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| Ethiopian airlines. |
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| Addis Ababa airport. |
Despite traveling to several countries and generally feeling less surprised with differences, there are still new things (or reminders of things I should have remembered) to encounter in each place. I mean, like, packing an adapter and then chucking it out my suitcase, because “I won’t need it in Zambia. I mean, they speak English, so their power system must be the same.” False. Definitely needed an adapter. Fortunately, other travelers were not so unprepared and I was able to keep my electronics happily juiced. Another thing - what is up with dehydrated coffee granules? Nothing like dehydrated coffee granules to induce some serious first-world-problem cravings for a latte. And let’s just say the water to coffee granule ratio should be generous if you want your coffee to taste like coffee and not sludge. And it’s easy to forget what wearing Deet 24/7 feels like and that it strips off ink from anything you touch. I mean the stuff is probably toxic, but malaria is no joke either and the stuffs works to repel the li’l blood suckers, so compromise?
On the flip side, African community/hospitality is some of the best I’ve ever experienced. From the importance of greeting and saying goodbye to every person individually, to cooking all morning over a pit fire to prepare lunch for us, to the kids’ bright smiles as they played games with the students, the joy and love of Zambians for each other and us was so evident. Many times I find people who have less material items are much happier than those of us who have more. It manifests in the glee of chasing a chicken or racing a spare tire down the road, playing duck, duck, goose over and over or posing for pictures. Having less just simplifies life and lets us be thankful for daily blessings; there’s no distraction from envy or from what really matters. *Because “stuff” never truly satisfies our deepest longings.*
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| Duck, duck, goose |
FUN FACT: What’s up with Zambia?
(The Republic of) Zambia is a landlocked country in south-central Africa. A former British colony, it became peacefully independent 55 years ago. It’s official language is English, but there are more than 70 languages and dialects spoken by Zambians. Its economy relies on copper mining, agriculture, tourism, and energy (solar and hydroelectricity). The nation is officially Christian, but a variety of religious traditions are present. More than 1.7 millions people live in the capital city of Lusaka. Medically, they are experiencing a generalized HIV/AIDS epidemic with national rate of 12%+ for adults.
(The Republic of) Zambia is a landlocked country in south-central Africa. A former British colony, it became peacefully independent 55 years ago. It’s official language is English, but there are more than 70 languages and dialects spoken by Zambians. Its economy relies on copper mining, agriculture, tourism, and energy (solar and hydroelectricity). The nation is officially Christian, but a variety of religious traditions are present. More than 1.7 millions people live in the capital city of Lusaka. Medically, they are experiencing a generalized HIV/AIDS epidemic with national rate of 12%+ for adults.
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| Billboard campaign to "know your status." |
So, what did our trip look like during the week? I’m glad you asked. Each morning we crawled out of our beds and mosquito nets at 5 o’clock and ate breakfast at 6. By 6:30 we were on the bus to the Circle of Hope Linda extension site, which regularly offers HIV testing and care for HIV+ patients. During the week, they continued to see their regular patients, while we set up in tents in the lawn and held general medical clinics for 4 days. We had 3-4 providers in our team seeing patients and the 9 students were spread among various areas of the clinic, including shadowing with the providers, working triage with our nurse, helping dispense drugs with our pharmacist, and doing home visits and community HIV testing with the local volunteer HIV counselors. For two of the days, the students rotated through the cervical cancer screening clinic with the nurse practitioner. Each day our team collectively saw 65+ patients and did approximately 50 HIV tests with about 10% testing positive.
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| Packaging medicines the first day of clinic. |
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| Triage and POC lab station. |
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| Two providers in the tent, one to the side, and one behind. Pictured here are the 4 providers with 2 students. |
Medical problems ranged from colds to perforated ear drums, infertility, high blood pressure, carpal tunnel, arthritis, a laceration, STIs, fibrocystic breast disease, skin infections, sickle cell anemia, and protein deficiency. Some had masses that needed scans and others appeared to have active TB (tests pending before we left). We were able to do prenatal exams and check fetal Doppler sounds.
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| Patients waiting in the shade for their turn to be seen by the providers. |
FUN FACT: What did we eat?
- Breakfast was usually toast and an egg with baked beans and a side of ham or sausage.
- Lunch was usually nshima (see the next FUN FACT), greens or pumpkin leaves with peanut sauce, and meat (fried chicken, sausage, fish, caterpillars).
