Mary Westfall’s Blog

On top of the world

Hello all! I have been having a few troubles with the internet the last couple of times I have tried to post, but this time…success! Hope you all have had a good weekend.

On Saturday a couple of other students and I made the trek out to the water tower. This is one of the Macha “attractions” as it gives a wonderful view of the countryside. This part of Zambia is remarkably flat so it is sometimes hard to get the lay of the land. To climb the water tower we had to go in through a door to the utility shaft in the center of the tower and climb a narrow metal ladder up several stories. When we opened the door we found the ladder, some old boxes and tools…and a bed with a 10 year old boy on it playing solitaire on an old desktop computer!!How random! His couple of changes of clothes were hung over some old boxes and from all apparent signs the water tower is his bedroom. He may belong to one of the families that lives around the tower, but it was such an unexpected thing, both the living in the tower part and the contrast of apparent poverty and the computer - this place is full of surprises!

So those of you who have gone down in the Big Well of Greensburg, Kansas have a good idea what it was like to climb the tower…only in reverse of course. For those of you who haven’t think about an old metal ladder in a damp smelling, relatively dark tunnel. When we climbed out on top of the tower the view took our breath away. Brillant emerald fields and forests stretched away on an even plain to the hills far in the distance. The green expanses were crisscrossed with red roads and dotted with clusters of houses. One little compound near the tower consisted of 6 small houses with thatch roofs, a bare dirt yard surrounded by a homemade pole fence, and a large garden complete with rows and rows of bannana trees waving their broad leaves in the light breeze. Stretched across the compoud were several rows of brightly colored laundry and near the clotheslines a group of small children (surely the cuprits of all those dirty shirts ) were jumping up and down waving at us. “How are you!” they cried, again and again (this is for them the correct English greeting and probably the only English they know). This compound may be a polygamist family where the husband has anywhere from 2 to 6 wives. In those families usually each wife has her own hut and her children stay with her (until they are older and then they may move into a hut for older children). Polygamy is decreasing slowly in this region but is still quite common.

Sunday has been a lovely, relaxing day including church and a wonderful lunch at Dr. Spurrier (the medical director) and his wife’s house.

Saturday was my last official day in the pediatric ward and it is hard to leave. It is so easy to become invested in every case there. However, I’m sure they won’t mind if I check in every once and awhile :-). I switch to maternity on Monday, so that will be an awesome learning experience. The maternity ward manages both pregnant mothers and postpartum mothers with their newborn babies…so lots of good experience both in obstetrics and pediatrics.

The next time I am able to post I will do another Q and A! Thanks again for all the comments!

Love you all!

Big day

NOTE: this was written on Sunday night but just posted due to internet issues

Hello all! It is 10:30pm here, quite a late hour by Macha standards, and I should probably be getting ready for bed. However, it has been a big day and I feel that it is all running around in my mind. It is nice to have this way of getting it out. I am on call today so I did rounds in the hospital before church and then took the on-call phone to church with me. Halfway through the service I got a call - I was needed at the hospital to give the official medical pronouncement of death.

It was a long walk back to the hospital. Although this was a patient that was expected to die sometime soon it still weighed on my heart. She was only 29 years old and HIV had ravaged her body till she looked brittle and hollow. A Canadian physician who is volunteering went with me and as we walked to the little brick building that serves as a morgue the rhythmic, wailing lament of the grieving family filled the air. Around the door of the morgue a group of 5 women sat in the dirt alongside an older woman with grey hair - the young woman’s mother. Together they kept up the sound that is like a song but also like a cry - it seems to be the traditional sound of grieving, something families do together as they sit around a lost loved one. It seems healthy to me in some way, like a way to express a feeling that is beyond words.

After this sobering experience I spent some time alone in prayer and had my own little moment of grief for a young woman who I did not really know, but who touched my life somehow. When I was done I left her in God’s hands- I will carry the memory as a reminder of the importance of the medical work being done here and as a testament to the impact of each individual life, even in the midst of a public health crisis like HIV. But be assured that her memory and those of the others are not a burden to me. Those chapters are closed but the story goes on - there is still so much more of life and joy and healing here than there is of death.

