The most useful treatments in medicine are not the high tech patented medications that pharmaceutical reps constantly push on GPs and other doctors at home. In fact the most useful treatments are not even medicines per say. Oxygen, fluids and blood are usually the first priorities and the most effective interventions for seriously ill patients few other treatments are as beneficial and work so quickly. One might think then that these simple low tech treatments would be easily available here in St Francis, unfortunately not so.
We do have some supplemental oxygen. This does not however come from ports in the wall connected to a mains supply like in a hospital at home. Nor does it even come in refillable and mobile cylinders like a GP would have at home. Oxygen is delivered through a few oxygen concentrators. These are helpful but can only deliver low flows of oxygen up to four litres per minute (giving maybe 28% oxygen, hypoxic patients at home would receive up to 100%). For paeds and neonates one concentrator can serve a few patients but for the adults its just one machine per person. With two to three available on each of the male and female medical wards this can often lead to difficult decisions as to who it is gets the supplemental oxygen.
But fluids should be in good supply, and they are in fairness, just not consistently the same fluids. A bag of fluids costs the hospital about $5 so we are encouraged to be judicious in the use of fluids, ‘if the gut works use it’. Through some complex ordering and procurement process the hospital gets essentials like fluids from medical stores in Lusaka. Problem is medical stores don’t always issue what is ordered. With fluids one month we may have ample supplies of normal saline and little dextrose, the next month the reverse. Then the next month again we may have little but ringers lactate.
At the Tuesday morning clinical meeting we get a list from pharmacy what is out of stock. Items currently out include oral cloxacillin (in the absence of flucloxacillin an essential drug for us to treat staphylococcal infections), spironolactone (a very useful potassium sparing diuretic, used in cardiac and hepatic failure to help the body clear excess fluid) and even cotton wool.
Oh and blood, though we have just got some in last evening. Being short of meds and fluids is an inconvenience and we have to search for alternatives. However when a patient needs blood there is no alternative treatment. When I cam here as a medical student in 2003 the hospital sourced its own blood supply. The staff would go out a couple of times per week usually going to schools and encouraging teenagers to donate (this group less being likely to be HIV positive if not yet sexually active and beyond the age for asymptomatic maternal transmission). The blood was then screened in house. When I went to donate then it was just a matter of going to the lab having a needle put in and letting the blood out into a giving set. There was rarely a shortage of blood.
Since that time the blood bank has been centralised. Blood supplies are managed nationally, screened centrally. The hospital now has to order blood from the nearest blood bank in Chipata. The blood comes pre typed with A+ or O- or whatever on the label but there is little trust in the system and all the blood is retyped here. There are frequently shortages of particular blood types and from time to time we go a few days with no blood what so ever. Patients die because there is no blood. This is progress, Zambia style.
So what can you do in the absence of blood? Use you own, your colleagues, the medical students. This should be easy but as part of the centralisation process the hospital no longer has access to sterile blood giving sets. That leaves us literally putting an IV line into the donor withdrawing 20mls, giving it to the recipient, getting a new sterile syringe repeat the process etc (over twenty times for one unit of blood).
This is a tedious process and can be messy, its hard not to spill a small amount of blood when swapping for a new syringe. The patient or parent needs to give informed consent, the donor needs to be screened for HIV and Hepatitis B. Fortunately one of my colleagues has taken on the mantle of managing this process when it needs to happen. She has a clear knowledge of what donors are available, their blood types and who needs blood the most, particularly amongst the children. The other evening I helped her take 400mls from one of the medical students with the desirable O negative blood group and split it between three sick children who are all doing well since.
I am a little envious as my previous donation went to a middle aged woman with anaemia secondary to her HIV medication AZT. I was fairly pleased that her haemoglobin went from 1.9 to 8 after 400mls of my blood (the margin of error in the lab is plus or minus 2) but unfortunately I learned she died a few weeks later, but at least not from anaemia.
A centralised blood transfusion service makes sense in a country like Ireland with first class infrastructure. Zambia covers a huge area with sparse population centres and disastrous infrastructure and really it would make more sense if certain hospitals could be licensed to manage their own blood supplies. There could be regular inspections to ensure proper screening and quality control is available. In theory there are more risks to transfusions this way but every transfusion carries a risk and the biggest risk to a patient with critical anaemia is not getting blood.
