Sometimes the hospital seems an uncomfortable place to be in. A five hour and a half ward round seeing all the patients in a packed medical ward can be pretty uncomfortable as can arriving in OPD to see a queue out the door. SCBU is always uncomfortable when you have to go there on call. First of all it is full of tiny babies who I have little experience in looking after. Then it is hot, very hot and getting worse as the temperature outside rises and then there is the omnipresent smell of milk which I find somewhat nauseating.
Mwai is 3 days old and weighs just 1800g. He lies in his incubator in the Special Care Baby Unit in St Francis. Incubators here are not like what we know at home. Mwai’s incubator is basically a box with glass panels. There is a light bulb in the box under which there is a tray of water to disperse heat and moisture through the incubator. Mwai shares the incubator with a few cockroaches. Mwai’s mother Clemintina kindly agrees to talk to me so I can get an insight into the life of one of the mothers here in SCBU. Exildah a qualified nurse who is now training to be a midwife helps me translate, we move from the incessant heat to a cool office.
Clemintina explains that Mwai was born in the hospital as she had a twin pregnancy. She delivered at 36 weeks but unfortunately Mwai’s twin was still born. Tragically for Clemintina her two previous pregnancies did not carry to term and she lost both in the second trimester. ‘Despite all the other losses I am happy to have Mwai’ she explains before going on to say that so far things are going well, Mwai is bright and alert and feeding ok. However she finds it difficult hat her baby is here in SCBU. ‘It is difficult for me having been here for some few days, but my mother has come to be here to support me.’
The mothers of the SCBU babies stay in a room nearby and come regularly for feeding. Many of the babies are too premature to suck effectively so are fed with expressed breast milk via a tube. Clemintina finds that the environment makes it hard for her to bond with Mwai ‘I am not feeling ok because I would like to be with my baby, but here I can only spend some hours so there is distance between me and my baby. I didn’t really expect to have to stay here, but for the sake of the baby I know I must stay wherever there are good things.’
Clemintina does though understand why her baby needs to be in the incubator ‘I was told that my baby wasn’t strong enough so it had to be kept warm’. Even Clemintina finds the heat difficult to cope with and she has noted the cockroaches attracted here by that same heat ‘If there would be any poison for them, that would be good.’
Clemintina is 23, married, Catholic and has a lot of aspirations for the future. Exilidah translates that she wishes for the baby to grow up well, go to school and lend a helping hand in the future. ‘This is our African way of life’ Exildah explains, ‘people who have gone to school and been educated will plough back, if one is to be educated it benefits all members of the family, (that person) becomes a source of income, a bread winner.’
Currently Clemintina and her husband survive as subsistence farmers, they grow maze and ground nuts which they then sell at the market. Clemintina says she would like just four children. I ask will she consider using birth control to limit her family size to four. I am surprised by her response that she wishes use the ‘Jadel’. Exildah explains that this is a subdermal progesterone implant. Implanon a similar product is available in Ireland and I have previously had some patients opt for it as a contraceptive method but until now wasn’t aware of its availability here. Exildah explains that it can be got for free from the Ministry of Health but unfortunately not enough staff are trained in its insertion.
I tell Clemintina that I feel that is wise and responsible plan to have and ask her what she thinks of the Catholic Church’s view on birth control. ‘I understand the Catholic Church and family planning issue, but looking at my history it is difficult for me to say I am not going to use family planning because at the end of the day I might be the one who to die.’
I also want to ask Clemintina does she know why her three other babies did not survive. ‘I have been told it is about hard work (on the farm), that is the reason the babies die, there can be other reasons such as witchcraft.’ The topic of witchcraft presents itself to me almost everyday but I am surprised to hear it from Clemintina who comes across as a well informed and independent thinking young woman. I ask who may be responsible for the witchcraft ‘it could be from my own family’ but do not challenge what seems to be a deep seated belief in much of the population here.
Exildah outlines her thoughts on the reasons for Zambia’s high peri-natal and maternal mortality rates. ‘We are a developing country, most of our women come from far areas as to where they can find a clinic. The other thing is our literacy levels, most of the women in rural areas are uneducated, they get married at an early age.’
