Friday, July 18, 2008

my Zambian adventuress - Part II

I have been keeping up with the 2008 Zambia Medical Mission (ZMM) by blog. There have not been any pictures yet, but I am expecting some any day. There have been several audio blogs from various team members in their own special areas. I encourage you to keep up with the mission - you won't be disappointed.

I got you as far as Lusaka and staying in the Lodge and finally getting clean. I will try to get you started on the mission. (I am away from home, so I don't have access to my pictures right now. I will post some pictures when I get back home. I know these blogs are lengthy, but I hope they are interesting.)

Before we left Lusaka, we had to go to the Nursing Council and interview so we could obtain our nursing licenses. The license used to be good for two years, but now you have to get a new license each year. They interviewed us one at a time. I was quite nervous this first time. They had received my US information, license, school information, etc. and already had a folder on me. They asked things like what kind of nursing I did and wanted to know what I thought I could bring to Zambia. I told them that my specialty was surgery and that while I wouldn't be doing any of that, I felt that I could offer compassion and good nursing care to people who seldom get to medical treatment. I also told them that I was hoping to learn from my experience in Zambia because I would get to see disease processes that I don't normally see in the States. I also told them that I was here to serve these people because Jesus loves them and Jesus loves me, so I wanted to help someone the way that Jesus would help them if He was here. They must have approved because I was granted my license for Zambia. They were very nice and personable. Now I look forward to talking with them when we interview.

The trip from Lusaka to Namwianga - where the mission is - takes about five or six hours. I am not really sure which. When you are little you ask, "Are we there yet?" and "How much longer 'til we get there?" The answers to these questions in Zambia is, "We are just near." That usually means that it is going to be a while. We made one short stop a little way outside of Lusaka at a place called Kafuwi. There are wonderful wood carvers there. I bought a few souvenirs and took some pictures (I will post them later). I sat in the middle of the front seats on the way to Namwianga, taking pictures of everything I saw. When there wasn't much to see, we were singing church songs. I was having a great time and so excited.

We arrived at Namwianga during the supper meal. It was already dark and quited cool. We unloaded our luggage and went to the Hamby's back yard and were served our supper. We got lots of hugs and wonderful greetings from the "advance team" and our Zambian hosts that had been waiting for us. I was so happy... I cried, of course.

The advance team goes about two weeks ahead of time to work through the logistical part of the trip and to get the medicines ready and all of the katundu (stuff) out that everyone needs. That means everyones' stored items, like sleeping bags, torches (flashlights), clothing, if it is something that we need every year - we just ship it over and store it until the next mission.

The main team - everyone who wasn't nurses or advance team - came in the next day. I asked if I could go to the airport to meet them and they let me along for the ride. Remember, my family (Michael, Jan/Mark/Jace/Lane/Katie Miller, Jill & Brooke Whitlock) were all coming in on this flight. Cindy Robinson and I rode together on one of the buses. The ride to the airport is two or three hours, so we did make a "geography stop." Now, you can be timid if you want, but sometimes the best way to deal with new experiences is to just dive right in there - especially if you get a chance to do it with just one or two, the next time is usually with 100+. I guess I should explain geography stop. It is when you need to stop to use the bathroom, but there is no bathroom and there is nowhere to stop... so, you just pull over to the side of the road. The women exit to the left of the bus (we don't have to cross the traffic - remember we are driving on the opposite side of the road), men exit to the right side of the bus and cross the road (vehicles do not stop for pedestrians). Men and women are separate. Nobody watches or looks at anybody else. All of the women look for trees, or tall grass. Just take care of your business (don't forget your Kleenex and hand sanitizer) and head back to the bus. Everyone knows who they were sitting by, and no bus leaves until everyone is back on board. Having that behind us (no pun intended), we traveled on to Livingstone to the airport. You can tell when you get close to Livingstone because you can see the mist from the falls. Victoria Falls is called "The Mist that Thunders" because you can see the mist from far away and you can hear the falls before you reach them. The falls are half in Zambia (Livingstone) and half in Zimbabwe (Victoria Falls). I will tell you about the falls when I talk about the trip after the medical mission part.

