Tuesday, July 27, 2010
I went to a local school today with the Zambian data collectors to assess children. The school we went is a Basic school, which is from grade 1 to grade 9. I noticed that not all students go to school for the entire day. At least from what I learned, for the lower grade, only half of the kids go to school in the morning and the rest go in the afternoon. The classes are divided by girls and boys, so all girls are in one class and all boys are in another.
In the afternoon, we went to the villages to visit some families and collect additional consent forms. It was a bit shocking to see how people co-habit with animals so closely. Chickens, pigs, goats, dogs, and guinea fowls everywhere. The dogs were sleeping most of the time, chickens tracing one another, and pigs all do nothing but sniffing on the ground. If there is one thing I have coped with well so far, it is with the animals. Usually they mind their own business and would not bother you.
There is one incidence though that made me concerned about the animals being so close. When we were in a family talking to a mom, she and her little kid (looks like about 2 years old) were sitting on the ground. The kid was eating some nshima (a type of staple food made of maize) from a bowl. I noticed that the chickens constantly sneak stole food from the bowl. The poor child was making fists angrily but he was too small to stop the chickens from coming. Her mom was talking to us and didn’t pay much attention to the kid.Then all of a sudden, a really bold pig almost ran over that kid to get the food. The mom finally realized it and drove the animals away.
The families we visited live in typical rural households. A typical family has multiple small houses. They cook in open huts, sleep in the house made of brick with a grass or tin roof, and they keep their animals outside with dogs to safeguard their home. The typical daily food they prepare is vegetables with nshima. Only in special occasions will they eat meat and poultry. When we arrived, they offered us stools made of tree trunks. One family offered boiled pumpkins and it was probably the best food they had.
Sunday, July 11, 2010
I went to a restaurant for the first time tonight (yay there is a restaurant!). The restaurant was about 20 min walk from the campus, and was literally in the middle of the villages. A group of us medical students and researchers went together. After walking in pitch dark with a bunch of flashlights, we saw a house with bright light in the field, and so it is the restaurant!
Prior to going, we all ordered by text messaging to the owner of the restaurant. You have to order in advance because they don’t always have what you want. And if you order when you go there, you’ll have to wait for 2-3 hours before getting your food. The options are very limited so you just order from the few things they have. Nshima is a type of famous staple food here. It is made of maize. The flavor is kind of a blend taste similar to rice. You are supposed to eat by using your hands and mix with sources. I had Nshima and Tonga chicken with some greens (The type of green vegetable that are abundant here is rape).
We had to struggle with some grasshoppers and bees during the dinner, otherwise the restaurant was really fine and I enjoyed my first soft drink since I got here as well. It is fascinating to think how dependent we were on these products in North America. Forget about diet coke, I was happy enough to see glass bottles of Fanta and Spirit.
It is not news that Sub-Saharan Africa is in an endemic of HIV. However, I am still shocked of how prevalent it is here everyday. When you review medical charts, almost every other one belongs to a HIV positive patient. Luckily, most of them are on ART, and HIV is moving towards like other chronic disease. The stigma has largely diminished. People go to ART clinic regularly to get their treatments. A vigrous big public campaign has been put in place to urge people to test for HIV, called VCT (voluntary consulting and testing). In schools and side of the roads, you’ll see billboards with signs like “Protect you and your family. Get tested for HIV”.
Today I had my very first suturing experience on an HIV positive patient. He was suspected to have kaposi’ sarcoma, an indication of stage IV HIV, and we wanted to biopsy his skin to test if he has it. I wore double glove and sutured the-cutaeously on the skin cut after the biopsy was done. Interestingly, I was so focused on the suture that I totally forgot it was a HIV positive patient.
I saw a live snake today on the path in front of my house! It was light green color, quite big and long. The snake was slithering along the side of the path near the grass edge. At one point, it crossed the path to the other side, and the entire length of the snake is longer than the width of the path. It was pretty fascinating to watch, at a distance of course. I am glad that it is dry season and winter here now, so snake is relatively scarce. I heard that in rainy season like November, there were snakes and rats everywhere. Rats even came into the houses.
