Friday 7 June 2013

Supervision, Zambian style

A bright sunny, slightly breezy winter's day in Chilanga and the 'Activities' timetable describes this afternoon's delight as 'Supervision in Game Compound' 
I decide to walk there as it's only a mile from the hospice, the road passes the Post Office where I have letters to post and I need the exercise.  Also, arriving alone and on foot keeps the profile low and lessens the risk of exposing our patients to 'stigma', the prejudice against those who are HIV+.  In the early days this resulted in people with the dread positive status being driven out of villages to die alone in the bush, family members refusing to share a bowl, toilet or indeed a house with an HIV+ person out of ignorance and fear. This stigma still exists to some extent, despite huge efforts at education and I don't want to make life any tougher than it is for these people. 
Letters posted (this is possible only at a Post Office; no post boxes anywhere else- for security reasons?) I walk the last few hundred meters to 'Game' clinic where I squat in the only available bit of shade under a small pine tree, and wait for Geoffrey Kankala.  It's now 14.25, still a bit early for a meeting planned for 14.15 but GK is used to my odd timing habits and, looking up the hill, I see him making his way down to the clinic, stopping frequently to greet friends and neighbours.
After a warm greeting, he conducts me to the home of Margaret Makukula or, in Zambian "Where Margaret stays"
When we arrive, Geoffrey leads me round the back of a small clump of buildings, each roughly the size and shape of a  native Zambian hut but made of anodised steel sheets.  As I pass one, I peep in and see a cosy little room with a bed and cupboards, all snugly fitted in the octagonal space.  I wonder vaguely where the kitchen and bathroom are, then remember  where I am.  Tribal houses, traditionally round, grass-thatched  buildings, any size upwards of 2 metres in diameter, are basically for sleeping and storage.  A kitchen hut, similar but with open sides, will be in the centre of a large cleared and flattened sandy area which is where family life goes on: food preparation, cooking, eating, washing up, hair-dressing, playing, drumming, singing, dancing....
Behind the last building, in the deepest shade, two women are seated, one on a wooden dining chair and the other on the floor on a rush mat.  The one on the chair jumps up, puts the chair in the shade for me as honoured guest, produces another for Geoffrey and, after shaking us both by the hand, sits down on the mat.  After introductions are made, I find the chair-providing woman is Margaret and the larger one on the mat is her older sister Mirriam.
I explain, somewhat lamely, my purpose in visiting them which they both take up with great enthusiasm.  I ask Margaret about her work as an Adherence Supporter.  The role of these dedicated people is to support those living with HIV, encouraging them to adhere to the course of life-prolonging HAART (Highly Active Antiretroviral Therapy) without which they would progress rapidly to the AIDS phase with fatal consequences.
Margaret has six patients in her care and tells me proudly she visits each one twice a week.  She explained to me that, HIV+ herself, she feels a strong heart connection with these people; "We are together, we care for each other and that keeps us going"  She described to me how she got involved.  Recently diagnosed HIV+ herself and in the initial stages of denial, anger and depression, a friend told her about seminars being run in Chilanga about HIV, Aids and the opportunistic TB which often is also involved.  She attended these seminars, run by CHAZ (Churches Health Association of Zambia) and by learning about the 'enemy' was able to turn around her feelings of loss and despair and begin a positive way of life where she could reach out to others and be herself supported by a community of people like her, each area led by a 'Zone Leader' who is a good friend and mentor- Geoffrey in her case.
As the afternoon wore on, we were served glasses of water and the conversation became wider-ranging, covering the benefits of keeping chickens to use the manure in place of artificial fertiliser, the high price of tomatoes and Mirriam's ambition to organise a braai (BBQ) at the bar she runs to raise funds for the hospice  "Well, most of the sexual behaviour which spreads HIV is after the beer drinking so they should support now what will later support them!" was her forthright view.
Margaret showed me the wooden stall by the road where she sets out tomatoes, sweet potatoes and bunches of spinach, her own little retail space.
Geoffrey escorted me back to the clinic where I caught a minibus bus home (enough exercise!) I found I had been very affected by the afternoon; as well as the enjoyable meeting and chat, I saw this as a snapshot of a sustainable model of HIV care in Zambia.  Indeed, the crucial drugs are supplied to CHAZ by USAID and other international Aid Agencies but the rest is real good neighbours caring for each other.