I thank Clemintina for her time and openness in talking about her and Mwai. ‘I called the baby Mwai because of my history, it means Lucky.’
Monday, September 27, 2010
Sunday, September 19, 2010
Africa Time
I may have mentioned before that things move fairly slowly here. When I first travelled from Lusaka up to Katete I had bought myself a ticket for the ‘7 o’clock’ bus. Arriving at half six I loaded my bags, the engine was running already, bus two thirds full, happy days I thought the seven hour journey will begin on time. Of course not. Over the next few hours I sat impatiently, the engine kept running, various people got on and off the bus, hawkers selling air time, biscuits, torches even wigs. From time to time the driver would rev up as if to move, but no. Workers from the bus company hassled any intending traveller trying to get their custom and not loose out passenger to rival bus companies.
At about half ten the bus was full and it left. For the three and a half hours waiting in the hell that is Lusaka inter-city bus terminal I fidgeted, looked at my watch frequently, got up several times to look around for signs of movement. I was the only white person on the bus and also the only one impatient for its departure. The Zambian people sat patiently just letting the time pass.
It is a Sunday afternoon working in the hospital and I stop for a moment to look around the ward. Yeah there were thirty sick patients there but the place is a sea of tranquillity. Most of the patients are lying on their beds. Each bed had a bedsider, a relative staying with the patient to provide care including changing, washing and giving oral medications. Looking through the ward all of the bedsiders and the patients are just sitting there waiting patiently, just like the people on the bus.
Trying to compare to similar experience at home I couldn’t see any relatives just sitting by the bedside waiting and waiting. Remembering Sunday’s in Castlebar hospital the relatives might by watching the TV seeing Mayo loose in Croke Park again, or reading a newspaper or magazine. There is no TV on the ward here and nobody is reading. I can’t help wondering what are they thinking about, what is going through their minds. I try to find out from some of the patients and bedsiders that speak English. There isn’t anyone about to translate and my Chewa doesn’t extend beyond medical terms.
Kenny has been in hospital for about a week. He has renal failure either due to sepsis from his pneumonia, his HIV meds or recent treatment with gentamicin from a rural health centre. Unfortunately I can’t offer him dialysis so all I can do is stop his HIV meds and hope his renal function improves. He says he passes the time talking to his wife who is by his bedside, usually about their children who are at home. ‘I am always encouraging them to be strong and to be realistic in everything that, one must be convinced in mind to say I am sick’ Kenny says. His wife explains that she just spends the time nursing her husband, she needs nothing else to occupy her mind. Kenny adds that when he is awake they chat and crack some jokes.
Meck has very little English but explains his main thoughts is fear of relapse of nose bleeds which have been cauterised a few days ago (medically it is the least of his worries). He inquires what my name is, in the hecticness of the past few days I obliviously haven’t formally introduces myself to him. He then adds that he wants to go home and see his children.
Further up the ward Edison’s dad sits by his bedside. Edison is 19, has just been diagnosed HIV positive, has a pathetically low CD4 count of 3 and is also in renal failure. His dad has really good English. He says he feels sick himself at present and spends some time thinking about that ‘otherwise I think about the young boy, most of the time when I am here I consult the bible and read and get courage out of the readings’. He stays each night in a boarding house next to the hospital while his sister sleeps on the floor beside Edison.
He likes the boarding house, fifteen to twenty people are staying there ‘the place is good, we always take prayers there’. He swaps shifts with his sister at visiting times, that is six in the morning and half past four in the afternoon. What does his sister do during the day time? ‘She goes back to prepare some breakfast, she remains there washing clothes for Edison, doing other things’. He explains that his wife is at home with their six other children and he thinks also of them. He thinks especially of Edison’s twin brother who is well ‘but right now he can’t go to school as I am here and need some money so I can’t afford the fees’.
I commend him on his English and enquire did he acquire this through his work. I expect him to say he has some government job or has worked in the mines or Lusaka. ‘I am just a peasant farmer, I got my education before this modern education’. I ask him how he feels about Edison’ illness ‘I don’t feel right, I can accept it because he is a human being and my son, I can not decide how he might have got that illness’.
