The smoke that thunders

"The smoke that thunders" or Mosi-oa-Tunya, is what the locals call Victoria falls and it certainly lives up to its name! Even though we're approaching the winter/dry season in Zambia, Josh and I were lucky to catch the falls when it was still huge and thundering.

The falls are about 1.7km wide when the river is flowing at it's peak and are 360 feet high. The mist from the falls was just huge! I can't imagine what it's like during the middle of rainy season.

We had 3 lovely days down in Livingstone, the town named after the Scottish explorer who is believed to be the first European to set eyes on the falls. We were able to live it up and stay at a place right near the falls by using my local address and cell # for a "resident's discount." This allowed us to walk to the falls, located 500 meters down a path from our room, a few different times. We had the chance to see them at different times of the day and I think both Josh and I agree that the last time we went was the best...it was early in the morning before we left on our last day and we caught a nice rainbow arching of the falls (picture above). From the Zambian side of the falls, you can get super close and compeletely drenched as you walk across the "Knife's edge bridge" to a tip of land that juts out towards the face of the falls. Josh and I got soaked the first day we went down and luckily had some plastic bags to wrap our cameras in. Being so close, you can't see the entire falls unless you get up into the air by helicopter or ultralight, but even the quarter of the falls we could get a glimpse of were quite breathtaking.

Sadly, we never saw the falls from above, at $130 per person for a 15 min ultralight flight we decided we'll save that for a time when we have extra money to burn someday. But we did walk across the border to another bridge that divides Zambia and Zimbabwe and saw the falls from across the canyon, which afforded a wider view as you'll see from a picture below...

On Friday, we did a whitewater rafting trip on the zambezi river below the falls. Not only are the falls themselves beautiful, but the canyon and gorge that has been created below the falls is also magnificent. Most of the rapids were class II and and III at this time of year b/c the water is still high. There was one class V that we capsized on and I think I drank half of the zambezi river at one point when I got stuck under the raft for quite a while. Nothing like the sense of drowning to get your adrenalin to kick in! Happily, we made it out in one piece. :)

We also spent a day in Botswana doing a river cruise and game drive in Chobe national park (only 1 1/2 hrs from the falls).... I never expected to see so many animals!! It was really neat, expecially for this Discovery channel/Animal planet nerd :). The park is known for having an abundance of wildlife, including elephants, hippos, crocs, giraffe, all sorts of antelope, lions, and on and on. The guides said the only two species missing from the area are cheetahs (b/c there are too many trees and not enough open space for chasing game) and rhinos (due to poaching).

It was a great few days and we were sad when it was up.....Alas, we'll both be back in DC soon!

My time here is sadly almost over - I leave on Friday to head back home.

And for Josh, I think more than 3 days in one time zone will be a welcome relief...we just counted and he's been to 8 countries in the last few weeks: England, Egypt, Ethiopia, Ghana, Zambia, Botswana, Italy, and Zimbabwe (if you count walking over the bridge for 5 min, haha :)).

I'll have another post or 2 from my last week here so stay tuned!

Soaking wet after running across the knife edge bridge

Looking across at the falls from a bridge crossing into Zimbabwe.

On the Chobe river in Bostwana. We caught a herd of female and baby elephants coming down for their first drink of the day.

Sunset cruise on the Zambezi river above the falls.

Our last morning at the falls...sad to leave!

At the clinic

After a slow internet connection for a few days, I'm back online at last!

Here are a few pictures from my time working in the screening room at the University Teaching Hospital (UTH).

This first picture is in the screening room....you can see the nitrous oxide gas container in the background. They use this gas to do cryotherapy (ie: freeze off) early stages of pre-cancer.

The image on the TV is my attempt at capturing a photo of the cervix. The TV helps a lot with zooming in and getting a clear and focused shot.

I worked with a fabulous nurse name Annie last week at UTH. She was so kind about involving me in every part of the screening process. I had a chance to speak with patients and perfect my skills with capturing good images with the digital camera. To return the favor, I worked with her on implementing a new online form that they will be using for patient records...electronic records here in Zambia, I'm impressed!

On Fridays, the nurses, doctors and cervical cancer staff meet to discuss last week's cases and update on progress with the program. Each nurse presents a picture of each of her clients and describes their age, HIV status, and her diagnosis (ie: negative, positive for possible precancer cells, or a referral for things like polyps, more advanced cases, persistent bleeding, ect).

