Pediatric Maternity

After morning reports, I follow one of the doctors to do rounds in the female ward and maternity ward. As we step into maternity ward, it suddenly strikes me that the women are so young! If it weren’t for their bulging bellies heavy with near-term pregnancy, the room could pass for a pediatric ward. Many of them are still teenagers, but are already on their second, third, or higher pregnancies. Poverty breeds, oh how true that is. Just walk around the village; it is a rare sight to see a woman of childbearing age without a little baby on her back.

ART Clinic

I am running the ART clinic this week. No, I am not teaching remedial painting. ART stands for antiretroviral therapy. For three afternoons per week, patients with HIV come to the clinic for review and to get more medications or, for those who are newly diagnosed, to start ART. Being in a country with one of the highest HIV infection rates in the world, the clinic is always booked solid.

And so I sit behind the desk in the clinic with a nurse next to me to translate and to help me fill out the forms. One after another, the patients come in. I ask about their general health, check on their adherence on taking medication, any side effects experienced, check the last CD4 count, and examine any new complaints. The vast majority of them are in excellent health, with no signs of immunodeficiency or any opportunistic infections. It is heartening to see how well the drugs work at keeping their CD4 counts stable or preventing them from dropping further.

Unlike the rest of the world, HIV transmission in Africa is mainly through heterosexual sex and from mother to child. So the types of people who come to the clinic run the gamut: men, women, the young, the old, babies. One patient could be a school teacher, the next one could be a farmer from a far-away village, followed by a six-month-old baby whose mother was never tested but are now both in hospital for opportunistic infections. There are those who are open about their HIV status, while others have not completely accepted it and have not even told their spouses. The most frustrating ones are the women who are on ART, but their husbands flatly refuse to come in for testing or to use condoms. The power of denial, that most potent ingredient in the making of the next generation of multi-drug resistant strain of the virus, can never be underestimated.

The Zambian government has made a huge effort to rein in the spread of HIV. At the ART clinic, patients get their otherwise prohibitively expensive antiretroviral medications for free, which are from a combination of government funding, donations from NGOs and pharmaceutical companies. These medications, like almost every other drug used at the hospital, are manufactured in India. I remember hearing a couple of years back that NGOs like Doctors Without Borders were publicly calling pharmaceutical companies to make antiretroviral drugs available and affordable to sub-Saharan Africa. Maybe this is a result of that, or maybe India has always been the source of medication to third-world countries.

I have seen billboards that encourage people to go for HIV testing with the goal of having an “HIV-free generation” in Africa. The ART clinic gives me hope that, with the continuing sensible government health policy, availability of affordable medications, and campaigns to education people and dispel any myths related to HIV and AIDS, Zambia is taking small steps to reach that goal, which may be a lofty one, but not a pie in the sky.

Bouncer Job

At the hospital, the outpatient department (OPD) is the first place patients go when they get sick during working hours. It is run by clinical officers who see all the patients that come in, prescribe medications, order relevant tests, and admit the serious cases. So they are more or less the bouncers for the hospital.

Clinical officers (CO’s) are people who have had basic training which is equivalent to an undergraduate degree in health science. What they lack in formal training, they make up through experience: a lot of the things they know, they learn on the job. The CO’s at Lubwe Hospital are very good at efficiently screening a horde of patients, picking out the ones with serious problems, and admitting them to the ward.

Because both CO’s at the hospital are away to attend workshops, I have been playing the role of CO for the last three days. In the morning, I arrive at the OPD to the familiar sight of a courtyard packed with crying children carried on the backs of their mothers, with a few elderly people here and there in the crowd. It is a rare sight to see men with their sick babies in the hospital. This is, after all, an area still steeped in the traditions of a male-dominated society. Child-rearing still falls squarely on women’s shoulders.

OPD waiting area on a slow day

I take the stack of patients’ files from the patient registration window and head into one of the clinic rooms with a nurse. With the nurse interpreting, I take quick histories from each patient, do abbreviated examinations, and decide whether to send the patient to the lab for a couple of tests, or send them on their way with a few days’ worth of medication, or as a last resort, admit them. Most of them have nothing more than a little respiratory tract infection, many of them come in with a self-diagnosed case of malaria, and diarrhea among children is so common, their mothers don’t even remember to mention it unless questioned specifically about it. It is so easy to just get into autopilot and write everyone a script for either an antibiotic or antimalarial or both. After a dozen scripts of the same things, I eye the pile of files, in which I seem to have hardly made a dent. I am constantly being reminded of how many people are waiting outside by the sound of moaning and crying babies. I try to go as fast as I can, but talking through an interpreter can be frustrating. Quite often, I ask what I think is a straightforward question, only to see a five-minute discussion between the nurse and the patient, with a one-word answer coming back to me at the end. Thus, history-taking can be a trying experience.

