Photos Updated

More photos from South Africa, Swaziland and Zambia have been posted here:
http://picasaweb.google.com/danandamyhess

Return Reflections

We're back in Baltimore. Every time I travel by air, I can never quite wrap my mind around the distance of where I've just flown from. Air travel seems so deceptive. We traveled part of the way around the world in just over 24 hours. Can Macha, Zambia really be that far from here?

I've composed a list of what I've missed from life in the States followed by a list of what I'll miss about Macha, Zambia.

What I've Missed in the States:

Talking with my family members on the phone and in person
The NCHS FACS department
Sitting on the love seat by the window while reading
Resources within easy reach
Milk and ice cream
The variety of food and groceries available
The Mount/Wilkens/Gilmore Dinner Club
My dance classes
Having a house to ourselves
Hot showers
Our washing machine
Spending time with U.S. friends
Afternoon walks and talks with Bekah


What I'll Miss About Macha:

Riding bike down a dirt road and path early in the morning on the way to school
Priscilla's nchima and relish
Visits at the homes of other ex-Pats in Macha
Hearing my students say in unison: "Good morning, Mrs. Hess!"
Laughing and chatting with Beverly
The warmth and friendliness of the people in Macha
Seeing women carrying babies on their backs
The beautiful night sky - I've never seen anything like it here!
My students who would randomly stop by the house in the afternoons
Eating lunch with Dan every day
The calm, peaceful, relaxing pace of life
The singing of the students at Macha Girls Secondary School


It's been good for me to reflect and create these lists. Hope you enjoyed reading them!

Reflections Before Flying

Today is the day we leave Africa. In many ways it feels as though we've already left. Nonetheless we know we have not yet arrived at home. It remains to be seen how this experience has affected and changed us. Although we are very ready to be home, there is some apprehension about the transitions ahead. Perhaps that is a good sign, evidence that we were really here and engaged in life.

Leaving Macha seemed a bit unreal, as though, after a couple of days we'd surely find ourselves on a bumpy ride up the Macha road once more. Even though our time there was only about six weeks we had grown used to being there. As we were preparing to leave many friends asked us when we would be coming back. One friend taught us a Tonga phrase appropriate for this transition: "Akabwenene taabuli kuswangana." Loosely it means, "Those we have met we will meet again."

worried

Today was my last day working at Macha Mission Hospital. It was a pretty busy day, but it went well. It's hard to believe that my time here has already come to an end. To mark the occasion, here's a reflective quote from Elaine Wynne, a Canadian physician who makes regular working visits to Macha: "At home I take care of the worried well, but here it's the unworried sick."

Sew What?

In the States we don't teach FACS at the elementary level. It's too bad, really. I've enjoyed teaching some sewing and crocheting to children grades K - 5. And you should see how proud of their bags they are! Last Friday was "open house" for the parents and caregivers of the students, and I had all their bags displayed. Not all the bags were finished but the parents/caregivers were able to see their child's progress. I'm proud of the students for all their hard work, and I'm so glad they enjoyed the project. When Mrs. Krause and I first discussed what "home ec" skills I could teach, we talked about crocheting. Due to some difficulty procuring the hooks, I decided to teach some basic sewing skills that would enable the children to sew a bag. In retrospect, I really think it all worked out for the best. I've begun teaching some crocheting to students who have completed their bags, and it's more difficult for some of them to get the hang of it. I'm very glad we didn't start out with crocheting. Now it's a fun, challenging addition to sewing bags. Pictures to come later!

What's in a Name?

Tonight we had dinner at the MIAM cafeteria and got into a discussion about local names. Some of our favorites have been: Hairness, Loveness, Sameness etc. I've always liked my name and checking my email after dinner I found out that I will actually be allowed to have it printed on my med school diploma. Apparently there was a policy against first initials on diplomas (not middle initials). But now, after several trans-Atlantic emails and "a lot of deliberation and several conversations with other campuses around the system" the policy is (apparently) a thing of the past. It will read: J. Daniel Hess.

Busy

Last week was one of the busiest weeks I've had here in Macha. Part of the busyness was because several visitors came to Macha. First was a Nobel Laureate named Peter Agre who is the head of the Johns Hopkins Malaria Research Institute (JHMRI) with which Malaria Institute at Macha (MIAM) is affiliated. On Monday afternoon we were all invited to a lecture at the MIAM campus and enjoyed Dr. Agre's lighthearted account of his humble roots in North Dakota and his serendipitous discovery of the "Aquaporin" water channel molecules which lead to a momentous call from Stockholm. Woven throughout was a message of the importance of education, research and discovery and a call to young Zambian researchers to work hard and make the most of opportunities they have.