I got to present my set of digital images and was evaluated by the group on my technique...they said I got off to a good start! :)

And here are a few pictures from my walk home from the hospital. I pass through some beautiful streets lined by jacaranda trees (they're purple when in bloom) and I also pass by a big golf course. I've only seen a group playing once though!

I had my first night out dancing on Saturday night with a group of colleagues...the club had some great music and the dance floor was full all night! Very fun!

Josh arrived in town on Sunday! It's really great having him here and we're headed to visit Victoria Falls on Thursday for the weekend. We'll be sure to get some good photos!

behind prison walls

I sat in the shade of an avocado tree looking out at the faces of 100+ women in the female ward of Lusaka central prison. A few CIDRZ colleagues had gathered there to give a talk on HIV and cervical cancer. After initial approval, it took several letters and 3 meetings with the head officer at the prison in just the past week to get the "final" approval, but there we were, inside the prison, with the chance to speak directly with the female inmates.
The women gathered around on cardboard and plastic mats. I could see all their cooking supplies hung up on the surrounding trees and a communal food area in the shade of another tree. We were gathered in the outdoor space where they can spend the daytime and you could see a few shabby buildings where I think there were sleeping quarters. There was also a makeshift washing area with sheets hanging around it to offer a bit of privacy.

Dr. Manassa Phiri, a well known public figure in Lusaka, works for CIDRZ and gave the 1st talk on HIV/AIDS. Most of what was said was in Nyanja and Bemba (2 of the common local languages here) so I had to gage the response from the faces around me. But I got the gist of it. :) Dr. Phiri was really good at interacting with the group. He would pose questions (How is HIV transmitted? How can you protect yourself? ect...) and see what answers the women had. They were really talkative! I was surprised. Often when we go and give health talks, everyone is shy to say anything at first. But these women were very interactive and at the end there was at least an hour of questions they had. Several women came up to Dr. Phiri at the end with questions about medical problems they currently have. They have a prison clinic, but I imagine the care is minimal there. We are in talks to see if there's a way to bring cervical cancer screening to them via a mobile clinic.

What was really a surprise to me was how many children were there in prison with their mothers. Any child under 8 1/2 is allowed to be with the mother in this ward and at least every 3rd woman had a child, many around 1-2 years old. I was shocked at first to see these toddlers living with their mothers behind the prison walls. But after thinking about the family structure here, where the mother is fully responsible for the care of the children, I realized in some cases, it probably made more sense that the child stay with the mother than be left behind. There's not much of a foster care system here that I have heard of and even if the mother had relatives, they often have many children of their own and may not want to take another child in. It was comforting to see that several ladies looked out for each child, so it was almost like a big motherhood for the children that were there. But still, to see so many young kids in prison with their mothers was heartbreaking.

Throughout the talk, I also couldn't help but watch as I saw family and friends walk up to the chain link fence with bags of food and letters to give to their family members inside the prison. If they get a permission slip, they can walk right up to the fence and speak with an inmate. Often, there were children that came to visit and my tears filled up when I saw them holding hands with their mother/sister/aunt through the wire fence as they talked to each other. I don't know what the majority of crimes were that these women are imprisoned for, but my heart went out to them.

The second prison we visited was an all male remand prison, meaning the inmates were on trial or awaiting conviction. We first sat and chatted with the chief officer, named Happy, no joke. He was a minister and very friendly. He talked about how excited he was that we had come and paid notice to his prison and that they needed more of this kind of dialogue.
We were then escorted in by Happy into an open dirt yard with 3 plastic stools set up in front of 500+ men, gathered and seated on the dirt in front of the chairs. About 3 guards stood by leisurely keeping an eye out....no handcuffs, no fence to separate us. I'm not sure what it was about the inmates, maybe the many smiles that they welcomed us with, but I didn't feel threatened during our time there, which I had been worried about when we first heard about what it would be like inside.
This talk was another example of a group of people really interested in learning, or at least in keeping us there for as long as possible. I don't think many women had been to visit recently! We were a highlight of the week I think. My colleague spent the whole talk on HIV and answering a barrage of questions, from "If I have sex with a prostitute, can I still get HIV?"....to "How do mothers pass on HIV to their children?" You could tell there was a wide range of knowledge on the issue, including some interesting misconceptions, such as "If I have sex really quickly with different people, I can't get HIV, right?"...I think we clarified that one. :)
Needless to say, it was an entertaining talk and a prisoner served as an english translator so I could understand all the questions and answers being given.

