It’s Been a Hard Day’s Night…Week

It’s Been A Hard Day’s Night……Week

Maybe we should have taken heed of the portents.

The weekly morning meeting started out with the news that the river would probably be completely dry by mid week and the bores were over taxed and could be tapped out by about the same time.


The work day started started with the chaos of the “head count”. Well let’s say the day to day tumult was added to by the head count. Someone somewhere in government (I was never truly able to ascertain whom), had determined that, on the busiest day of the week, every staff member at the hospital had to progress through several different desks and produce several different documents to prove they in fact existed and worked at the hospital. One staff member wryly observed that they wanted her birth certificate, passport, degree, licence to practice and her kindergarten report card. Ok the last bit was made up. It’s not that they didn’t actually have all this information already.

So while all the patients were making their now even slower progressions through their various queues , the staff were queuing up to prove they all existed. All this queueing was happening in the very  small corridor outside the administrative office where the photocopier was going overtime making copies of all this stuff.

Fortunately no-one cared if we counted or not.

On the very same day it had been determined (again I’m not sure by whom) that the floors in Maternity, Female Ward and the Family Health Clinic had to be resurfaced. The decree was that these areas needed to be closed and the patients moved out for the alleged three days it would take. Umm where? Certainly not to the corridor outside the admin office. So, amidst the chaos of the staff not being able to do their jobs because they needed to be tapped on the head, all the patients and hospital equipment had to be moved to somewhere. The female patients were squeezed (even further) into a section of the Male Ward and into the newly built Central  Sterilizing Room. Fortunately the sterilizing equipment had not been moved in yet. However, while there were basins in there for washing there was of course no toilet.


FCH was squeezed into a sweaty shoebox that was the patient Chapel, with the pregnant moms having to sit outside on a bench, inhaling the fumes of the solvent being used to prep the floors. The same fumes that caused the nurse to have an asthma attack and end up in Outpatients. Meanwhile the poor labourers were toiling away in the increasing heat. The move meant the nurses had no access to their computer (or the network) so we quickly had to rig a wireless piggyback to the room, dodging amongst the floor work in Female Ward (as that was where we had to position the extender) and then actually make some space so they could do their job.


On Wednesday there was a regularly scheduled visit from a Harare Orthopedic surgeon. In the middle of the working and operating day the power went out as per usual. More a hassle for them than for me across the hall trying to fix another computer. The complicating factor this time was that the generator quickly overheated from the load (the radiator was low on water) and shut down too. So everything (except for the computer system protected by the impressive back up battery array) ground to a halt until the generator could cool down and be restarted.

So, maybe we should have paused for a second and thought that, just maybe, the planets were not aligned for attempting  a major overnight upgrade of the computer software. However, the narrow window provided by the tick over into November (and therefore increased internet bandwidth) was at hand. I stayed up until midnight on Wed night in case I needed to be available to any prep work. The support staff in Canada let me go to bed while the download happened and then I got up at 4 to be on hand while the update progressed. All progressed reasonably fluently while most others were in bed but, as the sun and everyone else started to rise and started to get on the internet, the internet speed progressively degraded and made it  increasingly hard for the support team to do the necessary things via remote control. Increasingly we had to resort to them texting me with step-by-step instructions. I think you can imagine how tricky it would be to make sure cryptic command line instructions get relayed 100% accurately (is that meant to be a space there?), especially to a Mac user.

I didn’t share with the team back in Canada  that, all through this, the computers and the hospital had been running on back-up battery all night because the generator was having a rest from the toils of the previous day.

All too quickly the start of  the work day approached and then passed with the update still not completed. So I also had to run around to various departments telling people to not turn on the computers. Of course, in all the additional chaos on top of the usual tumult, just because you tell one person it did not mean the message got relayed to the next. So I had to go around more than once when we discovered folks trying to log in and thus interrupting the process. I then ticked  off more people by deliberately disconnecting them all from the internet so as to free up bandwidth.

Eventually the main update completed but all was not finished. It was then I discovered that each individual Virtual Machine had to be updated in order for them to “see” the update. Remember this is a Mac user trying to divine a path through the idiosyncrasies of Windows Networking and VMWare. So picture me banging away, swearing repeatedly under my breath (to be polite) while taking longer than was probably necessary because I didn’t really know what I was doing, to update each VM then saying to the receptionist “Go” every time I would get a machine done so she could call each department and let them know. All the while I was cognizant of the dozens of patients waiting in ever lengthening queues.

This already laborious process worked for those machines I could convince it to work on from the central console. There were just some that wouldn’t behave so, in addition, I had to run to various departments to physically assault, sorry update, the computer there.

All through this the staff and the patients were their pleasant, accommodating, unflappable selves. We never cease to be amazed by the locals’ ability to not be phased by all that is going on. Despite the massive interruption, everyone was still very kind and ridiculously grateful, sometimes for the smallest things (like the update enabling the chart number to be printed on the receipt!)  By the end of the (very long) day all the patients had been registered, seen, and attended to with the same minimum of fuss and not a single person expressed any hard feelings. Remarkable.

As of Friday the floors were still not finished………..

A special thanks needs to be said to the staff at Applied Informatics in Health Society (AIHS.ca) which supports MOIS. For the last three weeks they have been graciously replying to the bombardment of emails I have been sending and then pulled out all stops to tweak the update to suit some specific Karanda requests as the Nov 1 deadline approached. They then worked many long, frustrating hours getting the update done over a very slow connection. An impressive feat given the time difference, distance and poor infrastructure. All of this for free as they have donated the software and their time to support this project in Karanda. Can’t express how important that is and how grateful the hospital and community are.

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. 

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!

Alohomora

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. 

Run Lori Run


Lori sets herself the goal of running one half marathon per year (Paul was content to rest on his laurels from the FSJ triathlon last year. “I was on call, OK”). This year Lori and a close FSJ friend chose Edmonton as part of her “farewell tour”. Maybe a little surprising that she took so long to return to Edmonton to do so having gone to university there and given the number of times we come here each year (mostly for soccer). Nevertheless, she managed to complete it in a respectable time despite blisters and a niggling Iliotibial Band. No that was not the name of the music playing as she ran. 

Her “tapering” prior to the race included drinks on various outdoor decks during the week and attending the excellent play, “Prepare for the Worst” (foreshadowing) at the Fringe festival with a friend from U of A, having dinner at The Manor Bistro the night before the run, and walking down to the N Saskatchewan 🙂

Meanwhile friends and colleagues have been graciously sending us off: Lori’s work colleagues, Paul’s work colleagues, a very touching farewell at church, brunch at the Petrucci’s (which was no less touching and even more emotional) and lunch with Paul’s office staff. I think they are making sure we are truly leaving!

Soon on the itinerary will be the long drive to Vancouver/Victoria to deposit Liam at university.