a few cultural observations

Any self-respecting anthropologist would look at this list and say
'duh', but considering I never took Anthro 101 in college, here's my
take on a few things which have stood out for me in the previous weeks:

PRIVACY: The western view of privacy and the Zambian view of privacy are
almost diametrically opposite. Most Americans I know value their
privacy, spend their time trying to move to free-standing houses, build
high fences, complain to the police if their neighbors make too much
noise, and would think very hard before inviting their parents to come
live with them. Zambians, on the other hand, find that kind of
existence weird, isolating, and tiring. They can't imagine even wanting
to spend that much time by yourself, or needing that kind of space, or
having to manage to cater for yourself all the time. Alone time is
mostly to be avoided, rather than cherished.

SICKNESS: Zambians can be hard to pin down here; they are much more
willing to suffer through horrible, disfiguring diseases at home for
months or years before they come to the hospital. On the other hand, we
have almost every week someone show up to the hospital 'comatose'
because they just don't feel well so to dramatize that they refuse to
speak, eat, or move. The next day they are almost universally fine.
Westerners generally avoid both extremes of the approach to sickness;
they wouldn't ignore a tumor growing on their cheek until it erodes into
their mouth, but neither do they embrace this exaggerated 'sick role'
that some Zambians feel the need to do.

EFFICIENCY: This would be one of the more obvious differences in culture
here; I've been struggling to try to pursue less efficiency in my daily
life. It's probably the most endearing and most frustrating part of
working with Zambian staff. Lack of efficiency gives priority to the
relationship instead of the schedule; it's lovely to have people drop
what they are doing to spend time with you, and it's very annoying when
things just don't get done for days on end.

I love the things which transcend culture however, but just take on
different forms in different areas -- kids playing hopscotch: at home
with sidewalk chalk, here with patterns drawn into the mud with sticks;
cottage industries: kids selling lemonade at home, kids selling mangoes
from their trees here. And of course Slinkys and balloons, which seem
to cross all cultural lines.

Christmas Time is Here

Merry Christmas!  Our version of poinsettas here -- the flame lily, or 'Doctor's Joy', as Gwen Amborski calls it (she should know, having lived here all her life).  Poinsettas actually bloom around Easter time, so we've got our lilies and Christmas flowers backwards.  These grow wild in the fields around the hospital, and my other Christmas colors are being supplied by the red and green of the gigantic watermelons growing in my garden, the green and gold of the mangoes, and the silver of the evening rain on the trees in the mornings.  (Thank goodness for our internet access, because otherwise no one seems to know when a watermelon is actually ripe.)  Other than that, I've got lots of recordings of Bing Crosby singing about a White Christmas and such to get me in the mood.

Last time I wrote to you all was back in October; we've now passed the one year anniversary of my Mukinge stay.  I got the news that I passed my ER boards, which was good, although a near thing, having momentarily forgotten about the presence of things like CT scanners during my test.  The tests here are still challenging as well, although of different natures, like what's the proper food to serve to a Chief, what is causing the raging fevers of a patient, how best to support the people who come knocking on my door asking for help, or what decision to make about my future that's coming up in now less than a year.

Christmas time for me is always a time to remember gifts that have been given to me; I cannot even believe how blessed and lucky I am to have so many of you thinking of me, giving me the gifts of packages, time, emails, and prayers.  Rarely a week goes by when I don't have some kind of package slip waiting for me in my mailbox here, and it's been a joy to share some of the things from home with the people here from Zambia and elsewhere.  My big load of kids toys is especially fun around Christmas time.  Many of you have supported the work out here financially as well, allowing us to buy a water pump to supply running water to over 30 houses here at Mukinge, several different purchases of much needed medications for the pharmacy, 4 oxygen concentrators, and to remodel an entire house to help retain needed nursing staff for the patients.  Coming up in the year to come we're hoping to remodel two more staff houses as well as the male ward of the hospital.  Potentially we may have found a donor to help us upgrade our operating room facilities as well.  And I think I may redo the tennis court as a Christmas gift to the mission complex as well.

A year has gone by quickly; I blogged a few months ago about lessons that I've learned in a year and I'm struck by how much I've learned and changed in just a short amount of time.  We continue to serve and help as best we can for the people here.  Thank you for your service to me and us over the year.

