Most of you are at Keats this weekend, and my prayer is that it is filled with celebration and shared stories. I have been keeping a bit of a diary on Facebook, so I have cut and pasted most of my entries from the last month and a half about life here in Zambia. It's really excessively long, and I apologize, but I've tried to be as descriptive as possible about the experiences God has graciously given to me.

Sept 13 All in the Perspective:
My water situation is a bit interesting. The water is on in the morning and evenings, and occasionally in the afternoon. So I'm learning on how to plan my day accordingly. It means filling up large buckets in the tub to assist with flushing the toilet ( I actually always have to dump water down the toilet as the tank never seems to fill). I'm also filtering water for drinking and this seems to take alot of time, so in my spare time I'm doing random checks of the water situation!

But then I walked over to the area where the patients familys stay while they are here...an area called "the Fires" and I can't begin to complain about my situation. There's no shelter for them at this point, so it's an open area where they cook and and sleep. There's a tap where they can haul water from. There was quite the line up when I walked past. Women at the well is what it reminded me of. Weather wise it's alright right now for them to sleep outside, but I think in our winter it gets quite cold.

Off to make some coffee (great beans here, and I brought my bodum so I am in the money!) and then to observe a workshop for caregivers of hiv+ children. Apparently we've moved past the stigma for adults, but not for children. They only have about 48 kids on the meds right now.

Sept 20 Submerged in Immunity (or lack of):
In the last few days I have come to dream about AZT/3TC Nevirapine, etc. I am so in the throws of HIV/AIDS therapy that all I think about are the ARVs (antiretroviral therapy), immunity, and therapy that goes with it. I am constantly evaluating what I am eating to see if it is balanced and immunity building. But that said, I have gotten myself another cold. I think it's the nature...I've got to build up a new resistance to these Zambian viruses (and I pride myself on being so hearty!).

Yesterday and today I have been working at the ART clinic. Patients come in for their biweekly, monthly or every 3month check up. I've seen the most healthiest looking of people to walking skeletons and everything in between. The testing, drugs and medical advice are all free, so people are much more willing to disclose their status and seek help in the last few years. (this is actually in part to George Bush...he has started a program called PEPFAR...which funds all of this)

This afternoon I sat in with the docs for their assessments. Very interesting, and I have to say, almost motivated me to want to become a nurse practitioner with a focus on HIV/AIDS. We'll see. The day was winding down and a few extra patients were straggling in. In walked a 10 year old boy (looks more like 8years as he's small) by himself. We asked where his parents were and at first he said they were at home, but then after a bit I asked the translator to ask again, he said his mom is in Lusaka and his Dad is dead. Apparently he stays with his Grandma. He lives in a village a ways away, and had decided to catch a ride with a pig truck that was going through. His Grandma had made him come and get tested awhile ago, and now here he was on his own for follow up. I have to say, it was quite heartbreaking. This little 10 year old living with HIV, covered in a rash, (a common opportunistic infection) sitting at his doctors appt. Does he realize what all these tests mean? What adherence is? What prophylaxis treatment is? How his life is impacted by these 3 letters? Of course there is no child and family services to call. Instead we congratulated him on being such a "clever" (or clevah as they pronounce it) boy for coming to his scheduled appointment, write a prescription for clotrimazole and point out where the pharmacy is on his way out. See you in 2 weeks (providing that pig truck is coming through again I suppose).

Life is in the Details:
Am learning about the ins and outs of living in Macha. For laundry, you have to do it before the afternoon, so that there is enough time for it to dry on the line. (no machines here!) i don't mind some of the simpler ways of doing life, especially as I have the time for it. I also realized today, that I have no microwave...I haven't actually missed it yet, until I pulled some frozen dinner out of the freezer and realized I'd have to recook the thing to heat it up.

My garbage is collected by me and thrown into a pit in the backyard where I burn it weekly. My tub doesn't exactly work, so instead I fill buckets of water in the tub and then dump them over myself with a scoop. If I'm motivated enough I'll heat up some water in a kettle and dump that in so it's not too cold.