Saturday, October 30, 2010
Keeping the Faith
Mshanga calls me at half six in the morning saying I can meet ‘the Father’ this afternoon at four this afternoon. This presents two difficulties, first unlike most Zambians I don’t wake up until seven and secondly I will still be working at four. After some conferring we arrange to meet at six instead. Arranging a meeting with the local Catholic priest seems more complex than it should, with Mshanga who I have seen as a patient acting as go between.
Down at Katete Boma St John the Evangelists is a quaint church the outside painted in bright colours. The priests have a comfortable home behind. I greet Fr Lawrence and Fr Lazarus, they are both much younger than most priests at home, well spoken and intelligent. I firstly learn that in addition to St John’s the parish includes no fewer than 13 outstations some up to 80km away on rough roads. This might explain their elusiveness and why there is rarely actually a mass at St Martin’s at Katete Stores.
I ask the priests how they spend their time apart from Sundays when they are travelling around try to get a mass in in a few of the outstations. Fr Lazarus talks about some office work they have to attend to as well as visitations to schools and the hospital. He explains their role when called to see a sick person ‘at least we are able to talk, just like that, give a bit of hope to them, we don’t give the sacrament (to those that are not Catholic) but we will visit and pray for anybody’.
I am interested in the role the Catholic Church plays in life here. They explain that the parish is now fifty years old and Fr Lawrence adds ‘the Catholic church is one of those Churches with a lot of numbers. Everyone is expecting us to lead by example in a number of issues. We have a branch of home based care, an orphan’s programme that cares for everybody regardless of denomination’. They go on to outline the Church’s role in helping newly married couples as well as civic duties including helping people understand legislation, helping in community development and involvement in elections monitoring.
Having seen and experienced some of the vast number of new age Christian and Evangelical Churches around Katete ask the two fathers of their views on these ‘new’ churches. ‘We try to develop relationships and instil the spirit of ecumenism like during world AIDS day, even allowing those churches to use our premises, the choirs arranging choral festivals together’ says Fr Lawrence before he outlines challenges that arise for instance when a person passes away and there is confusion within that family as to which Church the deceased belongs.
This seems a little like a rehearsed Fr Jack ‘that would be an ecumenical matter’ type of response but it does seem that different Churches cooperate much more here than at home like recently when there was hospital Sunday and a number of Churches held a joint service at the hospital.
Maybe I can angle a better response by addressing the issue of funding. The priests explain the various ways the Church is funded here (entirely from parishioner donations with no outside funding). Firstly there is the Masika where each household gives some of the harvest to the Church. Then there is the Zambala (basket collection) people are expected to give 2,000kwacha (35cent) for this. There is the Yachitukuku a further collection for premises collection. Finally and most astonishingly to me there is the Mtulo which Fr Lazarus explains is a type of Church tax. Public employees and business people are expected to give 10% of their income and those not working 15,000 kwacha (€2.50) per year.
The only bit of criticism I get about the Pentecostal Churches, which I believe are heavily funded from outside is from Fr Lazarus ‘we are told they get money from America and Saudi Arabia’. He further tries to explain their increasing popularity ‘they have some leaders who are charismatic those sects, that people just get inspired by’. This point help emphasise some of the challenges these priests face covering a vast area and huge numbers of people ‘to have a greater impact where the place is today is difficult, some of the people they don’t know us, that physical contact is not there’ he adds. Indeed Zambia has over four million Catholics and just 382 diocesan priests.
Four million is a lot of people and religion is a big deal here so what role can the Church play in health promotion? ‘It has been very supportive we have three Catholic mission hospitals in the Eastern Province’ Fr Lawrence explains. Fr Lazarus talks about the role of the missionaries in health, education and agriculture. So what about HIV? ‘We have to accept this is a disease in our midst that needs full time support for those suffering, those that are not infected are affected through brothers, sisters or other relatives’ says Fr Lawrence. He outline the role of the Church in home based care, helping people get access to medications, some parishes have even set up their own VCT (voluntary counselling and testing) centres.
‘There shouldn’t be stigma because that kills fist he adds’ before explaining the Churches preaching on abstinence. This leads nicely on to my number one question that is the Churches attitude towards the use of condoms and other contraceptive methods. As a doctor I offer patients advice on contraception, prescribe contraceptives and encourage condom usage. As a Catholic I think the Church gets unfair criticism on the whole condom/HIV issue. Yes condom use needs to be encouraged and will help in the fight against HIV, but the church suddenly turning around and telling everyone to use condoms is unlikely to have a dramatic impact. Indeed people abstaining from sex out of wedlock would in theory have a dramatic impact.
