As the final exams are approaching for all of the schools, we won’t be running P.E. sessions at Munali anymore. We used our extra time to spend the entire morning at Fountain of Hope. During the first hour, we helped out weighing the babies in the clinic. They were adorable as usual. There were a bunch of donated pamphlets that we were meant to give out to the mothers. We were kind of laughing at the idea because hardly any of them can read. They looked at us like we were crazy when we gave the packets to them. The two Zambians who work in the clinic full time looked like they were thinking along the same lines. Laugh out loud, useless foreign aid.
After things quieted down at the clinic, we talked to Roy, the managing director, about getting started on a new assignment. We’ve been feeling lately that there are so many funding and organizational obstacles to the association’s development that we could really help with, people just don’t realize that they can ask for help. We told Roy we really want to help in a more concrete way than just hanging out with kids (even though it is great for them to see people from another country who care about them). Roy seemed happy and asked us to help him with a funding project. We were really excited because we haven’t done any sort of fund raising work yet.
Global Giving is an organization that links NGO’s and other non-profits to a wider range of donors. A group can post its project online with a full description of its mission, a problem it faces, the project it has developed to address the problem, and the goal amount of money. The organization can post extra information, website links, pdf documents, and photos to supplement the description of the project. Donors can visit the website, choose the theme they are interested in (women, education, children, nutrition, etc) and peruse through all of the different projects. Once they’ve chosen an organization, they choose the amount they want to donate and Global Giving wires that money to the recipient. It’s great for groups like Fountain of Hope to spread awareness and tap into a larger source of donations.
Roy told us the community school at Fountain serves over 400 students, but they only have 20 desks. They want to raise the money to buy another 120 desks, each at $90 a piece. The total amount necessary would be just short of $11,000. Sarah and I got to work putting together the project. When it was time for us to leave for Chipata, our work was nearly finished. Roy seemed really pleased and we assured him that we’d complete the layout and get it posted online on Friday morning.
We ate lunch down the street and then caught a bus to Chipata. The bus conductor was such a jerk. I paid him ten thousand kwacha and was expecting six thousand kwacha in change (meaning I’d paid 2 thousand for me and 2 thousand for Sarah). I only got three thousand back. We told the conductor and he just shrugged us off and kind ignored us. We asked him again and this time he was like, “Yeah yeah I’ll give it to you”. When the bus stopped (not at the right place, by the way), we got off and I asked him a last time for change. He refused to give it to me and we started arguing in the middle of the street. Sarah joined in, followed by 3 or 4 other Zambians. The driver insisted that the ride cost 3,500 each, but we had agreed on 2,000 each before getting on the bus. Furious, we continued to argue with him for several minutes until finally the bus just started driving away, nearly running over Sarah’s feet.
The next bus ride that took us the rest of the way to Chipata was the complete opposite. The bus driver charged everyone the correct amount and gave everyone perfect change, including us. He was friendly and really polite. One little baby on the bus kept reaching for the money as people paid. The conductor gave the baby a 100 kwacha note to play with and let him keep it when the mother said it was time for her to get off the bus. Meanwhile, the women in the bus were displaying their usual spirit of community and compassion. When one little girl got onto the bus, a random lady pulled her into her lap and held her tight and safe, then guided her in paying the conductor. The girl was totally nonplussed and the woman did all of that without ever being asked. It was her instinct to follow the famous African proverb, “It takes a village to raise a child”. It was such a nice experience and contrasted so strongly with the argument we had with the previous conductor. Things can be so hit or miss here, just like in any other city.
Our session at Chipata went well. The students were in the middle of the exams, so we didn’t get to meet with our entire group of usual students. We could only meet with the 8th grade before they had their test, but there were many familiar faces so we weren’t disappointed. We started the lesson with a demonstration of proper condom use. It was as typical as you can possibly imagine. I stood in the front of the room with a condom and a banana and showed them the entire process, from start to finish. They really lost it when I pulled out the banana and told them to pretend it was a penis. Even Sarah and I couldn’t help but join in on the laughter. It is one thing to explain sex and condom use to pre teens in an American health class, but quite another to explain all of that to students barely 2 or 3 years younger than us…in Africa.
We proceeded into our topic for the day: treatment and ARVs. We explained anti-retroviral drugs with as much detail as we could manage without confusing the students. We tried to stick with the most important information—following instructions accurately, drug resistance, possible side effects and handling them, and places to receive free treatment nearby Chipata. Most of them were afraid to write down the names of the HIV clinics in front of all the students (two girls actually stayed late and were attempting to memorize the list before we caught on and offered to write them copies to fold up and keep in their bags).
At the end of the lesson, we started to answer their anonymous questions from the following week. As we responded, a student or two prompted us for even more information. A few of them are really desperate for as much information as possible. It seems like they never get the opportunity to ask questions. We keep getting anonymous slips that say things like, “You’re saving me Sarah and Chrissy I love you” or “I like you Sarah and Chrissy thank you so much please be my friend”. That makes us think at least a few of them are grateful for what we’re doing (or they just think it’s great that we talk about sex with them haha). All in all, we were sad for the students who clearly seem to have HIV, but happy and satisfied to be giving them information.