Some of the patients and bedsiders are outside sunning themselves. I find Frank stretched out on the ground. He was just admitted today, diagnosed with HIV yesterday. The lumbar puncture I have done today has found Cryptococcal meningitis a serious opportunistic infection found in advanced HIV. ‘I feel better’ he says looking relaxed and at ease.
Samuel’s mother is outside also. He has been admitted quite sick with diarrhoea and vomiting. He was in hospital in January, was diagnosed with HIV then but didn’t attend for follow up and has not been taking treatment. Samuel is among those men that present here like images from a live aid video, gaunt with sunken cheeks, wasting away. His mother is an upbeat and resourceful woman. She doesn’t leave the hospital instead she gets food here and does the washing in the bathroom. She says the bedsiders pass their time discussing patient’s conditions. ‘We encourage each other, encourage them (other relatives) not to feel lonely in the hospital’
Perhaps it is this positive attitude and outlook to life that allows people here to remain so patient, knowing things will happen when they will and that not everything is under their control be it what time the bus will depart or when or if their loved ones will get better.
At about half ten the bus was full and it left. For the three and a half hours waiting in the hell that is Lusaka inter-city bus terminal I fidgeted, looked at my watch frequently, got up several times to look around for signs of movement. I was the only white person on the bus and also the only one impatient for its departure. The Zambian people sat patiently just letting the time pass.
It is a Sunday afternoon working in the hospital and I stop for a moment to look around the ward. Yeah there were thirty sick patients there but the place is a sea of tranquillity. Most of the patients are lying on their beds. Each bed had a bedsider, a relative staying with the patient to provide care including changing, washing and giving oral medications. Looking through the ward all of the bedsiders and the patients are just sitting there waiting patiently, just like the people on the bus.
Trying to compare to similar experience at home I couldn’t see any relatives just sitting by the bedside waiting and waiting. Remembering Sunday’s in Castlebar hospital the relatives might by watching the TV seeing Mayo loose in Croke Park again, or reading a newspaper or magazine. There is no TV on the ward here and nobody is reading. I can’t help wondering what are they thinking about, what is going through their minds. I try to find out from some of the patients and bedsiders that speak English. There isn’t anyone about to translate and my Chewa doesn’t extend beyond medical terms.
Kenny has been in hospital for about a week. He has renal failure either due to sepsis from his pneumonia, his HIV meds or recent treatment with gentamicin from a rural health centre. Unfortunately I can’t offer him dialysis so all I can do is stop his HIV meds and hope his renal function improves. He says he passes the time talking to his wife who is by his bedside, usually about their children who are at home. ‘I am always encouraging them to be strong and to be realistic in everything that, one must be convinced in mind to say I am sick’ Kenny says. His wife explains that she just spends the time nursing her husband, she needs nothing else to occupy her mind. Kenny adds that when he is awake they chat and crack some jokes.
Meck has very little English but explains his main thoughts is fear of relapse of nose bleeds which have been cauterised a few days ago (medically it is the least of his worries). He inquires what my name is, in the hecticness of the past few days I obliviously haven’t formally introduces myself to him. He then adds that he wants to go home and see his children.
Further up the ward Edison’s dad sits by his bedside. Edison is 19, has just been diagnosed HIV positive, has a pathetically low CD4 count of 3 and is also in renal failure. His dad has really good English. He says he feels sick himself at present and spends some time thinking about that ‘otherwise I think about the young boy, most of the time when I am here I consult the bible and read and get courage out of the readings’. He stays each night in a boarding house next to the hospital while his sister sleeps on the floor beside Edison.
He likes the boarding house, fifteen to twenty people are staying there ‘the place is good, we always take prayers there’. He swaps shifts with his sister at visiting times, that is six in the morning and half past four in the afternoon. What does his sister do during the day time? ‘She goes back to prepare some breakfast, she remains there washing clothes for Edison, doing other things’. He explains that his wife is at home with their six other children and he thinks also of them. He thinks especially of Edison’s twin brother who is well ‘but right now he can’t go to school as I am here and need some money so I can’t afford the fees’.