My fellow colleagues said that it is rare that any public groups come and speak to prisoners in Zambia, they are often a forgotten or ignored segment of the population. But these inmates were so hungry for knowledge and for someone to show that they cared enough to visit them. I was really impressed that CIDRZ had taken it upon themselves to include this group in their outreach. I hope they keep up the dialogue and help these inmates access the same services that are available to the rest of Zambians.

some pictures at last!

I finally had a chance to upload some pictures!

I promise to be better about taking more of them so you can get a better glimpse of my time here.

There's a random one I took during my layover in Frankfurt when I took the train into town and walked around the riverfront. I was definitely in a jetlag daze that day but it was sunny and warm so it was a nice break during the many hours of flying.

And a few of Ollie, the feisty and adorable kitten that keeps me company and provides many laughs and a few unintended scratches. He (though I think it may be a she) is always trying to get on the table to take a nibble from whatever you're eating. We're trying to keep him off, but every once in a while he succeeds.

There's also a few of the house I'm living in. From the inside and one looking into the garden. It has a huge avocado tree that shades the swing you can see in the picture. I spent almost half of one Sunday sitting under it and reading a book. I forgot how wonderful it is to read for fun!! There's also a mini garden with lettuce and peppers. So I made a yummy salad the other night with avocado, the lettuce from the garden and some tasty, locally made feta cheese. You didnt' think I'd go a month without cheese, did you! haha. Yesterday, I found passion fruit in the market, yum!!

the strike goes on

You have to roll with the punches...



So I had hoped to go with my colleagues to deliver a cervical cancer health talk at a local high school this morning. We arrived late because our transport was delayed (i'm getting used to that occurence :)) and just as we were sitting down to meet with the headmaster, we heard these booms behind us at the school gate. Some teenagers from another school had come to throw rocks at the gate and cause a ruckus. The headmaster excused himself and walked out with some type of stick to scare them off with. We watched from his office as students and teachers gathered in the yard to see what was going on. It turned out to be nothing, just some teens taking advantage of the climate of frusteration the current strike has brought about. They ran off. Needless to say, we decided to reschedule the talk since most of the teachers and half the students hadn't even come that day.



When I got back to the hospital, I saw in the newspaper that the president has gone off to South Africa for a knee operation. Hmm, interesting... let's just say negotiations to end the strike aren't moving very fast.

Sick people are lined up outside the hospital, waiting for the government health workers to return to work....and at the high school, students were complaining that their teachers aren't there to move forward with classes. I heard that workers were being threatened with beatings unless they joined the strike, so that doesn't help either!

Somehow I find it not surprising that the med school is still running though! I see the students walking to class every morning around 7:45am as I walk into the cervical cancer building.
Everyone is hoping that negotiations will come to fruit soon. Seeing the patients lined up and only a few clinicians there to tend to them is sad and frusterating. And this is when you start with so few to begin with!!! I wish I had more than a year of med school under my belt so I could be more useful!

On a more positive note - this afternoon, I joined some of the CIDRZ nurses for a lunch presentation. Seeing their determination and dedication to the work they are doing reminds me that strides are still being made and no strike is going to keep them from trying to do their work.
Let's hope Monday brings a productive spirit to the resolution making!

And on a random note, I haven't had many sweets since i arrived (yes, I know a little over a week isn't a long time, but it is to me!) So I just had a banana milkshake and it tasted like the best milkshake I've had in a long time. Ahh, absence makes the heart grow fonder. And food will always make me happy.

While English is the "primary" language in Zambia, in Lusaka, the most common local dialect is Nyanja. So I'm trying to pick up as much as I can, especially because the staff I spend all my time with are Zambian and the patients are more likely to speak nyanja than english. My attempts at greetings like "mwuaka bwanji? ... "good morning, how are you?" have been met with approving responses back in nyanja and a good dose of laughter. When all else fails, I find a smile never seems to hurt either so I end up doing that a lot when I meet people in the clinic.