Supervision is.... well, as you've gathered above, it's not the sort of supervision  we in the UK would mean, either in medical or  counselling mode, where the practitioner shares the challenges and management of and provides support and help for their client and themselves.  This is done by a more experienced and specially trained counsellor of high wisdom and good interpretation skills, if you're lucky!

Here, the support aspect is more figurative; the people I'm supervising are volunteers (fits within the UK model of professionally trained but unpaid counsellors) whose generosity leads them to look after six clients each.  These are patients of the hospice, are HIV+ and are enrolled on a life-long course of HAART (Highly Active Anti-Retroviral Therapy) which will greatly prolong their lives and make the concept of 'living positively' in the HIV sense a reality.
Urban and suburban residential ares are known as 'compounds' which vary from open, rolling hill country with grand bungalows with double garages, their own borehole for water supply, gardens plus gardener to tiny, cramped  houses,some housing several families in an enclosed area without proper sanitation, water supply or electricity.

Wednesday 22 May 2013

Winter setting in

Those days as autumn arrives, the scent of burning leaves, cool evenings and mornings, warmer clothes hustled from the backs of cupboards and a new school term starting.  Migratory birds long gone, the stalwarts left behind settling into their winter routines; especially keen for any scraps of food available as extras.
This is Zambia and many people are surprised to realise there is such a thing as a winter here. The sun is hot as the sky is blue and cloudless as the rains are long past and won't come again until January 2014.  But the days are shorter; sunrise at 06.10 and sunset at 17.50 and in this climate buildings are constructed for keeping cool rather than for keeping warm.  An outbreak of scarves, gloves, sweaters and woolly hats occurs and the shade-seeking of summer inverts to everyone standing in the sun in the mornings to allow the sun to warm them.  The air is so dry that the difference in temperature between sun and shade is very marked; children try to extend playtime not only because they prefer it to classes but to extend their time out in the sun.
Our clinic patients are early starters, turning up for the 08.30 clinic sessions as early as 06.45; maybe they were offered a lift- some travel some distance to attend here.  In summer they relax in the shady clinic waiting area but these days they are more likely to be seen facing the rising sun, looking like a rather muffled up set of meercats. 
To see photos at the clinic, look on facebook

Mother of Mercy Hospice and Health Centre, Zambia

Friday 12 April 2013

April mixture

I'm writing this from Kitwe, a Copperbelt town about 5 hours north of Lusaka by big bus, where I am enjoying a week's vacation with good friends.  
The Copperbelt region is one of the older colonial areas of Zambia and the main towns of Ndola and Kitwe boast some attractive older buildings, more trees and parks, asphalt roads and paved pavements than I'm used to.
After Independence, Rhodesia became Zambia in the north and Zimbabwe in the south; Zimbabwe having the agricultural wealth and big farms while Zambia being the more industrial, based on copper.  Copper is Zambia's main mineral wealth though emeralds and other gems are also mined here.  Sadly, the world copper price was very low after Independence, contributing to the poverty of this struggling new country.  Currently, high demands have led to high prices and many countries are involved in Zambia's mining endeavours; possibly once again Zambia is not reaping her just deserts?

While I was here, I was sorry to hear that the local Community School, run by one of the  Borromeo Sisters for the OVCs (orphans and vulnerable children, either HIV+ themselves or orphaned by Aids) was broken into and some property, mostly cables and the children's cups, plates and spoons (300 of each) was stolen.  Building work was in progress and a gap in the rear wall had been left closed but secured only by wire instead of a padlock.  Now bricked up....  I don't want to think of the desperation (or evil) of someone who would steal from these kids and their school.  Now to source for new eating utensils; only the equivalent of £200 but  ZK 1 600 is quite a sum, about one month's teacher's salary.  Not that the teachers at Guardian Angels get salaries: as volunteers they get allowances the school can afford.  The government has promised (frequently) to pay those good people who teach in community Schools all over this country as there are insufficient places in government schools to provide for all Zambian kids.  But they are still waiting.  Community schools generally achieve good results; Guardian Angels has a high success rate in the grade 7 exams that pupils must pass in order to progress to secondary school.  And this is the time of year when exams are being written- good luck and blessings, kids!