I still try to develop the point and explain abstinence is an unrealistic expectation for most people ‘you are blocking out procreation, which is good in marriage, the Church doesn’t allow contraceptives’ Fr Lazarus intercedes. I further outline my view of the benefits of the option of contraception to a woman who has children and wishes to keep her family to a manageable number. ‘In that case now we say natural family planning’ he continues. I try to gently explain the massive unreliability of this especially in resource poor setting like Zambia (most households don’t have a thermometer) but he cleverly replies condoms don’t work if not used correctly either.
We talk a little about traditional beliefs in Zambia which the fathers feel is declining over time, though not judging by the vast majority of patients I see with traditional healer tattoos. They feel on of the biggest challenges facing the Church here is from poor relations with the government ‘the political powers are not pro-poor and the Church is pro-poor. The Church speaks out and the government says you should preach and not talk about life issues’ Fr Lazarus explains before Fr Lawrence recalls a recent event of a Bishop being threatened by members of the ruling party for speaking out. ‘Another challenge, there are Catholics in the government, we still have problems with corruption leave their Catholicism?’ he adds.
On other challenges facing the Church Fr Lazarus again speaks of HIV/AIDS ‘that is a big test on one’s faith, people ask how is God there’ they also talk about challenges from Satanism, those who covet money and material goods. They also speak of difficulties facing young people and feel there should be some spiritual counselling in schools.
They ask me is there anything that has surprised me in Zambia. I speak of things like the positivity of people in the face of adversity, how people go to Church and celebrate service even though there is no priest and the strength of faith in people here. I explain that poverty may partially explain this, Fr Lawrence agrees explaining a Marxist thought ‘religion is an opium of the poor’.
The conversation tails away, they want to know where in Ireland I am from, what I think of the Zambian work ethic. Unsurprisingly despite living all their lives in Zambia they have met several Irish priests and religious including an Irish priest 40km from here. They even bring up some mention of the Irish enjoying a drink or two. I am tempted to respond to this by asking if they have ever met a Fr Jack Hackett but I hold my tongue.
Down at Katete Boma St John the Evangelists is a quaint church the outside painted in bright colours. The priests have a comfortable home behind. I greet Fr Lawrence and Fr Lazarus, they are both much younger than most priests at home, well spoken and intelligent. I firstly learn that in addition to St John’s the parish includes no fewer than 13 outstations some up to 80km away on rough roads. This might explain their elusiveness and why there is rarely actually a mass at St Martin’s at Katete Stores.
I ask the priests how they spend their time apart from Sundays when they are travelling around try to get a mass in in a few of the outstations. Fr Lazarus talks about some office work they have to attend to as well as visitations to schools and the hospital. He explains their role when called to see a sick person ‘at least we are able to talk, just like that, give a bit of hope to them, we don’t give the sacrament (to those that are not Catholic) but we will visit and pray for anybody’.
I am interested in the role the Catholic Church plays in life here. They explain that the parish is now fifty years old and Fr Lawrence adds ‘the Catholic church is one of those Churches with a lot of numbers. Everyone is expecting us to lead by example in a number of issues. We have a branch of home based care, an orphan’s programme that cares for everybody regardless of denomination’. They go on to outline the Church’s role in helping newly married couples as well as civic duties including helping people understand legislation, helping in community development and involvement in elections monitoring.
Having seen and experienced some of the vast number of new age Christian and Evangelical Churches around Katete ask the two fathers of their views on these ‘new’ churches. ‘We try to develop relationships and instil the spirit of ecumenism like during world AIDS day, even allowing those churches to use our premises, the choirs arranging choral festivals together’ says Fr Lawrence before he outlines challenges that arise for instance when a person passes away and there is confusion within that family as to which Church the deceased belongs.
This seems a little like a rehearsed Fr Jack ‘that would be an ecumenical matter’ type of response but it does seem that different Churches cooperate much more here than at home like recently when there was hospital Sunday and a number of Churches held a joint service at the hospital.
Maybe I can angle a better response by addressing the issue of funding. The priests explain the various ways the Church is funded here (entirely from parishioner donations with no outside funding). Firstly there is the Masika where each household gives some of the harvest to the Church. Then there is the Zambala (basket collection) people are expected to give 2,000kwacha (35cent) for this. There is the Yachitukuku a further collection for premises collection. Finally and most astonishingly to me there is the Mtulo which Fr Lazarus explains is a type of Church tax. Public employees and business people are expected to give 10% of their income and those not working 15,000 kwacha (€2.50) per year.