By lunch time, my ears are ringing from having tried to listen to the chest of countless sick babies who scream at the top of their lungs at the sight of someone in a white coat approach them with a stethoscope. Pediatrics is now inching lower and lower on my list of potential careers; I find it hard to think when babies are screaming next to me. I know, I have not done my pediatrics rotation yet, but in these couple of days, I feel like I might as well be a vet – the one who is sick is not able to say what’s wrong, all histories are collateral at best.

By now, I really come to appreciate the hospital’s two-hour lunch break. It gives me time to vegetate after lunch and clear my head so I can face the onslaught of patients in the afternoon, when my own energy gets into a lull.

Blissful Oblivion

For the last five weeks, I have been so insulated from what has been happening in the rest of the world. There is no TV, no radio, and definitely no internet. World War III could have started and I am living in Lubwe in blissful oblivion. Okay, that is not true; the one national newspaper they sell at the market would probably report it, although the paper normally makes it here a day late.

There is satellite TV at the guesthouse, but the account hasn’t been paid in months and service has been suspended. When I turn it on, I only get to watch the TV Guide channel and, occasionally, BTV (Botswana TV). So the other day, I was bored and started to flip through the menu on the TV Guide channel. And what do you know, I can read news from the wired services! I go through the half dozen categories with about ten items of news in each and devour each and every story.

Now, whenever there is power during my time off, I turn on the TV to read the news. I follow the neck-and-neck race between Clinton and Obama, read about the tattered economy of neighboring Zimbabwe while Mugabe declares his confidence in winning the upcoming election, and am extremely relieved to find out that Britney can now see her children and Paris is still living it up in Vegas. It feels so surreal to be reading about the shenanigans of Hollywood celebrities in a part of the world where those “news” couldn’t be more irrelevant.

Holding Down Fort

Both medical officers at the hospital are away these couple of days. So I am the only “doctor” around – a pretty scary thought to me, even though the patients don’t know any better. Fortunately, all the nurses in all the wards – male, female, pediatric, maternity, and labor wards – know what they are doing and are always there to save my skin.

I spend these couple of days on ward rounds. The nurses on each ward go with me from bed to bed, translating and generally helping me communicate with those patients who don’t speak English, which is the vast majority. They recommend which patients can be safely discharged, but give me the power to sign the discharge card. They write down in the drug chart the medications I order and gently remind me of the correct doses when I get them wrong. Just like that, I slowly go through the wards, reviewing those who are staying, discharging those who can leave, and clerking new admissions.

By now, I am fairly familiar with how everything works in the hospital. I have learned to live with the limitations of various departments. Want an x-ray? Better order it while there is power and get the patients to the x-ray department right away; you never know when power is going to go out. Want to order a particular medication? Better check with pharmacy to see if they normally stock it; even if you know they do, still check, because they may have just run out of stock. Want a lab test for anything? Better check with the lab, because they can run out of reagents for even the few tests they can do. Want to refer a patient to the provincial hospital? Just write the referral letter; you never know when the hospital will have a vehicle going to Mansa, it could be tomorrow or it could be next week. It can be frustrating sometimes when you know a certain medication can give a patient so much relieve or keep his condition under so much better control, only that the medication is still under patent in the West and there is no way any of them would be able to find it or to afford it. One way to keep your sanity is to tell yourself that you have done your best for the patient under the circumstances with the tools available. It may sound defeatist or fatalistic, but here, to have the expectations from life we take for granted in the West is not only wildly unrealistic, but also a sure recipe for one’s mental implosion.

My Rubber Stamp Collection

It’s hard to believe that I have been in Zambia for a month now. As my visa expires tomorrow, I need to go to Mansa and get it extended for another month.

The people at the immigration office recognize me as soon as I step inside. Apparently the population of foreigners here is on the small side. I hand over my passport and watch the bureaucratic process begin: out come the forms in triplicate and rubber stamps galore. They ask me if I have been following the presidential race in the States; they obviously have been. One of them is surprised that I am thirty-one and not married, while he already has five children at age twenty-seven. We continue to chat about this and that. Soon, they finish writing down my details and rubber-stamping my passport. And I am granted permission to stay in the country for another month.