And that was the theme of the rest of the day. In the afternoon I went to a soccer game (football as it is more logically called here ). It was a major community event that took place in a dirt field near the market. There were no bleachers but there was a great turn out as the fans clustered around cheered and booed as occasion required. It was the Macha boy’s team versus a neighboring village and the community feeling was as strong as at any high school football game at home. It was a good reminder of the normalcy of life here too - this is a great community of people: families, neighbors, school kids, people just living out their lives in ways quite similar to ours, although the externals look quite different.

The highlight of the day though came at the end. On evening rounds the nurse called me to deliver a baby. Now I have assisted in deliveries at home, but always with other physicians present. This time I was the only “doctor” (in training) present, but strangely and uncharacteristically I was not nervous. The nurse has had a lot of experience and she was a good coach for both me and the mother :-). This was the mother’s first child, so the process was a little slow and difficult, but in a relatively short time, I was holding a brand new healthy baby girl. Both mother and baby did beautifully after delivery and the new mom was delighted with her adorable daughter.

I left the hospital elated at this new life and thanking God for the timing that let me help to bring in a new life in the evening after helping to pronounce one ended in the morning. A good reminder that there is always hope and always new life…and always a chance to try to improve conditions for the new generation. Macha Hospital is doing that, and it is an encouraging thing to see.

Q and A Part 2

Hello all! I have not had internet access for a few days due to storms so this is my first chance to do a second question and answer post. So without further ado, here are the questions I saw in the comments:

1) Did I bring the right clothing? Absolutely yes, although in the cities it is now more widely accepted for women to wear pants (or trousers as they say here ) In the rural areas it is still considered inappropriate. So I have about seven skirts (most of which were made by mom - thanks mom!) in light fabrics and bright colors - so I fit right in except for the glaring abnormality of my light skin, hair, and eyes ;-). Which leads me to my second question…

2) Laundry: the lovely ladies who provide housekeeping services for the MIAM research facility and dorm will do my laundry for a small fee. However, they only do it about once a week so any needs in between times involves handwashing in the bathroom sink and hanging out in the shower or the outside clothesline (I brought a small bottle of woolite from home having used this approach during study abroad in spain).

3) Internet: yes, I am able to get on pretty frequently which is an unheard of blessing in the midst of rural Africa. We have internet thanks to the devoted efforts of some of the community developers here. It is basically required because the MIAM research facility is an important malaria research field lab and the hospital is involved with a lot of research in HIV and TB control. So the various studies require internet access to collaborate with out of country peers, check data, etc. We get internet via satellite so storms frequently interrupt our service, as do power outages. These also sometimes mess up the interfaces so we don’t have access for a day or so after a storm Additionally, the internet is very slow and cannot open some sites (including my school email account). However I am certainly not complaining as it is usually available and gives me a wonderful link to share this experience with those I love and get encouraging news from home!

4) Time off: This is dependent on patient load and flow in the hospital and varies day to day. We work 6 - 7 days a week (only sunday if you are on call) with usually a half day on Saturday. In the evenings I am free after 6pm unless I am on call. During my free time I visit with the other students (initially I was alone except for a Dutch medical student - now there is a medical student from the States and his wife, a German medical student, two student malaria researchers from the States, and 2 new Dutch students for antibiotic research). Probably my favorite free time activity is walking and exploring around the area (yes, safely, and keeping to appropriate paths). One of the docs here also loaned me a great Tropical Medicine textbook to read up on my patients and the common diseases here - I also have a data collection project to complete in open time. I also brought a few paperbacks from home which is nice - and of course there is the internet!

5) Getting to town: the short answer is no, we don’t get into town :-). The nearest town of any size is Choma, about 2 hours away down a ridiculously bad road. Seriously. I can’t even fully explain it. It is of course not paved and the rainy season washes out huge rivulets and grooves, and creates massive potholes. It is too far to walk and motor vehicle transport is extremely limited, both because there aren’t a lot of vehicles in Macha and because no one wants to travel that road if they don’t have to (the damage to the vehicles can be serious). So there is an occasional transport option, but it isn’t something you can easily do in a day, and that is usually all we have off in a week.Going in to town might be something you do once a month or so.

6) Bread: I had a question about the bread (which is so wonderful by the way). There is one little brick one room store that sells bread to the community. They have an outdoor stone oven that they bake the bread in. The staff works hard to keep the oven fire just right and the bread is available once per day until all the loaves are sold. So usually people ask at the store in the morning, “when will the bread be ready?” and then people come to get their loaves. Families who must survive off of what they grow themselves usually don’t buy bread - they prepare the traditional nshima as I described earlier.

