Some Like it Madziya

The weather continues HOT. We are so grateful for the electric fans in the accommodation and for the intermittent, albeit slight relief from our own sweat the fans bring as they rotate past. We have never had our eyelids sweat before! Paul, Thea, and I have gone for a couple more morning walks with the surgeon. We also sit in the courtyard of the accommodation in the morning having breakfast and after work before it gets dark at 6:30 and the mosquitos come out. Otherwise we try to avoid being outside except to transition from the accommodation to the hospital. Even that short journey is draining. We cannot fathom how the locals go about their day-to-day business and even work outside in the current heat. We at least have the privilege of electric fans, clean drinking water (ceramic filters provided in the house)  and showers every couple of days, although with the current drought the water is turned off at about 4 pm every evening and on again at 6 am. There are also intermittent power outages. 

 

Paul has spent some time in the OR this week as the two nurse anesthetists were away at a seminar. It was nice for him to be back doing some relatively familiar clinical work though, like everything here, some adaptation was required. The “anesthesia drug fridge” is a cooler box with some ice packs in it. They regularly have to switch out monitors and medical devices as they seem to function according to their own rhythms. He has tried to organize things a little, troubleshoot the machines (even simple things like stopping ‘US State Department’ printing out on the ECG and getting the date and time correct) and writing down the steps needed to do so. Something that hasn’t been in his job description before is being available to plug and unplug the diathermy/cautery machine. The switch (haphazardly) doesn’t work so the only way to make it work then not work is to intermittently plug and unplug the wire. The air-conditioner in the OR is an imposter so the environment is not a lot cooler in there. It is a challenge to get gloves on and off because your hands are so sweaty. And doing the sterile pre op scrub when the water is turned off requires adaptation as well. The power outages add that little extra bit of spice. 

 

He and I continue to try and to fine-tune the use of MOIS. One of the challenges has been to understand the flow of patients in the outpatient department, which is the grab all for everything that presents to the hospital. Even with both of us taking turns to sit in there and track what is going on it is difficult to comprehend this multi-headed hydra-like mass of humanity. Each morning, the patients who have congregated in the area overnight attend a service at the nearby church as this is where they get their number in the queue. They then queue at the registration window to get their “appointment”. Then they queue at the payment window. Somewhere in this time they queue at a desk to get their details written down for the “government book”. Next they queue at the nursing station to get their vital signs taken then queue at another desk for the nurse to take their history. The nurse then determines if they need to get in the queue to see the doctor or maybe directed to the queue outside operating room or the one outside the OBGYN room. If it is determined the patient needs lab or a prescription, then it’s back to the payment window to pay for these services then to the queue outside the lab or pharmacy. This whole process can often take 2-3 days given the numbers of patients passing through but also because the patient may not have the money immediately available. Also somewhere in there each patient is meant to queue at the desk inside the OPD to get their diagnosis and treatment recorded once completed. Somehow the very patient patients make their way through all these queues to receive the limited care available.

 

Tracking all this is quite a challenge. At each of these steps there used to be a ledger book where the patient’s details were recorded. Then at the end of the month someone would have to manually go through each of these books and tabulate everything. You can picture rooms were getting filled with these ledger books. Thus the idea behind the computers was to try and decrease the amount of repetitive information that was being recorded, to speed up this flow and to make the end of month reporting easier (and save on ledger books!). With such a Brownian flow of patients this has proved a challenge and, each day, there are still patients who are treated but don’t get recorded and others who appear in the department but seemed to have missed one of the various points along the way. We have had some success and managed to get “off book” in some departments like the Operating Room, Lab and Pharmacy (where yes every individual test and every drug was being manually recorded in multiple ledger books)

 

The girls have been helping out here and there with computer entry, pill counting and occasional visits to the on-site school to show the children things like cat’s cradle and origami. Their own schooling has been a challenge as the internet is erratic and inconsistent. The hospital has a data cap that usually runs out before the end of the month and so the internet then degrades even further. Thus it is not even likely we will get this update out before November ticks over.