After a little bit of grocery shopping, I start to make my way back to Lubwe. Five hours roundtrip just to get a stamp in my passport – I am glad I am doing this only once.

New Life, Slipped Away

One of the two doctors at the hospital is away to attend a workshop. After rounds in the morning, the other doctor also leaves for Mansa. I am left on my own for the rest of the day. By now, I am familiar enough with the hospital and the staff that being on my own is not so stressful as long as there are no major emergencies.

In the afternoon, I run the doctor’s clinic with assistance from the theater nurse, who acts as my interpreter. No drama there – just seeing all the patients, renewing medication orders, and setting up follow-up appointments, etc. Afterwards, I head to the female ward to admit a patient.

Just as I finish writing up the admission, the ward nurse comes to me and tells me that there has been a delivery in labor ward earlier. The midwife resuscitated the baby before leaving but the baby is not breathing very well. A chill runs down my spine – neonatal cases are way out of my league at this point. I follow the nurse to the labor ward. The mother of the baby is resting in bed, the baby lying under the heat lamp with an oxygen tube in his mouth and a nasogastric tube in situ. I take the baby’s covers off. He is struggling to breathe – each short and noisy breath is following by a pause. His eyelids, hands, and feet are swollen with edema. He is still pink all over. His heart beat is quite strong, but only about eighty beats per minute. I turn on the suction and try to clear his airways but there is nothing. The oxygen tube is just resting in his mouth; it’s too big to fit inside his nose and there are no pediatric nasal prongs available. The nurse informs me that the hospital does not stock surfactant, but atropine has been given. I make eye contact with the nurse, looking for help. “He’s in God’s hands now,” he replies. I cover up the baby; the nurse tells the mother to get us if anything goes wrong and we go back to the ward.

Five minutes later, the grandmother comes in to the ward. The baby is not breathing. We run back in to labor ward. The baby is lying motionless under the heat lamp, with his edematous eyelids tightly shut. I listen to the heart – still beating strong. Intubation would be ideal, but I have never even seen an adult laryngoscope or endotracheal tube in this hospital, let alone a pediatric set. I pick up the bag-valve-mask and start to bag the baby. The first squeeze reveals a big crack in the bag – it’s useless. Another one is hanging next to the cart but is only partially working. I put a finger over the leaking hole and give it another go. The baby’s abdomen starts to inflate as I squeeze on the bag. His lungs are still so incompliant that all the air is forced into his stomach. I look up and ask the nurse to call the midwife in as I continue with my effort to revive the baby. All of a sudden, the heat lamp goes dark and the oxygen concentrator grinds to a halt – power is cut. If his life really is in God’s hands, then God must have the most cruel sense of humor.

With a last desperate attempt, I give him another injection of atropine. Pulling out his nasogastric tube, I stand there alone, with one hand holding the mask tightly against the baby’s face, one finger over the leaky hole, and the other hand gently squeezing on the bag. I watch helplessly as his abdomen inflates with each squeeze of my hand. I know he is not going to make it and my efforts are futile, but my hands seem to have a mind of their own and refuse to stop. I can feel his heart beat grow slower and weaker; I can see him slowly turning blue, first his fingers, then his hands, and his whole body; I can feel his temperature drop. Eventually, the rational side of me finally takes over and I stop the resuscitation effort.

The nurse tells me that he is going to tell the family. Relieved that the language barrier has shielded me from having to be the bearer of such awful news, I walk out of the hospital, which is now shrouded in complete darkness.

Around the Village Again

By now, I am fairly familiar with my way around the village. Today, my running buddy Anton and I had a walk around the village before our run. Anton is a senior at the local high school and is the 200-meter run champion. So whenever he comes to run with me, he slows down to accommodate my pace. And as always, when we go out to run, we always end up with a group of kids trailing us, gawking and laughing at the funny-looking foreigner.

Just a normal Sunday afternoon by the lake

Some rich businessman in the village is building this huge house with a sweeping view of the lake. How rich is he? Just look at those giant glass doors.

This guy's boat has seen better days

It's beer o'clock at one of the two bars in the village

There are many shacks like this one at the village market where villagers have their little retail business.