Ants have been a major problem though. Whenever I leave a small piece of bread crumb on the counter, within minutes there will be a big ant troop moving. The toaster in the kitchen is their favorite site. I was pretty apprehensive about this at first, but now I have learned to live with them.
This afternoon at the OPD (Out-Patient Department) I was with another Dutch medical student seeing patients. Suddenly we all heard it was getting rowdy outside. We didn’t pay attention at first, but then the noise get louder and louder, so we stepped out to see what happened. I haven’t seen such a gathering for a long time. Men, women, children, women with babies, were all standing around, talking and pointing at something. The center of the attention was a man in red shirt at a distance. He appeared pretty angry and was throwing stones at one of the hospital building window. A bit distance away, an old woman was crying. We were puzzled by what happened. A nurse told us that the man was angry and bit that woman, and now he was throwing stones. A few men went over to catch him, and people said that he would be put into the cellar. The so called cellar is a small room in the Macha police station, which is right in the next to the hospital. It is a little brick house with merely three rooms, the “cell”, the “inquires office”, and “the office in charge”. A few moments later, the entire crowd was running and yelling, without knowing what’s going on, I just saw people laughing and screaming, as if they are all going to the same direction trying to catch that person or that person is approach to this direction and people are running away. It was such a chaos! People seemed to be enjoying this though because they were all out and looked very happy even when they were running and screaming. Eventually we had to lock the office door to not let it interferes with work.
Wednesday, June 30, 2010
Another interesting day today. I was in the “male ward” following round this morning. They call it male ward for men age 5 and up, so you would see 7, 8 yr olds sitting on the beds playing with their crutches. The ward is divided into surgical and medical sides. On the surgical side, there were many trauma, broken bone, and fracture cases. Many of them were from ox cart accidents. Ox cart is the major form of transportation around the area. On the medical side, there were astonishing amount of HIV/TB infection, almost every other beds was such a case with all sorts of complications. I saw a patient with Steven-Johnson’s syndrome and another with Kaposi’ sarcoma.
In the afternoon, I went with two Zambian research team members to a local school for the parent meeting. The purpose of the meeting was to explain to them the project and ask them to sign the consent form. The parents were very enthusiastic and asked tons of questions. Their biggest concern was collecting saliva sample. They believed that there was something suspicious about taking saliva. Eventually we were able to explain to them. Some of them could not write, so they used ink fingerprint as a signature. The school we went was a basic school, which include grade 1 to grade 9. The kids were really curious when they saw us. Many of them came up and stared at me, LOL I guess they have never seen an Asian face before.
Oh and a really funny story today. I am usually a bit apprehensive about taking adult pictures because I am sure if they liked to be photoed. But today at the market when I was taking surrounding pictures,a woman came up to me and said “can you copy me”? So I “copied” her on the camera and she was very happy to see herself in the camera.
Friday, June 25, 2010
Football (not the American kind) is a huge thing here. Especially now since the world cup is playing on African continent. Everyone is talking about it. People take tremendous pride of their African teams. Among them, Ghana is many people’s favorite.
Although not a football fan myself, that Sunday afternoon I was talked into watching a football game between Macha Sparrows (the team represents macha) and a team from another area. The football game was played on an open space of sand ground near the town market. The teams are supposedly professional leagues in Zambia, so they have their uniforms. The players all had pretty amazing skills and they played furiously. I soon found out that some players were actually playing with bare feet, but that didn’t affect the intensity of the game at all.
On my way back some, I saw some beautiful sunset lighting up the clouds, and juxtaposed among the trees. So I thought, what a world.
Thursday, June 24, 2010
This morning I went to the local Christ church. Most people here are raised Christian, and going to church on Sundays is their routine. I went to the Brethren in Chris (BIC) church, the largest around this area. The church is located in a well-constructed brick building similar to the houses on campus. The interior was a T-shaped room with long benches on three directions of the “T” and a podium in the center. When we got there, the room was already packed. There was a lady at the door to escort us to our seats. Women and men were seated at two opposite sides. Children were sitting on the ground in the front just under the podium, and students were in their uniforms sitting towards the front as well. Old women were dressed in pure white and wear a white head cover.