I commend him on his English and enquire did he acquire this through his work. I expect him to say he has some government job or has worked in the mines or Lusaka. ‘I am just a peasant farmer, I got my education before this modern education’. I ask him how he feels about Edison’ illness ‘I don’t feel right, I can accept it because he is a human being and my son, I can not decide how he might have got that illness’.
Some of the patients and bedsiders are outside sunning themselves. I find Frank stretched out on the ground. He was just admitted today, diagnosed with HIV yesterday. The lumbar puncture I have done today has found Cryptococcal meningitis a serious opportunistic infection found in advanced HIV. ‘I feel better’ he says looking relaxed and at ease.
Samuel’s mother is outside also. He has been admitted quite sick with diarrhoea and vomiting. He was in hospital in January, was diagnosed with HIV then but didn’t attend for follow up and has not been taking treatment. Samuel is among those men that present here like images from a live aid video, gaunt with sunken cheeks, wasting away. His mother is an upbeat and resourceful woman. She doesn’t leave the hospital instead she gets food here and does the washing in the bathroom. She says the bedsiders pass their time discussing patient’s conditions. ‘We encourage each other, encourage them (other relatives) not to feel lonely in the hospital’
Perhaps it is this positive attitude and outlook to life that allows people here to remain so patient, knowing things will happen when they will and that not everything is under their control be it what time the bus will depart or when or if their loved ones will get better.
Sunday, September 5, 2010
The Big Smoke
Having been working hard for the last couple of months and given some new Doctors have arrived from the UK I decided to take a few days off. First thing to do was go down to Lusaka to pick up my work permit. Like everything else here the process of getting this has moved slowly. Many months ago a whole multitude of forms were sent to the Zambian Medical Council (including a translation of my degree from Latin to English). Only once registered with them could a work permit be applied for.
The head office of the department of immigration is in a leafy relatively affluent area of Lusaka. Inside it looks like any public service building at home, various desks computers and large numbers off staff who appear to be doing very little. Despite all the computers I have to check myself through various hand written books to see if the permit is ready. On seeing that it is I am passed through various desks until I find the one from which to pick it up, most of the staff are sitting down looking around or taking calls on their mobiles. Anyways I get the permit go to a further desk to get my passport stamp and get out of there.
I have travelled the five hours to Lusaka with some others from St Francis. Sabina a Swedish nurse who has been here for a few months and is going to spend some time in an orphanage in the Copper belt and a Canadian couple Steph who is a nurse here in St Francis and Ben who is on a placement in Katete from Engineers without borders. We decide to go to a movie that evening.
While lots of people in Lusaka live in poverty there is wealth here, a couple of shopping centres similar to what we have at home and a cinema. The entry fee of K14,000 (about €2.40) is cheap compared to home but beyond the reach of the vast majority of Zambians. It is nice to see a movie and relax but several times the surreal-ness of the previous day being working in an isolated hospital and now being in a fancy modern cinema hits me.
There isn’t a lot to do in Lusaka so having completed our business we leave the next day. I have a couple of more days off and hit to Malawi. Whilst most people might go to Malawi to relax by the lake, swim or dive, my interest is in seeing Lilongwe’s famous tobacco auction floors. Malawi’s capital is considerably smaller than Lusaka but is a much shorter distance from Katete even allowing crossing the border and temporarily importing the car (I discover on the way back I should have temporarily exported it from Zambia, but this offence is overlooked on showing my newly acquired work permit and mentioning I work in St Francis).
The public are allowed to come see the tobacco auctions by appointment. I have arranged to get a tour at 9 am and after much getting lost in Lilongwe’s industrial area arrive about ten past and subsequently have to wait around, African style, for an hour and a half. Ronald from the communications department is going to show me around. He a short man, very neatly dressed friendly and cordial. He explains we have little time as he is busy preparing for a launch the following day of a company wide HIV/AIDS policy. There is a certain irony in a company involved in the business of selling carcinogenic tobacco taking an interest in their employee’s health but it is encouraging in many ways.