Thursday 21 February 2013

February contrasts

In England, February often feels like a confusing month; unsure whether it marks the end of winter, the start of spring or is some kind of neutral territory in between.  Despite the snowdrop and crocus spring serving suggestions, chill winds and snow often counteract that impression.
In Zambia, they are much clearer- just summer months.

Having followed January in Zambia (28 degrees, summer, sunny, some rain, everything green and growing) I received the news that my Dad had died on the 31st January so I returned with little warning to England on the 4th February.
So now England (-4 degrees, winter, cloudy, some rain, everything grey and moribund)  A challenge to the system; first the temperature- a rush to charity shops to buy a coat and sweaters, leggings and long sleeved polo neck tops to wear under my other clothes. Yes, hot water bottles, blankets, hot baths were needed to keep the body temperature above hypothermia levels.
I made my way by coach to Somerset, to Bridgwater where I lived pre-Zambia and where my Dad, John, had recently lived and died. Many meetings with family and friends, funeral planning, mostly cheerful as, after the Requiem Mass, the most important item was the big hospitable party. The term 'wake' being out of favour, we celebrated this Geordie lad's resurrection to a new life with a party to gladden his heart: enough to eat for all, an open bar and, stroke of genius, photos of Dad's life at all ages projected on a screen with a selection of his favourite music playing in the background- well done family, especially the geeks!
Time running down now, two weeks nearly done as was my energy at this point.  Back with my brother to his flat near Heathrow to be sure of my return which happened easily and efficiently though mostly in a blur as I by now had a dose of flu, unsurprisingly with the temperature change and stressful time.  
I did see the rather shy emergence of snowdrops and crocuses (crocii?)
I'm glad to report my flu has responded to my prescribed treatment of being in Zambia (28 degrees, summer, sunny, some rain, everything green and growing)


Sunday 27 January 2013

Lusaka's secret pool

Sunday is my day off so I usually try to do something to make it different to the rest of the week. This is a particularly appropriate style of life for a Christian, enjoying myself on the Lord's Day, celebrating some of the good things the Lord has given me.
Lusaka is where I usually go as there are more opportunities there.  I live in Chilanga, a small town about 15km away from the capital, Lusaka, and the possibilities locally are limited to Munda Wanga, the wildlife park, which I'm keeping in reserve for another Sunday....coming up later in this blog!
This Sunday morning dawned sunny and warm so I headed off to St Ignatius' Church for Mass with my swimsuit and camping towel in my backpack.  This involved a (mini)bus ride to the infamous Kalima Tower bus station followed by a half hour walk guided by my extremely useful street map.  
After Mass, I followed my trusty map to the Sports grounds and found the pool.  No one was in the office at the entry so I went on in, undressed and went up as directed by the painted sign to the poolside. The pool, 50 metres by 25 metres, gleamed in the warm sun as invitingly as I've ever been gleamed at by a stretch of water.  Walking , as instructed by another sign, through the (dry) footbath, I dived in to the deep end and found the reality fully lived up to my expectations.  The water, initially cool on my skin was refreshing without being chilly and very fresh and clean.  Swimming peacefully, I realised there was a false note in this blissful scenario which was the paucity of other swimmers, a mere half dozen in this huge expanse.  OK, the paths round the pool and the seats  for spectators were dilapidated and the diving boards removed from the frames but the grass surrounds were trimmed, there was no rubbish, the tall acacia and baobab trees made a lush green background and dragonflies were dancing over and sipping from the clear water.  This municipal pool seems to be Lusaka's best-kept secret; at 10/5 kwacha for an adult/child (the equivalent of about £1.20/60p) it has to be within the purse of many Zambians who I know spend considerably more to go to pools in hotels and  'Water Fun Parks' with flumes, slides etc.  Maybe some advertising?  Or maybe it can be kept as our secret?