Greener Pastures

Like people everywhere, Zambians are always looking out for a better life. Well, those who have the means anyway. Zambian doctors are no exception. From talking to nurses and the doctors at the hospital, I get the impression that many Zambian doctors are looking to leave the country. Popular places for them to go are their southern neighbors Namibia, Botswana, and South Africa, or even the UK. Reason: better working conditions and pay. The exodus of doctors from Zambia

is partly addressed by recruiting doctors from neighboring D.R. Congo, where even worse working conditions, pay, and the seemingly nonstop internal conflict have sent many of their professionals fleeing.

Last year, at Hervey Bay Hospital in Australia, I met quite a few doctors from South Africa. The South African doctors decided to go to Australia basically for the same reasons: working conditions and pay. Also, another reason they cited for leaving South Africa was the increasing violence and crime rate in the country, which Zambian doctors are willing to live with.

The next rung of the ladder is the U.S. I have met a few doctors in Australia who are looking to go to the US, especially specialists who want to practice state-of-the-art medicine. Instead of waiting for the Australian government to approve the latest and the sexiest procedures, they can just go to the US, learn them, and start using them. Of course, the better pay in the States, even with the US dollar in the gutters nowadays, doesn’t hurt.

It seems that the U.S. is where everyone wants to go; it’s at the top rung of the ladder. Well, not EVERYONE, but it’s the general trend anyway. Yet, my plan is to slide down a rung and stay in Australia? Maybe the grass really is that much greener on the other side of the fence.

~~~~~~~~~~

A view of serene Lake Chifunabuli from the hospital early in the morning

The ever radiant Doris is our theater nurse

Through the magic of the white coat, I look quite doctorly in this picture with Dan the nurse, if I do say so myself.

Jonas, Louis, and Alice having lunch

Buying Direct

I cross the road from the hospital to head back to the guesthouse for lunch. At the gate of the guesthouse, I am stopped by a couple of fishermen. They show me a bucket with a huge catfish inside and ask if I want to buy it. What is this? Is it a coincidence or have they been waiting for me to sell me the fish? Regardless, the fish looks pretty good. We agree on a price; the fish is mine.

After lunch, I sit inside the lounge and listen to music. Howard, the cook’s son, comes in and asks, “Do you like beans?” “Uh, yes. Why?” I am wondering why the weird question out of nowhere. “Someone wants to sell you some beans.” “Who’s here?” I wonder aloud as I walk out to the courtyard to find a farmer with a big bag on the back of his bike standing next to the kitchen. I check out the beans; they are actually pretty nice. I buy half a gallon of it and send the farmer on his way (nobody has a scale around here; a lot of things are sold by volume, even flour).

Okay, word must have gotten out that a foreigner lives here and he eats local food. I wonder who will come next, the tomato lady, the eggplant woman, or the sweet potato man. The caterpillar girl probably shouldn’t come, she may be disappointed.

Just Another Day

0800h – morning report from the night shift nurse.

0915h – ward rounds. I am in the female ward for these two weeks. Most patients in the hospital only speak the local language Bemba. For the entire ward round, I have to rely on the nurse to translate for me. History takes twice as long to take, sometime a seemingly simple question takes ten minutes of back and forth between the patient and the nurse only to get a two-word answer back. What investigations to order? It’s really simple. The lab can only do full blood count, ESR, specimen microscopy, culture, and sensitivity, random blood sugar, urea and creatinine; forget about liver function test, blood chemistry, or those fancy tumor markers, they are either out of reagents or they don’t do them at all. The only imaging available are x-ray and an ancient ultrasound machine. There is no ECG machine, no spirometer, not even a torch for checking pupils. So I am learning to manage patients purely based on the clinical picture. Empirical treatment rules!

1140h – go to the lab to get results ordered earlier. Find out that reagents for full blood count are running low, so are test strips for the glucometer.

1150h – check with the pharmacy to see what kind of proton pump inhibitors they stock. They don’t stock any. I can get some cimetidine if I want. Also, normal saline stock is running low; although I can get all the Ringer’s lactate I care to drip down patients’ cannulas.

1235h – finally out of the ward. Lunch time is officially 1200h to 1400h.

