from where we were.  Sensing adventure, I agreed after my Canuck colleagues graciously agreed to cover my clinical duties for the day.
Departure time was 7:00, but being the seasoned African veteran that I am now, I knew not to arrive before 7:30.  We got on the road at 8:00, but only relatively speaking, as we then spent the next hour in the nearby town buying corn meal and chickens (dead) and cabbages and picking up two women who wanted to go out to the town and trying to find a canister that wouldn't leak to hold some extra fuel.  After we filled up by siphon at the gas pump (watching the man sucking in the gasoline to get it flowing brought up so many objections I wasn't sure where to start, but it was the only way to get the fuel in the tank) we finally set off about 9:30.  There were now 8 of us in the Land Rover, including a lady whose luggage I was sure either had a fair supply of Limburger cheese or catfish stink bait in it.  6 of us were actually going to deliver the certificates, and we were well supplied with 30 Cokes that the director bought for us to drink on the way (I must have looked thirsty).  Why does it take 6 to deliver a certificate?  Because that's Zambia.  It brought to mind the lightbulb joke (How many Zambians does it take to change a lightbulb?  4.  Really.)  To be fair, I added nothing to the trip but a warm body, a stomach in which to reposit Cokes, and a digital camera with which to take the pictures of the graduates.
Although it has been touch and go since my experience at the Ren Fest (I think there is a previous blog showing my picture before the nausea set in) I have conquered my recently aggravated motion sickness, which was a good thing, as the road is less than perfect out to the bush.  We stopped when we saw one of Lason's friends who had just gotten back from a game hunt, and swapped the leaky petrol fumes for 2 day old slaughtered meat smells as they needed some gas and we apparently needed some game meat.  After dropping off both of the ladies on the way (the cheese lady was so ecstatic after getting home, rushing around hugging people and smiling, that I asked how long she had been gone -- 5 days) we arrived at Kamakechi around 2 hours later, to find that the graduates had not really come to take their test and get their certificate.
Lason got angry and made a show that we were going to turn around and go home, a prospect which made me a bit frantic, as I was hoping that the cheese smell would have more of a chance to dissipate before we climbed back in.  Fortunately, they materialized after about 10 minutes, called by an unknown (to me) messenger source, and we set down to take the test.  Meanwhile, some of the local ladies had unloaded the back of the van of its cargo of chickens and tomatoes and cabbage and cooking oil and were making a headstart on the celebration feast, a fact which I appreciated, since it meant I would be subsiding on more than a sugar high, and we were also unlikely to bolt at that point.
During the test, Lason and I and the driver decided to go looking for a few of the local people who we would like to encourage to start ARV's.  This whole process, although amusing to me, is really remarkable in that we literally spend eight to nine hours in a car to track down three or four people.  It brings to mind the parable of the good shepherd, who was determined that no one should be lost, and I have nothing but respect for Lason and the guys in the program in their efforts and endurance to do this day after day.  Unfortunately, about the time that we made it another 30 kilometers down the road, the deluge hit, literally turning the road into a foot-deep raging torrent of red mud.  We're laughing that we should have brought a boat, and it turns out two of the women we are looking for are actually staying in the camp behind the hospital, about a 5 minute walk from my front door.
So we shimmy back on the slick water soaked road, stopping briefly to check out a nearby copper mine that has fallen on bad times (owned by a Lebanese man who is currently in a Zambian jail for stealing cars -- an extra bad 2006 for that particular Lebanese man) and get back in time to discover that everyone has passed (it's now about 4 o'clock) and eaten their feast.  Passing isn't that difficult a task, as you only have to get 40% right, but I felt better that everyone had scored 80% or above in this particular class.  They serve us our part of the feast, and then I pose with each of the graduates to get their picture taken before we hit the road again.
On the way back, now taking the road at higher speed since there are fewer Cokes to be broken and we're about 3 hours behind schedule, we spot some mushrooms after the previous rain.  The car skids to a halt on the mud and everyone else in the car scrambles out to collect them.  I am assured repeatedly by two of the men, who readily admit they have never picked mushrooms before in their life, that these are quite safe to eat (I'm sure they are right, but feel I have plenty of groceries at home and don't need to risk it), and we proceed to stop at several mushroom stands on the trip back home.
Here's hoping that I'm not busy treating 5 cases of mushroom poisoning tomorrow.

I am going to try to attach a photo to this -- the last time I tried this it didn't work, but this is a different format, so we'll see if this comes through.  Somebody make a comment, since I won't be able to go on the blog itself to verify.  So you should be looking at a smiling picture of me holding a certificate.

Cultural dissonance

I was riding around in the back of a Land Rover for 9 hours today as we
bounced down a sluice of red mud, and the conversation among the other
Zambian men dwelt a good while on what they should be doing to get
ahead, get noticed, get promoted, etc. Many Zambians spend a fair
amount of time and energy trying to negotiate the system here to get
ahead, especially since the government is one of the main sources of
steady employment and advancement. I was struck by the thought that
although many people in the US would be right at home in such a
conversation, few of the ex-pats I have met in Zambia share those same
basic life values. It's less of a cultural disconnect and more of a
selection bias, where people who come to Africa to work for awhile in
general are less interested in 'getting ahead', at least on those terms,
and many have a fair amount of disdain for people who hold things like
career advancement, monetary success, etc as important. I'm sure that
the sources of friction that often occur between NGO's and their
indigenous workers comes not just from cultural clashes but also from
philosophical ones, as people interested in advancement are drawn to
NGO's which offer opportunities, but are run by people who are not
interested as much in that type of success.