Wednesday evening I was called to assist with a C-section at 1:30 in the morning. Because the woman was somewhat unstable it took a while. The baby (2nd twin) was not alive when delivered, but the mother eventually recovered and has been doing fine. I went back to bed around 4am.

Later in the week a team, led by the British orthopaedic surgeon Allan Norrish (Cure International), came to evaluate and treat the patients we thought could most benefit from such a specialist. Thursday afternoon they saw at least 50 patients and scheduled ten relatively major operations and about the same number of minor procedures for the next day. Some were asked to travel to Lusaka where they would undergo free hip replacements or other procedures. On Friday more patients were added to the list as needs arose (e.g. patients from OPD) and a fairly solid 14 hours were spent in the operating theatre. (The day also included a laparotomy and bowel resection by Dr. Spurrier for a man with necrotic bowel and a symphysiotomy for a woman in labor whose pelvis was too small for the baby's head). It was a busy end to a busy week, but I felt like I saw and learned a lot. I'll try to post some pictures soon.

Death

A couple of weeks ago I was on call with Elaine Wynne, a Canadian physician volunteering here for a couple of months. At the start of our evening rounds we found the clinical officer absent (delayed) and a queue of children waiting to be evaluated for admission. When I was calling the next child back, a man waiting with a child wrapped onto his back (as mothers typically do) said, "No doctor, take this one. This baby is very sick." We walked back to the waiting room and the child he laid on the table frightened me - sunken eyes, emaciated face. Its body was warm, but it was not breathing and there was no heart beat or pulse; it was too late.

During the rainy season there are often shortages of food. They have outlived the previous harvest. The number of children we see here at the hospital with severe protein energy malnutrition (PEM) is disheartening. It's even worse if you hear that the fathers are well fed, or that the mother believes maize porridge is enough for children (never mind that the family has beans, groundnuts or even chicken). Money and years have been spent on rural nutrition education, and yet marasmic children are still brought to the hospital. But what good is nutrition education if there truly just isn't enough?

Today, on Sunday morning rounds, I saw a patient admitted two days ago for PEM and gastroenteritis (namely, bloody diarrhea). When I saw it this morning at 9:00 the child seemed no worse than at Dr. Thuma's evaluation yesterday. It was now getting fluids (ReSoMal) via a naso-gastric (NG) tube instead of the initial IV fluids and had been started on the hospital's severe PEM protocol. I didn't think there was much else to do at the moment. However, upon returning less than two hours later to evaluate a different patient, the nurse asked me to review this child. She said, "It seems to be collapsing." The child was not breathing. There was no pulse. I felt helpless.

The child may have died because of some electrolyte abnormalities caused by the infusion of IV fluids. You could also blame the pathogen causing the bloody gastroenteritis. But the bottom line is, this child died hungry.

Tired on Saturday

Lying down on a Saturday afternoon
Distant singing wafts into the open window
On the tail of a wasp looking for a new home
Alongside the broken-record calling of African doves
And chirping song of winged others
From the trees beneath which children giggle.
There is also the far off horn of a truck honking
Someone riding by on a bicycle or walking by on foot
And the memory of last night's rain on the roof
Which dropped two inches in an hour and carried me
Off to sleep.

Zambian Textiles 101

Another week in Zambia is almost over for us. Twice this week, I had to ride home after a very heavy downpour. It was quite the adventure. The dirt roads and paths suddenly have streams or mini lakes, and all the sand turns to mud. Needless to say, I arrived home yesterday and Tuesday with muddy feet and legs. Fortunately, I didn't slip and fall over while riding, it didn't start to downpour again, and I had remembered my chitengi, so I was able to wrap that over top of my skirt, and my skirt stayed clean. Well, mostly clean.

A chitengi is a patterned piece of woven cloth worn as a wrap-around skirt. It's similar to a sarong except the fabric is not quite as soft and filmy as a sarong. I've purchased one since I've been here, and it's been very handy. I've even learned the Zambian way of wrapping and securing it. Women use them often. They wear them over top of another skirt or slip. Sometimes it serves as the main skirt, but other times it serves as dust and mud protection. Women wear them or take them along when traveling. When riding in the back of a truck numerous women were wearing them over top of their skirts or pants. When traveling on one of the big busses (picture a coach bus) women might carry them with them when the bus stops for a toilet break. There are no public toilets along the side of the road, so a chitengi is very convient to give yourself some privacy while doing your business. Chitengis also serve as loungewear. You may see some women who wear western clothes to work relaxing at the end of the day in a t-shirt and a chitengi.