1405h – go to anti-retroviral therapy (ART) clinic. I sit in with a clinical officer as he sees HIV patients who are either starting on or continuing with ART. Frustrations all around as patients have not been able to follow the instructions on how and when to take their medications. A young mother from one of the islands of the big lake comes with her eight-month-old baby, both of whom have just been tested positive for HIV, to start treatment, although people from the islands tend not to come back after only one visit. Someone has sent a neighbor to pick up the medication for his five-year-old son, even though he knows patients have to be reviewed each time before new meds are given. An HIV-positive woman on ART tells of her husband who flatly refuses to use condoms or to come in and get tested. Long discussion with social workers ensues; home visit is planned.

1655h – ART clinic over. Head back to ward. A newly arrived patient is waiting for review by the medical officer. Another round of playing telephone with the nurse and patient. Admit patient, get ready to go home.

1740h – a wardie tells me Dr. P. is looking for me; he is waiting for me in the operating theater for an emergency surgery. The surgery is for a 36-week pregnant woman with placenta previa. The surgery is straightforward. Both the baby and mother are fine. Dr. P. sutures up the uterus and leaves me to close the skin. As I put in the last stitch and slap on the dressing, power is cut. One of the nurses turns on her mobile phone and we clean the patient up under the faint blue glow of the phone screen. I help the nurses push the patient back into the maternity ward.

1950h – I am back at the guesthouse. Famished and parched, I wolf down my dinner in candlelight.

The Great Sporting Event

Forget the Australian Open, forget the Super Bowl, the real great sporting event today is the African Cup final, with Cameroon playing Egypt.

The game starts at 7 p.m. local time, just as it gets dark outside and when electricity is usually cut. After dinner, I get together with Christian, my guesthouse mate, and Anton, my running buddy, and head to the marketplace to watch the game. We arrive at the market to find that the only place with a generator running is the “Home Video” place, the local movie house/TV lounge. They are charging 1000 kwachas (30 cents) admission today for the game. We squeeze past a group of people loitering at the door and find ourselves in a stuffy and small room packed with over a hundred villagers sitting on bench seats fashioned out of planks and cinder blocks. Finding seats in the front row, we sit down to watch the game on the 18” color satellite TV at a corner of the room.

The room is stiflingly hot. I am thirsty; they are not selling any drinks. Don’t they realize how much more money they could be making just by having some cold ones there? Slightly annoyed, I squeeze my way out the door to the bar down the road to buy some drinks for us.

With a cold beer in hand, I sit down again to continue watching the game. Because Egypt is the defending champion, most of the people in the room are cheering for Cameroon. The Egypt supporters get drowned out during heated moments of the game. Maybe it is a good idea that people are not drinking; the last thing I want to see is drunken fights breaking out in a packed room with one small door that opens in.

At the end, Egypt retains the trophy with a score of 1:0. Promptly, everyone stands up and orderly files out of the room. There is no fighting, not even arguments. These villagers must be the most civil soccer fans around!

Musungu!

It’s a familiar scene now. I walk through the village to the market to get some bread or whatever. As I walk past villagers’ houses, hordes of kids run out, point at me and scream “Musungu! Musungu! Musungu!” while adults either stare and give the gesture of greeting by clasping their hands together or stare and say “Chungulo (good afternoon)” or just stare. Being the only foreigner in a thirty-kilometer radius, this kind of attention is pretty much unavoidable.

I learned that “musungu” is the local language for “white man.” I was hoping that it may translate to “evil foreigner that breathes fire” or something more dramatic. But no, it just means “white man.”

Man, these people are calling me white? I really should start working on my tan!

A Break from Lubwe

It was two weeks ago when I last went to Mansa, the administrative center of Luapula Province. As my food supply is getting low, I jump at the opportunity when Ms. K., the hospital’s medical licentiate, invited me to go along with her to Mansa.

Two hours and one hundred kilometers later, we arrive at Mansa’s town center. I head to the Barclay Bank ATM to take out money. After half a minute, out comes the cash I wanted. Compared to the ordeal last time when I tried to cash my traveler’s checks, this is as painless as it gets. I really have to remember never to touch traveler’s checks again!

I desperately want to check my emails. Unfortunately, power is out in the whole town. So we decide to head out of town to see Mumbuluma Falls, one of numerous waterfalls in this part of the country.

Less than an hour out of Mansa towards the border with Congo (D.R. Congo, that is, the country formerly known as Zaire, not to be confused with Congo-Brazzaville farther north in the continent), the Landcruiser stops at the end of a well-maintained gravel road. The roar of the falls can be heard as we step out of the car. A few people are washing their clothes at the river bank at the other side of the river just above the first falls. Ms. K. tells me that these are Congolese villagers who depend on this river for their water supply. We must be really close to the border now. The tribes living along the arbitrarily drawn border between Zambia and Congo regularly cross it as they had for thousands of years. To them, the central governments of their respective countries are so far away, their lives are hardly affected by the countries’ policies. There is no citizenship, no immigration formalities, no border checks – those are for foreigners like me and urbanites from Lusaka.