7) Denominations: there are several denominations present in Zambia reflecting the different missionary presences in the past. The largest one here seems to be BIC (brethren in Christ). Denominational differences don’t seem to be much of an object of contention here.

Fred: Thanks Denise for inquiring about Fred :-). Fred, I am happy to report, is dead. I killed him myself after finding out that he might be not quite as harmless as the mosquito spiders. All of you who know how much I dislike spiders (including the killing part) can be impressed by my achievement - however, I must confess that the other night I was not so brave. The largest spider I have seen yet, roughly the size of a tarantula (although it was a different kind because it was crawling on the ceiling),  decided to have a slumber party in my room. I tried to be brave and kill it but only succeeded in wounding it…it crawled in to an inaccessible corner of my little closet…finally my dorm mate had to help me take care of it. Sigh. Oh well, you win some, you lose some.

Love you all!

The weekend

Hello all! Hope you had a wonderful weekend…I certainly did, and I can guarantee mine was warmer than yours :-). We have been hanging out with highs in the mid-80’s since I have been here. Sunday I had the day off at the hospital so I went to church in the morning. It was so much fun. The church was established in 1906 by the first missionaries to this area. To get there you must walk 10-12 minutes down this narrow winding dirt “road” through the bush. I don’t know if I mentioned before, but dressing up for certain occasions is very important here. Of course at all times women wear skirts - usually a brightly colored/patterned piece of cloth that is tied around them sarong style (they usually have an under skirt as well). Then they just have simple short sleeved tops. But all those who are able have a “Sunday outfit”(and you would be surprised at how poor some the families are who do this). Many of these dresses and slacks and collared shirts have clearly been worn for many years (and many were probably hand-downs to begin with), but everyone is still as dressed up as they can be. This church in Macha has a very large congregation, and people walk from villages surrounding to come. So as you walk along the path in front and behind you are small groups of dressed up people, chatting and laughing on their way to church. It is very much a community feel and as I have said before, Tonga culture places a high value on personal interaction. I can’t walk anywhere without greeting and being greeted by everyone I pass, and everyone you talk to seems to really want to get to know you (as much as their English and my Tonga will allow ). As you come up to the church you step out of the surrounding trees and high grasses into a big open area with a fairly large brick building - even from across the field you can hear that people are already singing inside. Inside the church rows of simple wooden benches are lined up in front of a lecturn and a cross. The windows are open as there is no AC and about 500 people will pack into this building for the service. In front the girl’s high school choir is singing and clapping and dancing and the people in the seats are singing too so that the sound fills the building and spills outside.

The service is between 2 to 2.5 hours long. Seriously. But it is great because of the music. Hymns in Tonga, praise songs with a rhythmic beat, a few slow solos thrown in for good measure - but people here can SING and they enjoy it and I (who have never been a vocalist) can’t help but enjoy it with them. And I don’t want to give the impression that the services are wild and unruly - although everyone sings their heart out and people frequently stand and clap or even stomp their feet or sway to the music - it is all very orderly and very much like everyone is one big choir, not like a bunch of people trying to be soloists. The sermon is long too, but it is funny because there are 2 people preaching - one in Tonga (the local tribal language) and one in English (the offical government languge). Usually they alternate who is talking, but sometimes they both get going and just preach at the same time. And “meet and greet” time here is like nothing I have ever seen at home - it is like marathon meet and greet with everyone wanting to greet everyone and people wanting to know “how are you?” “how is your family?” “how is your work?” “how are you feeling today?” etc, etc. A little overwhelming for someone from a more reserved background, but very friendly nonetheless

Also this weekend I went to the market with some people from the hospital, went for a wonderful long walk out to the river, read a good book, and generally enjoyed about a day and half off (we got out early on Saturday).

Thanks again for the comments - it is so fun to hear from home. And stay tuned for Question and Answer take 2!