We were supposed to stay inside the terminal, but I found this really nice, nice airport man who took me right out onto the tarmac to take pictures. I thought Ellie (Hamby) was going to faint! She was afraid that I just ran out there - she probably had visions of me being carted off and deported. Anyway, I got some great pictures of the plane coming in and landing and everyone getting off. Boy, did they look tired! I know that is exactly how we looked, but after my shower and rest it seemed a little more distant. We got all of their luggage out and then the fun began.

You just can't imagine what it is like if you haven't been there. Usually when big groups get together for anything there is just chaos, but not so with this group. I told you about the advance team. Well, everything was ready: there were sack lunches and drinks for the group that just landed; there were vehicles designated for luggage and for people; everyone was given their housing assignments (and their shipped items were waiting for them there); there was a schedule of not only the rest of the day, but for the trip. If you needed to know it, it was on paper and in your hands. Before we left the airport, there was more hugs and greetings and some picture taking. We got pictures of our family all together with our ZMM matching shirts on.

We got back to Namwianga, got settled in and had team meetings. The next day we went to church. There are several choices for church. I stayed at Namwianga and went to church in Johnson Auditorium (George Benson Christian College is the college at Namwianga, there is also a secondary school there). The service there is mostly in English, with singing in English and Chitonga. The men sit on the left side, the women sit on the right and visitors and young people sit in the middle - mostly. This is their culture. There is a separation of men and women for most things. Church was really wonderful. The singing was great and different. They really lift their voices. They just don't hold back. I think they each would sing the same if they were the only one singing. Here if you are in a small church, you sing with a small voice - like you don't want to be heard (in case you are off key or something). They are just singing for God and they want to be sure He hears them. They have a harmony unlike others I have heard before. I think there must be one or two Zambians somewhere that can't carry a tune, but I have yet to find them. I love just listening to them sing.

If you want to venture out a little, you can travel to one of the village churches to visit. Some are close enough to walk to and some are further and you need a vehicle of some sort to get there. Some of the village churches have visiting Americans preach while we are there, but have translators - so the services are a little longer. Also, unlike here in the States, you don't know exactly what time the service will start because Zambians don't wear watches. Time is not a big issue to them. I think if you are a type "A" and have issues with punctuality, you might really have some problems with living on Zambian time. They get everything done that needs to be done, but they don't hurry or watch the clock like Americans do. I have heard that worship at a village church is a wonderful experience. Doug and I had talked about doing that this trip.

Later that evening, the Church (the people, not the building) threw us a welcoming meal and fellowship in Johnson Auditorium. It was wonderful. The benches were moved all around the room and there was quite a feast, and more cake than I had seen in a while. Everyone was there. We mixed and mingled and got to know people. There were several groups that sang songs: from the secondary school, from the college, a group from the church, women from the church, they asked the McCoy family to sing (Burl & Jan, cousin Debbie & her girls Molly & McKenzie - not the usual family, but they sounded great!), and then the large group from the States. It was very moving... I cried. At this point Dr. Ellen Little said maybe your malaria medicine and your antidepressant are working against each other. But I got better over the next few days.

We headed out EARLY the next morning. Out loading before 5:30am and on the road by 6:30. I found my friend Carol Higdon and we sat together on the bus. We had some talks previously about my fears and what the team expectations were for me and my job. The night before, I was just so terrified. I really just was afraid that I would not be able to do this diagnosis (even though we were using a protocol set up by a physician) and prescribing treatment (even though we had an extensive formulary). You know there is a reason that nurses aren't allowed to do this in the States. Carol and I hit our knees and prayed about it. She prayed over me and for me; for God to use me, my knowledge and compassion to do His will. Well, here it was time to go and I was nervous, but generally feeling better.