We arrive at the end of the gravel road to Mumbuluma Falls

Villagers doing their washing just above the upper falls

Upper falls

Lower Falls. Water levels are very high at this time of the year

At the edge of lower falls

After a picnic by the falls, we head back to Mansa to do some shopping. Compared to ShopRite, in which most produce is trucked in from South Africa, the open-air market in town has the better and cheaper locally-produced fruits and vegetables. As we walk from stall to stall, Ms. K. has to explain to people that, no, I am not part of the group of Chinese here to build the bridge across the river that forms the border between Zambia and Congo.

The main street of Mansa

All the cabs are required to be painted sky blue

The market for all your fruits and vegetables needs

Different types of caterpillars are on offer at this stall

These women just realize I am pointing my camera at them

All stocked up on provisions, we make our way back to Lubwe as the sun starts to set.

Fever = Malaria

Malaria is endemic in Zambia. To give you an idea how common it is here, whenever people have fever, they just say they have malaria; the two words are almost interchangeable. It’s so common, people get malaria like we get colds. Everyone knows the symptoms; self diagnosis is common, so are anti-malarial medications. Almost everyone here has had malaria at one point in their lives; it’s kind of like a rite of passage. The pharmacy at the hospital has a huge section reserved for different anti-malarials. I really didn’t have to spend the money and bring my own malaria treatment. The pharmacy here has better, and far cheaper, malaria treatment medication than hospitals in Brisbane. The latest malaria treatment, artemether plus lumefantrine, is difficult to get in Brisbane and not even available in the United States, is a dime a dozen here.

Malaria in this part of Africa is of the falciparum species, which, while causing the most number of malaria-related fatalities worldwide, is highly curable when treated early and aggressively. It doesn’t cause relapses like the other more benign varieties like ovale, malariae, and vivax. Whichever it is, I am trying my best not to get it. Between taking my malaria prophylaxis religiously, wearing long-sleeves in the evening, sleeping under a mosquito net, and spraying insect spray around my room regularly, I am hoping I can avoid joining the club.

In the hospital, treating patients for malaria is a daily chore. They may come with some other problems, but almost everyone gets a blood slide done for malaria. Quinine flows like the keg at a fraternity party and, because hypoglycemia is a common side effect, everyone on quinine eats sugar by the cupful. Good thing diabetes is not common here. I am sure that, by the end of these eight weeks, I will have seen more malaria cases than I will for the rest of my medical career, barring any future medical trips to malaria-endemic regions.

HIV In A Bottle?

There has been a pretty big controversy in Zambia since last week. The Minister of Health announced that HIV virus has been found in bottles of the contraceptive injection Depo Provera made by an American company. He said the product has been pulled from the market until further notice.

This news really delivered a blow to a country with the world’s sixth highest rate of HIV infection and among the highest birth rates. Among the women in rural areas, many of whom have minimal education, it seems that they are destined to live a life of bearing one child after another, regardless of their ability to raise them. They are thus trapped in a life of crushing poverty. Contraception is at least one way to help them break out of this life; and Depo Provera is the only contraception that can be administered by health workers with minimal medical skills to a scattered rural population. It doesn’t require the women to remember to take a pill every day; it doesn’t require cooperation from the men; and it only needs to be given every three months.

With this hasty announcement from the Minister of Health, I am sure the drive for birth control will suffer a severe setback. The sensationalism surrounding it alone is enough to make people wary of receiving injections of any kind. Why were they looking for the virus in Depo anyway? How did the suspicion come about? How likely is the HIV virus to be able to survive in a contraceptive solution? Was it really the virus itself that has been found? Has it been confirmed? None of these questions were answered, just an announcement without any explanation. So, you can just feel the knee-jerk reactions going around the country.