 

We have never been birdophiles before but the birds in Africa have been fascinating. We have been introduced to so many: the magnificent fish eagle (national bird of both Zimbabwe and Zambia), the bizarre secretary bird, the ugly maribu stork. The vultures are just cool. Here at Karanda very large herons roost in the trees in the mornings and evenings. They are so ungainly- they remind me of the storks in Dumbo – and make a deep squawking noise like a bow being dragged across a giant double bass. We do appreciate the opportunity to see and experience what we have on this trip; many of the locals never have the chance to go on a game drive or even to a botanical garden to experience the diverse fauna and flora of their own countries. 

Purple Rain

Our second trip through Harare International airport went much smoother than the first. I (Lori) have just funded another gold-plated toilet for some government official as it was the fourth $75.00 visa I had to purchase for entry into Zimbabwe (because of the way the safari was organized, we re-entered Zimbabwe twice). The kids and Paul are travelling on their Australian passports and are able to get dual entry visas. The jacaranda trees that were just starting to show off the first time we landed were already losing their purple blossoms, covering the ground in a psychedelic carpet. Now there just needs to be some real rain as all the dams and lakes are very low. In Harare, we were frustrated in our attempts to take money out of an ATM and use our Visa card (sorry Ted Sloan no soccer shirt for you), except thankfully for our major grocery shop prior to going to Karanda. It was a challenge trying to gauge how much to buy of everything. We are able to get bread locally and some fruit.

 

It has been interesting getting into the rhythm of life here. There is singing and devotions each morning at 7. We don’t know what the Evangelicals make of a Catholic family showing up but they are very welcoming even if we don’t offer testimonies. The nursing students’ singing is achingly beautiful. https://www.facebook.com/paulori/posts/10154461412750977 

Dr Thistle (from Ontario) and his wife who is Zimbabwean have three boys and the older two were home from Harare on school break the first week so it was nice to have some kids close in age to the girls for board games and soccer. Exercise is a challenge as it really is only feasible prior to 6:30 am before it gets hot or around 5:30 pm before it gets dark. This morning Paul and I got up at 5 to join Dr. Stephens for a hike up Baboon Mountain.  It was already 27 degrees on its way to 37 by the time we got back at 7 am. We all find we have to stand up slowly or we get light-headed because we are so vasodilated.

 

In retrospect it was very helpful for me to have gone to Nyanga District Hospital first as because it was so quiet there, I could ask the pharmacist lots of questions and understand the processes and the different medications. In contrast, Karanda Mission Hospital is way busier, including the pharmacy. Interestingly, the staffing levels in pharmacy are about the same except that there is no pharmacist at Karanda, rather a pharmacy technician, Memory, and two nurses, Nyasha and Mugute. Similar to Nyganga, the staff are well trained and very smart. The drug inventory is much better at Karanda (although I wouldn’t have thought so if I hadn’t seen the situation at Nyanga first); I never thought seeing a Novo-cephalexin 500 mg stock bottle would make me feel homesick but it was reassuring to actually recognize a product. I wish at times I could pull out my university notes as there are some drugs I have not encountered since then (can you spell suprilide? Chloramphenicol oral is still available?). I’m now resigned to the mini-plastic bags for dispensing medication with sparse information on them and the poor quality of some of the tablets. Even the product info inserts are cheap-looking. My first job was entering all the drugs into MOIS (the computer system Paul expanded when he was here a year ago) so that the staff can enter patient meds into the system and stop recording everything manually in a ledger book. The staff are quick learners. I also have worked on updating the inventory list Paul established last year that has been very helpful for hospital staff to know what drugs are currently available. While I may have evaded inventory at the FSJ Pharmacy this September, I have done lots and lots of pill counting because they pre-pack many medications and I want to free up the staff members’ time to practice on the computer. I never thought I would be dripping with sweat merely counting tablets but the pharmacy is not much cooler than outdoors. Paul is a little more comfortable in the computer room as that has to be air conditioned to keep the computers cool. Very little chance of ‘store medication below 25 degrees’ here.  I also made simple syrup from scratch so we could make nevirapine suspension because the pharmacy is awaiting a delivery of nevirapine pediatric suspension (given for 6 weeks to babies born to HIV-positive mothers). The pharmacy’s pestle is broken but still functional and there was no glycerin to wet the tablets or preservative; however, it will at least bridge the baby until the family can get to the local clinic, which we hope have stock.