And, of course, I cannot forget one of the most practical uses of a chitengi: a baby-carrier! Who needs fancy baby carries with metal frames and all kinds of straps and snaps? A simple piece of cloth works very well. In Swaziland and here in Zambia, we've seen scores of women carrying their babies on their backs. They bend over, swing the baby up on their back, the baby holds on (if it's old enough), and the woman takes a chitengi and wraps it around herself and the baby and ties the two ends together over one shoulder (in Swaziland they tie the pieces together in front, not over the shoulder). Voila! The babies look snug and safe and the woman's hands are free for whatever task she has next.

For you textiles buffs out there, the cotton fabric is a one up, one down fairly open basic weave,the threads are yarn-dyed a base color and then a pattern is printed on, from what I can tell.

Hope you enjoyed your textiles lesson!

Daily Life in Macha

Perhaps you're wondering what our our life is like day to day in Macha. To help with the illustration, we've included some of the differences in everyday terminology below. We both report to work at 7:30 in the morning. Amy rides her borrowed pink bicycle to school about 10 minutes away (20-30 by foot) and Dan walks 5 minutes to the hospital.

Amy's day at MICS begins with a staff prayer meeting before the students arrive. This is followed by a chapel service with all the students and staff and then classes are underway by 8. There are six grades at MICS - Reception (Kindergarten) through grade 5. Amy teaches sewing (FACS!) to each grade and language arts (spelling & phonics) to grade 3. She also helps with library and art on Thursdays and Fridays. From 12 - 1 she has some planning time, but she's found she often has planning to do at home too. Her school day is over at 13hrs (that is, 1pm).

Dan's day starts with a morning report of sorts with the other students, physicians and medical officers. Then it's off to round on the wards where you're assigned (Maternity, Paediatrics, Male, Female). On Tuesdays and Fridays, rounds are brief and problem focused allowing time to get to the operating theatre (that is, the OR) for the bulk of the morning. There the "major room" is kept busy with exploratory laparotomies, bilateral tubal ligations, hernia repairs, etc, while the two minor rooms are a flurry of dressing changes, wound debridement, incision & drainage, dilation & currettage, casting, etc.

By 11am much of the cases are finished and some of us head off to the Outpatient Department (OPD) to see patients there (OPD is open daily at 11 except for Sunday). If all goes well we can break for lunch at around 13hrs and resume our duties in OPD at 15hrs (3pm) working until there are no more patients to be seen (usually not too much later than 17hrs). If there are other things to take care of on the wards, then the late morning or afternoon is a good time to get that done, OPD will go on without you. Saturdays start with rounds at 8 and are followed by OPD until lunchtime (i.e. whenever all the patients are seen).

Lunch, of late, has been nsima (the Tonga word for cooked maize mealie meal) and relish (sides of veggies or meat). We've hired a local woman to help with some things around the house, namely lunch prep and some laundry here and there. After lunch Dan heads back to OPD while Amy rests from her tiring day (or plans for up-coming lessons), or goes to buy bread, eggs or vegetables from a shop or the market. She can also sometimes be found at the local library - a small library housed inside a large shipping container.

There used to be four med students here, so we established a Q4 (every fourth day) call schedule. Now there are just three of us, but we've kept the schedule. We have a cell phone that gets passed around so that we can be reached if necessary. Being on call means helping the main person on call with evening rounds at 20hrs (again problem focused) and being available if anything (e.g. a C-section) comes up overnight. Sundays the on-call folks make morning and evening rounds and take care of anything urgent in between.

After "knocking off" (finishing) at work the evenings are our own. They are usually filled with cooking, reading, watching a borrowed movie or perhaps visiting some others in the area.

Flying Soon

In just fourteen days we will be headed to southern Africa for a two month stay. Our first two weeks will be spent visiting friends in South Africa & Swaziland before heading to Zambia for the remaining six weeks. There, Dan will be working at the Macha Mission Hospital, a Brethren in Christ hospital in rural southern Zambia about 70km (44miles) from a town called Choma. Amy will be volunteering at a school called Macha Innovative Christian School (MICS) nearby. Our travel is being made possible through the Mennonite Medical Association's Student Elective Term (SET) and Dan is also receiving credit towards some graduation requirements at school.

We are excited about this opportunity and hope to share some of our experiences here on this blog (and in person when we return).