During the morning handover, one nurse’s knee-jerk reaction was particularly high. She proclaimed that “we should all just use the natural methods for contraception!” Upon prodding for elaboration, she offered, “the withdrawal method, the calendar method, and lactational contraception.” Her earnest and emotional reaction, along with her advice, was met with stifled chuckles from the rest of the staff. If an educated person has this kind of reaction to the news, just imagine what the uneducated villagers would think.

I will keep my eyes peeled to see how this controversy develops.

Kung Fu Hustle

After ward rounds, I sit by the desk to write some notes. Out of nowhere, the nurse asks:

Nurse:
Do you know kung fu?

Me:
That’s random. No, I don’t.

Nurse:
I think you do. Every Chinese does.

Me:
Where’d you get that idea from?

Nurse:
On TV, we see that people in China are trained in kung fu from the time when they’re little.

Me:
No, actually, we’re born already knowing kung fu. It’s in the blood. My mom told me that I’d kicked my way out of her womb, and then cut the cord with a kung fu chop.

Nurse:
Really?

Me:
No, of course not! I don’t know kung fu.

Nurse:
(Eyes me suspicious, unconvinced)

That was not the first time someone in Zambia has asked me if I know kung fu. Just the other day when I went jogging past the village market, some kid was mimicking kung fu moves at me and challenging me to a fight. I laughed and jogged passed him, thus perpetuating the stereotype by showing my incredible restraint and tolerance.

Should I feel flattered or offended?

Lower Expectations

Being the only day off, Sunday is the day I take care of chores like doing laundry. Here, doing laundry means actually washing every piece of my clothes by hand. When I have to put in the hard labor, what goes in the laundry is determined by the smell test: if I hold it near my nose, do I feel like my breakfast is making its way up? Yes – it goes to the laundry; yes, but just a little – it can probably be worn at home for another day; no – it’s as good as fresh. I know, it’s a bit like back in college again.

As I sit by the faucet in the court yard washing my laundry, Alice the cook expresses her surprise that I know how to wash clothes by hand. “If I don’t know how to wash my clothes by now, I’m in real big trouble,” I tell her.

People here seem to be surprised by what I can and would do. Besides my laundry skills, people also seem to be surprised that I would eat on a daily basis nshima, the local staple food, and all the various leaves and other foods the locals eat, and that I can take cold showers in the morning. What kind of spoiled foreigners had come to stay here before? What do the locals expect of foreigners? Whatever it is, the expectations seem to be pretty low. I am glad to see it doesn’t take much to impress them. Thank you, my predecessors who had come before me and set the bar so low.

Village Night Life

After dinner, I want to check out the night life in the village. So I head out with Alick and Christian, who are both from around this area and are also staying at the guesthouse.

We step into the first of two bars in the village. Ten or so tables are arranged haphazardly around the room, which is illuminated by a single bare light bulb and a spotlight aimed at a bare wall. A boombox sits at the bar, playing music by a Zambian band at top volume. A couple of women are sitting at the bar drinking and a small group of men are sitting and drinking around a table next to the dart board at the other side of the room. We are the third group.

The bar consists of a few dusty bottles sitting on a couple of wooden shelves on the wall, accompanied by a few bottles of hard liquor. The only beers available are the local brews Castle and Mosi. Each grabbing a Castle, we sit down at a table halfway between the dart board and the bar. Alick recognizes that one of the men sitting at the table is the local priest at the Catholic church. I may be mistaken, but I thought Catholic priests are supposed to refrain from patronizing drinking establishments; and here he is, taking a swig of his beer in between throwing darts. Has the church relaxed the rules to attract and retain priests to rural areas? Is the priest openly flouting the rules knowing that he can get away with it? Are the people so devoted to the priest and the church that they don’t question his conducts? Of course, a priest drinking and having entertainment is really no big deal in comparison to the big scandals the Catholic Church has been involved in recently. But isn’t making this comparison akin to indulging in the kind of moral relativism the Church has been warning us about? Slippery slope, anyone?

We next visit the bar at the other side of the market. On our arrival, we just double the number of patrons at the bar. This place has a pool table. We play pool until the barkeep tells us that she wants to go home. I look at my watch – eleven o’clock. I guess that’s late enough for a Saturday night out in a village in the middle of Zambia. The night life on the weekend here is pretty dead. But for the villagers, most of whom do not have formal employment, a Saturday night means nothing to them – it’s not any different than a Monday night, or a Wednesday night, or any other night of the week.

As the bar shuts, we retrace our way back to the guesthouse on the dirt road as a light shower comes down.