Paul has been doing similar work to when he was here last time – expanding and fine-tuning the use of MOIS (Medical Office Information System). The girls have been helping do some data entry and pill counting and have also visited the school for the staff members’ children.

 

I read a very interesting book at our lodgings “When Helping Hurts – How to alleviate poverty without hurting the poor and yourself”. It made me think about a lot of issues, especially wrt short-term volunteer stints and also how to approach helping within our own community. We are humbled by the example of the people who work here full-time – it is exhausting. I find I am changing emotional gears often, getting laughs from patients when I attempt to speak Shona but then being overwhelmed by meeting so many patients who are HIV positive. I was enjoying a casual chat with an acquaintance but then we met her cousin, whose 5-year-old died from malaria 2 weeks ago. It places the fragility of life and the blessings we have in a whole new perspective. 

 

Two Cows?

From Cape Town we flew to Victoria Falls. For our first activity, Paul had booked us to do a hike down to the base of the falls and swim under a water fall. A spectacular experience. Although the lower age limit was listed as 16, we weren’t questioned about Thea’s age (as she is taller than Lori and Rachelle) and now we feel there should actually be a maximum not a minimum age given how strenuous it was. Between my fear of cliff edges and the steepness of the climb up and down, I barely coped. It was fantastic but humbling, especially seeing our guides carry several life jackets and paddles back up and prepare to do the whole trip again an hour later. imgp1812That afternoon we wandered along the top of the falls in 38-degree heat. In the evening we had a sunset cruise on the Zambezi River followed by a short concert from Mick Thomas and Wally. It was very strange travelling around with the musicians. I discovered Mick Thomas and I have similar taste in fiction. There were 13 other people on the tour – a British couple (concidentally a friend of theirs married a woman from my home town a couple of years ago and they attended the wedding at Castle Mountain) and the rest are Aussies, all in our age demographic. Thea and Rachelle were the only kids so became mascots in a way and were quite comfortable sitting with other people by the end of the tour. Everyone was very easy to get along with to the point that Rachelle was putting Snapchat filters on Mick’s face to transform him into a drag queen and a deer (and showing him). The highlight of the concert that evening for me was the excellent version of Four Strong Winds – almost made me cry as we are so far from home.imgp1902

On Saturday we were driven and boated around part of Chobe National park in Botswana. Botswana was a British protectorate and gained its independence peacefully 50 years ago. There are only 2 million citizens in a country the size of France. Chobe Park itself is massive and the safari experience exceeded my expectations. First off we saw two leopards, which is apparently a fortunate sighting. This was followed by close-up views of literally hundreds of elephants (70,000 roam around Chobe, up to twice that many in the whole country), cape buffalo, kudu, tsessebe, giraffes, impala, sable, hippos, crocodiles, and fish eagles plus scores of other birds. Botswana banned hunting 2 years ago and our guide said poaching has dropped since then. That evening we abandoned the girls to room service and went with the group to a magical meal outdoors on a heli-pad followed by a 2-hour concert from Mick and Wally. (A few people were nodding off by the end because it had been such a long day but the mosquitos seemed energized rather than soothed by the music, esp. Saturday Night in Halifax.)imgp2574

We passed through Zambia briefly so Paul and Rachelle could swim in the Devil’s Pool on the Zambian side of Vic Falls and we could fly out from Livingstone to Nairobi. Thea and I stayed back with a few of the others sipping drinks at the Livingstone Hotel and listening to the hippos.

Apart from seeing the Rift Valley, the drive from Nairobi to the Maasai Mara was disheartening because of the stark poverty and also because of all the garbage along the side of the highway. It is sad that modernization has introduced so many disposables yet garbage disposal and recycling systems are low on the priority list. There needs to be more accountability from industry and government. We know that in Rwanda a monthly citizen pitch-in day has been instituted. Similar programs could be introduced elsewhere if people could have food security first. After a jarring 3 hours on unpaved roads (I felt like a piece of shake and bake – shaken from side to side, hot and sweaty and topped off with a fine coating of red dust), we arrived at the Maasai Mara Park. Just on the short drive through the park to our lodge we saw many animals.

