finale

Hey there to all you faithful readers....
I'm now officially back in the US, and as such, think that it's probably time for the blog to end. I was at the Global Health Missions Conference this past week and actually was stopped in the halls by a couple of people who I had never met except through the blog -- a funny experience, but also one that made me realize that more people than what I had pictured were reading the thing. So thanks to all of you.

They told me in my 'debrief' that most people will have about a 3 minute attention span for my stories about what my experience in Africa is like; that seems a little bit silly to try to condense it all into 3 minutes and I'm guessing that if you've made it through 200+ blogs then you're probably willing to stick out a bit more of my rambling. I've been trying to come up with some pithy insights, but a comment from one of the people at the conference has stuck with me: "the relationships that I have overseas are some of the most complicated relationships I've ever had in my life." I resonate with that comment as the experience has so many different layers to it.

I was reading Henri Nouwen before I left and he said "no one can help anyone without becoming involved, without entering with his whole person into the painful situation, without taking the risk of being hurt, wounded, or even destroyed in the process." Maybe I've been wounded some in my time overseas, but it's a beautiful scar, and one to treasure, not hide. Some scars open you up deeper.

I hope every one of you will pursue your call to be gloriously wounded that way someday. I am looking forward to connecting with each and every one of you.

Until then.

Matt

seed distribution continued

seed distribution continued, originally uploaded by mattcotham.

One of our hospital chaplains, Daisy Munguya, sharing with the crowd
about Joseph and the famine in Egypt.

seed distribution continued

seed distribution continued, originally uploaded by mattcotham.

Some of our ward attendants teaching everyone how to cook porridge with
peanuts mixed in....

more pictures

more pictures, originally uploaded by mattcotham.

seed distribution

seed distribution, originally uploaded by mattcotham.

These past two weeks have seen the distribution of all those seeds I
posted on the blog last week. It's been a great opportunity to spend
time with the communities, get other glimpses into local village life
(entertaining the local headmen, etc), and spread the love of God in the
places that we've been. I'm gonna post a few pictures so you get the
flavor....

The Glostavent

The Glostavent, originally uploaded by mattcotham.

The Glostavent -- perhaps the sequel to The Groundnuts Project -- is the
name for our new anesthesia machine. It arrived about a week ago and we
had a visiting anesthesiologist come out to show us the ropes the first
part of this week. It's been great -- although a little bit expensive
it's perfect for our environment and will be fantastic for what we're
doing here. It should help us to give safer anesthesia and smoother
anesthesia as well, especially for some patients who are more ill and
can't withstand the usual drugs that we give. What a great gift to the
hospital -- thanks to all of you who helped contribute to make this happen!

out with a bang

Haven't been writing all that much for a while -- perhaps it's best to
be winding down a little bit with the blogging and honestly after two
years I'm not sure that I have much more to say. The last few weeks
will be a tough transition for me -- transitions are always tough, I
think -- and I'm going 'flat out' as David likes to say trying to spend
time learning about our new anesthesia machine, get the restaurant
finally open, get all these seeds packed, transported, and distributed,
cover the 4 wards in the hospital that I'm responsible for, get the HIV
study off the ground, and manage to get my stuff distributed, packed and
on it's way. This week and next will be especially busy as the
groundnuts project finally draws close to the end, meaning that I will
just be remaining with a few things left on my list. I wouldn't have it
any other way, however.

The groundnuts project

The groundnuts project, originally uploaded by mattcotham.

The Groundnuts Project -- sounds like a 60's band. I spent last Friday
traveling with the hospital truck to a nearby district to pick up around
4,000kg of seeds for peanuts and soybeans to bring back for seed
distribution this week. It's been kind of a madhouse with staying up
late to pack up seeds, leaving early in the morning the next day to
travel out to the villages and do the distribution ceremony, and cover
my inpatient duties at the hospital. We ended up moving around a total
of around 8,000kg of seeds, which has been developing my back and
stomach muscles -- Zambians have such good core strength, I think it
comes from hoeing and hauling around 50kg sacks of maize! You could
continue to pray that people feel the love of God through the work at
the hospital and through these gifts of seeds, and that there will be a
good harvest for the families that plant them.

fire on the mountain

fire on the mountain, originally uploaded by mattcotham.

When I was a kid we accidentally burned down the neighbors yard by
putting some not-quite-extinguished coals in a bag of grass clippings.
I think I'm getting a little payback this week. It's a little late for
the burning season here -- it's usually in June-July -- but the last few
days we've had a couple of fires creep pretty close to the hospital.
This is the hill next to the hospital, and then the next day the field
behind my house was set on fire and burned to about 50 yards of my back
door. It makes me a little bit nervous when you realize there's no fire
department for about a 4 hour drive. But everything did fine, and
actually now I'm pretty safe since there's nothing left to burn....

jewish zambia

We are cranking out the circumcisions these days at the hospital. Who
would have thought that adult circumcision would be such a popular
thing, especially since we aren't doing childrens' circumcisions very
much. There's a big push in the country because circumcision is thought
to decrease the HIV and sexually transmitted infection rates, so there's
funding to get these done. I honestly don't really understand the
popularity amongst the local populace, but we get lines of 10-15 young
men every Saturday outside of the OR to get the snipping done. Many of
our hospital staff has signed up at one point or another. Fortunately
I'm involved very peripherally -- only to give a few words of comfort as
they gingerly make their way around the hospital on Monday morning.
I won't put any pictures with this post. :)

Leaving home

Hello again from Mukinge!

Time in Zambia is rapidly drawing short for me -- my departure date has officially been set for November 10th, which is just 10 weeks away from today as I write this.  I had my end-of-term review this week with the director of the mission, which seemed maybe a little premature -- what if I set the hospital on fire next week? -- but has given me a chance to do some reflecting and thinking about what I've been learning over the last two years:

- community: except in a family, there's not many communities like a mission community, where you work, socialize, exercise, eat with, go to church, and in general never escape a small group of people from widely different backgrounds (Ireland, NZ, China, England, America, Canada, Zambia) and ages (2 weeks to >70 years old).   Psalm 133 -- 'How wonderful, how beautiful, when brothers and sisters get along! -- expresses the idea that a vibrant community is one where every day brings a sense of expectancy to see what is being done in each others' lives and in your own.  I've been growing in learning about forgiveness and refusing to 'close the door' on a relationship because of past issues or hurts; God's mercy is new every morning and I cannot deny the possibility that each day brings a transformation in each of our lives.  (Read C.S. Lewis' "The Weight of Glory" for a more erudite exposition of that theme.)  It's been a good journey to learn to live with that sense of possibility.