We stopped on the way to pick up the rest of the Zambian nurses/medical officers (the equivalent of a P.A. here) and then we were on our way. Each physician, nurse, dentist, optometrist and other medical person had our own individual nurse/interpreter. They were there not only to interpret, but because they are the real experts at the conditions that we would see. Each nurse works in a clinic or hospital and sees these illnesses/complaints on a daily basis. They take their vacation to come and work with ZMM to help the people that don't have access to the clinics because of where they live. They are true heroes. We could not even begin to do any of this mission without them. We bonded with our Zambian colleagues and were truly sad to part by the end of our mission time.

There were quite a few Zambian nurses and medical officers on my bus, so there was a lot of singing on the way. Carol and I took turns singing and talking about the days ahead. We had a song book, and tried to keep up, but some of the songs have different melodies so we did o.k. about half of the time.

We drove on the paved road for a while and then we ventured off into the bush. The places we visit are remote. If they were not so remote, the people would be able to get to a regular clinic area to be seen. Many of the people that ZMM sees, only see physicians once a year - when we come. We set up our clinic sites at schools because they are a common place, known to the people and between villages. They have buildings and bathrooms (such as they are - usually walled, but only a hole in the ground - I will explain more later). There is no electricity, so we can only have clinic during daylight hours.

We would be driving along and Carol would point out someone walking through the bush. Once, I looked out of the window and someone was so close to the bus that if we had hit a rock and moved just a bit - we would have run them over. Each person we saw was smiling and waving, just like we were old friends. Carol said we would see them again because they were headed to the same place we were going. They were coming to see us! I said, "Really?" She said I would see. Well, I don't know how long we were on the buses - one or two geography stops worth... We had trouble with a tire once, and something else, but we weren't stopped long. Finally we got to the clinic site and I could hear the people before I could see them.

When I got off of the bus I saw something I will never forget. There was a group, a fairly large group of women and children walking, dancing, singing, praising God because we were there to take care of them. I can still see it and feel that feeling. Of course I cried this time - so did everyone else who had never had this experience! We took pictures. We clapped. We hugged each other. We cried. We prayed and gave thanks. There just really aren't words to explain exactly how it felt.

Finally, we got a grip on ourselves and moved on to start unloading and setting up the clinic. We try to get started as early as possible and work until we lose our light. Generally, we treat ~ 18,000 people over five to six days of clinics. So we see around 2000-3000+ people a day. We don't want to turn anyone away, so it is imperative to get as many working hours in as we can. It was probably between 9 and 10:00am by the time we got set up and started. We moved all of our supplies into our areas. You could tell who the people where who had been before. They moved like a precision machine unloading, setting up, getting medical supplies to the different areas. Beyond that sight was a large crowd waiting to be seen. Some walking for days to get there; some with every worldly possession they had. They had to be able to feed and house their family while they were there. Waiting... everyone was waiting on us. While we set up, Darrell Conway and his interpreter were sharing the gospel of Jesus Christ.

There is a starting point for the clinic. The people are all gathered and then separated: Men, Women and children. Then separated further: eyes, teeth, medical, spiritual. Then medical is separated further: needing to see physicians and nurses, or needing wound care. Some needed immediate care. Many needed all of the services - they were sent to the place they needed most and then redirected to the next area. There is an area where vital signs are taken, babies weighed and the ailments written down. Then they are taken to the areas where they will be seen. Each area has a way to mark who has been seen so we don't keep seeing the same ones over and over while others are missed. In each area, there are multiple team members to make sure that things run smoothly and that no one is left out/overlooked. From the treatment areas, the people are taken by the pharmacy and then offered spiritual counseling.

No one is forced to talk to the spiritual people, but it seems that most want to. Many are wanting Bibles. We carry Bibles in Chitonga for the people, but it is hard to have enough to pass out. We make sure that church leaders from these villages have them first and then give others away as long as we have them.

When we (nurses/physicians) were ready to get started, we stopped for a moment to discuss what we would see, go over the formulary one last time and spend a moment in prayer. We kept this routine daily. I am sure the other areas were doing the same things. I set up my table right next to Carol Higdon's. She told me that if I had any questions about the diagnosis, that my Zambian nurse couldn't help me with or if I just wanted a little help, she was there for me. And she was. There we were, all in one room - with our little tables, stethoscopes, blood pressure cuffs, gloves, wipes, vitamins & pain relievers, note pads, suckers (for the kids) and a few other sundries. The pharmacy was in the same building and the physicians were around the corner. We were off to the races.