I have solved the issue (or rather have found others help me solve the issues) of my toilet not filling (there was a big bug in the hose) and the electric water (everytime I touched a tap or ran water I was getting little shocks...apparently my neighbor's stove had a live wire going into our water!). I feel like these are major accomplishments in the first week. The maintenance supervisor is getting to know me well. He also sent in some reinforcements to deal with my bee problem...hundreds, literally, hundreds (wasn't there something on the news a few years ago about African Killer bees?...I think they must have come across my backyard!) swarm my dripping faucets, so in order to fix the faucet they sprayed the bees...poor guy got stung quite a few times in the process. I was ready to pump him with Benadryl on a moments notice.

Just a bit of life here in Macha...

Sept 29 Weekly Update:
We had a fantastic thunderstorm last night, which could rival those in the prairies. Along with it came a bit of rain, which felt very refreshing, as it has not rained a drop here since April 1.

I just finished my week and a half of orienting to a few different units at Macha Mission Hospital. I’m now about to figure out where I fit in as a nurse with a lot of education (comparatively) but no African nursing experience! It’s been great to be on the different units as I’ve got to do stuff that I NEVER get to do back home (like deliver a baby) and very challenging to see what resource-poor medical care is actually like (a baby died in front of me, and had she been in North America she would have had a very different outcome). Ideally I’ll be able to split my time between the ART (antiretroviral therapy) clinic and the Mother Child Health clinics, doing mobile clinic visits to the surrounding villages focusing on Prevention of Mother to Child Transmission (PMTCT). Man…these Zambians love their abbreviations!

The mobile clinics are quite fun, but this is always where I feel at a loss the most in terms of my lack of language ability as people in the village have a very basic grasp of English, if any. The Mother Child Health clinic sends out two nurses to villages up to 20 km away monthly to do public health activities…immunizations, prenatal & postnatal care, family planning, and weighing all the kids under 5years. This is my favorite part. They pick a random tree, throw a big chain over it, and hang a scale. Then the women scramble to get there first to string up their child to have the weight recorded. There’s a sling for the younger ones, and the older ones just hold on to the scale and hang there! I must take some photos of this! The pace of life is very slow, except when it’s time to get in line to have your baby weighed…then you run like mad! I am going to have these women show me how they tie their babies to them, because it seems like it’s the ultimate sling, with just a piece of cloth (I have yet to see a Baby Bjorn here! I’ve also yet to see a stroller…babies are meant to be carried on the mom with access to the boob at all times).

On Thursday I caught the local truck into town (Choma) to get my groceries for the next couple weeks. It’s a 70 km, 2 ½ hour very bumpy ride. Think of that fantastic Wondershow ride, “The Sizzler” with bumps. I think my bones may still be rattling slightly. But I was lucky enough to ride in the front & made friends with the driver and so on the way back he took it upon himself to be my tour guide, slamming on the brakes, or on occasion, reversing the truck if he ever saw any wildlife (I’m not sure how the 30 people in the back felt about this extended tour), so I got to see some impala (I think that’s what they were) and baboons up close.

The mosquitoes continue to attack me with a vengeance, and for some reason I feel that they have a more potent bite than north American mosquitoes as I am constantly itching every part of my body, which has resulted in numerous scabs…I look like I picked up some terrible disease! I need to find both a natural repellent (maybe I’m too clean?) and a natural itch reliever. I heard eucalyptus oil might be effective.

I’m off to a kitchen party this afternoon…I think it is like a bridal shower. Of course I don’t know the bride, but as I am in the new person in town, I get invited to all community activities! The weekends have been fairly busy with social stuff. Every Saturday night this couple from Pennsylvania host a pizza and movie night at their place over at the Malaria Institute. Weekday evenings are quiet, so we have started to have Wed night card night at my house. The inaugural night was this past Wed and quite a success. Someone taught a few of my neighbors how to play Dutch Blitz, so we had a hugely competitive game going.

Alright I better wrap up this novel, and start my day.

Oct 14 Celebrating:
Celebrating a birthday in a foreign land, one should have flexible expectations as to how things unfold. For example, one could not assume people would show up on your doorstep with flowers and cake, or even a card for that matter. In some places it is expected that the birthday girl/boy actually bring cake for others.

That said, I have very loose expectations of what will happen today, with the exception that I was looking forward to a bit of a sleep in (I was aiming for 7:30-8am...that's sleeping in), along with an excessive 2 cups of coffee, and maybe some nice eggs and toast, while checking email and connecting with people on facebook. This I could control...I did not need anyone to provide any type of entertainment for me, and was fairly confident as I fell asleep last night that I was to have a fantastic morning.