- transformative development: entire books, thesis, and international organizations have been dedicated to figuring out how to best help people in Africa.  It seems to me that Africa itself has had more difficulties showing progress than other nations in the developing world, especially in the areas of poverty and disease.  I've been struggling with these concepts as we've been working with the nutrition project, to try to bring some small amount of transformation in the farming practices in a way that doesn't foster dependence, shows the love of God for the people, and will make a change in the area.  I've been learning from lots of different sources and experiences.  One conclusion that I have come to, however, is the one that our western ideals of independence and self-sufficiency are neither biblical or practical for the region.  We should be aiming for interdependence, where all of our gifts on both sides of the coin are freely offered and control is relinquished to achieve the greater purposes for the area.  Of course, for true interdependence, each gift has to be honored, even the gifts that don't seem so important from a western perspective.

- hope: for many people, hope is at best a vague longing, a feeling in the pit of your stomach that things could be better, a dissatisfaction with the state of the world.  Here I've been in touch with a more concrete definition of hope, however, that not only recognizes the dissatisfaction but also knows that a remedy is coming.  Every day has the potential to be a depressing day in the hospital -- small kids with cancer, HIV and its consequences on individuals and families, neglect and malnutrition, inadequate health care being offered by referring institutions and by the hospital itself, witchcraft and shamanism, and death and disability in all of the patients at the hospital.  Learning to have hope in a setting like this one has been difficult, but life-changing.

There's still a number of things going on in my last few months -- organizing 16,000kg of seeds to distribute to the surrounding communities, getting anesthesia machines and soft-serve ice cream installed at the restaurant that we built this year, working on a survey research project for children taking HIV medications, organizing a training for community malaria health-care workers, and of course just being a doctor in the hospital with all its usual challenges and joys.  I have been so appreciative and blessed by your support and prayers over the past two years.  I've mentioned it in previous emails but you have been so generous with money and time for the work here in Zambia.  I think it's been a real picture of interdependence in my life to be here.

Thanks so much for all of you.  I will be back in Fort Worth after Nov 19th and through the holidays, and then likely back to Denver sometime at the beginning of 2009 to start up work again (this is still in the air, so if you've got some job tips, I'm all ears!).  I hope to have a chance to share with each of you what these last few years have been like and where I'm heading next.

All the best,
Matt

Captain and crew

Captain and crew, originally uploaded by mattcotham.

Captain (the kid on the right) was in the hospital for about 3 months
last year; he came back today after not feeling very well for a while at
home. The man on the left is his brother, who's two years older than
him. Captain's 18 years old. He hasn't gained any weight since he was
7 years old -- he was 16 kg when he was admitted then, and he's still 16
kg today. We actually spent a lot of time with his family when he was
here in 2007, organized a meeting with everyone, sat them down, and so
forth, but they have basically said that he's on his own, despite his
chronic diseases. It's very sad to me.
For some strange reason on the bus today we got a mysterious package
from someone I don't know -- full of Twix bars. So I decided that they
must be (at least in part) Captain's Twix bars. Not that Twix is
exactly the nutritional answer for a kid that's malnourished, but part
of Captain's problem is the loss of hope and love in his life, too.
Maybe a gift of chocolate can help him remember that love.

a birth and a death

The Tompkins welcomed Emelyn, their third child, into the world
yesterday morning at 9am. After a somewhat stressful week, she arrived
one week late and without any complications. I've blogged about this
before, but it's a little bit weird being expected to make the medical
decisions for your friends and people that you live with closely; it's
difficult to maintain a good perspective on things and still be
respectful to what other people want to do. Fortunately, my role was
basically as a remote observer, as two of our nurses did all of the work.

The president of Zambia, Mr. Mwanawasa, died yesterday after being in a
coma in France for over a month. Zambia has traditionally been a very
stable country, with orderly elections and a good democratic process.
Like during any crisis, at home or abroad, this democratic process will
be tested as new elections take place over the next few weeks.
Sometimes it's difficult to remember what it's like for a country to be
only 40 years old or so; the pull of inertia to keep the status quo may
not be as strong as a place like America.

I'm pretty optimistic that it will go pretty smoothly, however, in
contrast to the debacle in Zimbabwe just to the south of us.

chicken coops and generosity

My neighbors, Pam and Menda, want to start an orphanage. In fact, they
are already supporting several orphans, but are currently working to
build an actual dormitory and house so they can have a stable place for
them to live. To do that, they raise and sell chickens in their
backyard. They are not the only ones. In fact, we have so many people
raising and selling chickens for various charitable causes around the
mission station that at one point it became quite tricky for me to
navigate the social circle of the 'chiken corner' when I was deciding
from which of my neighbors I would buy my next chicken.

That's pretty typical of my experience of African generosity. My host
family where I learned Kikaonde for 2 weeks not only farmed three entire
fields for their family, but also cultivated an additional 2 fields for
the support of orphans in the community. At our church, we all go and
hoe the hospital field so we will have maize to sell or give to hungry
people who come to the service. The Nurses Christian Fellowship
sponsors work days to buy clothes for their trips to the local prison.

I don't know many people at home who are volunteering to work an extra
job and donate the entire proceeds of that job to their local charity.
If they are out there, I'm certainly not one of them. I'm humbled by
how pale and flabby my giving is in comparison to that kind of 'sweat'
giving that so many people do here. Let me tell you, it's not easy to
hoe one extra field, much less two for the support of people around
you. That kind of exercise of love builds a strong Christian body.

I have benefited so much from being able to learn from people like the
Mendas and my neighbors. It also makes me want to help in whatever ways
that I can -- contribute some clothes to a yard sale, buy an extra
chicken here or there (at one point I was up to seven in my freezer --
not an easy fit in my rattling old fridge). Hopefully my love has
gotten stronger as well for the chance to work alongside people like them.

which is dirtier, the bath or me?

which is dirtier, the bath or me?, originally uploaded by mattcotham.