Question and Answer :-)

Hi all! So as promised I will answer the questions i noticed in the comments:

1) Meals:

Well, the traditional Zambian meal is nschimi (it is possible I am spelling that wrong ). It is kind of like cornbread batter (except more cornmeal, less good stuff). That is served in a common bowl. A little bit is scooped out with the right hand, rolled into a small ball, the you use your thumb to make a dent in it so you essentially have a scoop. You then use it to dip/scoop up some of whatever “relish” is being served at that meal (they really call it relish in english - I think that is so funny) . That may be some cooked veggies or beans (for most families) or if they have animals or are able to afford meat, cooked chicken, beef, or pork. I am staying at the MIAM dorm, part of the research organization affiliated with Macha Hospital. The research group (with the help of a partnership with Johns Hopkin) has built a pretty nice compound here in Macha. One perk is that a small staff of ladies who do housecleaning for the facilities also cooks meals in a small kitchen to provide for students and researchers who are here from out of town. You have to pay for these meals but it is very little. Right now they are cooking for me and one other person, a student from Hopkins here doing research for his doctoral thesis in malaria. The ladies are taking very good care of me - the veggies come right out of the huge garden behind the dorm. They cook for me in the same idea as the nschimi and relish: usually a plain carb like rice or pasta and in a separate container some veggies or chicken or something like that. They also make some other things (like some sort of amazing homemade bread)…so I am eating much better than I expected (I brought a big stash of nuts and granola bars just in case )

2) Fuel: As I understand it there are one or two gas (or petrol) stations between Livingstone and Choma in the couple of modestly sized towns we passed through. You have to be careful though driving in Zambia because there are long stretches where fuel is not available.

3) Hospital routine:  the day starts each morning with physicians meeting in the morning - the “on call” doc from the night before discusses what happened with patients and we discuss if any medications or xray or lab materials are out of stock and what we are going to do to manage in the meantime. Then we break into groups of 1 or 2 and go to the separate wards for rounds. During rounds we evalaute each patient and make treatment plans (except some days are just problem rounds for the most ill). After rounds we either go to the operating “theatre” as they call it here, outpatient clinic, HIV clinic, or maternity ward (to manage deliveries). Those activies take up the rest of the day as well as dealing with any acute issues that come up in the wards or surgical emergencies (like today - a woman had a rare and severe complication during delivery and had to be rushed to surgery - after several long hours - she was wheeled out in good condition! ).

4) Spiders and snakes: okay this wasn’t really a question but I wanted to update…I have not seen any snakes (thank God!) but they are here. I helped change the bandages on a boy’s foot that had to be partially amputated after a cobra bite, so they are here but they are shy and rare in general. In the ongoing spider saga the mosquito spiders seem to have hatched their broods of offspring because the walls are dotted with countless tiny specs that skitter around and could grow to be as big as their parents. Fortunantly they won’t all survive. That kind is harmless and mostly stays on the walls and ceilings. I’ve gotten pretty okay with them now - they are the African equivalent of daddy long legs. Bad news though on Fred - turns out he is another kind of spider (I had noticed that he was rather different). Large, furry, and sticks to the ground and likes to hide under mats and stuff. Apparently these are called “water spiders” and I have been encouraged to destroy Fred…possibily easier said than done as he seems to have disappeared

Joy and Sorrow

Today I wanted to tell you a little bit about Macha Mission Hospital, but I have noticed some questions in some of the comments. When I have a chance to post again I will have a post dedicated to answering them.

Macha Mission Hospital was started by the Brethren in Christ, and one of the key American individuals involved in the early project was the father of one of the physicians who serves here. The hospital is staffed by an American physician (who lives here with his wife), another American physician who works mostly in the research arm (this is the son of one of the early docs), a Danish physician, another American who is here part time, and 3 Zambian doctors. The hospital compound itself is really lovely with brick buildings and some nice landscaping, but the wards are fairly primative: long rooms with old metal bedstands lining the walls. There is a mens ward, womens ward, TB ward, maternity ward, and pediatric ward. There is nursing care but most of the patient’s needs are met by family members who stay with them in the hospital. There are some limited diagnostic services available: Xray (when they have film available), ultrasound, and some lab tests…however, much of the time diagnosis depends on history and physical exam and a trial of treatment. There are a fair number of medications available, although the supply often dwindles and they have to make do.