Ronald leads me onto the floors. We walk past a sign stating ‘To all our Customers, Please do not bribe our members of staff: It is unnecessary, It is Costly, It is evil’. We enter a massive shed the size of several playing pitches, there are bales of tobacco over the entire area and the whole place is a frantic hive of activity, people are hurrying here and there, buyers inspecting bags of tobacco, workers literally running with barrows bring new 200kg bales onto the floor. It is an impressive sight all the more so because all the people here are African, this is not some white dominated industry or a remnant of colonial times, it is indigenous commerce.
Ronald explains that in all ‘Auction Holdings Limited’ the company which runs the floors employs 4,000 people. The company is 42% government owned with the remainder in private ownership. The government he explains are keen to protect and promote the industry which accounts for 70% of Malawi’s foreign exports and 15% of its GDP.
The auctioneer proceeds along the rows of tobacco at an alarming pace selling each bale. He chants out words and prices at an incomprehensible speed, someone behind him takes note of the ticket on the bale and the buyer. About 10,000 bales are sold each day
I am interested to know who is buying and selling the tobacco. ‘80% comes from small farmers who produce 5-10 bales per year and can expect to get about $200 per bale’ outlines Ronald. The small farmers don’t come to Lilongwe to sell the tobacco themselves but instead sell to agents who then bring the tobacco to the auction. There are only five buyers, representatives from tobacco companies here in Malawi. These buy the dried leaf from the floors, process it and then export it to tobacco companies in China, the US and Europe where it is made into Cigarettes and other tobacco products. A few more steps along the chain someone in Ireland is forking out whatever it is, over eight euro for a pack of fags.
I guess the average smoker at home is spending about €3000 per year if smoking twenty per day. The tobacco farmer in Malawi has to survive on $1000-$2000 per year to support him and his family. I am unsure on the maths as to how many smokers’ habits his 1000-2000kg of tobacco feeds. It’s hard to know what view to take on this industry. On the one hand it provides valuable employment and capital into the country from export revenue. On the other hand tobacco is a harmful product the health effects of which I see everyday when working in General Practice at home. In addition there are reports of child labour in Malawi’s tobacco industry.
Perhaps the mission statement in Auction Holdings Limited reception sums up my confused thoughts on it ‘To play a leading role in improving and managing the best systems for handling and marketing tobacco and other products and services which are user friendly, fair and provide value to shareholders and other stakeholders.’
The head office of the department of immigration is in a leafy relatively affluent area of Lusaka. Inside it looks like any public service building at home, various desks computers and large numbers off staff who appear to be doing very little. Despite all the computers I have to check myself through various hand written books to see if the permit is ready. On seeing that it is I am passed through various desks until I find the one from which to pick it up, most of the staff are sitting down looking around or taking calls on their mobiles. Anyways I get the permit go to a further desk to get my passport stamp and get out of there.
I have travelled the five hours to Lusaka with some others from St Francis. Sabina a Swedish nurse who has been here for a few months and is going to spend some time in an orphanage in the Copper belt and a Canadian couple Steph who is a nurse here in St Francis and Ben who is on a placement in Katete from Engineers without borders. We decide to go to a movie that evening.
While lots of people in Lusaka live in poverty there is wealth here, a couple of shopping centres similar to what we have at home and a cinema. The entry fee of K14,000 (about €2.40) is cheap compared to home but beyond the reach of the vast majority of Zambians. It is nice to see a movie and relax but several times the surreal-ness of the previous day being working in an isolated hospital and now being in a fancy modern cinema hits me.
There isn’t a lot to do in Lusaka so having completed our business we leave the next day. I have a couple of more days off and hit to Malawi. Whilst most people might go to Malawi to relax by the lake, swim or dive, my interest is in seeing Lilongwe’s famous tobacco auction floors. Malawi’s capital is considerably smaller than Lusaka but is a much shorter distance from Katete even allowing crossing the border and temporarily importing the car (I discover on the way back I should have temporarily exported it from Zambia, but this offence is overlooked on showing my newly acquired work permit and mentioning I work in St Francis).