The only bit of criticism I get about the Pentecostal Churches, which I believe are heavily funded from outside is from Fr Lazarus ‘we are told they get money from America and Saudi Arabia’. He further tries to explain their increasing popularity ‘they have some leaders who are charismatic those sects, that people just get inspired by’. This point help emphasise some of the challenges these priests face covering a vast area and huge numbers of people ‘to have a greater impact where the place is today is difficult, some of the people they don’t know us, that physical contact is not there’ he adds. Indeed Zambia has over four million Catholics and just 382 diocesan priests.
Four million is a lot of people and religion is a big deal here so what role can the Church play in health promotion? ‘It has been very supportive we have three Catholic mission hospitals in the Eastern Province’ Fr Lawrence explains. Fr Lazarus talks about the role of the missionaries in health, education and agriculture. So what about HIV? ‘We have to accept this is a disease in our midst that needs full time support for those suffering, those that are not infected are affected through brothers, sisters or other relatives’ says Fr Lawrence. He outline the role of the Church in home based care, helping people get access to medications, some parishes have even set up their own VCT (voluntary counselling and testing) centres.
‘There shouldn’t be stigma because that kills fist he adds’ before explaining the Churches preaching on abstinence. This leads nicely on to my number one question that is the Churches attitude towards the use of condoms and other contraceptive methods. As a doctor I offer patients advice on contraception, prescribe contraceptives and encourage condom usage. As a Catholic I think the Church gets unfair criticism on the whole condom/HIV issue. Yes condom use needs to be encouraged and will help in the fight against HIV, but the church suddenly turning around and telling everyone to use condoms is unlikely to have a dramatic impact. Indeed people abstaining from sex out of wedlock would in theory have a dramatic impact.
I still try to develop the point and explain abstinence is an unrealistic expectation for most people ‘you are blocking out procreation, which is good in marriage, the Church doesn’t allow contraceptives’ Fr Lazarus intercedes. I further outline my view of the benefits of the option of contraception to a woman who has children and wishes to keep her family to a manageable number. ‘In that case now we say natural family planning’ he continues. I try to gently explain the massive unreliability of this especially in resource poor setting like Zambia (most households don’t have a thermometer) but he cleverly replies condoms don’t work if not used correctly either.
We talk a little about traditional beliefs in Zambia which the fathers feel is declining over time, though not judging by the vast majority of patients I see with traditional healer tattoos. They feel on of the biggest challenges facing the Church here is from poor relations with the government ‘the political powers are not pro-poor and the Church is pro-poor. The Church speaks out and the government says you should preach and not talk about life issues’ Fr Lazarus explains before Fr Lawrence recalls a recent event of a Bishop being threatened by members of the ruling party for speaking out. ‘Another challenge, there are Catholics in the government, we still have problems with corruption leave their Catholicism?’ he adds.
On other challenges facing the Church Fr Lazarus again speaks of HIV/AIDS ‘that is a big test on one’s faith, people ask how is God there’ they also talk about challenges from Satanism, those who covet money and material goods. They also speak of difficulties facing young people and feel there should be some spiritual counselling in schools.
They ask me is there anything that has surprised me in Zambia. I speak of things like the positivity of people in the face of adversity, how people go to Church and celebrate service even though there is no priest and the strength of faith in people here. I explain that poverty may partially explain this, Fr Lawrence agrees explaining a Marxist thought ‘religion is an opium of the poor’.
The conversation tails away, they want to know where in Ireland I am from, what I think of the Zambian work ethic. Unsurprisingly despite living all their lives in Zambia they have met several Irish priests and religious including an Irish priest 40km from here. They even bring up some mention of the Irish enjoying a drink or two. I am tempted to respond to this by asking if they have ever met a Fr Jack Hackett but I hold my tongue.
Monday, October 18, 2010
Life in Slow Motion
‘I feel like its two years when its only six weeks, the time passes very slowly’ says Newton as we chat in Kizito. Newton is lying on his bed, there is a Denham pen inserted just below his knee, at the end of his bed hangs a 5kg weight and a 2kg bag of sand. The weight is applying traction to his leg through the pin allowing his shattered thigh bone to unite and maintain its original length.