I won't say that sometimes I don't become frustrated with the
difficulties of the basics of life (at least the basics for an American)
-- electricity outages (I had several pieces of equipment get fried this
weekend with various power surges, including my computer cable --
fortunately I have a backup) and water. This week the water has been
intermittent; this was my long-awaited bath today after two days with no
water in the morning. Perhaps I should have held out for one more day....

which is dirtier, the bath or me?

which is dirtier, the bath or me?, originally uploaded by mattcotham.

kind of pretty, in a gross kind of way....

handovers

This week marks the official handover of my job as the director of
clinical services at the hospital to one of the other docs who's
planning to stay longer than me. I've been nominally in charge for
about 18 months now (at times it seems like no one's in charge, but I do
my best) but since I'm planning to head back to the US in November we
wanted to try to do the transition a few months early to help work out
the bugs and make sure things go smoothly. So far, it has been less
than smooth, but we've got three more months to work it out.
How to hand things over well must be a recurring issue for missionaries
and aid workers all over the world. I haven't figured it out yet. So
many of us want developing countries to be 'self-sufficient'; this is a
more complicated issue than it seems on the face of it. So much more is
needed to keep a project running here than at home, and it's almost
impossible for the community to support these projects with the limited
resources that they have, even if the community has embraced the idea
and wants to make it work. I see projects that would have died for the
lack of the funds to buy 20 gallons of fuel (currently priced at around
$14/gallon in the town where I live). I see equipment in the hospital
which doesn't work because of lack of batteries, or the simple matter of
a UK-style plug (about $2, plus a 5 hour one-way bus ride to get to the
store that sells them).
But these small expenses, at least to me, loom larger for a community
that is chronically strapped for cash, living on the wages of
subsistence farming (on average $800-1000/family), or who has extended
themselves financially to buy into the 'American' dream of possessions,
comfort, and entertainment. Add to that the need to support large,
extended families -- the money order post at the post office must be the
busiest place in town -- and most of the time even small expenses can be
difficult to meet, and unfair for an institution to expect to be filled
from the pockets of the workers.
So I've been learning to let go, but it's difficult because I know the
road has been made much smoother for me by the gifts and resources that
I have at my disposal as a rich American with good support from home.
The road is more rocky for someone similar trying to do my job without
those resources. True 'self-sufficiency' is still a long way off. In an
ironic way, I'm beginning to see that a good handover actually means
that I continue to be involved, present, and available to help meet
needs even as I'm not the one in charge. Or to put it another way, to
not only hand over responsibility, but also to hand over my resources
and the control of those resources so that the job can continue to move
forward without me.

the power of prayer

My friend Hilary has been out to visit me the past month (she's the one that has been guest blogging on the site) and she's been challenging me to improve my prayer life with the patients at the hospital.  One of the beauties I've found about practicing medicine here in Africa is that I feel less self-conscious when I'm spending time with my patients (maybe because I feel so much more self-conscious everywhere else....) and often feel free to share the gospel or pray with them and their families.  However, even though I pray for patients on my own, or in prayer meetings, or with the chaplains, I rarely do it with the patients themselves.  Part of me gets nervous for my patients when I pray with them -- what if they don't get better?  What will that do to their faith?  And part of me just plain gets nervous for myself -- what does it mean to take a public step of faith, in the middle of a whole ward, with other patients looking on; God's reputation, so to speak, at stake?  Can my faith survive another 'unanswered prayer'?   It's a test of the strength of my relationship with God to see if it can withstand months and months of heartfelt prayers that often seem to end up being answered with deformity, or disability, or even death in my patients.  Maybe it would be better just to ask for safe things -- God to 'bless them', or 'give them comfort', instead having the boldness to ask for what I really want to see happen -- my 7 year old patient Edward to wake up from his cerebral malaria coma and drink some water; my 16 year old patient Tom to get up from his mysterious paralysis and walk again, my 60 year old patient Vincent to fight off his drug resistant TB and go home after 120 days in the hospital.
Most of us have been faced with situations like that in our own lives -- the parent who died from cancer, the young person who died in a traffic accident, the young baby that died from SIDS -- and these things often test our faith.  It can be difficult to work in a hospital where those crises of faith happen every day, several times a day, as you watch the hope fade away from some of your patients and their families until they become resigned.  But Hilary reminded me that God's reputation is God's business, and it's not my job to pray the prayers and answer them too (a conundrum which sounds easy, but quickly becomes complicated when you're the doc caring for the patient that you're praying for).  This has been freeing for me to keep praying for patients on the wards, in the hallways, sitting on the fence outside -- wherever I find them, and let God take the circumstances and use them for himself as he sees fit.

Back to usual

I wanted to say thanks to Hilary for being willing to contribute to the
blog for the past few weeks. She's winging her way back to the US
today. I hope you've enjoyed it a little bit. Now you're back to just
boring old me....

Mukinge Hill Academy teaching staff

Mukinge Hill Academy teaching staff, originally uploaded by mattcotham.

The fabulous teaching staff at Mukinge Hill Academy: from left to right
- me (Auntie Hilary Burg), Auntie Patricia Fungaloko, Auntie Grace,
Auntie Mabel Pollock, Auntie Brasselo, Uncle Humphrey, Mr. Fungaloko
(teaches at Mukinge Basic School). Normally everyone has beautiful
smiles - maybe we waited a little bit too long to take this picture :-)

last day of school

last day of school, originally uploaded by mattcotham.

report card - end of term

From Hilary: Hi, everyone! I'll be headed back toward the United States of America a little later this week…. I hope my guest blogging has provided a wider perspective on life here in Kasempa, Zambia. It's been a little hard to describe the differences between education in the United States and education in this part of Zambia in just a few entries. I think the general prevailing attitude is one of doing the best we can with the resources available. We haven't had running water in the school the entire time I've been here (there is a faucet in the classroom but nothing has ever come out of it), which makes science and art projects a bit challenging. There's no photocopy machine for the school, and there's only one math book for each grade level, so the kids take turns copying the problems out of the book then passing it on to the next student. As you can imagine, it takes several hours/days for all the kids in a particular grade level to complete the homework for the current math lesson. I've been amazed at the lack of wastefulness when it comes to paper. The kids typically have a small exercise book for each academic subject in which they write all the answers during their independent curriculum work. The kids are very careful to write on both sides of the paper, all the way across each line on the page. If a child leaves the school, his or her exercise books are=0 Acollected, and the remaining blank pages are torn out one by one to be used for taking tests, etc. It's quite a bit different from our throwaway society.

 

Things have been a little bit different instructionally as well. As I mentioned in a previous blog, the students spend most of their days working independently on the main academic subjects (social studies, science, mathematics, English, word building) with some whole/large group instruction for Zambian social studies, Kikaonde, art, and physical education. We had the students stop doing the independent curriculum work one week before the end of the term in order to allow enough time for grading and doing report cards, which meant that we were able to provide a little more creative instruction during the last week of school. Apparently the kids don't spend a lot of time writing in school; during this last week I gave a mini-lesson on writing a five sentence paragraph about their field trip to Mukinge Hospital (introductory sentence, three sentences with supporting details, concluding sentence), collected their first drafts and made corrections, then handed the corrected drafts back with instructions to write a final draft. The first drafts needed a lot of work, to say the least; the kids also told me that they had never done a final draft of their work before, so explaining the idea of fixing mistakes and turning in a second copy of their writing took a little bit of=2 0effort. Our second writing assignment was also a bit challenging but highly entertaining; I had the kids write a short script then create their characters with popsicle sticks, pipe cleaners, colored markers, and stickers. (One of my favorite scripts called Cat and Mouse went something like this: CAT – Look, I see a fat mouse that I can eat. MOUSE – I think I will go for a little walk. CAT – I think my dinner is in front of me. MOUSE – I think I can smell danger. I will run home. CAT – My dinner has disappeared.… pretty good for a first attempt!) Once again, the kids' creativity came to the forefront as they started making capes, hats, and all kinds of other decorations for their characters.

