On the road

More diary stuff...

15th July 2006

A few weeks ago, Catholic Relief Services donated a brand new Toyota Landcruiser to the hospital for outreach work. Lukwipa HIV support group have invited us to visit them, so Sister Martha, Bernadette and I hit the road with Mr Banda at the wheel. I have never been to one of these meetings before so I am not entirely certain what to expect. The road to Lukwipa is hilly, and within a few minutes I am feeling decidedly queasy. We arrive at the support group meeting and are invited to sit on the only bench, while the support group members are sitting on mats on the ground. Nobody seems to know what to say at first, and we all smile brightly at each other in the silence.

The discussion starts with some easy questions about nutrition, and Sister Martha is translating for me. I think I am doing all right. And then someone asks if it is OK to get married if you are taking ARV drugs. I say that these issues are for individuals to decide, my job is to help people to try and live as normal a life as possible. This answer satisfies nobody, and soon we are on to a debate about whether it is a sin to have a relationship if you are HIV positive. I am completely out of my depth with this. I talk a bit about risk reduction, condom use, disclosure of HIV status, rights and responsibilities but I am speaking a foreign language in more ways than one. I think what the group really wants to know is how God might judge them for their behaviour, and my vague answers about individual conscience are not up to scratch. I look desperately at Sister Martha, hoping she can do better than me.

The meeting then descends into complaints about our failure to ensure that blankets are distributed equitably, and the difficulties they have in finding enough food to eat. Like good international NGO workers, we tell them that we cannot help them with these problems, and then we climb into our shiny $45,000 4WD and go home. They seem pleased that we came to see them, although I don’t know if anything I said was helpful. But maybe our presence is more important than our advice.

18th July 2006

The first day of the mobile clinic – the hospice team are finally on the road. Although the team is somewhat depleted today – Bernadette is sick, so Cecelia and I go along with Joost driving. One of the many rules of using of the CRS vehicle is that all occupants have to sign a disclaimer before getting in, as the insurance doesn’t cover personal injury. We are giving a lift to four women who are going home from the hospital, and so I start the day with my clipboard and pen in hand, asking our non-literate passengers to sign a form that they are unable to read. There is much confusion, until eventually Cecelia signs for all of them. Conditions of use duly satisfied, we set off down the dirt road.

We arrive in Chimusanya, at a tiny church where the clinic is to be held. A small queue has already formed outside. We unload our boxes of drugs, and the first patient comes in. Predictably, it is total chaos. We see three times as many patients as we were expecting, and everyone seems to have a come with a ripe bronchitic cough today, so it all takes ages to sort out. We haven’t brought the right drugs with us, and we count out the pills crouched over the tiny wooden pews in the semi-darkness. I run out of paper halfway through the morning and end up writing notes on spare pieces of cardboard. And the patients keep on coming.

But in the midst of all the disarray, I am genuinely pleased to see the last patient arrive. Norah, the woman who had the Cesaerean section last month, turns up with her baby daughter Blessing, and when she tells me that they are both doing fine, the day suddenly doesn’t seem so bad. We emerge from the gloom of the church to find that Joost has achieved some celebrity amongst the children of Chimusanya – the Landcruiser is surrounded by admiring five year old boys. Somehow we manage to leave without causing serious injury to any of them. Not an auspicious start to our outreach service, but a start nonetheless.

Online and dangerous

This post comes in the wake of two wonderful events - one of these is the recent arrival of internet access in Mpanshya. More significantly, my sister gave birth to a baby girl this morning, thus continuing the family tradition of female domestic dominance. Never mind Stephen, there's always the Playstation if it gets too much. And welcome to the world Rebecca, today I am wishing I was in a less far flung corner of it.

26th June 2006

It is a chilly Monday morning. Chas gets up at 5am to get a lift into Lusaka with the ambulance. I grunt a goodbye and take possession of his half of the blanket in an effort to stay warm. I get up not one moment before I have to, and I brace myself for the cold shower. My standards of personal hygiene have declined with the ambient temperature; these days I only wash if I really, really need to.

27th June 2006

Today is another momentous day for technology in Mpanshya. There has been talk of a satellite internet link being installed since we arrived, courtesy of a Swiss donor. I come home at lunchtime to find a ragged looking hole has been drilled in the wall of the back bedroom, and a mysterious box with blue lights has been deposited within. I discover later that the only place where you can actually get online is the convent, but the power for the connection is in our house, so any would-be surfers are obliged to knock on our door and request that we plug in. There is something distinctly Zambian about this arrangement, but it would seem churlish to dwell on a minor inconvenience in the face of such astonishing developments. Before we came here, we prepared ourselves somewhat glumly for a life without access to modern communications; now it seems that we will soon have broadband in our house. If I was actually bothering to follow the World Cup, I’d be resolving to cheer for Switzerland now.