As the sun rises early, so do most people, and so my sleeping in ended around 6:40am, which I was still quite happy about, only to be slightly disturbed by the sound of running water. Not that big of a deal, as most of my faucets are somewhat leaky, and so if the water is on, they are on. But then I realized I may have left a bowl in the kitchen sink, which could have caused a bit of an overflow of water, so I thought I better jump up and check. I flipped over the mosquito net, and plopped my feet down onto my bedroom floor, only to find they were submerged in a few inches of water. Nuts! I ran out of the room to see that someone (okay, I'm the only one who lives here, so me) had decided to leave the bathroom sink on at full last evening when the water was off, and for some reason did not see the need to close it before going to bed. The water generally turns on around 5:30, so there was a good hour's worth of water throughout my entire house, which equates to a few inches deep in the bedroom, bathroom, hall, and living room, and just a sprinkling into the kitchen.

Here I sit three hours later, fans on full (only was electrocuted once by the fan in the clean up), windows wide open, wind breezing through, so very thankful for the zambian heat which has aided me in the process.

FYI: A dustpan works wonders for scooping up water, and yes, you can get blisters from wringing out towels enough times. Sadly I could not concoct a pump to get ride of it, and thanks to the higher ledges on all the doors, it was just one big pond in here.

Carolyn also has some experience with me in flooding a certain garage, but this time I really wanted to outdo myself!

Welcome to my 30th!

Oct 29 Nursing in a "resource poor" environment:
So it's been just over a month now that I've been here and I've got some thoughts/stories on the nursing part of things. I apologize if there's alot of medical terminology, and will try to explain, or feel free to ask me if you have questions. These are just random and not in order, but I just wanted to jot them down.

First of all I wanted to follow up on that 10 year old boy who came to the ART (Anti Retroviral Therapy - for HIV/AIDS) clinic by himself a few weeks ago. He came back last week, again on his own, and our head nurse sent him away, saying he wouldn't be seen unless a caregiver came with him. I was quite frustrated by this, and actually not only in this case, but in general, there's a very paternalistic attitude taken by the staff...at any chance they get they are "schooling" patients in generally quite harsh tones. Anyways, back to Billy. So I was worried that he had been driven away by this nurse, but in he walked yesterday, the last patient of the day, with a women quite a bit younger than myself. I recognized him right away and pulled him in as I didn't want them to be sent away for showing up too late in the day. There was a different nurse working with me and I explained a bit of the situation and then she proceeded to chat with his mom for quite some time. I guess Billy's 2 siblings and Dad have all died (she listed the causes, of which I'm sure were all opportunistic infections related to HIV). The Mom hasn't been tested and lives in Lusaka, while Billy stays with the Dad's family. None of this family is willing to come with him to the clinic. For whatever reason the Mom has to stay in Lusaka. So that has left Billy showing up on his own. The boy is losing weight and his CD4 % is 13. He needs to be started on ARVs. But how can you put a 10 year old boy on medication for life? How can you ensure adherence on meds that if you miss a couple doses your chance of drug resistance increase drastically? How can you not treat this child? It's a gross dilemma. We got the counsellors involved and as I left they were attempting to find a solution. I just kept reiterating the point that he's already been rejected by his family, we cannot add to that rejection. I know now that he will be followed up...love living in a culture where we can track him down, even if it means we show up at their house (this has been done).

So we ran out of CD4 tests this week at the hospital. Not only can do we not test viral load of HIV patients, we now had to limit our CD4 to 14 a day. This is crazy when we're seeing up to 90 HIV clients/day. We use the CD4 as a marker for a person's immunity, and then treat them based on how well/unwell they are. We wouldn't normally test all 90 patients, but 14 is definitely stretching us thin.

I met a guy at ART clinic this week who is my age, a bit taller than me and weighs 79lbs. This is HIV at it's ugliest. His body is literally wasting away. And yet he has a smile that could light up the room. While I was trying to be horrified by the situation God showed me the beauty and grace in him.

Question: How many immunizations can you fit into 30 min? Answer: 80+ if the circumstances involve 1 Zambian classroom of girls requiring tetanus vaccine and you have a group of nursing students eager to dole out the shots. Oh, actually that'd be 81...we have to include the one girl who almost got missed but luckily we can administer vaccines from the back of the pickup truck while driving away. Don't bother with alcohol swabs or listing off side effects. Just line em up and inject away!