 

So all in all, being and teaching in Zambia has been a great experience. If anyone has the opportunity to teach or work in Africa or another foreign land, I highly recommend pursuing the adventure. And if you come to Mukinge Hill Academy in Zambia, bring lots of rubbers (erasers), high quality pencils, and paper – we would certainly appreciate the contributions! Please feel free to email me at hilaryburg@aol.com if you would like any further information or have any questions… and thanks for bearing with the sideways pictures, weird text appearance, and other blogging mishaps! Lots of love to all, H ilary (Twasanta, mwane – that means thank you in Kikaonde!)

---

It's time to go back to school! Get the latest trends and gadgets that make the grade on AOL Shopping.

still learning the languages

From Hilary: Hi, everyone! Mabel and I celebrated the last day of school for the term this past Friday with the kids. The language lessons are still continuing…. from Mabel I've learned that "yunks and yunks" means years and years (for example, "I've lived in this house for yunks and yunks"), and that "She's a real gaig" means that someone is very funny. I've gotten used to the kids telling me that their stomachs hurt by saying, "My stomach's paining me," but it took me a while to figure out that my reminders to put a period at the end of each sentence weren't very effective because the kids refer to a period as a "full stop" (in addition, capital letters are officially known as big letters). Learning the form of English spoken by people from the United Kingdom like Mabel has been helpful for me; Zambia was a British colony (Northern Rhodesia) for some period of time, so I think Mabel's version of English is perhaps a little more familiar to the children. I didn't realize "quite" had so many variations of meaning until I saw the phrase "quite good" on the children's report cards and asked Mabel about it. I was trying to figure out the difference between good, quite good, very good, and excellent; I was mostly puzzled by the two phrases "quite good" and "very good" since to me these meant pretty=2 0much the same thing. Mabel explained that "quite good" means "almost good" or "less than good." Oops - I think I had tried to pay a few of the children a compliment earlier in the week by telling them that their work was quite good…. I hope my words didn't demoralize them but maybe inspired them to work a little harder.

---

It's time to go back to school! Get the latest trends and gadgets that make the grade on AOL Shopping.

village friends

village friends, originally uploaded by mattcotham.

nutrition class

nutrition class, originally uploaded by hilary.

In honor of Dr. Matt

Hilary: My guess is that Dr. Matt will probably continue to be rather understated about the difference he's made during his time here in Africa, but it's clear that he's found his way into the hearts and lives of many individuals and families in this community. Here's a sampling of some of the things that Zambians and non-Zambians alike have shared about Matt:

Everyone says Dr. Matt is very hardworking.

People don't tell him thank you nearly enough.

I am so pleased with that young man.

You (Matt) are coming back, aren't you?

He's the best single (unmarried) cook.

I didn't know Dr. Matt was so talented (playing the piano, and so on)

Is there anything the man isn't good at?

Even his cat is intelligent.

His language (Kikaonde) skills are impressive.

Dr. Matt is a very good doctor.

He is a good brother in the Lord.

We will miss him very much.

Matt still has a little more than three months here in Zambia before he starts heading tow ard the United States of America, but his host family – the Yanjishas – have already expressed their sadness about the fact that he's headed away from Zambia. I think prayers for a wonderful transition for people on many continents who love and care about Matt would be warmly appreciated. With love to all, Hilary

Photo captions: Scenes from the community education class on nutrition that Dr. Matt has been teaching; giving a lift to a member of the Yanjisha family.

---

It's time to go back to school! Get the latest trends and gadgets that make the grade on AOL Shopping.

occupational hazards

Hilary: I've been spending a few hours each week praying for the hospital patients with one of the chaplains, so I've had the opportunity to experience some of the joys and sadnesses that the medical staff here encounter on a regular basis. I think teaching and doctoring are not all that incredibly different; the specific job descriptions may vary, but doctors and educators are both essentially interested in helping people and making the world a better place, at least from my perspective. There are, however, a couple of specific differences about working in Zambia that stand out to me:

1. Matt's job is a lot less dusty than mine. By the time I walk the half mile to school on the dusty road being passed by multiple vehicles traveling far too quickly in my opinion, spend the day surrounded by lovable but dusty kids, then walk the dusty half mile back, I'm usually covered with a fine orange coating. Matt, on the other hand, comes back from the hospital looking just as clean and shiny as he did in the morning. It's a bit irritating :-).

2. Matt's patients don't spend most of their days rubbing their hands in his hair and attempting to braid it into little plaits. My hair naturally tends to be a bit on the voluminous side, but it seems to have reached new heights and widths with the help of my amateur classroom beauticians. (note from Matt: perhaps Hilary should shave her head like I did?)

---

Zambian social studies

Hilary: Recently I had the chance to sit in on the Zambian social studies class that Auntie Fungaloko, the grade 1 instructor, teaches to our grades 4 and 5 students twice each week. The subject matter is a little bit heavier than the geography-focused social studies the kids work on during their independent curriculum time. Currently the kids are studying "Social and economic problems in Zambia" including HIV/AIDS, unemployment, and poverty. The kids' homework assignment for the week was the following:

1. Decide 3 ways in which to educate people in your neighbourhood about HIV/AIDS.

2. Interview your parents or grandparents about how life in Zambia has changed since they were young. Write down what they say.

3. Pick one social problem (HIV/AIDS, unemployment, poverty) studied in this unit and draw a picture story to show how the problem is being dealt with. Write good English to explain what is happening in your pictures.

The next unit in the social studies book focuses on human rights, including sections on the Law of Inheritance (passed in 1989, this law ensures that widows and children receive a substantial portion of their deceased husband's/father's estate; previously the estate often returned to the husband's original family) and violations of human rights.