The service started by a group of women, all addressed in beautiful African gowns made of Chitenge patterns, singing cheerful African songs in front of the podium. The lyrics were in Tonga mixed with English. The song sounds like a medly and towards the end of each segment, the audience would sing along with it. Everyone was smiling and moving with the rhythm and the echoing made up powerful sounds in the church. There were some men sitting on the podium. I guess they must be the priests and important figures of the neighborhood(such as a chief or headman). After the singing was over, two priests came up to the front of the podium and made some announcement. One of them would make the announcement in Tonga, and the other would translate it into English. One announcement I remembered was that there were some sort of Women’s conference at the church next week.
I was reminded in advance that as a tradition they ask new comers to go up to the front and introduce themselves to the entire church. So not surprisingly, the priests invited “the visitors to identify themselves and come to the front”. So I went up along with a few others. After I introduced myself in English, the translator said something in Tonga, and people laughed. I was very confused, later they told me that the priest didn’t get my name so he translated “her name is her name”. It’s funny cuz people frequently pronounce my name as Ping (my favorite is that one of the doctors in the hosptial called me “Pink”…) Among other visitors, there are a group of people from South Africa selling Bibles, and there was a guy from Kenya.
The rest part of the service include a speech by Dr. T, who is a pediatrician from the U.S and has been working in the hospital here since the 70s, he is also the director of the research institute and helped made my trip possible. He gave a moving speech about patience, service, and gratefulness. Although I am not religious, the main points he delivered is true to life in general.
After the speech, there are more singing by different groups. There was the Macha male voice (I heard that they released a CD recently), the equivalent “macha female voice”, a group of old ladies and a group of students singing. There was even a man singing and playing on the keyboard. The audience also sang along with some of the songs in Tonga. It was quite amazing.
at the end of the service, the children left first because they had Sunday schools to attend right after, then the sequence is students, old people, and men and women. The entire service lasted more than 2 hours so I was super hungry when it was over:)
Friday, June 18, 2010
Life here is very simple. I’ve been getting up before 7am everyday and go to bed earlier as well. The roads are unpaved, and when you are driving, you have to slow down from time to time to let donkeys, dogs, roosters, cows, pigs…you name it, to cross. Interestingly they recently put on some speed-bumps on the road (see picture), but as a matter of fact, with sand road like this you really cannot drive too fast. People I have met so far are all very nice. I still could not recognize local people very well, partially because I have met so many people these days. I remember the first day I had an awkward encounter of forgetting a colleague I just met about 20minutes before. Food is the only thing I have not got used to yet. There’s no meat in the little market here. Although I have heard that they have live chicken, I don’t know how to handle it anyway. So I have been practically a vegetarian since I got here.
I spent my Saturday morning in the hospital again following rounds at the pediatrics wards. I feel like I’m learning so much everyday just by seeing all these cases. Today I saw a malnutrition baby with rachitic rosary, which means bead-like bumps present at the junction of ribs and cartilages. It is often seen in children with rickets (Vitamin D deficiency).
Tonight we had some friends over and cooked dinner at my house “Cheetah est”. Among them, there was an girl who has been volunteering here for two years teaching at a local high school, and a nurse who was here working at the hospital for about an year, a couple medical students and a Zambian researcher in the lab. After dinner, we all watched the US versus England football game.It was a relaxing day overall.
I could not upload pictures due to the slow internet. will upload later!
The hospital has several wards for inpatients, including the male and female wards, pediatrics, TB wards and maternity wards (with a delivery room called the “labor suite”:). The operating room is called the “operating theater”. It also has several departments including OPD (Out patient department), labs, pharmacy and a chaplain.
