Week 1

Muli bwanji!

Today marks the end of my first week in Zambia. Meeting Mumba, Martha, Chileshe, Sala, Tojo, and the rest of the family was such a relief and a pleasure. I've never known such friendly and gracious people. I am very fortunate to be invited into their home for my time here.

The girls prepare delicious food every night. It took about two bites to get used to nshima (known as ugali on cedar ave in minneapolis) every night. It's accompanied by mphwa (little eggplant), kapenta, beef, chicken, the unfortunately named rape, fish, peanut-based dishes, and other relishes. I'll be fat by the time I get home.

There was a holiday and long weekend after I arrived so the TTAF clinic was closed both monday and tuesday. I spent Sunday and Monday on Dr. Tim's farm meeting a lot of the TTAF boys and getting adjusted to the new time zone. There are a lot of great kids here at the farm, the clinic, and the various schools and orphanages I've visited. Chileshe, the seven-year-old with whom I share a room (he gets the top bunk), always wants to play. We spend at least an hour together each day mostly practicing reading in the dinosaur book I brought him. He calls me uncle. It's a good feeling.

There's another good kid I've gotten to know who I'll call Adam. Adam is ten years old and HIV+. He lives with his uncle at the school his uncle runs. Prior to starting treatment he was seriously ill with several opportunistic infections, including generalized flat warts and TB. I met him while I was getting oriented in the clinic on Tuesday, one of two patients who showed up even though it was a holiday. He was out of ARVS, a particularly serious situation since he has already failed on first-line HIV treatment and is now taking the drugs reserved for patients who become resistant to the first set. Missing doses quickly leads to resistance and when he develops resistance to these drugs there's nothing left to fall back on.

I went to the transit home where Adam lives to start doing a "needs assessment" of the place and rode the bus with him and another "uncle" of his to his appointment at the clinic. I bought him some biscuits and he sat on my lap in the crowded bus. He never let go of my hand. I may have squeezed his hand a little too hard a few times. I've blinked back a lot of tears on this trip.

This morning another volunteer and I shadowed Dr. Betty at Jon Hospice. The adult patients at Jon Hospice are mostly bedridden and fighting TB. Many do not know their HIV status, the rest are positive. I did rounds with Dr. Betty and got to apply some things from school, espically physical exam skills. I've got a feeling I'll have a positive Mantoux when I get back.

Towards noon we were looking over chest x-rays in her office when a nurse came in to say that one of the female patients had died. I hadn't met this patient and went with Betty to certify the death. A relative was sobbing by the side of the bed but Betty, being the excellent teacher she is, launched right into an explanation of the procedures necessary to certify a death. The culture surrounding death is different in a country with a life expectancy of 35 than it is in the US. The body was still warm when I checked the pulse.

There's a lot more I'll share with you guys but that's enough for one email. I got to prick kids' fingers at an outreach and dispense ARVs in the TTAF clinic. I've met all kinds of people and am learning a lot every day. The time is flying by and I'll be home soon. I miss you all!