- Dinner included traditional African food (chicken or beef, coleslaw, and “chips”), pizza, shawarma, fried chicken, and restaurants where we were able to order our own choice of foods either for our self or to share (burger, pasta, mango lettuce salad, chicken tikka masala, and spaghetti).
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| Caterpillar |
FUN FACT: What is nshima?
Nshima/nsima is a dish made from maize flour (white cornmeal) and water and is a staple food in Zambia (nshima/ ubwali) and Malawi (nsima). It is relatively cheap and affordable for most of the population.
The maize flour is first boiled with water into a porridge. It is then 'paddled,' to create a thick paste with the addition of more flour. This process requires the maker to pull the thick paste against the side of a pot with a flat wooden spoon (called an nthiko) quickly whilst it continues to sit over the heat. Once cooked the resulting nshima/nsima is portioned using a wooden/plastic spoon dipped in water or coated in oil called a chipande, each of these portions is called an ntanda.
Nshima is almost always eaten with two side dishes, known as "relishes": a protein source: meat, poultry, fish, groundnuts (peanuts), beans; and a vegetable, often grape leaves, pumpkin leaves, amaranth leaves, mustard leaves or cabbage. Traditionally diners sit around a table or on the floor surrounding the meal. The diners have to wash their hands as nshima/nsima is eaten with bare hands. Eating is done by taking a small lump into one's right palm, rolling it into a ball and dipping it into the relish. An indentation in the ball can be made to help scoop the relish or soup.
Our commute time and evenings after dinner were spent presenting case studies, learning about HIV, teaching physical exam skills, discussing ethical challenges in medicine, conversing about mental health topics, and sharing how to prepare for and deal with possible failure of our plans for school/career.
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| Teaching about HIV and the anti-viral drugs available to treat the virus. |
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| Discussing difficult medical ethics cases after clinic while waiting for the bus to arrive. |
On our last day of the work week, we participated in a training session of local CHE (pronounced “chay”) leaders. Now, I was not familiar with the CHE concept until this trip, so let me give you a brief tutorial.
[commence tutorial time]
Two sites had a pretty job definition of CHE, so I’ve included them both here.
“One of the best strategies for proclaiming the love of Jesus among the poor, CHE is being utilized by hundreds of Christian churches and organizations in over 125-countries around the world! CHE teaches local community leaders how to identify their own needs and how to mobilize the community to use local resources to achieve positive—sustainable—results. Lives and communities are transformed from the inside out as people come to Christ and work together to address local needs.”
“CHE is Christ Centered Community Development: Community Health Evangelism (CHE) is a Christ-centered educational program that is being used by hundreds of Christian churches and organizations across the globe. CHE equips communities to identify issues and mobilize resources to achieve positive, sustainable change. Lives and communities are transformed as people come to Christ and work together to address local needs.
CHE is Integral Mission: CHE seamlessly integrates evangelism and discipleship with community health and development. Through CHE ministries, individuals become followers of Jesus and communities are lifted out of cycles of poverty and disease.
Our strategy includes church planting, disease prevention, and poverty alleviation, but our purpose is much deeper. Our purpose is a transformation in lives and communities that is as deep as the human heart, and as broad as the whole range of the human experience in the world God made. Through our work, Jesus is recognized as Lord over all creation, and our development activities bring glory to God by reflecting the depth and breadth of His Kingdom plan.”
[end tutorial time]
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| Our team and the local CHE leaders. |
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| Building a "chicken tractor" or mobile cage to help with clearing grass and providing fertilizer for gardening. |
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| Charcoal refrigeration. |
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| Tippy taps for hands-free hand washing. |
During our time with the CHE leaders, we broke into groups with the locals to help construct solar ovens, chicken tractors, charcoal refrigerators, and tippy taps and learn about solar water purification and the benefits of moringa trees, also dubbed “the miracle tree.”
FUN FACT: What is moringa?
Short version: moringa is an invasive tree that grows crazy fast and produces a massive amount of leaves, pods, and seeds that are packed with vitamins, minerals, essential amino acids, and protein. Nearly every part of the plant is utilized. Different parts of the plant can purify water, fertilize gardens, boast animal health and milk/egg production, and heal wounds. It grows in dry, sub-arid conditions. 