Tuesdays and Fridays are the days for surgery. Today Dr. Yomo, an orthopedics surgeon from Lusaka, was here to do some operations. There is no orthopedics surgeon in this hospital, so they accumulate orthopedics cases to wait for him to come do procedures every two or three months. The first case I saw today was a partial hip replacement. The patient’s femur head was fractured so they had to replace a prosthetic femur head into the position. The whole procedure was quite traumatic and there was lots of drilling, cutting and pulling. I was surprised by how different the standard of sterilization is here. Except gloves, all the gowns, caps, clothes, and covers are reusable. The cloth covering the patient had stains on it. The scrub-in protocol is pretty standard however despite the lack of equipments. I asked about the post-surgery infection, and was told that it was not a significantly large amount. These patients are usually on heavy antibiotics post-operation for a long period. The next procedure I saw was plating a broken radius. The patient broke his radius and ulnar bones, however only radius was stabilized with a plate because there was no extra plate available for the ulnar. “Hopefully the ulnar will be straighten and grow back itself”, says Dr. Yomo. Another frequent thing Dr. Yomo said during his surgeries was “normally we would do this and that, but here we don’t have it, so we will do… instead” It was amazing to see some creative ways he used the instruments. When he was taking the fractured femur head out, he used a speculum to stabilize on one side and pop it out. In resource poor setting, you just have to make do from what you have.
I also saw a C-section today. Compared to the one C-section I saw back in the US which took about 2 hours, this one took about 10 min. There are two surgeries room. One is for “major surgery”, which requires full scrub in with surgical gowns and gloves. The other two rooms are for “minor procedures”, and all you do is put on the sterile gloves. This C-section was done in a “minor surgery room”. The patient was a skinny 16 year old, it literally took the surgeon Dr. Moon a minute to cut open the belly and expose the uterus. Another few minutes, he took the babe out. The newborn was delivered post-term and was compressed in the uterus and couldn’t get out for the past two days. There was no warmers or any fancy cleaning equipments we use in the US. The newborn was patted in the back to let it cough out the mucus, and wrapped in a towel. A nurse uses rubber bulb to suck out the mucus in the babe’s throat and nose. When the babe started to cry and get less blue, it was putting to the side of the mother. The entire procedure took 10 minutes. I still couldn’t believe that.
Besides the hospital, a few days in Macha, I have been quickly introduced into the social circle of students and researchers around the campus. There are quite a few medical students and researchers from Holland, as well as a few Americans. Tonight, I went to a Dutch family’s house for a movie night. The husband manages the properties in the institute, and the wife is a doctor at the hospital. They have a 6 year old girl. When we came in, the little girl was playing puzzle with a Zambia girl. They have a projector to play the movie on the wall. It was pretty nice. The movie we watched was called “the cider house rules". It is about this boy growing up in an orphanage in Maine. The doctor in the orphanage wanted to make him his successor and trained him to be a good Ob/gyn doc (the orphanage also does abortion for women). However, the boy didn't want to become a doctor like him, rather, he was eager about the outside world. So he left, and worked in a apple farm, there was a lot of things happened, he fell in love with a beautiful woman whose fiancée was at the WWII and was also his friend (similar to the love twist in “Pearl Harbor”), he had to do an abortion procedure for the girl in the farm who was raped by his father,and many other things, eventually he went back to the orphanage to take place of the doctor, who overdosed himself with alcohol before the boy returned. It was an interesting movie with some mixed message, but it's interesting nonetheless.
When we walked back from the movie night today, it was pitch dark and really serene. Everyone here walks with a flashlight at night. It is so dark in the surroundings that you really can not see anything when there is no light - just too few photons I guess. But the stars are really big and bright. It’s mesmerizing to watch them. They are also sorts of in 3 dimensions, you can tell which star is closer and which farther away. And it’s even more amazing to watch when they are half covered by cloud. It makes you feel that they are really close to you.