As you can imagine the hospital is a story of great hope but it has its share of hard stories too. First, some of the good news. Macha Mission Hospital is affiliated with a wonderful research facility that investigates malaria. With the use of a relatively new treatment compound Macha has seen a reduction in Malaria cases in their area by a staggering percentage. In the past, at this time of the year there would usually be 70-80 children in the pediatric ward, most suffering from malaria…and a fair number would die. Now we have a ward population of about 25 - and only a few are being treated for malaria. In a similar way Macha Hospital has tackled the issues of HIV/AIDs and TB by organizing an extremely well-run HIV treatment clinic and protocals to treat TB. This has impacted the incidence and mortality of these diseases significantly.

With all these advances, it certainly isn’t all good news. This is a resource poor area and the main cause of mortality in the pediatric ward is malnuitrition. How horrible that in our world children are still dying of starvation. Children and adults still die of infections that would be entirely controlled by the wide range of IV antibiotics available in the West.

Today was a good example of both the joy and the sorrow of this kind of work. During a lull in rounds this morning I was playing with a delightful healthy looking boy who had been admitted for a simple procedure. He had round cheeks and bright eyes - about 18 months old. He laughed out loud as I pretended to try to catch his hands sticking through the bars of his crib. As I played with him I reflected on the fact that this same child was treated a couple of months ago for a form of starvation that claims many lives around here (protein energy malnuitrition). He had been thin and wasted, with glassy eyes, and altered skin and hair - like many of the other children on the ward. But now he was happy and playful - just a little boy. This was one of the joys of the day…but it was quickly followed by sorrow.

As I played with him I heard a loud wail go up from the room behind me…a room that functions as a small ICU simply because it has a couple of oxygen tanks. A 1 year old boy had just died from severe starvation and HIV - his little body was marked with bone and skin changes that in medical school I thought I would never see. The room I was in went still, but in a moment the routine of the ward went on. The death was dealt with in a quick but considerate way as the crying mother was gently escorted out. This kind of thing is less common now, but still happens enough that things can’t grind to a hault because of it.

It was hard - I had seen that child only moments before…the medical team knew he was failing, but there was nothing we could do. I am comforted believing fully that this innocent one is with his Father in a place where there is no suffering. I don’t tell this story to make people sad but to share the realities of what is going on here. If I only talked of the beautiful scenery, warm people, and medical progress the story would be true, but incomplete.

And yet, I would like to emphasis the hope. I think that we often hear of “starving kids in Africa” and maybe feel that the problem is so overwhelming that it cannot be addressed or improved…but I am witness that there is a whole ward full of children right now who are being treated effectively…and most of them who probably would have died before this hospital will now go home with their mothers.

One day, one life, one spark of hope at a time. There is good work being done here and I am glad to see it.

I love you all!

The journey to Macha

Hello all! Sorry for the delay in posting….there have been problems with the internet since I got to Macha. I arrived on Sunday after a three hour bus ride from Livingstone to Choma and then a 2 hour long drive from Choma to Macha (with a missionary couple who was headed this way). Although the day was long it was very enjoyable because I got to see the countryside. The road (even the “main” road from Livingstone to Choma) is mostly dirt and as it is the rainy season there are giant washouts and potholes, making for interesting travel ;-). Most of the way there was lush jungle on either side, sometimes interspersed with cleared areas -small agriculture fields planted mostly with maize. Occasionally a house was visible from the road - sometimes it would the more expensive options: concrete block or mud brick with a tin roof, but often it was a “traditional” house of round logs arranged vertically in a circle and topped with a thatch roof. All of these places were meticulously clean, usually with a large dirt yard around the house with a cooking area, a kitchen garden, and a homemade fence around it all. Several times I saw someone carefully sweeping the dirt area with a twig broom. There were a couple of more modern towns with a row of concrete shop buildings and a thatch hut bus stop, but by far most of the area is rural. I didn’t see many animals like the kind we tend to think of in Africa as those are mostly on game parks at this time (they interfere with the agricultural pursuits of Zambia’s people - the people mostly grow maize and they tend cattle of some variety unknown to me). I did see several groups of baboons running alongside the road and climbing some trees - they are disliked by most people who live here as they are strong and clever and will break into houses, storerooms, and vehicles to steal food. There are also lots of beautiful and unusual bird varieties that were visible from the road. When I arrived in Choma I stayed for a few hours with a wonderful missionary lady in her 60s who has served in Africa for many years. She took me to church with her which was an awesome experience. Zambian culture places strong emphasis on the importance of greetings and on getting to know someone. In general they are extremely welcoming, warm, and open people. The church service consisted primarily of some of the most moving acapella singing I have ever heard - strong, rhythmic voices filling the tiny church. The doors at both ends of the building were left open and small children were free to come and go throughout the almost 2 hour long service…a couple of local dogs apparently also like to come for church and wandered in to lie in the center aisle :-). When I arrived in Macha with the missionary couple we had dinner at the house of the head doctor and his wife, and then I settled into my room in a dorm type building they have for visiting staff and students. It is nice, except for the large variety of spiders that share the place as well. I have named a particulary large fellow in my bathroom “Fred” hoping that will help him seem less threatening :-). They are useful because they kill mosquitos but I still don’t care for them much. There are lizards that live in the houses here too - they are small and keep to walls. They don’t bother me. Well this is certainly long enough! I will post another time about the hospital and Macha. Thanks so much to everyone who has left comments! It is so nice to feel connected to home even from far away. Love you all!

