Nyanga Sunset

We have been trying to learn more about Zimbabwe. The population is approximately 13 million. There are 16 official languages but English is spoken throughout Zimbabwe, Shona is spoken by about 70% especially in the north, and Ndebele is spoken by about 20% of the population. The national food is sadza – pounded and cooked maize. The Rhodes museum at the Rhodes hotel (Cecil Rhodes original homestead) gave us some background about Rhodes (a complicated character) and then the movement for the original land owners to take back the land. Independence from Britain occurred in 1980. Prior to that Zimbabwe had been a big agricultural supplier in Africa but now it is a net importer of maize. Tobacco is the most successful crop (which is depressing for a pharmacist who has a strong interest in helping people quit smoking). Milk production has dropped from a peak of 256 to 58 million liters annually, but small-scale dairies are gradually developing. The $US is the official currency. Robert Mugabe has been president since 1980, is now 92, and has promised to live to 100. We have been able to see the work of many excellent sculptors, and are hoping to become more familiar with some of the Zimbabwean painters, musicians, and writers.


The healthcare situation is dire. HIV prevalence is about 15% and most of those affected are co-infected with TB. Under 5 mortality was at 84 per 1000 live births and infant mortality at 57 per 1000 live births (ZDHS, 2010-2011). Maternal mortality was at about 960 per 100,000 births in 2010. It is estimated that over five million people are at risk of contracting malaria annually (National Health Strategy 2009-2013) There is continued and increasing incidence of chronic non-communicable conditions such as diabetes and hypertension (Zimbabwe STEPS survey, 2005) Between 1988 and 2005/6, life expectancy at birth fell from 63 to 43 years (National Health Strategy 2009-2013). Health management has weakened as a result of experienced health service (doctors, nurses) and programme managers leaving the country. Medical equipment is often old, obsolete or non-functional. The shelves are bare of surgical supplies such as sutures and drugs (except HIV, TB and anti-malarials supplied from out of country). The health system is grossly under-funded. The current budgetary allocation works out to approximately US$7 per capita per annum against the WHO recommendation of at least US$34.


Nonetheless there is progress. Locally at Nyanga District Hospital there was no maternal deaths last year. The new infection rate for HIV is declining, except, unfortunately, in women aged 15-24.


We have been staying at the NetOne (government-owned mobile-network company) holiday cottage near Nyanga. Uncomfortably we read in the Mutare newspaper today that the CEO, aptly named Reward Kangai, was recently removed from his post for allegations of swindling millions of dollars.


On the work front we’re not sure we contributed a great deal. Lori hung out in the dispensary (trying not to stress out about the fact that the rare medications that are available are all white tablets obtained from Indian suppliers and have no distinct markings so that amoxicillin looks like carbamazepine and are dispensed in small plastic zip-lock bags that are not child-proof and only have the drug name and directions on them – far from meeting the numerous legal requirements for dispensing in Canada). She did have some interesting professional conversations with the pharmacist. When discussing illicit drug use in the respective countries, she learned that one of the antiretrovirals has certain LSD-like properties and is being abused, sometimes in combination with cough syrups, possibly contributing to development of viral resistance. Paul was able to attend some telemedicine meetings with Dr Admore Jokwiro (our host physician) and will follow this up. He spent a bit of time in the OR and helped in the out-patient clinic. One day we accompanied Admore to the nurse clinic at Nyatate and the Mt Melleray Mission hospital. Nyanga doctors visit these more remote sites intermittently. The clinic has a telemedicine link to Nyanga for more urgent consultations. Despite the isolation and small size, the clinic does deliveries and has a very active public health program.