There was a young girl that visited the clinic I was at on Monday, she was maybe 17 years old. When asked about why she came in to be screened, she said her aunt had cervical cancer and advised her to get tested. And so she had come to the clinic closest to her home, in Chilenje, where we were stationed that day. I could tell she was pretty frightened of the whole situation. Let's just say pelvic exams are not commonly done here. I believe there are a total of 9 pathologists in the whole country so annual gyno visits with pap smears are not even an option for the majority of people. Most women have never had anyone look inside them and most have never seen the "stirrups" that my fellow female readers here are familiar with from our annual checkups.
So the visits usually start with a few minutes of explaining how to actually lie down on the examining bed in the right position. :) The nurses are pretty matter of fact and try to make the process as comfortable as possible. By acting like its not too big of a deal, I think they help make the environment less intimidating. "We're all women here!" is often said with a laugh, and "we have to help each other!" But as you can imagine for a young woman who has never had anyone examine her, and with the various misconceptions that are prevalent in the community, it takes a brave person to voluntarily come in and get screened. The young girl I mentioned above spoke good english so we chatted as the procedure went on and I tried to keep her mind off the process. After lots of deep breaths together and a good hand squeezing, it was over and she had a big smile on her face. "It wasn't that bad!" she said, after we went back to the computer desk to show her the digital images the nurse had taken of her cervix. It's pretty neat to see the change in a person in a matter of minutes after they come in and get screened, I could actually see the sense of empowerment in her face as she walked out the door. "Tell your friends and family to come in," we said. "Oh yes, I will! Thank you!" she said. The women who come in and get screened are often the best at passing on the message, as we all know, word of mouth is often the best way!

Today, we're headed to a high school to give a health talk to the students and teachers. The government workers are still on strike so we'll see how the turnout is, but I'm excited to see how the talk goes with a younger crowd. In the afternoon, I'll get to attend the weekly meeting of the cervical cancer team nurses as they present different cases and discuss strategies and technique to employ in the clinics. So much to learn!

xoxo,
Kristen

Back on track

After a bout with an annoying travel bug, I'm finally back on the scene. I hadnt' been sick once this whole year yet and of course soon after I arrived, I came down with a cold. But 12 hours of sleep can do a body good so I'm on the mend!

Today, unfortunately, our mode of transport was out of commission so we couldn't go into the community and do door to door meetings as we had hoped. Part of the program here is spreading awareness via peer educators who visit a community and go house to house giving information about cervical cancer and locations for screening. I hope to get to join them next week when they go again. Most of the staff believe this has been the most effective method of getting the word out and bringing women into the clinic. Word of mouth is often the best way!!

On Monday, the nurses and doctors who work for the government went on strike to push for higher wages. I saw them lined up outside the hospital on Monday morning. When I asked how long this could go on, there didn't seem to be an answer...but I know they're still out of the hospitals and some of the clinics as well through today. The patients in the hospital are left waiting and unattended to unfortunately. It seems only a few clinicians are still working and trying to cover for all the staff that are out.
Luckily, CIDRZ is an NGO so the staff here are not following suit. But sadly, even the clinics not run by the government have been pretty empty as people seem to assume that the strike is citywide. I've been told this happens maybe once a year, so hopefully it will resolve soon!

In the meantime, I'm helping with a training manual for the peer educators that work in the community and clinics to spread awareness about cervical cancer and to mobilize women to come in to get screened. These women have been chosen from HIV support groups that CIDRZ organizes. Once trained, they get brought onto the cervical cancer team to work at the screening clinics and to do outreach into the community. They do an amazing job at educating the community and mobilizing women to come to the clinic. The stigma and misconceptions surrounding both HIV and cervical cancer are too numerous to list, but just for an idea, here are a few of the things I've heard:
- America invented HIV in a lab
- if you are found to have cervical cancer, it means you were a prostitute
- family planning methods cause cancer

To top it off, douching is a common practice here in Zambia because a woman is supposed to always keep her cervix and vagina dry. So many of the women here are even more prone to infections with HIV and HPV because they remove all the protective mucous and bacteria that is there to fight off those nasty viruses! So there's more than just getting the health care to these communities, its also about learning how to overcome the challenges that cultural beliefs and practices put forward as well.
There's so much to learn, and as I'm just starting to grasp some of the basics, I'm working to help edit the training manual my right hand lady, Susan, who supervises all community efforts for the cervical cancer team, has put together. What a trip!

More to come soon....!
xoxo,
Kristen