Tuesday, June 15, 2010
This Is Africa (TIA) Three days in Africa I still haven’t got over the fact of how wondrous this place is. It is a different world. The house I am staying at the research institute and the hospital campus is quite nice. The place has the rare luxury of hot water and internet. It even has its own generator. Last night the power was out in all other places for couple hours, but in my house we only had a couple minutes of black out. Internet is painfully slow, but I’m getting use to it- compare to the surroundings, I feel quiet spoiled to be honest.
The research institute has its own garden where we can get fresh vegetables and fruits. I went and got some fresh carrots, strawberries, and lettuce. I didn’t experience much jetlag the past few days. It is quite nice also that I have completely quit coffee since I got here. Embrace a different life style!
This morning I rounded the hospital pediatrics wards with Dr. S. The peds wards here only admit children younger than 5 yrs old. Most of them I saw were newborns or infants carried by their moms. The wards have several rooms. Each room has up to 16 beds with tight space and very poor ventilation. There were lots of kids with malnutrition and HIV/TB infections. It was heart wrenching to see these little kids wrapped in layers, weighed less than 2kg, and had no fat around their bodies. Their skin is hypo-pigmented and hair color golden because of protein deficiency. There was one critical room (similar to ICU in the States) where there is AC to monitor the room temperature. The kids there were all quite sick – I saw one with meningitis and another with cerebral palsy and spastic diplegia.
Sunday, June 13, 2010
It was quite chilly when I got up this morning. The temperature must have been down below 10C (50F). I landed on the coldest month of
The bus ride to choma is quite interesting.
When I arrived at Choma at the bus station, again there were more than a dozen people came up to offer you to go to all different destinations. Most of them are not with any taxi/cab companies but have their private cars. When I asked for directions to the place where I was supposed to meet the driver, a man insisted to walk me over there which was only about two minutes away. He was very friendly, but asked me tons of personal questions like “are you married?’ I found it slightly amusing and frustrating at the same time.
People here refer a certain time of the day as hours. So they would say 2:30pm as “fourteen thirty hours”. I was going to meet the driver Stem at 13 hours. Stem comes up to choma once a week to pick up mails and do all kinds of shopping for the institute. He drives a big truck with a mechanics and an accountant. They were nice enough to let me sit in the front of the truck, and the mechanics and other people who hitchhiked back to Macha with the truck had to sit in the open trunk.
The route from Choma to Macha was almost all on unpaved sand road. So whenever there is a car driving by, the sand would be blow all over and block the sight. What’s worse is that it really irritates the throat and the lungs. Luckily we were in the front and could close the window. I feel bad for people in the back of the truck breathing in the sand. The truck broke down in the middle and it took them a while to fix it.
Whenever we stopped at little village centers, we were surrounded people carrying goods to sell. There were woman carrying cabbages, tomatos, bananas, green pepers, all sorts of vegetables, and men tend to have stuff like sunglasses, shoes, or small groceries like mirrors and toothbrush. They were much more, and it was really amazing to see the scene.
Finally, regarding my stolen laptop and electronics below is the reply from a colleague:
“Oh too bad! I should have warned you! Joburg is very famous for these things happening. The best story I’ve heard was that a finnish guy had put new leather shoes to his suitcase, coming from helsinki-joburg-lusaka. When he opened the suitcase in
Wednesday, June 9, 2010
The flight from Johannesburg to Lusaka was a short one—1.5 hours later, I was in Lusaka, the capital city of Zambia. The land was a mix of green and yellow, a typical scene of African. I picked-up my only check-in suitcase quickly, so I can meet with a colleague and hand her the laptop the lab asked me to bring it to her. I put the laptop in my check-in suitcase because I already had my own laptop in my backpack and couldn’t fit another one without abandon other necessities I need on the road. So I wrapped it in a blanket and locked my suitcase and never gave it a second thought. As soon as I got the suitcase though, it doesn’t feel right. The locks on my suitcase were broken, and all the items in the luggage were clearly shifted and all over the place. With a glimpse of hope, I searched the entire suitcase thoroughly, but could not find the