As we left, the Sport In Action peer leader at Chipata, Missau, asked us if he could ask us a question. Missau is awesome…his organizational skills and dedication to his work are really easy to admire. He is always helping us in the classroom with the language barrier and whenever there is a time conflict and we need to change the time of our session, he stays on top of things and makes sure it all works out. It is such a privilege to know him and work with him. What makes us especially happy is his dedication to our HIV program. He told us he thinks the information is vital here and our knowledge on the subject is really useful. He wants us to leave him a full description of everything we’ve taught and all of the information we’ve been giving students through the anonymous questions. He plans to continue the sessions and we are both so happy to see our pilot program continue into something more.
He explained that he lost both of his parents and has no family to financially support him. Because of Sport In Action, he is able to attend school, but between classes in the morning and working at Chipata in the afternoon, he has no time for a job. As a result, he has no money to finance the fieldwork he needs to complete for his schooling. He asked us if we had any money we could spare as we approach the end of our stay. He said he only needed 80,000 Kwacha, the equivalent of about $16 or $17. We both said we would check our money and let him know next week because we wanted to talk it over before committing. But we both know we’ll be coming home with more than $500 each in DukeEngage money because we were so stingy for 7 seven weeks, so we’re definitely willing to help him out.
As we walked out of Chipata, we talked about how much we would love a few more weeks in Lusaka. The occasional run-ins with rowdy conductors, the racism, the sexism, and other challenges make us think we’ll never come back to Lusaka. But the women’s happy and welcoming faces, the students’ eagerness to learn from us, and the laughter of little kids chasing us down the red dirt paths makes us want to come back. We were talking about how amazing it would be to come back and do an independent study on life in the Chipata compound (or any of the other compounds in Lusaka). We could spend a day or two at a household, learn about the family members and life in the compound, and then move on to the next household. We’d meet everyone in the neighborhood and be able to learn so much about the small details of their lives. Gah, if only we had more time.
When we got home, I changed quickly and had a bite to eat before leaving with Ivy to spend a few hours in the maternity ward at the University Teaching Hospital. Sarah stayed in to have a relaxing night, get some work done, and avoid the sight of needles and doctors, two of her least favorite things. I was a little nervous that we wouldn’t be allowed into the labor ward, but we were allowed to observe all of the women giving birth with hardly any investigation at all. That would never happen in the States.
The ward was definitely different from what mothers are used to in my country. There is absolutely no privacy. The doors leading into the rooms from the hallway are always wide open, and the windows looking in on the rooms are never curtained. There are four mothers in each room. Most of the beds have curtains around them, but hardly any of them were actually closed.
It was also not very clean at all. There were many uncovered trash bins and open buckets labeled “.5%” or “soapy water” with bits of dirt floating in them. Newborn babies are weighed on a scale with a latex glove wrapper separating them from the surface of the scale. I was very anxious to see that the babies are essentially placed on garbage when they’re weighed. I noticed drops of blood on the floor, and when one women bled all over the floor during her child’s birth, the blood was left untouched for over an hour before it was finally cleaned up (to make matters worse, that particular mother was HIV positive). We noticed one bedside table where an IV needle had been pulled from the mother’s hand and left on the table. It was going to be reused on the same woman despite the fact that her blood had dried up on the edge of the needle. Reusing a needle like that is not good practice—it could introduce infection to the woman’s blood.
All of the mothers give natural births. There are no painkillers used at all. They give birth on hard tables that we would see in the examination room of a doctor’s office (or at least I recognized them as being similar to the tables they had for patients at my pediatrician’s office). The nurses cover the beds with black trash bags and replace the bag for each new mother. That’s about the only sanitation measure they take with the beds. I heard screaming and wailing and begging like I’ve never heard in my life in that ward. Women were in unreal amounts of pain, many repeatedly slapping their legs to distract themselves from the pain in their backs and stomachs while others were repeatedly screaming for Jesus and God to see them through.
One mother, a woman in her mid thirties who was pregnant with her third child, spotted me and actually shouted “Sister!!” before grabbing my hand and making me rub her tummy to massage out some of the pain. She was just repeatedly shouting “Jesus Jesus give me strength Jesus see me through” over and over. I was kind of terrified. When the baby came, there were no nurses or doctors present. She just looked at me with this horrified expression and I was so stunned. I had literally no idea what to do. I was actually standing there, holding this stranger’s legs apart, and telling her to keep pushing while I watched her baby’s head come out of her. Panic panic panic. The nurse showed up just in time to catch the baby. It wasn’t breathing at first, so she picked it up by its feet and started aggressively smacking its back until it finally started crying. Then she used a suction device to suck the mucus out of the baby’s airways. Every time she picked up the baby, it was by its feet and she made no effort to support the baby’s head or neck as she placed it back on the table. I was like, “Oh my god. I just held that woman’s legs apart while she pushed a baby out of her vag and this nurse is about to kill the baby. What the heck!” Don’t worry though, the baby was fine and so so cute!