The public are allowed to come see the tobacco auctions by appointment. I have arranged to get a tour at 9 am and after much getting lost in Lilongwe’s industrial area arrive about ten past and subsequently have to wait around, African style, for an hour and a half. Ronald from the communications department is going to show me around. He a short man, very neatly dressed friendly and cordial. He explains we have little time as he is busy preparing for a launch the following day of a company wide HIV/AIDS policy. There is a certain irony in a company involved in the business of selling carcinogenic tobacco taking an interest in their employee’s health but it is encouraging in many ways.
Ronald leads me onto the floors. We walk past a sign stating ‘To all our Customers, Please do not bribe our members of staff: It is unnecessary, It is Costly, It is evil’. We enter a massive shed the size of several playing pitches, there are bales of tobacco over the entire area and the whole place is a frantic hive of activity, people are hurrying here and there, buyers inspecting bags of tobacco, workers literally running with barrows bring new 200kg bales onto the floor. It is an impressive sight all the more so because all the people here are African, this is not some white dominated industry or a remnant of colonial times, it is indigenous commerce.
Ronald explains that in all ‘Auction Holdings Limited’ the company which runs the floors employs 4,000 people. The company is 42% government owned with the remainder in private ownership. The government he explains are keen to protect and promote the industry which accounts for 70% of Malawi’s foreign exports and 15% of its GDP.
The auctioneer proceeds along the rows of tobacco at an alarming pace selling each bale. He chants out words and prices at an incomprehensible speed, someone behind him takes note of the ticket on the bale and the buyer. About 10,000 bales are sold each day
I am interested to know who is buying and selling the tobacco. ‘80% comes from small farmers who produce 5-10 bales per year and can expect to get about $200 per bale’ outlines Ronald. The small farmers don’t come to Lilongwe to sell the tobacco themselves but instead sell to agents who then bring the tobacco to the auction. There are only five buyers, representatives from tobacco companies here in Malawi. These buy the dried leaf from the floors, process it and then export it to tobacco companies in China, the US and Europe where it is made into Cigarettes and other tobacco products. A few more steps along the chain someone in Ireland is forking out whatever it is, over eight euro for a pack of fags.
I guess the average smoker at home is spending about €3000 per year if smoking twenty per day. The tobacco farmer in Malawi has to survive on $1000-$2000 per year to support him and his family. I am unsure on the maths as to how many smokers’ habits his 1000-2000kg of tobacco feeds. It’s hard to know what view to take on this industry. On the one hand it provides valuable employment and capital into the country from export revenue. On the other hand tobacco is a harmful product the health effects of which I see everyday when working in General Practice at home. In addition there are reports of child labour in Malawi’s tobacco industry.
Perhaps the mission statement in Auction Holdings Limited reception sums up my confused thoughts on it ‘To play a leading role in improving and managing the best systems for handling and marketing tobacco and other products and services which are user friendly, fair and provide value to shareholders and other stakeholders.’
Wednesday, September 1, 2010
Kulamba
While working in Geriatrics at home I once commented to a colleague how our image of elderly people was quite skewed. From experience there I sometimes thought all elderly people were ill, suffering from various degrees of poor mobility and dementia and needed high levels of care. Only when working in General Practice did I get to see that the majority of elderly people lived quite healthy and independent lives and continued to make a valuable contribution to society.
Occasionally here in Zambia after long hours and days on end working I get a similar view of the people. It comes to seem to me that all Zambian children are malnourished or currently seriously ill with malaria and that all Zambian adults are suffering from TB or some HIV related illness and that most will die before forty. In reality thankfully most Zambian children whilst underprivileged by our standards are well nourished and many have the opportunity to go to school. Most Zambian adults are not HIV positive, have jobs, families, relationships and interests.
Time spent away from the hospital on weekends off helps give me a fresh perspective of life in Zambia, gives me an opportunity to see the beautiful countryside and to experience local culture. The people of this part of Eastern Zambia mainly belong to the Chewa tribe. National borders in Africa were mainly decided by European colonists so the Chewa people occupy much of Malawi, the Eastern part of Zambia and northern Mozambique. Every year in August they hold a thanksgiving ceremony called Kulamba (worship) close to Katete.