The Mara Loyk lodge is a series of luxury tents just outside the park. Our first real drive in the park was an animal smorgasbord and, as in Chobe, we had a very knowledgeable guide. The wildebeest and zebra were just beginning their annual migration to Tanzania. We again got to see leopards and were thrilled to spend time watching lions both in the morning and towards evening when the cubs were more active. We saw our first hippo on land and several birds we had not seen before. imgp3176The concert that evening took place around the campfire. Mick played our favourite song ‘If You Were a Cloud’, but forgot some of the words! (cue Stephen and Paul).

Wednesday we went on a nature walk with several of the Maasai who work at the lodge and learned a bit more about some of the animals (if you surprise the notoriously aggressive cape buffalo, lie flat on your stomach and play dead even if approached or licked) and about how some of the trees and shrubs are used by the Maasai. Later in the day, Rachelle and Paul joined the group visit to a Maasai village. Paul said it was interesting but it felt voyeuristic and somewhat contrived; after the welcome and the tour we had to exit via the “market” to be offered various items to buy. imgp3703It was upsetting to learn female circumcision is still the traditional practice. One of the Australians on the music tour is a lawyer and ex-politician and is involved in combatting female genital mutilation in Somalialand. Rather sobering social studies lesson for Rachelle and Thea that day (other schoolwork is not getting done at present because of inconsistent internet).

The concert that evening was a potluck from various audience members including those in our safari truck. Our guide David taught us a traditional welcome song so ‘David and the Wifis’ performed that; the English guy Neil performed two numbers on our ukulele; Paul, other Paul, and Neil performed a song about the group to the tune of Hotel California that Aussie Paul wrote; the Mackeys performed the Arrogant Worm song Canada’s Really Big; and two women sang back up while Mick and Wally sang Step In Step Out.

Our final day in the park we spent driving further afield and by this time I had seen enough animals. It was thrilling to see a massive crocodile though. imgp4086The final concert was short as some people had an early morning. For the second time on our adventure, we have felt uneasy about our accommodation. When we tried to use the Visa card to pay for our extras, the transaction would not go through. When we called Visa in Canada to find out why, the service agent said it was because the merchant was coming through as an off-shore on-line gambling syndicate. We had to have the tour guide pay and reimburse him. I knew it was very unlikely the lodge was owned by a Kenyan and that any profits would be plowed back into the economy but now we are really suspicious that it is even worse than just foreign ownership and that the Russian mafia or other profiteers own the lodge.

Our visit to the Maasai Mara ended with Rachelle receiving a second proposal, from a Maasai man, just after our final breakfast (the first proposal was at the Botswana border). Trish, one of the other Aussies, wanted to see the kitchen at the lodge and dragged Rachelle along. We were still sitting at breakfast and heard a big commotion and Rachelle came barreling back into the dining area unable to talk. Apparently the Maasai chef told her she was beautiful, was looking for another wife,  and offered Trish two cows for her; Trish countered with 22 cows. Rachelle is still traveling with us……imgp3590

 

Art and Animals

imgp1193The last few days have me searching for appropriate adjectives. Harare was no less overwhelming the second time we were exposed to it – so many people desperately trying to scrape together some money selling produce and other items beside the main highways and even in the middle of the city streets. Our unflappable driver Tafadzwa (we keep getting tempted to ask him to do something outrageous such as a moon landing to see if he will still respond ‘No Problem’) took us to the local bird park this time and we were awed by the size of some of the birds and the initiative of the owner to continue to care for injured and endangered birds in the face of great financial challenge. That evening our hosts – who publish a quarterly magazine ZimArtist – took us to an exhibition by several local artists. The convivial event felt a planet away from the seething streets of downtown Harare. Paul met David Filer, who is renowned world-wide for his realistic pencil drawings of African wildlife (www.davidfiler.com). We also especially enjoyed the paintings by a woman who had every Zimbabwe bank note printed since 1980 as her background canvases with a local cow or steer painted overtop (‘cash cows’ – a telling statement). En route back home, our hosts drove us past the road that is closed every evening at 6 pm and reopened at 6 am and obsessively guarded by the army because Mugabe’s town house is down it, although he rarely stays there.