---

It's time to go back to school! Get the latest trends and gadgets that make the grade on AOL Shopping.

secondhand best

I'm told there used to be a concept called the 'missionary barrel';
instead of throwing something away or giving it to Goodwill, you instead
sent it overseas for a missionary to sort out and use. Thankfully, that
concept has largely died, but it still holds true from time to time when
it comes to medical supplies -- send the expired stuff, the odd-sized
things, the rehabilitated or too antiquated equipment out to the field.
(Before I came, I was reading that Africa now has a waste disposal
problem because of the sheer number of antiquated or even
non-functioning computers that are sent out; apparently they contain
some kind of hazardous chemical inside which my 2 foot deep trash pit in
the backyard isn't quite adequate for.) Unfortunately, our patients and
doctors aren't particularly odd-sized (or expired for that matter!) so
we have an entire shelf in the storeroom full of size 9.0 and 5.5
surgical gloves! (that's really big and really small if you're non-medical)
We've been blessed with recent donations to cover the purchase of a
brand-new anesthesia machine for the hospital which will allow us to
give safe gas anesthesia to our patients at the hospital; saving us
money, providing for a safer anesthesia, and allowing us to treat
patients more effectively that we used to be able to. It's unusual that
something brand-new comes from donations and it got me stirred up again
about why we settle for less than the best when it comes to the work
that we are doing here. Don't get me wrong, we do our absolute best
with what we are provided with -- work extra hours, fill in the gaps,
trust in God to make up the difference -- but you get demoralized
because you know that your 100% effort is limited to say, 70%
effectiveness, because of the circumstances that are around you.
I was reading about the miracle at Cana and the fact that the wine that
Jesus made was 'the best wine'. Even though it would be 'wasted' on the
already drunk guests, it was still worthwhile to produce something that
would be the best to him. The difference between offering what could be
the best wine instead of watered down grape juice often lies outside of
myself and my control -- on the supplies from the government, the
donations of strangers -- and it's been really beautiful when the church
has recognized that responsibility and stepped up to fill the
difference. It's been one of the joys of being here to see that gap
slowly closed, little by little, with help from outside ourselves here.
It's very good when we can truly offer 'the best' to those who come
looking for our help.

more cards

more cards, originally uploaded by mattcotham.

hearts and chicken feet

hearts and chicken feet, originally uploaded by mattcotham.

FROM MATT:
We had a gift from the academy this week as Hilary got the kids to draw
pictures for us and gave them to us at prayer meeting. Now in general,
I'm not a big kids' picture fan -- random scribblings don't inspire me
to clear off my refrigerator and proudly display them for everyone to
see. These were a bit more amusing than the usual run of the mill
cards, however, as the combination of memory verses, favorite pictures,
and words of encouragement didn't always match up so well....

So we've got the piranhas eating the smaller fish with the encouragement
to "be kind one to another" -- good advice there.
We've got "Dear Mr. Mat, how are you? are you fine? for all have
sinned and fall short of the glory of God" (that particular verse was
very popular for almost everyone, trying to keep us humble I bet.)
We've got "Thank you for coming, even young mens will fall" -- that was
sent to the Schuberts, with three teenage boys.

So maybe I'll keep these on display for a little while longer than average.

It's time for a field trip!

It's time for a field trip!, originally uploaded by mattcotham.

Hilary: More kudos to the staff at Mukinge Hospital for
allowing us to bring the children for a “career day” field trip to the
hospital! Mabel and I walked the dusty half mile to the hospital with
our grades 3-5 students for a series of short presentations on the
different kinds of jobs found in the medical facility. Special thanks go to Dr. Edgar
Mutimushi, a Zambian physician who reminded the kids about the
importance of studying hard and showed the kids how to use a stethoscope; nurse James
Mesa, who has a winning smile and informed the kids that interior qualities
such as being kind and having a compassionate heart are important parts of
being a nurse; lab technician Paddy Chandalala who amazingly welcomed us into
the lab and let the kids look at slides through a microscope, many if not all
of them for the first time; and radiographer Kamfunte Kanyama who beautifully
explained what she does and brought along a sample X-ray for the kids to look at
firsthand.
In addition, Mr. Tantula invited us into the physiotherapy department
for a brief tour, and Uncle Gilbert explained what goes on in the outpatient
department. We also had the opportunity to walk by the pharmacy, tailor
shop, kitchen, optic shop, and nurses’ training college. Yippee for field
trips!

MHA Annual Concert and Sports Day

The annual Concert and Sports Day at Mukinge Hill Academy held last Saturday, 19^th July was a success, in my humble opinion. "Concert" is perhaps a strong term, although this is the official title given to the event; the kids sang songs complete with plenty of body movement, recited poems and memory verses from the Bible, and acted out a play based on the story of Joseph and his brothers from the Old Testament (see picture posted last Sunday). The sports part of the day included running races, potato sack races, wheelbarrow races (plenty of crashes in this one), three legged races, long distance races (twice around the perimeter of the school grounds), and a long distance race for the children's mothers (somehow this race ended up being significantly shorter than the long distance race for the kids :-)). I think we had around 70 parents and community members in attendance in addition to all our students; it was great to see the local community including lots of staff members from Mukinge Hospital supporting what's going on at the academy.

---

The Famous, the Infamous, the Lame - in your browser. Get the TMZ Toolbar Now!

the namesake, part II

the namesake, part II, originally uploaded by mattcotham.

I got a chance to meet the baby named after me last weekend when we went
out to visit my host family from the village. I don't really know why I
enjoy the fact so much that there's another kid running around out there
with my name -- it's not exactly as if Matthew is an uncommon name --
but it still makes me smile. As you can see from the picture here, he's
off to a healthy (read: fat) start! As we do more of our malnutrition
outreach, I'm grateful for the kids that do at least start out fat --
they've got a leg up on the rocky road of subsistence farming ahead of them.

Mukinge Hill Academy

Mukinge Hill Academy, originally uploaded by mattcotham.

Our play: Joseph and his brothers

Our play: The Story of Joseph, originally uploaded by mattcotham.

Three kinds of English

Theoretically the schoolkids, Mabel, and I all speak English, but the number of differences between Irish-, Zambian- and American-English have been pretty amazing. From Mabel I've learned that rubbers are erasers, wool is yarn, lollipop sticks mean popsicle sticks, joined up writing is the same as cursive writing, and that anorak is a preferred term for jacket. Apparently people often refer to children as "pets" in Ireland; the schoolkids seemed to think Mabel was a "wee bit" funny for calling them animals in the beginning but they seem to have become accustomed to it.

 

For the first few hours in the school I thought I was having an easier time understanding the children than I was listening to Mabel until one of our young ladies asked, "Auntie Hilary, may I go to the room?" Now, we have two small rooms connected to the back of the classroom which we sometimes use for small group instruction, plus a few of the grade 3 students travel back and forth between our classroom and the grade 1 classroom since we're a little short on desk space, so I wasn't entirely sure which room this child wanted to go to. "The room?" I queried. "Yes, auntie, may I go to the room?" "Which room?" I asked. The somewhat frustrated child then quietly informed me, "Auntie, I need to go to the toilet." Ah yes, the roo m.

 

Lately I've started teaching the kids and Mabel how to say short phrases in Spanish. Maybe we'll all be able to understand each other soon :-). Hasta la vista, Hilary

---

The Famous, the Infamous, the Lame - in your browser. Get the TMZ Toolbar Now!