One of the nurses from St Augustine, John Banda (the quintessential Chewa name) takes a group of us along to the last day of the four day festival. The overall set up reminds me most of the ploughing championship at home. It’s down a dusty (rather than muddy road) there is lots of traffic, throngs of people are coming and going and there are all manner of stalls and hawkers pedaling their wares. The centre-point of the festivities is however quite a bit more entertaining than comparing one furrow to another.
In the middle of the area there is a raised circular platform for dancing and entertainment to take place. Overlooking and right beside this is a thatched shelter housing the Undi Paramount Chief of the Chewa people on his throne. Next prime viewing position goes to a viewing stand containing dignitaries including the president of Zambia. The general public are formed in a circle around, those at the front sitting, more standing towards the back other further back perched on trees to get a good vantage point of proceedings.
When we arrive the colour of our skin pretty much guarantees us front row seat and our cameras get us into the press area right beside the chief’s throne. Various people are introduced from each of the three countries of Malawi, Mozambique and Zambia. These then proceed to the chief with all manners of gifts in thanksgiving to him including several mattresses, a chest freezer and a washer dryer interspersed among many wrapped unidentifiable objects. The gifts are given as a form of worship to the chief
The chief is sitting on his throne (an armchair like one from your grandmother’s living room) receiving these items. He is surrounded by ivory and a leopard and lion skin, though I am unsure these are real. Several men in brightly coloured dress carrying bows and arrows surround him, John explains these are the subordinate chiefs.
After each presentation of gifts, there is dancing. Many of the dancers are people (or two together) dressed in the form of an animal and believed to be transformed into such for the festival. John explains this is called the Nyao and that nobody is to know who these people really are or to disclose their identity. People who perform the Nyao are taken out into the bush for two months initiation and training by elders. John tells me later that previously almost every male Chewa had to undergo that initiation before they got married. Others dance with fire or are dancing up along tall poles, it is an amazing spectacle.
The whole experience is a fascinating mix of traditional culture and the modern commerce required to support such festivals. Despite the fact the signal is fairly rubbish here both the major mobile phone operators are out in force as are the banks. Outside that there is of course the mass commerce of food stalls, clothes sellers and just like festivals back home alcohol. Indeed the main sponsor of the event is Chibuku. This is a cloudy beer (called shake-shake) sold in milk carton type containers that is extremely popular. Whilst it’s advertising slogan promotes ‘taste the goodness’ my main encounter with it is in frequent alcohol related medical problems such as liver disease (again much like home).
Front row seats guarantee photoparama for us. In typical Zambian fashion at one point we are told not to be taking photos unless we fork out for an official press pass and then a couple of seconds later one of our groups request to meet the president is enthusiastically granted. We file up to meet ‘His Excellency’ Rupiah Banda (himself a Chewa, from this area and extremely popular here).
We get a brief handshake the chance to say where we are from, I utter something ridiculous like ‘I am from Ireland our countries are great friends’. Sadly we don’t get a photo op nor do I get the opportunity to ask him what kind of a country is he running that we often have no blood supply for several days or that the country ‘ran out’ of Insulin a few weeks back or why aid agencies withdrew hundreds of millions in assistance due to fears of irregularities in the department of health or for that matter why is it taking so long to process my work permit. Nonetheless it is of course a great honour to meet him before he leaves in his motor cavalcade.
It was strange to see the president being subordinate to the chief at the event and while he was being whisked away back to Lusaka I was comforted to think that the Undi Paramount chief would be staying locally providing community leadership. Not so unfortunately. John explains that the chief lives in Lusaka and because of this ‘is not nicely connected with the people, I think it would be better if he stayed in the area’. Whilst political leadership in Zambia often serves self interest it is truly heartening to see and experience the richness of the local culture and the pride the people have in that culture.
Occasionally here in Zambia after long hours and days on end working I get a similar view of the people. It comes to seem to me that all Zambian children are malnourished or currently seriously ill with malaria and that all Zambian adults are suffering from TB or some HIV related illness and that most will die before forty. In reality thankfully most Zambian children whilst underprivileged by our standards are well nourished and many have the opportunity to go to school. Most Zambian adults are not HIV positive, have jobs, families, relationships and interests.