I don’t spend much time in the surgical wards. The hospital’s surgeon Mike Currie spent over twenty years working as a GP in Somerset so there is little flow in medical consults compared to the stream from the other direction requesting lymph node biopsies, formal chest drains, reviews of abdominal pains. Like medicine though surgery is different here. Back home Newton’s comminuted fracture of his femoral shaft would have been treated with open surgery and internal fixation without the need for lying in bed for six weeks. Either way though the fracture should heal well.
Newton explains that he was working cutting down a tree with a chainsaw when the accident happened. ‘It fell and one of the branches got stuck in the neighbouring tree, then wind came and without knowing it feel on my leg crushing it’. Thankfully he was not alone and there were people there to free his leg. However he was in an isolated area of the bush about 50km from his town. He recalls how his colleagues brought him to a nearby village where they were able to splint the leg with some sticks. There they were also able to call his uncle who came and picked him up.
He went to a town’s hospital but as there were no doctors there his uncle decided to drive him a further 80km to St Francis. ‘The following morning I went to X-ray and then to theatre for the pin.’ I glance at the X-ray showing fragments of bone where once a smooth femur existed. While the time passes slowly Newton can feel that his fracture is healing ‘my leg is getting better, at least, it is not as painful as it was and I can lift it a bit’. Newton passes the time listening to gospel music on a small radio his friend has brought him, reading any magazines he can lay his hands on and talking to fellow patients.
Newton describes the downsides of lying in traction as including have to wee into a jug, open his bowels onto the bed pan and pain from the pin site ‘right now the fracture part is not paining, but what is paining is here in the knee and and it doesn’t allow you to move, you have to be here, I have just been lying here on the bed, I have not stepped onto the floor.’
He is not a big fan of the hospital food either, and particularly the quality of the nshima ‘its not an easy thing but I just have to eat. You know the food prepared for many people is not as good as food prepared for individual persons.’ I assure him that in most hospitals I have worked the patients tend not to like the food.
I ask Newton about the effects of his confinement on family life and business. He is 32 married with three young children. Newton has a small business cutting timber. He cuts this under license in government owned forests ‘we pay loyalties to the local chiefs then you get a letter to recommend to the government’s forestry department. I sell the timber in Petauke and Lusaka. They use it for making furniture. It’s a fair living.’
The likes of health insurance, income protection even social welfare certs wouldn’t be common in Zambia and Newton explains he will loose a lot of money due to the fracture. Again as I have seen here time and again it is the family structure who will some to his aid. ‘Relatives will help me out and help out with my wife and children’. Newton’s aunt will spend the entire six weeks staying by the hospital, coming in with food and doing his washing. His wife needs to stay at home and care for the children but they do manage to visit once a week or so getting bus transport.
The knock on effect is that Newton’s two employees are also now out of work. He optimistically hopes to be back working within a month of going home.
Despite the income loss, pain, bad food and boredom of lying in bed for six weeks Newton has nothing but high praise for the hospital ‘out of all the hospitals I have seen I count this one the best, all the doctors and staff are so committed.’ So how long more has he left in traction ‘Four weeks and three days down, I have got countdown time in my head’.
I don’t spend much time in the surgical wards. The hospital’s surgeon Mike Currie spent over twenty years working as a GP in Somerset so there is little flow in medical consults compared to the stream from the other direction requesting lymph node biopsies, formal chest drains, reviews of abdominal pains. Like medicine though surgery is different here. Back home Newton’s comminuted fracture of his femoral shaft would have been treated with open surgery and internal fixation without the need for lying in bed for six weeks. Either way though the fracture should heal well.
Newton explains that he was working cutting down a tree with a chainsaw when the accident happened. ‘It fell and one of the branches got stuck in the neighbouring tree, then wind came and without knowing it feel on my leg crushing it’. Thankfully he was not alone and there were people there to free his leg. However he was in an isolated area of the bush about 50km from his town. He recalls how his colleagues brought him to a nearby village where they were able to splint the leg with some sticks. There they were also able to call his uncle who came and picked him up.
He went to a town’s hospital but as there were no doctors there his uncle decided to drive him a further 80km to St Francis. ‘The following morning I went to X-ray and then to theatre for the pin.’ I glance at the X-ray showing fragments of bone where once a smooth femur existed. While the time passes slowly Newton can feel that his fracture is healing ‘my leg is getting better, at least, it is not as painful as it was and I can lift it a bit’. Newton passes the time listening to gospel music on a small radio his friend has brought him, reading any magazines he can lay his hands on and talking to fellow patients.