Wednesday 23 January 2013

Zambian holidays

My Zambian colleagues seem to take a month's leave in a year, either in one piece or in bits here and there; this particularly for the Clinical officer who acts as a doctor at the clinics. and has no backup whereas there are, for example four nurses who can cover for each other.
I don't think my local colleagues go away on holiday as a time of rest and recreation; they are more likely to take the opportunity to visit distant family, catch up with a home job like planting maize or work on their house.  Transport is expensive here over large distances and staying away from home very pricey unless with friends or family.
There are some great holiday venues in Zambia though and my co-volunteer has currently gone to visit the Mosi oa Tunya (local name meaning 'The smoke that thunders' aka Victoria Falls) with a friend visiting from Ireland.  They are staying at the Maramba River Lodge, situated between Livingstone Town and the Falls.  The first time I visited the Falls, in 1998, my daughter was with me and her research into a good place to stay turned up Maramba.  Since then, I have frequently stayed there with a variety of visitors and found it a perfect little haven.  It consists of : brick and thatch rondavels, each en suite; in the centre, a small rocky swimming pool, bar and restaurant.  There are several walks nearby, including to the Maramba River, a small tributary joining the great Zambezi at the stage of heading for the spectacular 500m drop, the centre and purpose of this area.  Once, driving in to Maramba with an English friend desperate to see 'at least one elephant' we were amazed to find about twenty large elephants rampaging round the site, ripping at the trees, trampling and eating plants, lurching alarmingly round the parked vehicles.  After a while, many photos later, the staff picked up metal bins and sticks and  noisily ushered the elephants back into the bush.  This was a good reminder to us that we were living in the bush and to stay in our rondevels at night, not only to avoid a possible close encounter with an elephant but to avoid snakes and hippos and keep monkeys out of our cabins- they too can be destructive.

Wednesday 16 January 2013

A perception of the development of an HIV+ life in Zambia

I'm sure that regular readers of this blog are well aware by now of the fact that  I am working in Zambia as a counsellor at a hospice run by a missionary order of nuns.
The hospice in-patient unit is temporarily closed due to financial constraints so the work is running clinics for TB patients and those who are HIV+ and making home visits into the community, especially the poorer compounds, taking food to help those in need if the hospice has received donations from charitable companies and individuals.

I am frequently struck by the comparison between the way these people are now able to live compared with their fate in 2002, when I left Zambia. 

Now, able to freely access the ARV (anti retro viral) drugs they need to live with their 'status', a typical HIV infected adult is likely to be at work (if they are lucky enough to find a job in this area and time of high unemployment), working on their allotments to provide food for their family or at home, or giving voluntary assistance to neighbour and family members who are sick or in difficulties.
HIV+ children growing up with the prospect of taking ARVs for the rest of their lives, seem to be developing well and doing well at school and college. Now adults can mostly look after their own children, a task which used to fall to the Ambuyes (grandparents) who, their own child-rearing days behind them, had to cope with a whole new generation of kids. 

A much more cheerful picture than the one I left in 2002 to go back to England to be with my parents; when the best and only care on offer to those infected was fellowship, love and prayer, with a blanket, water and aspirin.  In those dark days, many people were banished from their homes and villages as others were afraid of catching the virus by sharing a house with the positive ones. 

So the pattern of care has changed from one which was basically palliative to one which supports the efforts of this increasingly large group of people to live a 'positive lifestyle', adhering carefully to the drug regime, taking as good care of themselves they can with a healthy diet, rest, relaxation and condom use for sexual intercourse even for a married couple who are both positive, to avoid re-infecting each other with a constantly evolving virus, slightly different in each re-infection.

And where next?  With good management of the disease, people's life expectancy should not be effectively shortened by their HIV status; more and better strains of ARV drugs may become available (at the moment there are only 2 'lines' of drugs available so anyone unable to take some for any reason or reneging on their drug regime, can rapidly run out of options)

Fellowship, love and prayer, of course, never go out of fashion; these continue to be an important part of the mix of help available, much of which comes through the churches (CHAZ, the churches health association of Zambia, is a big player in the field of the prevention and mitigation of HIV and Aids in Zambia.

Praise God