Time spent away from the hospital on weekends off helps give me a fresh perspective of life in Zambia, gives me an opportunity to see the beautiful countryside and to experience local culture. The people of this part of Eastern Zambia mainly belong to the Chewa tribe. National borders in Africa were mainly decided by European colonists so the Chewa people occupy much of Malawi, the Eastern part of Zambia and northern Mozambique. Every year in August they hold a thanksgiving ceremony called Kulamba (worship) close to Katete.
One of the nurses from St Augustine, John Banda (the quintessential Chewa name) takes a group of us along to the last day of the four day festival. The overall set up reminds me most of the ploughing championship at home. It’s down a dusty (rather than muddy road) there is lots of traffic, throngs of people are coming and going and there are all manner of stalls and hawkers pedaling their wares. The centre-point of the festivities is however quite a bit more entertaining than comparing one furrow to another.
In the middle of the area there is a raised circular platform for dancing and entertainment to take place. Overlooking and right beside this is a thatched shelter housing the Undi Paramount Chief of the Chewa people on his throne. Next prime viewing position goes to a viewing stand containing dignitaries including the president of Zambia. The general public are formed in a circle around, those at the front sitting, more standing towards the back other further back perched on trees to get a good vantage point of proceedings.
When we arrive the colour of our skin pretty much guarantees us front row seat and our cameras get us into the press area right beside the chief’s throne. Various people are introduced from each of the three countries of Malawi, Mozambique and Zambia. These then proceed to the chief with all manners of gifts in thanksgiving to him including several mattresses, a chest freezer and a washer dryer interspersed among many wrapped unidentifiable objects. The gifts are given as a form of worship to the chief
The chief is sitting on his throne (an armchair like one from your grandmother’s living room) receiving these items. He is surrounded by ivory and a leopard and lion skin, though I am unsure these are real. Several men in brightly coloured dress carrying bows and arrows surround him, John explains these are the subordinate chiefs.
After each presentation of gifts, there is dancing. Many of the dancers are people (or two together) dressed in the form of an animal and believed to be transformed into such for the festival. John explains this is called the Nyao and that nobody is to know who these people really are or to disclose their identity. People who perform the Nyao are taken out into the bush for two months initiation and training by elders. John tells me later that previously almost every male Chewa had to undergo that initiation before they got married. Others dance with fire or are dancing up along tall poles, it is an amazing spectacle.
The whole experience is a fascinating mix of traditional culture and the modern commerce required to support such festivals. Despite the fact the signal is fairly rubbish here both the major mobile phone operators are out in force as are the banks. Outside that there is of course the mass commerce of food stalls, clothes sellers and just like festivals back home alcohol. Indeed the main sponsor of the event is Chibuku. This is a cloudy beer (called shake-shake) sold in milk carton type containers that is extremely popular. Whilst it’s advertising slogan promotes ‘taste the goodness’ my main encounter with it is in frequent alcohol related medical problems such as liver disease (again much like home).
Front row seats guarantee photoparama for us. In typical Zambian fashion at one point we are told not to be taking photos unless we fork out for an official press pass and then a couple of seconds later one of our groups request to meet the president is enthusiastically granted. We file up to meet ‘His Excellency’ Rupiah Banda (himself a Chewa, from this area and extremely popular here).
We get a brief handshake the chance to say where we are from, I utter something ridiculous like ‘I am from Ireland our countries are great friends’. Sadly we don’t get a photo op nor do I get the opportunity to ask him what kind of a country is he running that we often have no blood supply for several days or that the country ‘ran out’ of Insulin a few weeks back or why aid agencies withdrew hundreds of millions in assistance due to fears of irregularities in the department of health or for that matter why is it taking so long to process my work permit. Nonetheless it is of course a great honour to meet him before he leaves in his motor cavalcade.
It was strange to see the president being subordinate to the chief at the event and while he was being whisked away back to Lusaka I was comforted to think that the Undi Paramount chief would be staying locally providing community leadership. Not so unfortunately. John explains that the chief lives in Lusaka and because of this ‘is not nicely connected with the people, I think it would be better if he stayed in the area’. Whilst political leadership in Zambia often serves self interest it is truly heartening to see and experience the richness of the local culture and the pride the people have in that culture.
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