Newton describes the downsides of lying in traction as including have to wee into a jug, open his bowels onto the bed pan and pain from the pin site ‘right now the fracture part is not paining, but what is paining is here in the knee and and it doesn’t allow you to move, you have to be here, I have just been lying here on the bed, I have not stepped onto the floor.’
He is not a big fan of the hospital food either, and particularly the quality of the nshima ‘its not an easy thing but I just have to eat. You know the food prepared for many people is not as good as food prepared for individual persons.’ I assure him that in most hospitals I have worked the patients tend not to like the food.
I ask Newton about the effects of his confinement on family life and business. He is 32 married with three young children. Newton has a small business cutting timber. He cuts this under license in government owned forests ‘we pay loyalties to the local chiefs then you get a letter to recommend to the government’s forestry department. I sell the timber in Petauke and Lusaka. They use it for making furniture. It’s a fair living.’
The likes of health insurance, income protection even social welfare certs wouldn’t be common in Zambia and Newton explains he will loose a lot of money due to the fracture. Again as I have seen here time and again it is the family structure who will some to his aid. ‘Relatives will help me out and help out with my wife and children’. Newton’s aunt will spend the entire six weeks staying by the hospital, coming in with food and doing his washing. His wife needs to stay at home and care for the children but they do manage to visit once a week or so getting bus transport.
The knock on effect is that Newton’s two employees are also now out of work. He optimistically hopes to be back working within a month of going home.
Despite the income loss, pain, bad food and boredom of lying in bed for six weeks Newton has nothing but high praise for the hospital ‘out of all the hospitals I have seen I count this one the best, all the doctors and staff are so committed.’ So how long more has he left in traction ‘Four weeks and three days down, I have got countdown time in my head’.
Sunday, October 3, 2010
On your bike
The only downside of having free weekends is finding something to do with them. Katete is a fairly isolated spot, the hospital is situated of the ‘great’ east road about 4km from the town of Katete stores. There isn’t much going on around here. I pass my free weekends sleeping, reading, going to the nearest supermarket (in Chipata 90km away) to stock up on food every few weeks and continuing my ‘Christian churches of Zambia’ tour.
This tour has been stuttering along a little unfortunately. Services starting much later than advertised, lasting several hours, being in Chewa (my understanding of which looks like it will never extend beyond about 10 cardinal medical symptoms) and often being frankly bonkers dampen my enthusiasm. I did manage last week to head along to the ‘Bread of Life’ service after a kind invitation from a staff member in the hospital. This service took place in a partially completed church literally in the middle of a row of other born again Christian or Pentecostal churches.
When we arrive the first thing I notice is there are no poor people here. The congregation consist mainly of well dressed young women with children plus or minus accompanying husband. One of the elders is talking about a forthcoming conference and is asking each member to cough up 100,000 kwacha towards hosting it (about €16, a lot of money here).
After that there is singing not form a choir, but from ‘the praise team’. Naff music is blasted through loudspeakers from a keyboard and the team sing uplifting Christian songs. It’s all very unZambian but at least a lot livelier than the JW service. There are much less people here though and all are well to do, this church doesn’t have the mass appeal brought by distributing free bibles but it seems to have targeted a niche in the market.
The pastor gets up to do his thing, first off all blessing all the children and casting the evil spirits out of them. He then begins his sermon which lasts well over an hour. He dressed in smart suit and speaks in English. I guess the reasons for this may include the targeting of more well to do Zambians who tend to be educated and have English and also the fact the pastor is from another part of the country and doesn’t speak the local language. He speaks through the loud speaker often with great gusto and pleads with the crowd ‘can I get an Amen?’ after the important points. A male member of the praise team stands beside and impressively translates everything into Chewa at great speed.
The first theme is to ‘think big’ which sounds reasonable until the pastor starts using the analogy of a ‘mad person’ who can not think big ‘their minds are finished’. Zambia is not the place to have a psychiatric illness. He talks about having the right attitude and mentions how a plane he saw once brining the bishop from America to visit had to have the right attitude towards the wind in order to fly. He talks about discipline and how George Washington with a small army defeated a larger one because of discipline. The next point is integrity and here he focuses on the evils of being or having a ‘sugar’ daddy or mammy. The entire congregation is asked to declare ‘I will never be a sugar daddy/mammy’.
