3 days in Kabwe (Oct 26 - Oct 29)

Oct 26 2008: Developing world?

- The tiny guest house where we are staying in Kabwe as a flat screen tv in the bar that plays mainly American music videos and football (soccer) games all day
- The computer in the District Health Office was playing a bad Michael Bolton song
- Nearly everyone has a cell phone and is on it almost all the time
- I played Wii tennis, bowling, and boxing (for probably the first and last time) at my country director’s house in Lusaka
- Some Zambians are following the U.S. Presidential election closer than I am!
- My hotel in Lusaka has wireless internet, a 24-hour gym, spa, 3 restaurants, and very comfy beds!
- Small village clinics being powered with solar panels

Reality check
- Power cuts are plaguing Zambia since Mozambique cut off some of its power supply. Life happens a lot in the dark (esp around dinner time- when the gov’t usually cuts power to save energy) – Zambia’s own energy conservation program ;)
- Sleeping under a net at night in Kabwe- not because it looks cool- because it will prevent us from getting bitten and getting malaria
- Villages with only a radio to communicate to the Districts- (cell phones only work if you stand on top of the highest hill to get a signal)
- Zambia just celebrated its 44th year of independence of Great Britain- think of how developed the US was 44 years after its independence in 1820.
- Found a baby roach crawling on my pillow…eew! (but that could very well have happened in my old D.C. apt! ewww!).



Monday, Oct 27 2008: Beyond our expectations

Our first day in Kabwe District….after about 3 hours of waiting around for both the Provincial Health Director (who blew us off) and then for the various members of the District staff, our four member assessment team was able to complete our District survey with the District PMTCT (prevention of mother to child transmission [of HIV]) Coordinator and the District Pharmacy Technologist. They have successfully implemented the drug logistics system for PMTCT to all 26 sites in the District. Woo hoo- good news! We broke for a very greasy lunch of ZamChick (Zambia’s version of KFC) and then hit the road for a 10 min drive along a semi-blacktopped dusty road to Chowa Health Centre.

I must admit that coming into these assessment activities- I sometimes assume the worst? Where does this come from? My western perspective? Past experience? I’m usually an optimist! I thought that facilities would not be completing forms correctly and that there would be dysfunction between the pharmacy and the maternal & child health wards. But at Chowa Health Centre, I was pleasantly proved incorrect. Mrs. Judith Phiri (a Registered Enrolled Midwife) and Mr. Enock Mutepuka (the Pharmacy Dispenser) successfully work together to treat more than 50 HIV+ mamas and some of their babies each month. Chowa clinic is very busy! And their Stock Control Card (inventory logs) were pristine! And Enock has dutifully reported each month to the District since last September! Judith has worked as a midwife for 30 years, and she retires next year when she turns 55. You could tell that her heart had seen so much. This health centre staff seemed to work so cohesively and had the patients’ health and needs at the center of their attention.

I am glad that Judith and Enock’s work was beyond my expectations. And was moved to tears when we were driving away along the dusty road when thinking about all the mama’s that get good care from Chowa Health Centre.


Tuesday, 28 Oct 2008: Old friends & nshima-induced naps

Had an interesting morning of bouncing around to four different health facilities in search of those who actually dispense anti-retrovirals (ARVs) to HIV+ mothers. The first site, Kangomba Health Centre, was not dispensing ARVs as the nurse who was trained to do that retired in January and no one had replaced her. Off to another clinic – but that centre turned out to be a full ART (antiretroviral therapy) site and treated a range of clients not just mothers. It was packed with clients for all services! The moms had lined up with their babies for the under-5’s clinic. Off to Kawama clinic that was brimming with clients! The nurses told us to come back after lunch because they were just too busy to see us then. So, third times a charm…off to Bwacha Clinic where we met with the MCH (maternal and child health) Coordinator, Grace. Grace and I met last year when I was here doing the preliminary assessment for this system. It was good to see a friendly face and encouraging to see that she was still working there- and that now with the new PMTCT logistics system that they had the drugs that they needed to treat the HIV+ moms. She said “We need to protect the health of these moms to protect the health of their children- the future presidents of Zambia.” After Bwacha, we visited Natuseko Clinic before lunch- a full morning to say the least!

Lunch was at a local place where a few women had cooked a mess of fish, chicken, beef stew, rice, chips (fries), and cooked greens (what they called rabe). For about $3.00 I had a coke, a whole fried fish, and a mound of rice and greens. The Zambian men on my team all ate fish with nshima. Nshima is a maize-based starch that is the cornerstone of most east African meals. It’s also called Nsima (Malawi), Ugali (Tanzania), and Dza-dza (Zimbabwe). It looks like a huge pound of mashed potatoes but it’s stickier and pretty tasteless. It’s boiled up and is basically a very cheap filler food. And it sits in your tummy like a rock- hence the naps my three team mates are taking until 2 p.m. when we start of to Kawama clinic post-lunch hour! The heat isn’t helping matters- full tummies and hot air will make anyone really sleepy!