And then Rachel arrives. She is a widow, and I have seen her several times over the last few months, since she and her two young children were diagnosed with HIV. She was one of five siblings, but is the only surviving member of her own family. She is very pregnant at the moment. Her oldest child died suddenly at home two weeks ago, she is here to collect medication for her little boy, who seems to be doing well. I have never seen this woman not smiling, and today, she beams and assures me that she is fine. I think she knows that my language skills would not withstand a more accurate description of how she feels at the moment, even if she felt inclined to discuss it, so we stick to business. Even after being here for a while, surrounded by evidence of sickness and shortened lives, some people’s stories get beneath your thickened skin.

I leave the clinic and am greeted by Theresa, who has been in the hospice for a few weeks. She has been getting in trouble from the carers for various misdemeanours – spitting on the floor, shouting at other patients, failing to put any clothes on. She would not seem out of place in an A&E department in the west of Scotland, but her disinhibition is pretty incongruous around here. I can’t help liking her, but then again, I don’t have to clean her saliva off the lino. She is sitting on the ground cradling a cooking pot between her legs. She grins at me and shouts “Hello sister!” I am pleased to note that she is fully dressed today, but as I come closer I realise that this uncharacteristic attempt at modesty has not included underwear. Still, it’s progress.

6th July 2006

The long planned fact finding mission to St Francis in Katete finally happens today. There have been weeks of negotiation with Sister Sabina as to how we might get there. She managed to beat us down from the new Landcruiser to the ancient vanette, but she did concede the services of the hospital driver, Mr Banda. We squeeze into the pickup with Joost, Bernadette, several members of the Banda family and some unidentified boxes. We set off only an hour late, waved off by Sister Sabina who tells us that we must not forget about Mpanshya. I think she is worried that we will have our heads turned by the Katete metropolis.

Before long we are bouncing along the Great East Road, which seems to be more potholes than tarmac in some places. We pass Luangwa Bridge and we are in new territory. Mr Banda maintains a steady commentary on the various fatal bus crashes which have occurred along the way (“and just here…came right off the road…many, many people dead”). I doze past the villages and farms, and five hours later, we reach St Francis.

We are staying at the Tikondane community centre next to the hospital, which is a great place, although sadly devoid of hot showers. We meet up with the medical director and she shows us around the hospital. It is enormous, with about fifty patients tightly packed into every ward, and it takes us the best part of an hour to see everything. Mpanshya feels sleepy compared to this place. Bernadette and I arrange to return in the morning to sit in on the ARV clinic, and we head back to Tikondane for enormous plates of nshima and Malawian Carlsberg.

7th July 2006

Bernadette and I show up at outpatients at 9am, and find it is already heaving with patients. We sit in with a British doctor called Rachel who manages to see about thirty people over the morning, and they are still queuing up when she leaves to go for lunch. She is incredibly busy, but she has other doctors, pharmacists and counsellors working with her; at St Luke’s we have a slightly more DIY approach.

We travel to Chipata later in the day, which is near the border with Malawi. We are staying with Richard, another VSO person. He is a man of rare generosity in the notoriously penny pinching volunteer community. He takes us out for fish and chips at what he describes as the best restaurant in town, although he concedes that the title of Chipata’s finest eaterie is not hotly contested. We are joined by Dennis, another volunteer who has recently arrived from Uganda, and we chat in the darkness when the power fails. He tells me that I bear a striking resemblance to the late Princess Diana. Time for a haircut, perhaps.

8th July 2006

We are in Malawi for the weekend, courtesy of our tour guide Richard. We have a brief visit to Lilongwe, where Chas becomes slightly overexcited about the availability of digestive biscuits and Hula Hoops. Richard takes us to Senga Bay on Lake Malawi, which is a lovely place. We check into a lodge there, and decide to take up the offer of a sunset cruise on the lake. It all seems like a very good idea until we are two minutes from the jetty, and large waves start slapping into the side of the boat. After 45 minutes of pitching and tossing our way across the lake, we stagger off the boat and make a brisk retreat to the nearest bar for stiff measures of Malawi gin.

We return to the lodge for dinner, and are greeted by our host, who is formerly of the RAF. Initially I am too busy picking unidentified foreign bodies out of my food to pay much attention to what he is saying, but eventually he gets onto the subject of politics, and expresses his nostalgia for the eras of British colonial rule and of Hastings Banda. Chas challenges him, and he responds with the usual strategy of stupid right wing bores, the Winston Churchill quote. I know that what he is saying is offensive nonsense, but I don’t know enough about African history to argue with him, so I have to content myself with a bit of theatrical eye rolling until he finally goes away.

The problem with Africa is that it is full of people who never tire of expounding on what the problem with Africa is, who seem to think that the British built an empire out of some altruistic impulse, and it’s all hit the skids since we left. It’s always on the tip of my tongue to ask why they stay if they find it all so disagreeable, but I know the answer. People like these are marooned on a continent that they don’t particularly like because they have nowhere else to go; they would find their homelands unrecognisable if they ever returned. So they stay on in Zambia and Malawi, preserving their own small empires and mourning some mythical golden age.