Church visits and shopping aside I try out some of my pastimes from home. There is a golf club in Chipata, the 4th oldest in Africa and 36th oldest in the world. I’m rubbish at golf but find it an enjoyable way to pass time and relax. Chipata Golf Club is more a brown patch of land through which many roads and paths cross and with 9 holes in the ground with flags located in fairly random locations. Anyway it’s cheap (the ‘brown fees’ are just 5000 Kwacha, less than €1) and a bit of fun for a gang of us to play one Saturday. It’s a pretty strange experience, teeing off there is no golf course to be discerned just brown landscape and people walking through it into town. On one hole we literally have to play out over a busy road, thankfully nobody manages to hit a car but we do witness a crash.
When you make it to the brown the caddy scrapes a smooth path on the ground to the hole for to put along. The browns are hard to judge, there are no breaks but you have to be careful not to hit the ball down into the dirt. At one point a guy just cycles over the brown on his way somewhere, elsewhere there is a homeless man living under a tree on the course.
On another Saturday I go for a cycle. I don’t own a bike, having a car here was my priority. Some of the other volunteer Doctors have bikes and I borrow one for an afternoon. The bike is a Chinese import costs about 500,000 (a little over €80) at Katete stores. They think this is great value, I think they have been had. It’s rickety, squeaky, the gears are stubbornly resistant to change and the back brakes don’t work.
I cycle across the road and down some tracks. For the first few kilometres I see nobody just beautiful peaceful African countryside. Cattle are grazing here and there but there are no fences, just open countryside. After a bit I arrive in a traditional African village, kids run out from everywhere to gawk at me (I’m not far from the hospital they probably see a muzungo every couple of weeks but I’m still a novelty). The village s fairly big and I am almost hoarse at shouting ‘Muli bwanji?’ (How are you) by the end.
Continuing on a few kilometres I come to a kind of gravel road with lots of people walking. I deduce that if I take a left on this road I will end up back at Katete stores and can make my way home from there. There are more people now, its 5 pm, making there way home from the stores or work or wherever they have been for the day. People enter and exit the road from various paths and tracks out of the bush. I feel vindicated when after a bit the road leads onto the tar but then discover I am not at the stores but quite a bit down the Mozambique road.
The tar is easier to cycle on, the bike creaks less. It’s a little uphill to the stores then downhill back to the hospital. On the way I overtake many people walking and am overtaken by a lot of people cycling. Walking and bicycle are far more popular modes of transport than vehicles. People here tend to cycle on single gear standard issue black bicycles (in fairness they look much sturdier than the one I am on). Young girls overtake me, old men overtake me cycling almost effortlessly, lots of bicycle taxis overtake me, some even carrying two passengers.
Back on the ‘great’ east road at the stores there is more vehicles. The road is narrow and vehicles approaching to overtake a cyclist usually emit a shrill blow of the horn so as to say to the cyclist ‘get the hell of the road’. I have done this to cyclists myself many time and now I see things from their perspective. It’s pretty frightening hearing the sound and suddenly there is a massive truck a few meters behind you travelling at over 100km per hour. You swerve off the road onto the dirt that runs alongside the tar, there is often a treacherous drop between the tar and the dirt and then it’s hard to get back onto the tar.
Everywhere along the road the kids are again shouting ‘How are you?’ I reply ‘I am fine and how are you?’ to which he same child responds ‘fine and how are you?’ I turn off the road safely back at the hospital. There is a beautiful sunset over the African countryside, its good to be here.
This tour has been stuttering along a little unfortunately. Services starting much later than advertised, lasting several hours, being in Chewa (my understanding of which looks like it will never extend beyond about 10 cardinal medical symptoms) and often being frankly bonkers dampen my enthusiasm. I did manage last week to head along to the ‘Bread of Life’ service after a kind invitation from a staff member in the hospital. This service took place in a partially completed church literally in the middle of a row of other born again Christian or Pentecostal churches.
When we arrive the first thing I notice is there are no poor people here. The congregation consist mainly of well dressed young women with children plus or minus accompanying husband. One of the elders is talking about a forthcoming conference and is asking each member to cough up 100,000 kwacha towards hosting it (about €16, a lot of money here).
After that there is singing not form a choir, but from ‘the praise team’. Naff music is blasted through loudspeakers from a keyboard and the team sing uplifting Christian songs. It’s all very unZambian but at least a lot livelier than the JW service. There are much less people here though and all are well to do, this church doesn’t have the mass appeal brought by distributing free bibles but it seems to have targeted a niche in the market.