Newborn Corner
At Mt Melleray, they manage 20-30 deliveries per month and are very proud of their Number 1 ranking for Maternal-Child outcomes for the region. While Paul was seeing patients with Admore at the mission hospital, Lori, Rachelle, and Thea checked out the nearby primary Catholic school (est. 1949). The school has 500 boarders, 200 day students, and 21 teachers. They grow covo (similar to kale) to feed the students and have also started a banana plantation. While we were there we felt like the penguins in the Madagascar movie as we kept ‘smiling and waving’ at all the students staring at us.
Mt Melleray School
On our last day here Paul provided a CPR/advanced life support course for 20 healthcare staff. He had to improvise a resus Annie from a cushion (the Paullow?) and the attendees were able to practice on that. 


Our experience on Sunday summed up many of the contrasts in Zimbabwe. We started with a hike up the iconic mountain near the cottage (1800 m). The mountains are very old and covered with Rorschach blots of lichen. The colour variations at this time of year, as the leaves start to come in, are beautiful but very subtle and difficult for the camera to capture. On the drive into town we were stopped by a fire that had sprung up in a stand of eucalypts. The fire was still flickering on both sides of the highway as we eventually drove through the smoke, which was fairly terrifying. No one was dealing with the fire. In fact, those workers employed to cut down the trees, saw them up and then load them into a truck _by hand_ were still working in the smoke! (Each day we seem to see another fire somewhere). That afternoon we visited Nyangombe Falls and toured the local resort of Troutbeck but Paul was “called back” to the hospital just before dinner as the local MP wanted to meet him and Admore and interview them for the local radio! Paul and Admore were still able to join both families for dinner


Although we were only here for 10 days, we feel we did get to know some of the locals in that short time and learned a great deal about their circumstances here. So many people at the hospital and at the shops in town were welcoming and open to sharing their experiences and hope for Zimbabwe.

Mt Melleray Mission Hospital

Nyanga Notes

Some thoughts and observations from Lori. The contrast between the airport in Dubai and the one in Harare was jarring. From the ultra-busy, aggressive name-brand consumerism, glitzty hub with slightly terrifying customs and immigration agent to the single-digit number of gates, random line-ups, and baggage handler/customs assistant who was eager to show us photos of his children on his cell phone.
I didn’t really know how I would react to Zimbabwe but I didn’t expect to experience the first-world guilt as a physical sensation; I find that my chest feels compressed and heavy. Yet people don’t want to be pitied. How can I transfer my sadness into a useful emotion? I feel helpless. Person after person standing at the side of the highway, some trying to sell produce or other goods while others are hitchhiking to somewhere. Regardless of economic status, people are dressed with care – no pajama pants worn in public here. I think the saddest part of extreme poverty is the waste of human potential. On the flight to Harare I watched the movie The Man Who Knew Infinity about the Indian mathematician Srinivasa Ramanujan who died in his 30s from TB but whose formulae are still in use today. It highlighted how genius is not dependent on culture or economic status (but life expectancy is).
I feel so naïve I don’t even know when I’m making a faux pas. When we asked our driver Tafadzwa about his family, he just said it was complicated. It was so awkward when one of the nurses we were introduced to suggested we could take her to Canada. Ditto our second driver. Everyone seems to be hoping that things will get better but then they will express pessimism at the likelihood of this happening. The ongoing emphasis on security is somewhat unnerving. Our first night in Harare we were on our own in a luxurious house and had locked up as instructed. The small dogs’ barking and howling woke us from a deep sleep and it was very difficult to go back to sleep afterwards. I’m glad I didn’t notice the baseball bats in each room until morning. At the cottage in Juliasdale near Nyanga we had the bizarre experience of wanting to go for a walk but being locked in our fenced yard and having to wait until the caretaker came by the house again. We haven’t felt unsafe, however.