That was only one of the mothers I interacted with over the course of the night. I spoke with one woman, Emelda, who was crying and moaning a lot. I tried to distract her by asking if had any other children. She just looked at me with this stony expression and was like “My first born died. This one will probably die, too.” Note to self: never assume their babies live. Emelda ended up going into surgery for a c-section. She and her baby both emerged in good condition. Cross your fingers it stays that way. I remember seeing that she was 23 years old in her file.
Another mother, Emilia gave birth and had a pretty serious tear afterwards. The nurse stitched her up right then and there. Only a few minutes later, the midwife told Emilia she had to get up and leave for post-labor ward. The woman just gave birth and got stitches and they had to up and waddling through the ward towards a new destination. They rotate women in and out of the ward so quickly. As soon as a woman gives birth, she’s got to get dressed and go to a new ward. Six hours later, she’s dispatched the hospital entirely. Makes the woman who stay overnight in hospitals at home look very spoiled, especially when all of the Zambian women give birth naturally.
There were two HIV positive mothers in the ward last night. I also check a mother’s file before approaching her bedside or observing a birth, just in case. One was named Tania. She had epilepsy, asthma, HIV, and Tb. She was 19 but on her third pregnancy. Her first child was born when she was 15 and died 5 hours later. At 16, she gave birth to a baby girl who recently turned 3. This baby was also a little girl, and it’s amazing she was so big and healthy because her mother was unbelievably malnourished. It’s hard to say whether she works as a prostitute, lives on the streets, both, or something else, but she’s unmarried and unemployed. Life is clearly rough for her.
The other HIV positive mother was named Grace. She was only 18 and in her first pregnancy. Unfortunately, she had gone into labor 2 months early. We never actually saw her baby arrive, but we stayed at her bedside for quite a while. Her body was covered in scars. There was a huge one the upper left side of her stomach and long one down the inside of her thigh. They were also small, circular scars all over her arms and chest. It made me think of what Vasco told us about the kids on the streets letting drops of melting plastic land on each other at night. Not going to go into details, but it kind of looked like she had genital warts as well. Her file also indicated epilepsy and asthma, in addition to HIV. What really struck me about Grace was her hands. On our street walk, I noticed that the girls living on the streets had such rough hands. Their fingers look too big for their bodies and are calloused and scarred. At first glance, they look way more like a man’s hands than a woman’s. Grace had hands like that, and the end of one of her thumbs was missing. Compared to Tania, whose life is a bit more mysterious, I was almost positive that Grace is a street girl. If her baby survives premature birth, it can look forward to a very rough childhood.
Despite all of these horrific details in their mothers lives, all of the babies we watched come into the world were healthy and beautiful. It made me very happy to carry them all wrapped up in blankets and towels to be weighed. Not to sound too maternal, but it is very special that something so perfect existed inside of someone else only moments ago. They suck their thumbs, rub their eyes, and watch what’s going on above them almost immediately upon being born. It’s amazing to see such much liveliness and awareness from a baby that was literally just inside of its mother. I did notice that many of the mothers didn’t seem to reflect the cliché reaction that I expect from most mothers. None of them cried with joy at the sight of their children and expressed pride, love, or anything along those lines. Then I remembered that most of them probably didn’t ask to become pregnant. I hope that over time more mothers in Zambia are able to wait until they’re old enough to actually want a baby before they get pregnant.
The night did not have a good ending. I saw a mother in labor surrounded by a nurse, a midwife, and a doctor. It’s rare that you see that many people around one mother in such an understaffed ward and they were using the ultrasound machine. Intrigued, I cross the room to see the ultrasound picture. Right as I passed the end of the woman’s bed, her baby burst out of her onto the table with a horrible squelching noise. I actually scurried out of the way because I thought the baby was going to slide right off the end of and hit me. It was really unusual, at least compared to the other births I’d seen. Right away I knew something was wrong. The baby was really gray, lying in a grotesque position, and some parts of its skin looked slightly macerated.
I looked closer and saw a very tight knot in the umbilical cord. The baby must’ve moved a lot when it was small, creating a knot, and then the knot tightened as the fetus grew. The nurse said the baby starved and suffocated as a result. It was probably dead inside the mother for a few weeks and nobody knew. She forced the mother to look at it and accept that it was stillborn. Then they wrapped it in a towel and took it away. The mother was in shock. She just lay in her own blood for several minutes and stared at the ceiling, completely lost for words. There was literally nothing Ivy or I could say. After that, it was time to go. I told Ivy earlier that evening that the one thing I really, really didn’t want to see what a stillborn baby, so I was really upset.
It was quite late when we got home. We filled Sarah in and talked a bit in the kitchen over tea and hot cocoa before going to bed. Of course, I dreamt about babies and childbirth all night long. Definitely not having a baby for a really long time. Sorry future husband, but it’s just not going to happen anytime soon.