Multiplication mission

Mathematics, or "maths" as people in Zambia refer to the subject, seems to be a bit of a challenge for many people in the country. One of the expatriate nurses shared with me that many of the Zambian nurses struggle with mathematical concepts, and this has caused some difficulty when it comes to administering the proper dosage of medication and other job responsibilities. In the classroom it's been frustrating watching the children calculate problems like "24 x 4" as "24 + 24 + 24 + 24" when they're supposed to be practicing their multiplication skills. It seems like they never learned their multiplication times tables, or at least the information never really sank in. So we have now embarked upon a "multiplication mission" for the next few weeks, focusing on memorizing the times tables. Many educators and others in the United States say that it's not necessary to spend much time memorizing mathematical facts since we have such tremendous access to technology, but I haven't seen a single calculator in our classroom and am fairly certain that most of the kids aren't using one at home, let alone other more advanced forms of technology. Plus, it seems to me that medical staff and other professionals don't exactly have time in the middle of a busy workday to find a calculator or a cell phone to determine the answer to a simple ma thematical problem. So, everyone, nine times four equals …? Mathematically yours, Hilary

---

The Famous, the Infamous, the Lame - in your browser. Get the TMZ Toolbar Now!

Zambian schoolhouse

Hi, everyone! For those of you who are regular or occasional readers of Matt's "Notes from the bush" blog and may not know me, I'm a friend of Matt's and fellow parishioner from Colorado who's working at Mukinge Hill Academy about half a mile down the road from Mukinge Hospital for the next few weeks. Matt agreed to have me as a "guest blogger" for the time that I'll be here, so hopefully this will give everyone a grander perspective on what life in this part of Zambia is like.

Mukinge Hill Academy hosts about 70 students in grades 1-5 (British system of education), and many of the staff members at Matt's hospital choose to send their children to this academy. There are two classrooms in the building, with grade 1 in the first classroom and grades 3-5 in the other, while the grade 2 students and teacher meet in a room at the church across the road. At this current point in time, the regular headmistress/grades 3-5 teacher is on "home assignment" in the United Kingdom, so a lovely woman named Mabel from Ireland, myself until the end of this current school term, and the regular Zambian classroom assistants are handling affairs until Janet returns. I'm working mostly with the older children although we do combine all the students for some activities such as preparing for an upcoming concert/sports day. 

 

I had seen the school last year when Tay and I had visited Matt during the summer of 2007, but working in it definitely provides a different experience. I'm still in the process of learning the children's names; David, Victor, and Success have been easy enough to pronounce and spell, but Chikumbutso, Kameya, and Kaumba make me think a little more. I had taught for several years in southern California before moving to Colorado a few years ago to begin a PhD program in education at the University of Denver and thought I'd seen a variety of educational arrangements in schools, but the format at Mukinge Hill Academy is new for me. The day normally begins around 7:45 am (the actual start time depends on when the keys arrive and with whom :-)), and the children typically begin working on individual workbooks in the areas of English, math, science, social studies, and word building. The students are basically using a home school curriculum, as it has been difficult to find teachers to serve in this part of Zambia and it was decided many years ago that a curriculum which encouraged students to function independently would be a good approach.

Anyway, the schedule itself is not terribly complicated: the students bring their goal sheets to Mabel and me at the beginning of the day for a checkover, spend most of the morning engaged with their workbooks, individually check in with me, Mabel, and the other assistants in the room as they finish each assignment, and take tests when they come to the end of a particular academic unit which Mabel and I then grade that same day. The students have an early-morning break, then continue the process of working on their individual assignments along with the continual checking and grading, have a late-morning break, then do something like art, religious education, or PE in the early afternoon until the end of the school day. There are other breaks during the week for assemblies and Kikaonde (language) lessons and occasional field trips, but that's the general idea.

Anyone who has ever worked with children knows that kids are an endless source of entertainment and creativity, and the children in Zambia are certainly no exception. For our art session on Friday, I told the kids that we were going to make friendship bracelets as do many children in the United States. The idea was to make a simple bracelet with two plastic "charms" or beads on it, but in no time the kids had moved on to friendship necklaces and triple wrap bracelets, along with extras to give to family members. It's all about sharing the love :-). We spent the afternoon practicing relay races, potato sack races, and three-legged races for the upcoming sports day and concert (more on this in the near future). Lots of love to all, Hilary Burg (aka "Auntie Hilary," as the children call me :-))

---

The Famous, the Infamous, the Lame - in your browser. Get the TMZ Toolbar Now!

Guest Blogger

Hi there everyone -- for the next month or so, there will be some guest
blogging from Hilary Burg about life in the local elementary school,
Mukinge Hill Academy, where she's working for the month of July. So you
can check out blogs about about the local education scene as well!
We'll try to be fairly obvious about who's doing the blogging....

4th of July, Zambia style

We celebrated July 4th this week along with the rest of you in America.
It's a pleasure to be able to get back to my boyhood days of playing
with dangerous fireworks. Firework season is in December in preparation
for New Years', so it's slim pickings these days. However, I've become
more resourceful after 18 months here, so I got my chess playing contact
from the BOMA to rustle around in the shop where he works and he
uncovered two stacks of fireworks buried beneath the cartons of mchuzi
mix and Colgate toothpaste. Zambia fireworks inspire even more
nervousness that the ones I remember from childhood that would chase you
around the yard emitting green sparks: the two cartons of fireworks that
we could find had a fuse that was about 2mm long (okay, maybe that's an
exaggeration -- it was really 1mm) and were shaped suspiciously like
bullets wrapped in paper. Not knowing exactly what to expect, we found
a fairly long stick with a live coal on the end from our bonfire and had
a go -- and were rewarded with a very satisfying amount of explosion and
flashing lights shooting up into the nearby tree. Despite the fact that
we've had no rain since April, there was not even one extra fire. And
nobody's eye got put out, so I guess we met the definition of 'fun and
games'.

snake attack

Probably the number one question that I get asked by people interested
in coming to visit is "what about the snakes". I've had some close
encounters with snakes since I've been here -- the time I went to the
pool to find a 6-7 foot spitting cobra swimming in the deep end; the
time I was riding my motor bike and a HUGE snake appeared out of the
grass about 10 yards in front of me -- its head had disappeared in the
grass on one side of the road before the tail appeared on the other
side; the four snakes I found on my doorstep in two weeks last
December. Remarkably, though, even if you get bitten, most people do
pretty well -- they get a big huge swollen leg that takes about a month
to go away, but there's not a lot of lasting damage.