laptop. Bewildered, I could not make sense of what happened. The colleague, however, was not surprised. She told me that the luggage was likely stolen at Johannesburg during transfer. “If they scan inside, then they could see the laptop pretty easily. You should never put electronics in check-in bags. This is Africa.” she said. I was shocked. I would never imagine that international airport could so easily do things like that. I went back in to file a missing item report, the people at the counter all concurred that this is most likely stolen in Johannesburg. “This is Africa!” a man waiting in line behind me said bluntly. He is filing for a missing box. Somewhat frustrated and amused by the notion, I proceeded to leave the luggage area. The person at the exit came up to verify my luggage ticket again, seeing I was the only person there, she murmured something like “drink money”. “Pardon me”? I said, wasn’t sure what she was talking about. “Money to buy drinks”, she said, one of her hands stretched out, and the other on my suitcase. Still confused, I asked if she wants tips. She was clearly irritated at that moment, and said “give me some money to buy drinks!” Still don't know what's going on, I gave her two dollars- I was afraid that she was going to hold my suitcase unless I give her the money! I guess it is somewhat understandable for people who earn a few dollars a day to ask for money like that, but I still couldn’t get over the fact that they stole my laptop with such ease. There is no way to locate where my laptop went; Zambian airport insisted that it could only happen in J-burg. Upon further examination of my suitcase later when I get to my destination Macha, I found out that I also lost my outlet adapter (It is European style outlet here) and the USB transfer cord for my camera. I can’t imagine not uploading any pictures in the next two months!!
Currency exchange is another deep learning curve I have to go through. With 1 USD to 5000 Zambian kwacha, I handled my very first million kwacha transaction today-all in cash! The hostel I stayed overnight in lusaka is called “chachacha backpackers” . The 6 bulk-bed lodge I stayed in looks exactly like Washington’s winter camp in Valley forge national park, except with mosquito nets. The temperature was at around 30C (85F) around noon, and dropped to what feels like 10 C (50F)at night. When I was using the sink, a giant yellow cat jumped on the counter quietly and creped me out. Some other friendly visitors include a lizard on the wall, numerous spider webs, and ant troops. However, none of the big 5 s, not yet.
The capital city Lusaka somehow reminds me of my hometown Ningbo in its early nineties. The poorly-paved road, the dust of yellow sands, the smell of the gasoline, the crowded open market, the aggressive taxi drivers calling out for business, are all somewhat reminiscence of my childhood in Ningbo.
Finally! The last couple days had been really hectic.finishing qualifiers, visiting Montreal, moving into a new apartment, and boom, pack and go! This morning, after 3 hours of power sleep, I woke up at 5am to catch the CT limo
to JFK airport. This is my very first Africa trip and I can feel the adrenaline rash in me just to think about it. Not for long though, I fell asleep very quickly on the limo.
My flight was with South African airways (SAA). If not for what happened afterward (it may not be their fault anyway), I would probably vote SAA the best airline I have flew with so far. SAA has excellent on-board service. They provided comfy blanket, a pillow, a headset, mini toothbrush set, eye-covers, and even a pair of warmers for feet! On the plane were many soccer fans going to South Africa for the World Cup. The majority of them are Mexicans and South Africans. They were friendly teasing each other all along the way. The South Africans were chanting their national soccer team “bafana bafana” (means boys), and the Mexicans proudly claimed that South Africans were going to loss, but “we still love you, we will love you more after you loss”. Upon landing, the SAA crew members even put on soccer uniform with “crew” words printed on it.
Fourteen hours later, with two delicious meals and numerous naps, and the entertainment of Sherlock Holmes, I arrived at my first stop in Africa- Johannesburg, South Africa, feeling excited and fresh.
It was local time Jun.8th at 8:40am when I arrived at Johannesburg international airport. The weather was very comfortable at its low 20C, not too warm or too cold. The sky was clear and peaceful. The airport itself was not that different as any other international airports. It has numerous coffee shops and duty free stores. The names of the stores were of Africa signature, such as “Out of Africa”. From the postcards I bought I learned that the “big 5” of Africa are “lions, leopards, white rhinos, elephants, and buffalos”.