With much love,
Matt

hail to the chief

We've been having sermons the last few Sundays in chapel on
relationships in various parts in our lives -- with family, friends,
workplace, government -- and one of the things that keeps hitting home
is the importance of respect. I remember in college how my friends from
the East Coast would make comments about relationships in the south as
'fake' or superficial because they placed a emphasis on respect, even
when you don't necessarily like the person who you're dealing with. All
I can say is that the issues you might bring up with Southern culture
are magnified to the Nth degree here.
For example, two weeks ago on Wednesday one of the district chiefs from
north of here showed up to have eye surgery. Unfortunately, he hadn't
coordinated with anyone at the hospital, so the eye surgeon was gone on
a trip, the cell phone service was down, and he had not arranged for any
place to stay or any provision for food or shelter. So I go to meet him
in the reception area, crouch down to the ground, clap my hands, and ask
his entourage what I can do for him, to which I am told 'whatever you
think is appropriate'. I am thinking to myself that it would be fairly
inappropriate in America to show up unannounced and uninvited and expect
someone to take care of you for two weeks, but I remember our chapel
talks on respect and wisely keep these thoughts to myself. I ask them
if they would like to stay in the hospital or stay in the guesthouse in
town a few kilometers away, to which they say 'whatever you think is
appropriate'. I think to myself that probably making him walk the 5
kilometers to town will be seen as 'inappropriate, so I start working to
find a private room for him to stay in. We have two -- one on the labor
ward and one on the female ward. I decide that the female ward room
will be more 'appropriate' than screaming women on labor and delivery,
so we go there. I then ask if they need to eat, to which they say
'whatever you think is appropriate.' I now explain to them that a 33
year-old American male take on appropriate might be a little different
than a 60 year old , requesting a bit more clarification on
'appropriate' and find out that yes, he hasn't managed to pack lunch for
himself. It now being 3 o'clock, our evening meal won't be served for 2
hours, so I go home to find something to cook for the chief. My
refrigerator contains mustard, eggs, green peppers, and potatoes, so I
decide that eggs are probably the safest of those options and make some
scrambled eggs for the chief, with some peppers mixed in. I deliver the
eggs to the private room where he is settling in, thinking that I can
now possibly go see the other 200 patients in the hospital, when the
chief's staff comes out and says that he is not happy because there is
no table on which to eat his eggs. The nurse in charge of the ward and
I look at each other. I suggest the rolling trolley that the nurses
dispense medicine from, but that suggestion is rejected as not
respectful enough. Eventually we decide to move my doctor's office desk
into the room, where he then happily eats his eggs.
Two weeks later, after his eye surgery but not quite long enough for him
to arrange a ride back to where he came from, my desk still missing from
my office, we have needed to spray for cockroaches in the ward. We
arrange for the chief to move to another room so he won't asphyxiate
from the fumes, but again we are told that we are not being respectful.
Fortunately, in the two weeks since his arrival some of the senior
Zambian staff have returned from their meetings and the cell phones are
working again, so I can defer this discussion of respect to one of
them. I am sure that it was handled better than my initial attempts at
appeasement, and we did manage to avoid cultural crisis and still spray
for cockroaches.

cockroach trouble

We've embarked on a number of building projects/remodelling the past
year -- repainting the chapel, installing cooking pots and remodelling
the kitchen, renovation of the Mwilu house, building of an ARV center.
After the kitchen remodel was finished, we decided to use the small
amount of excess money left to conduct a spraying of the entire hospital
to try to cut down on the cockroach numbers. Unfortunately, in order to
spray properly, you have to move all of the patients out of the ward for
3-4 hours, which can be a little problematic for wards like maternity.
Anyway, this week was the turn of the TB ward and peds 2, our
malnutrition ward. The TB ward spraying went smoothly, but peds 2 was a
bit more of a problem -- we sprayed overnight but the cockroaches there,
perhaps stronger from all of the malnutrition food they've been feasting
on for years, merely got angry, starting literally coming out of the
woodwork, covering the walls, jumping out on you, so forth. It was like
a bad scene from Indiana Jones. After some emergency purchasing of
additional bug spray, we managed to collect a bit of cockroaches 2 feet
across and at least 6 inches high. Pretty impressive. This is the time
of year where the bugs rule -- flying termites littering my doorstep
every morning with the remnants of a thousand shed wings, mosquitoes
giving malaria to close to half the hospital, black ants boiling out of
the ground in huge trains, ready to devour anyone who is slow enough to
pause accidentally in their path. I guess the cockroaches were just
upset about being left out of the fun.

the truth is sharper...

We still fight the struggle of getting people to come to grips with HIV
here in Mukinge. This is very much a person-by-person struggle, as all
of the posters and advertisements in the world seem to do little to
convince the village wife that she could conceivably be HIV positive,
much less need treatment for it. We have mandatory offered HIV testing
for all of our TB patients because the co-infection rate is around 70%;
one of my patients today became very angry because we were drawing blood
from her on the ward. This was a blood draw to determine if she would
be healthy enough to start on anti-HIV meds; she'd already had her HIV
test last week. To our surprise, however, she got very angry, claiming
that she'd never given consent for an HIV test and had never been told
her test results. Now, we pretty clearly document our counseling
process, and there were notes from our HIV counsellor on the chart, so I
was pretty sure that she'd been told both about the first blood test and
the results. But she was very adamant, spitting out Kikaonde far too
rapidly for me to follow, so I brought in the HIV counselors to come
talk with her again. After some further questioning, it was pretty
clear that she had gone through the whole counseling process as usual,
but was in such denial about her positive test that she couldn't even
admit that she'd been told the results.

As I was standing there in the nursing station with her and our
counselor, I keep thinking about how I could 'force' her to hear her
test results simply by repeating them again there until I was sure she'd
heard. I really wanted to, to a certain extent. I mean, shouldn't her
husband and children have the option of being tested, even if she was in
denial? Plus, it just seemed like cowardice to run away from the truth
like that. But for her, the truth was really a weapon in the truest
sense of the word, and to wield it like that against her would probably
do irreparable damage to her, as well as to our doctor-patient-hospital
relationship. So we left it alone, with her in her denial.

a disaster in the making

We had our disaster/emergency drill yesterday at the hospital, where we
practice what to do with mass casualty incidents. I had asked one of
our visiting docs to help me plan it and so she had organized several of
the nursing students to come and help. We had notified the nurses to
let them know we would be practicing today so that they could be ready.
What I didn't anticipate was the acting skills of our nursing students.
We drove up a carload of them to our outpatient department, where they
started wailing and keening after having tangled themselves up and
squirting ketchup all over themselves. Our watchmen went into a panic,
as did the chaplains, carrying the students out of the back of the
truck. Someone said that they had seen them all gathering in the
nursing training school just a few minutes before and 'there must have
been some sort of electrocution' that happened there. People were
scurrying left and right, I later found out that the staff in the
business office stopped their work for 30 minutes to pray for the
injured nursing students, and we called a halt to the whole process
after about half an hour to discuss some of the issues that came up.
Note to self: make sure that EVERYONE knows there's a drill on before
conducting one again.