The patient flow person sent my first patients in. I made it through that morning just fine. I had my protocol, my formulary, my nurse/interpreter/friend, and Carol near by. Most of all, I had God - and He was the One in control. I listened to hearts and lungs, looked in throats and ears (saw some really yucky ears!), felt of tummys and arms & legs and looked at rashes. I gave out vitamins and pain relievers, worm pills, a few shots for STD and wrote a lot of prescriptions for malaria medicine, antibiotics, creams for skin rashes, blood pressure medicine, etc. The littlest children were very afraid of the Makua (not sure about the spelling, but it means white person) because they had never seen one.

There is no stopping for lunch or tea. We still get lunch and tea (while we are working), but we stagger it so that people are always being seen. I saw my first baptism on my way back to work after my lunch break. They teach, then baptize, then teach the onlookers what they did and why. It was a reminder that Jesus took care of the people's physical needs like we were doing, but He also took care of their spiritual needs which is the main reason we have the ZMM.

The afternoon was filled with more of the same. I remember toward the end of the day, looking out at the lines and thinking, we are never going to get done, but a little while later, they said we were seeing our last patients for the day and told where to take our medical supplies until tomorrow. Just like that, we were done for the day. Generally, I felt very good about the first day when it was over and I was tired, but it was a good tired. I felt like I had done something to help. All of the patient's that I had seen were very respectful and appreciative - something we see little of in the States.

After we finished putting everything away, we made our way to the fenced in (with elephant grass) area where a hot supper was waiting for us. Also, warm water to rinse our hands after the hand sanitizer. We went through multiple bottles - big ones- of the hand sanitizer on this trip. You can't have dirty hands and help people get well. Also, no one wants dirty hands when you have to eat with them. I don't remember what the meal was, just that it was hot and good and just what we needed. We discussed how the day went, how many people had been seen and where, baptisms, sang some songs, chatted, chowed down and relaxed a little. We had a nice fire to sit around and when all the eating and talking was over, we made our way to our tents for the night. We lived in a tent city. Constructed during the day by the A-team (advanced team). We had an address - row & tent number because there were about 110+ tents for all of the 200+ team members.

I was in a tent with Jan, Katie, Jill and Brooke. We affectionately became known as the laughing tent. We love each other, get along very well and we love to laugh. Anyway, when you are just exhausted, sometimes you get a little simple and everything is funny. We laughed and giggled and snorted (at least I did) and generally had a great time. Mark, Jace, Lane and Michael were in a tent together, too, but they mostly slept and snored (at least Mark did). We had all the luxeries of home... we had all that we had to have: a sleeping bag, a pillow, our little suitcase/bag with something to sleep in and clean underwear, hopefully some clean clothing for the next day and most important our wet wipes - to bathe with. One night we did get a pan of hot (boiling hot) water to wash our faces and hands with and then our feet. For the brave people, there were grass enclosures that you could take a pan of water to and really wash off. I just have this fear that someone else is going to wander in while I'm al naturale (naked). Who knows, some day I may venture out a little and try that. I have camped many times over the years and with a good wet wipe or a small pan of water and no rinse soap, I can go for days. If you can stand the way you feel that is the key; we all smell the same after a couple of days anyway. And I couldn't feel much dirtier than I did when I got off of that airplane!

We made one more stop to the bathroom before we turned in for the night. There were no clouds. We could see our tent city, and the camp area where our Zambian patients were resting. We looked up and saw the Milky Way, the Southern Cross and at least a million more stars. I don't know how anyone can look at creation and not believe in God.

When our giggling played out and we finally got still, I remember thinking how great it was that I was in Zambia, with my family... and how pretty the Zambian nurses sounded singing by the fire. In the distance, I could bearly hear Darrell Conway and his interpreter talking to the people where they were camping. I was warm and sleepy and safe.

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