The pastor gets up to do his thing, first off all blessing all the children and casting the evil spirits out of them. He then begins his sermon which lasts well over an hour. He dressed in smart suit and speaks in English. I guess the reasons for this may include the targeting of more well to do Zambians who tend to be educated and have English and also the fact the pastor is from another part of the country and doesn’t speak the local language. He speaks through the loud speaker often with great gusto and pleads with the crowd ‘can I get an Amen?’ after the important points. A male member of the praise team stands beside and impressively translates everything into Chewa at great speed.
The first theme is to ‘think big’ which sounds reasonable until the pastor starts using the analogy of a ‘mad person’ who can not think big ‘their minds are finished’. Zambia is not the place to have a psychiatric illness. He talks about having the right attitude and mentions how a plane he saw once brining the bishop from America to visit had to have the right attitude towards the wind in order to fly. He talks about discipline and how George Washington with a small army defeated a larger one because of discipline. The next point is integrity and here he focuses on the evils of being or having a ‘sugar’ daddy or mammy. The entire congregation is asked to declare ‘I will never be a sugar daddy/mammy’.
Church visits and shopping aside I try out some of my pastimes from home. There is a golf club in Chipata, the 4th oldest in Africa and 36th oldest in the world. I’m rubbish at golf but find it an enjoyable way to pass time and relax. Chipata Golf Club is more a brown patch of land through which many roads and paths cross and with 9 holes in the ground with flags located in fairly random locations. Anyway it’s cheap (the ‘brown fees’ are just 5000 Kwacha, less than €1) and a bit of fun for a gang of us to play one Saturday. It’s a pretty strange experience, teeing off there is no golf course to be discerned just brown landscape and people walking through it into town. On one hole we literally have to play out over a busy road, thankfully nobody manages to hit a car but we do witness a crash.
When you make it to the brown the caddy scrapes a smooth path on the ground to the hole for to put along. The browns are hard to judge, there are no breaks but you have to be careful not to hit the ball down into the dirt. At one point a guy just cycles over the brown on his way somewhere, elsewhere there is a homeless man living under a tree on the course.
On another Saturday I go for a cycle. I don’t own a bike, having a car here was my priority. Some of the other volunteer Doctors have bikes and I borrow one for an afternoon. The bike is a Chinese import costs about 500,000 (a little over €80) at Katete stores. They think this is great value, I think they have been had. It’s rickety, squeaky, the gears are stubbornly resistant to change and the back brakes don’t work.
I cycle across the road and down some tracks. For the first few kilometres I see nobody just beautiful peaceful African countryside. Cattle are grazing here and there but there are no fences, just open countryside. After a bit I arrive in a traditional African village, kids run out from everywhere to gawk at me (I’m not far from the hospital they probably see a muzungo every couple of weeks but I’m still a novelty). The village s fairly big and I am almost hoarse at shouting ‘Muli bwanji?’ (How are you) by the end.
Continuing on a few kilometres I come to a kind of gravel road with lots of people walking. I deduce that if I take a left on this road I will end up back at Katete stores and can make my way home from there. There are more people now, its 5 pm, making there way home from the stores or work or wherever they have been for the day. People enter and exit the road from various paths and tracks out of the bush. I feel vindicated when after a bit the road leads onto the tar but then discover I am not at the stores but quite a bit down the Mozambique road.
The tar is easier to cycle on, the bike creaks less. It’s a little uphill to the stores then downhill back to the hospital. On the way I overtake many people walking and am overtaken by a lot of people cycling. Walking and bicycle are far more popular modes of transport than vehicles. People here tend to cycle on single gear standard issue black bicycles (in fairness they look much sturdier than the one I am on). Young girls overtake me, old men overtake me cycling almost effortlessly, lots of bicycle taxis overtake me, some even carrying two passengers.
Back on the ‘great’ east road at the stores there is more vehicles. The road is narrow and vehicles approaching to overtake a cyclist usually emit a shrill blow of the horn so as to say to the cyclist ‘get the hell of the road’. I have done this to cyclists myself many time and now I see things from their perspective. It’s pretty frightening hearing the sound and suddenly there is a massive truck a few meters behind you travelling at over 100km per hour. You swerve off the road onto the dirt that runs alongside the tar, there is often a treacherous drop between the tar and the dirt and then it’s hard to get back onto the tar.
Everywhere along the road the kids are again shouting ‘How are you?’ I reply ‘I am fine and how are you?’ to which he same child responds ‘fine and how are you?’ I turn off the road safely back at the hospital. There is a beautiful sunset over the African countryside, its good to be here.
Subscribe to:
Posts (Atom)