Zambia - finally

Hello  all! I finally arrived in Livingstone today. Upon arrival I was very overwhelmed.This  is what you think  of  when you think of Africa. Busy streets, some dirt roads, kids running all around, older buildings - some in disrepair, and lots of different languages (English and tribal languages). The Lord was looking out for me because a very kind older Zambian  social worker who I had struck  up an aquaintance with prior to the flight took me under his wing. He offered me the use of his cell phone (I had planned to buy one as they only cost about 20 dollars here because of how strong the dollar is… 1 dollar = 4500 kwacha). I  was unable to buy  one because all shops close at noon roughly on saturdays. He helped me get a taxi and instructed the driver where to take me and told me how to go about changing money, etc. I ended up missing the  bus to Choma (don’t worry, I saw  it as it was leaving and looks like a nice tour style bus), so the taxi took me to Jollyboys and I will stay the night here and leave for Choma at 6 am (bus loads at 5:30…yikes!). Jollyboys  is really neat - i wish you all could see it. It caters to young people who come to backpack and tour around Zambia. It is nice in an African way - a big open air lounge partially  covered by a thatch awning, a small pool with benches around it, and an open air restaurant and bar with picnic bench  seats. It is like a small compound with a wall around it and inside a  series of small buildings arranged around the central  courtyard. There are lots of people here in the 20’s - mostly from England, Australia, Germany, and Italy. I have visited with some cool people here while reading in the courtyard, including a medical student from Australia who is here working in another hospital! I went out into the town  to change money an buy a bus ticket and since my initial disorientation had  passed I recognized that Livingstone is a community oriented town with a lot to offer - the streets were busy because on Saturdays  people tend to be going about the town visiting friends and restaurants. There are quite a few foreign “locals”- people who moved to Livingstone from England or Europe after falling in love with Zambia, or because they work for one of the many charities and children’s homes that serve central Zambia. Some people at Jollyboys gave me information on the town and helped me get over my initial reactions. Tomorrow on to Choma then Macha - summary of the day, initially stressful and overwhelming - then relaxing and positive By the way, great news, laptop working again! It went from launching to a blue screen with a question mark to working normally! Thanks for all the prayers, keep it up!

Change of plans…

Just a quick note to let you all know about a change of plans. My flight to Livingstone was cancelled (in fact the whole airline liquidated) and I couldn’t get another flight. I was able to buy tickets for tomorrow so I’m back in the hotel. Sigh. On to Zambia tomorrow (hopefully)!! I appreciate prayers for my travel!

Great morning

Hello all! Wanted to take my opportunity to get online before I leave South Africa since my future access remains a little unclear. Had a wonderful morning today - woke at sunrise (yes, sunrise. Don’t worry I went to bed early ) to a beautiful day with the sun coming up over the palm trees and birds calling outside. Someone on the plane told me that South Africans know how to do breakfast - and I would say that is true! The free breakfast this morning puts bagels and pastries to shame. The massive buffet had everything from baked beans and stewed tomatos (common breakfast food in England) to vegetable stirfry to yards of fresh fruit and fresh squeezed juices to all popular American breakfast food (eggs, pancakes, etc) to amazing danishes….well, I could go on but don’t want to make you all jealous Thanks for all your thoughts and prayers…on to Zambia!!