 

Our experience upon arriving in the Johannesburg airport was a serious deterrent to South African tourism. After enduring almost two hours of a glacially slow line-up, we arrived at the understaffed Immigration counter to be promptly whisked away to a back room because we did not have unabridged birth certificates for Rachelle and Thea. We somehow managed to surmount this hurdle despite our earnest answers to the random questions we were asked frequently being misunderstood (‘Let the girls answer – when are you leaving South Africa?’ ‘When Dad tells us.’). A further wait to transfer our checked bags and a diversion by someone trying to make some quick cash meant we arrived at our gate for our next flight just as boarding commenced.

However, pampering in terms of amazing food and home comforts from our friend Hillary at Cypress Cottage B & B more than compensated for previous stresses. Graafe-Reinet is the fourth oldest settlement in South Africa and is an esthetic mix of Dutch Karoo, Dutch Cape, Victorian, and Georgian architecture. Hillary toured us around local sights such as the large, important fossil collection at her sister and brother-in-law’s merino farm that has been in his family for five generations; the diverse art at New Bethesda (think Nelson, BC, with less water) including the quirky glass and concrete sculptures of Helen Martins, the intricate tapestries by local textile artists, and the sculptures of Franz Bookoi; followed by a drive through the Cambaroo Game Reserve where we saw kudu, eland, baboons, vervet monkeys, tortoises, zebra, springbok, and a secretary bird. We finished with a drive up to view the Valley of Desolation (possibly not desolate, just a little lonely and misunderstood) and a traditional S African braai for supper. The following morning Hillary graciously invited Lori to join her with her friends for their daily walk at 5:30 am, which provided stark views as the sun rose, and an opportunity for a last conversation.

 

Saying good-bye to Hillary was difficult as we don’t know when we will meet up again but we were so pleased we were able to fit in the visit. On our way to Paarl from Graafe-Reinet we drove the circular route at the Karoo National Park, somewhat reminiscent of parts of Arizona with the added bonus of ostrich, zebra, kudu, and a helmeted guinea fowl (the only bird apart from the common ostrich we could reliably identify). The remainder of the drive felt like a 300 km-long game of chicken at times, with us getting passed regularly on solid lines with oncoming traffic despite us adhering to or exceeding the 120 km speed limit. The iridescent green irrigated fields and wineries of the West Cape were a shock to the eyes after the terracotta dust of Zimbabwe and the subtler earth tones of the East Cape. The situation in the two countries is vastly different. Our impression so far is that there is less unemployment and desperation, more productive agriculture, better roads and more infrastructure in South Africa versus Zimbabwe. Nonetheless as in Zimbabwe the gap between rich and poor is still vast, many have no access to healthcare and their housing is grossly inadequate, and many children do not get enough to eat. I think it was helpful to be introduced to the harsher reality of Zimbabwe before South Africa because my expectations for Zimbabwe would have been higher had we come to South Africa first.

 

We were generously hosted overnight in Paarl by the Klompjes, who provisioned us well before we left early for Cape Town.

 

The Kirstenbosch Gardens in Cape Town are absolutely incredible. We learned so much in our hour and a half tour. A particular highlight for me was the Boomslang pedestrian bridge to view the tree canopy. That afternoon we caught the cable car up Table Mountain and the Potgieters, who used to live in Fort St John and moved back to South Africa almost 5 years ago, managed to meet up with us up top. We had a super Mexican dinner with Eira Palme, who used to babysit our girls many years ago in Fort St John. She made the protests at South African universities real for us as she described studying hard for an exam the previous day only to be prevented from entering the university by the activists. Eira joined us for the beginning of the ‘safari-music tour’ – a house concert opened by Digby and the Lullaby followed by Mick Thomas and Squeezebox Wally. So much fun.

 

Our brief dip into South Africa was closed out by a visit to Robben Island which serves as a monument to the long struggle against apartheid (the foundations of which were introduced in 1948). Unfortunately recent trends in Europe, the US and Australia seem all too similar. The guides all served time as prisoners so their descriptions of the conditions were brutally honest and heart-wrenching. Sobering.