FUN FACT: What did we and didn’t we wear?
Mosquito repellent. Sunscreen, lots of it. But seriously. Also, most of the time we were in scrubs. Women could only wear capris in the lodge and in Livingstone. Skirts with the CHE training and at church. Men could wear long shorts or pants. Tattoos covered. Piercings minimized. Expensive jewelry/watches and sunglasses left at home. Women = no shorts.
And what of Livingstone? Well, it took about 10-12 hours to drive what Google maps lists as a 6-hour-and-47-minute trip. But get there we did.
The resort where we stayed was lovely. It felt so much like camping, but with none of the hassle. As the sun set, we gathered at the outdoor patio and watched hippos surface and sink again into the Zambezi river. Our team dinner, served outdoors by candlelight, was accompanied by the calming sound of chirping insects, the breeze from the cool night air, and the melody of soft chatter from diners at nearby tables.
FUN FACT: Where did we sleep?
In beds. Under mosquito nets. But more specifically, we stayed at a lodge in Lusaka and fancy tents in Livingstone. Yes, there was running water, toilets, and showers.
In beds. Under mosquito nets. But more specifically, we stayed at a lodge in Lusaka and fancy tents in Livingstone. Yes, there was running water, toilets, and showers.
Our Sunday started with breakfast, driving from ATM to ATM and a currency exchange site to get local currency (“kwacha” or as our students liked to call it “kwach”), and attending an A/G Zambian church where we worshiped and witnessed a baby dedication and baptisms! Such a joyful experience.
After lunch, we finally made it to the main attraction - Victoria Falls. In the local language the falls is called Mosi-oa-tunya, which means “the Smoke that Thunders.” It is aptly named. As we came at the end of the rainy season, the water levels were quite high and we were drenched in mist after walking the length of the falls. When I visit these grand sites of nature, I always try to imagine what it would have been like to encounter in the wild before it was easily accessible and boardwalks and bridges had been built. It must have been even grander than what we experienced, which was impressive even now.
FUN FACT: What's the big deal about Victoria Falls (according to wikipedia)?
Victoria Falls (Lozi: Mosi-oa-Tunya, "The Smoke that Thunders") is a waterfall in southern Africa on the Zambezi River at the border between Zambia and Zimbabwe and one of the Seven Natural Wonders of the World. While it is neither the highest nor the widest waterfall in the world, Victoria Falls is classified as the largest, based on its combined width of 1,708 metres (5,604 ft) and height of 108 metres (354 ft), resulting in the world's largest sheet of falling water. Victoria Falls is roughly twice the height of North America's Niagara Falls and well over twice the width of its Horseshoe Falls. In height and width Victoria Falls is rivaled only by Argentina and Brazil's Iguazu Falls. The Zambezi river, upstream from the falls, experiences a rainy season from late November to early April, and a dry season the rest of the year. The river's annual flood season is February to May with a peak in April.The spray from the falls typically rises to a height of over 400 metres (1,300 ft), and sometimes even twice as high, and is visible from up to 48 km (30 mi) away.
The next day, we made the long trek back to Lusaka, and the following day we were boarding our first flight of the long journey back home. Thirty-two hours later we had traveled from Lusaka → Harare → Addis Ababa → Dublin → Chicago where we debarked and then drove 3.5 more hours to Iowa City.
Some people ask why I do these trips year after year. We pay out of pocket, use our vacation time, spend a week with college students after they are exhausted from taking finals, and travel dozens of hours in cramped quarters to stay in a place with tropical diseases and at-time questionable food choices. Why? Because it’s worth it.
It’s worth it to do hard things, stretch out of our comfort zones, befriend new people, learn about other cultures, and share Jesus and his love with the “least of these.” It’s worth it to pay it forward by introducing the next generation of providers and nurses to medicine and integrating faith with our vocational passions. It’s worth it to see the joy on an elderly man’s face and he thanks us for the first “real” doctor checkup he has had in his life, to encourage mamas they are doing a good job raising their kids and keeping them as healthy as they know how, to correct misinformation and calm fears from previous medical experiences with local doctors (“either you or your baby will die in this delivery” is so not true), and for each culture to share our respective knowledge and ways of doing life to enrich both parties. That’s why I keep doing it.
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| Team photo including our interpreters and HIV counselors |
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| Me with some of the "reasons" I keep doing these trips. |
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