We have seen a couple of lovely hotels but they have no visitors.
Our first driver graciously took us to the Lion Park near Harare our second day in the country. While it could be criticized for having animals in captivity, we were pleasantly surprised at the size of the lions’ enclosures and how healthy they looked. Too healthy for how close our car got to them during feeding time! The zebras, giraffes, and wild pigs also had a lot of room to roam. The attendants were knowledgeable. We have seen baboons and wildebeest in the wild.
The hospital at Nyanga is less busy than we expected. Basically there is not enough money for it to function or enough money for people to attend it. The pharmacy is heart-breaking – insulin has not been available for 6 months let alone any more mundane medication like hydrochlorothiazide for high blood pressure. HIV, TB, and anti-malarial medications are readily available as these meds are funded from organizations outside Zimbabwe. I am learning about first-line medication for all three conditions – never encountered in community pharmacy in BC because of central dispensing for the first two conditions and the rarity of the third.
But humour is ever present. People are consistently polite, kind, welcoming, smiling and often laughing (esp. when we try to speak Shona). We had a very funny moment today when Paul asked our driver what music he listens to and he started blasting Bryan Adams’ Summer of 69!


A door opens on a new chapter. We are now en route to Harare via Dubai. We have had a stopover in England (and a dip into Wales!) to visit some old friends and some old haunts, showing Rachelle and Thea some of the places we lived and worked 20 years ago.  We were generously hosted by friends in Shrewsbury and Oswestry enabling us to be re-introduced to the standstill tailbacks of the M25, that feeling of standing still while being passed doing 75mph on the M42, to the castles of Chirk and Shrewsbury, to the flowering beauty of the Dingle in Shrewsbury, to walking in the Shropshire hills and on Offa’s Dyke, to steering into the hedge to avoid the oncoming postal van on the narrow lanes of Wales and detouring around the spaghetti spill

But Thea will tell you that the real reason for the stopover was so she could sharpen her broomstick flying and spell throwing skills at the Harry Potter experience.  Paul just wishes she had learned how to disapparate so he didn’t have to drive clear across London.  Lori will tell you the real reason was to see Kenneth Brannagh in “The Entertainer”. Rachelle will tell you it was so she could continue her “Handstand Tour” of great monuments, this time up at the top gallery of the Tower Bridge.   Paul will tell you it was so he could continue being asked directions in foreign countries. 

But the entertainment is over and the serious stuff is about to begin. It’s from London to Dubai then on to Harare with our 8 bags (4 containing medical supplies, soccer balls and soccer shirts) weighing in at 119kg (1 kg under the limit!). With a weekend  in Harare (again courtesy of generous hosts) to get settled and get groceries we  head out to Nyanga in the Eastern Highlands. We’re all obviously a little nervous and uncertain as to how that’s going to look and what our role will be. However we believe the good fortune and assistance we have been blessed with so far will continue and we will find our way. 

We Rise at Daybreak

The journey begins. 

With the van riding heavy we started the long drive to Vancouver en route to UVic for Liam and then Zimbabwe (via the UK) for us. While Liam waits in the queue to get his key for residence we finally have time to jot some things down. 

We would like to acknowledge some people who have contributed to this venture. To the nurses in ER and the OR who kept an eye out for expiring supplies and held onto many things that would have otherwise been thrown out. To the clinic staff who also furnished us with  medical supplies. To Lori’s pharmacy which did likewise.  To Home Hardware who donated (thankfully deflated) soccer balls. To the Fort St John Strikers who donated (a lot of) soccer shirts. To the members of the Fort St John Community Choir (and the Zeunerts) who provided duffle bags to carry all this stuff and a whack load of pens (amongst other things) to fill them. To the Fort St John Division of Family Practice who made the donation to build a “house” in Bwindi, Uganda. (There will be more on that later in a future post). 

As a result we are loaded up with our one “personal” bag and each of us will also have a bag full of medical and other supplies. 

We are also very grateful for the various enjoyable good-bye parties and to those who helped us finish up, pack up and get out the door. It may take a village to raise a child but it has taken a community to get us to this point and we thank you all. 

Once we have Liam ensconced in residence it’s back to Vancouver to do a “re-pack” and re-weigh before we fly out on Thursday. We will have 6 days in the UK to visit some old friends and old haunts before heading to Zimbabwe. Stay tuned. 

Oh, and in case you really have time to fill here’s a link to a video which includes our traditional departure “track”.

We Rise at Daybreak