Issues of expired drugs, unfamiliar diagnoses, and fatal diseases come
up routinely in the hospital and are part of what makes the medicine
here so challenging. This past week, we had the first severe case of
snake bite I've seen in the hospital -- a guy who was bitten 24 hours
previously and sent from one of our referring hospitals. Usually with
these severe cases of neuro toxins you expect them to die within just a
few minutes; why this man had such a delayed presentation I don't really
know (it was a 'green snake with a black head' -- more descriptive than
the usual at least, if someone wants to take a stab at identifying it).
But when he arrived at the hospital he was barely breathing and the
muscles all over his body were twitching uncontrollably. He was rapidly
accumulating fluid in his lungs because his muscles were so weak, and I
knew we didn't have much time.

Unfortunately, time was not the only thing in short supply; we have very
little snake anti-venom in the hospital, because it's expensive for us
to stock. Usually to treat a severe case of snakebite you need around
10-15 vials of anti-venom. I knew we had a hidden stash in the bottom
of the pharmacy refrigerator -- it was expired from 2004, but I had
resisted throwing it away in the hopes that it could still be useful.
Anti-venom is made from horses serum, and can be potentially dangerous
or even fatal to give if the horse serum reacts with your body. So I'm
contemplating giving a potentially dangerous drug which when it's good
can be trouble -- my batch, though, was 4 years out of date and slippery
from the mold from the bottom of the refrigerator. I've never given
this drug, or even seen anyone give it to a patient. And there's always
the chance that my diagnosis of neurotoxic snake bite could be wrong as
well, since I've never seen one of those, either.

I was surprised by our pharmacist, who reported that we had 18 of these
expired vials, about 10 more than I remembered having on hand. The man
was clearly dying, so I called in the other docs who agreed with me and
we started with 8 vials. They helped a little bit, but he was still
twitching like an electrocuted fish, so we ended up continuing to give
and give extra vials, nervously noting his wheezing with some of the
doses as he reacted to the medicine he was given. At vial #16, his
twitching finally stopped, and we ended up giving the full 18 vials to
him to make sure his symptoms didn't come back.

The next day, he's sitting up in bed, smiling, and saying he's feeling
much better! And he went home the next day after that with a slightly
swollen leg but not much the worse for wear. He also met with the
chaplains and decided to dedicate his life to God on the day he was
discharged. I can't help but think that it was unusual for him to take
24 hours to develop symptoms, to arrive at the hospital at just the
right time (an hour later he would likely have been dead), to need 18
vials to get better which just happened to be the amount that we had,
left over from some order back in 2002 or 2003, and that maybe there had
been a plan for him made a long time ago that was difficult to see until
he came.

babies in the grass

I had my first opportunity to deliver a baby on the side of the road
about a week ago -- this is an opportunity that everyone who works at
the hospital seems to get to enjoy at some point during their stay. I
was sitting in the maternity ward when the phone call from the girls
school came, saying someone was giving birth on the side of the road
about a kilometer away. The maternity nurse and I looked at each other,
and I offered to drive her out to the place on the back of my scooter,
so we hopped on board and zoomed at 20 kph down our rutted, dusty road
to the place where she was supposed to be. We found her sitting up in
the grass with a blanket pulled over her head and the baby on the dirt
at her feet. At this point, a small crowd had gathered, and I think she
was pretty embarrassed, so she wouldn't answer us or look out from
underneath the sheet. So we recruited about 7 women who had gathered
around to make a barrier by spreading out their skirts (the outer skirt,
not the inner one -- this isn't one of those risque stories) like a
fabric wall, at which point the young mother peeped out from underneath
her blanket and we were able to get the baby and her cleaned up. She
even agreed to be taken back to the hospital to sew up some small tears
(on the back of the motorbike, mind you -- people have to be tough here
to sit on the back of a motorcycle 20 minutes after giving birth)!

Fortunately, everyone did well and went home the next day.

the english cut

the english cut, originally uploaded by mattcotham.

There's too many puns to be made on 'the first cut', but suffice it to
say that after mom and dad brought me a pair of electric clippers one of
the fun things we've been doing is offering free haircuts to the men on
male ward while they are in the hospital. I thought that maybe we'd get
one or two guys who wanted to get a shave, but it never fails that when
we do it the entire ward files up for a haircut and we're surrounded
with piles of curly hair next to the laundry lines outside. Usually I
leave the job to our capable ward assistants (Mr. Bazelel Munguya
pictured here) but I had a go at it today. The first person asked me
for an 'english cut', which I later found out was not to be confused
with an 'english bobee cut'. Actually, in my opinion pretty much any
haircut that I give is by definition an 'english cut', or at least a cut
in english. However, the actual english cut consists of shaving on the
sides and leaving it infinitesimally longer on the top (by about 1 mm
longer according to the clippers). I think I have a picture from
Livingstone last year that may illustrate the topic...coming next....

top right

top right, originally uploaded by mattcotham.

So I think the actual english cut would be the top right. Perhaps with
a little practice I can manage the '$' in the back of the hair soon,
though?

the namesake

Got to meet my first baby named after me last week -- a lady I did a
C-section on about a month ago. Unfortunately, I couldn't find my
camera and she was headed back to the village, so there's no pictures,
but you can rest assured that he was very handsome at one month. :) No
one names their babies before they are born -- or even for several days
afterwards, for that matter -- so there's some opportunity to make
suggestions if they are interested. We spend a lot of our call doing
obstetrics here; with the average family size around 7-9 people, you can
imagine how busy that can get at times. It's more fun when there's
these personal connections, though. Does anyone else want me to be
suggesting their names to potential mothers?

comfort zones

Hello to all!  It's been too long since I've been in touch from Mukinge!  I admit that I've been playing a little bit of hooky over the past few months as I took some time out to visit with my parents and see some beautiful animals in Botswana.  Those times are really hard to express well in an email -- the scale is just too big to get across with pictures or words.  There's a comfort, or peace, to put it better, in time spent looking into a red sunset with your family as the tower of giraffes gracefully graze in the distance.

I've found my role at the hospital changing a little bit over the past few months as I try to get involved more with the local communities doing education and mobile clinics.  In April as the result of brainstorming with the district health nutritionist, our nurses on the malnutrition ward, and some of the doctors, we decided to put together a community-based malnutrition project aiming to address barriers to growing protein-rich foods, and then to provide seed for protein-rich foods like beans and peanuts to the families that successfully completed the educational part of the program.  So far we've had a lot of interest from the local community and we have had close to 300 families sign up -- could be quite a challenge providing food for that many families come October!  Right now, we still don't know where the funds will come from to provide seed for that many people, but we are confident that we will be able to provide.  It's been a stretch for me to do something like that without having all my 'ducks in a row' before I get started, but I've been changing what I feel comfortable with in the knowledge that we will be cared for, like we've been cared for 50 years.  I don't really like the phrase 'out of my comfort zone' -- it seems overused these days, and maybe not all that applicable to a place like Africa where the entire continent is sort of one big 'uncomfortable zone' as you face issues of malaria and overwork and problems with things like water and electricity.  But I've consistently found that the places where I need to be working are often just a little bit outside what I think I 'should' be doing.  Gracefully, I also find that when I arrive at those places, they are just the place where I am supposed to be.

Last week I substituted for our executive director, Mr. Fumpa, in the hospital's mobile eye clinic.  I drove off for two days to what was perhaps the center of the dust universe to see people complaining of 'smoke' and 'darkness' in their vision.  After two days of peering through dust and smoke myself (it's now burning season in Zambia, when they burn all the fields) I could sympathize well with them and their vision problems.  These community experiences have been a change for what's comfortable for me as well -- doing work in the hospital -- as I face life without the comforts of electricity or running water or the comfort of people who can help translate for me if I'm getting stuck with my Kaonde.  One of the things weighing on me as I begin to contemplate what will happen after I leave is the general discomfort of needing to leave the programs behind in the hands of the local people, who may or may not be able to carry on after I've left.  I'm starting to face the reality of my leaving more and more and am doing my best to encourage and identify local people to provide the impetus that most of these programs will continue to need.  So much of development aid these days is focused on 'sustainability', which is a concept that falls well short of the mark in places as poor as rural Zambia.  You often need outside resources to overcome barriers like transportation and communication that we take for granted at home.  I think what we need is 'sustained interest' from the rest of the world, which is perhaps a concept that's even trickier than sustainability.

There's a lot more going on the hospital that I could tell you about -- the fruits of some of the seeds that we planted last year are coming ripe: a new restaurant, a rehab of the admin block, the new nursing student dormitory, a HIV counseling center, internet access in the hospital, completing the construction of two more staff houses, beginning on our apartment complex, and so forth.  We've seen some miraculous recoveries that have had the docs scratching their heads and wondering how that person pulled through.  I have enjoyed seeing the basketball/tennis court put to good use almost every single day by the local youths and kids of the community -- makes the effort worth it.  My current goal is to find an ice cream machine for our new restaurant (a person can dream, huh?).  And as always at Mukinge, for every up there is a down -- this week we had a 14 year old boy die from cancer after traveling 4 days to get to the hospital.  I had a 1 year old boy die under my hands while doing my eye clinics because there were no IV cannulas to transfuse the patients with severe malaria at the clinic where we were at.  And despite our overall infrastructure progress we've continued to have issues -- the telephone system is down, the electrical transformer is about to go and causing electrical fluctuations which have caused the burnout of two water pumps, leaving us with a tenuous water supply.  Funds that we've raised have lost value as the dollar becomes weaker and the price of oil continues to rise, making transport in the rural areas even more expensive.

You all have been so generous with your support, emails, and finances to the hospital while I've been here, and I wanted to say thank you once again.  My current goals are to be finishing up around 6 months from now and spend some time in the states working and thinking about my future, so hopefully I can catch up with all come next Christmas season!

All the best,
Matt

the problem of pain

I was the substitute eye doctor last week as I covered for our executive
director when he got called away into town for a meeting. We ended up
seeing around 200 patients in the two days that we went out into the
community clinics, and most of the time there wasn't much help in
translating, so I was amazed at how 200 people could really pretty much
manage to sum up their complaints in about 5 ways: 1) my eyes hurt, 2)
my eyes feel like there is dust in them, 3) I can only see smoke and
blackness, 4) I can see far away but I get a headache when I read, and
5) People in the distance are blurry but when they get closer I can see
them okay. Maybe that was limited some by my language skills, but
honestly, that managed to sum up close to 190 patients (the other 10
were more fun -- my favorite was the 10 year old girl who was brought in
because she couldn't see when it was dark at night, but when they turned
the lights on she could see okay -- exactly what's the problem there?).
Most people when they present to the hospital don't even describe what's
wrong, they just name the body part -- ie "What's wrong?" "Eyes." (as
if I couldn't have guessed since they were coming to the EYE clinic).
Sometimes this gets pretty funny as you get a list of body parts from
some of the older patients, like learning anatomy: "How are you
today?" "Eyes, neck, chest, stomach, back, legs, arms, head." And when
you see them the next day, it's the same: "How are you feeling today?"
"Eyes." This can be frustrating when you're trying to work out whether
they feel better or worse.
It's funny that the vocabulary to express problems is so limited,
however. At home we're taught to elicit all the parts of someone's pain
-- is it stabbing? burning? like shocks? crampy? and so forth -- but
here there's really just one word for pain and it pretty much sums up
everything. Complaining is not so much of a right. I wonder if like
the Eskimos with their 82-odd words for snow if our vocabulary points
out our fixation on pain in the states, and also being pain-free, where
here the expectation is that pain is part of life, not something to be
dwelt upon.

Bupe

Bupe means 'gift' in Kaonde, which is somewhat appropriate as she's now become quite adept at finding little gifts for herself from our soft-hearted staff on peds 2, the malnutrition ward. Bupe and her family have basically moved to Mukinge over the past year as they've spent more time in the hospital than at home; one of the difficulties with treating malnutrition is that the children often require 1-2 months in the hospital to get better, but then the family can't do the farming at home, so they don't plant their crops and the cycle continues.
Families like Bupe's are part of the reason that we're doing our community intervention to reach families at home, teach them about farming for protein-rich foods (beans and peanuts and soy beans) and hopefully break the cycle before they get to the hospital. We're moving forward -- we've got around 230 families so far, and hope to be able to provide seed for all those families in October.
Projects like this make me worried, although they are good, because of the amount of control that you have to turn over to the community and families and overworked hospital staff now and after I go as well. But the opportunity outweighs the risks, and we're hoping for some miraculous changes in the years to come!

okavango

okavango, originally uploaded by mattcotham.

okavango

okavango, originally uploaded by mattcotham.

okavango

okavango, originally uploaded by mattcotham.

delinquency

delinquency, originally uploaded by mattcotham.

Not to rub it in, but here's a sample of what I've been doing recently:

back again

Blogging is bad when it's too introspective; I've had a hard time find
things worth blogging about the past few weeks after getting back from
vacation with my family. I've started thinking about where I'll be in
December and what life will look like after two years at Mukinge, but at
the same time I seem to find my responsibilities here continuing to
expand -- now spearheading our nutrition outreach, filling in for Jairos
in the mobile eye clinics, helping to orient pharmacists and lab
technicians, neither of which I have much of a clue about -- and so
forth. It's been a relief to have a full complement of doctors around
to take some of the burden of clinical work from me, but it's changed my
day-to-day routine quite a bit. Today and tomorrow we will go to the
villages to teach the community about nutrition, how to make a balanced
diet for their children, and suspend dozens of screaming children from
our scales as we monitor malnutrition in the various areas.