Our first African vacation!

We met our friends from Canada (Marc and Karla Drader, who are currently living in Germany) at Livingstone Airport in Zambia on Oct 2nd. It’s an 8 hour drive from Rundu to Livingstone, so we split the trip into 2 days so that we could get to the airport in time to pick them up at 12:30. The border crossing at Zambia was quite a cultural experience, as most of the many visa and car fees were collected in broken down motor homes! We managed to get to the airport just on time, only to find out that the plane was going to be delayed (it arrived 7 hours late) and then their luggage didn’t come until the next day! What a way to start..

Our first day we went River rafting down the Zambezi river. Apparently river rafting junkies travel from all over the world to raft these rapids, especially at this time of year as the waters are very low making the rapids even more challenging. None of us had ever done it before and it was so much fun, not to mention hair raising! (The highest level of rapids is a class 6, which they don‘t allow people to actually attempt, and we travelled through a series of class 4 and 5’s. One rapid we travelled through was going to be shutting down one week after we went as it was getting too dangerous - yes, this is the one that we completely flipped in!). The afternoon was spent on the top of Victoria Falls looking down at the beautiful valley and the rapids we had rafted through that morning. The falls are very low at this time of season but it was still a majestic sight.
http://www.facebook.com/album.php?aid=38326&l=f62e1&id=518018255

Our second day was spent doing a full day safari in Botswana at a Game Park called Chobe. We saw well over 250 elephants, fields full of the dangerous cape Buffalo, crocodiles, and hippos! The morning was spent on a boat along the river where we got to “swim” with the elephants crossing the river, the hippos playing hide and seek, and the crocs poking their heads up to say hi. In the afternoon we were given a private tour in a safari jeep in the bush where more wildlife made themselves known.
http://www.facebook.com/album.php?aid=38874&l=80099&id=518018255

Our third day was spent doing “Gorge activities” in the morning. Unfortunately Karla came down with the travellers bug and wasn’t able to join in. The first activity was called “Absailing”, or rappelling, where you propel yourself backwards down a cliff-face, and then hike the Gorge up (about a 20 minute steep climb). The second activity was the “Flying Fox” where you are attached to a sort of zip line and you run off the cliff to zip across the Gorge. The third and definitely most challenging was the Gorge Swing. This is very close to a Bungee jump as it is a 53 meter free fall and then the “swing” catches you and you and gives you time to recover before they let the line down onto the ground. Marc and Daryl found that although they wanted to yell, they couldn’t. Not to worry, because Sabrina’s scream made up for it all!

After the Gorge activities we met up with Karla again and had lunch on a little island called Livingstone Island. This is a very popular destination as we had the opportunity to literally sit one meter away from the edge of the falls. Karla was such a trouper - not many people can literally say they threw up “over” Victoria Falls!
http://www.facebook.com/album.php?aid=38883&l=b11e2&id=518018255

Much too quickly our time in Zambia was over, and we were on the road back to Rundu. Although we had already spoken a lot in the previous few days, the road trip was a great time of processing so many of the challenges that we face in our lives here. The next few days Marc and Karla were able to participate in our ministries here at the OVC project and home based care. They immediately clicked with the kids and we wish so much they could stay and help! They also got a tour of the hospital and saw our work environment.

Both Marc and Karla where overwhelmed by the heaviness and the struggles that we simply know as life here. We so appreciated having them here and listening to our every detail. Saying goodbye was extremely tough, as we knew we were returning to Rundu to deal with all the hardships here, whereas we felt a certain sense of jealousy that they just got to leave. These last few days have been really tough on us, as processing and discussing has brought to the surface several painful issues. Conversely, it also allows us to deal with situations and reminds us to pray and press into God for help and grace.

We truly had a wonderful vacation and felt a deep gratitude for good friends.

National Immunization Day

Once a year in Namibia it is National Immunization Day (NID) which is a series of days whereby the goal is to vaccinate every child under the age of 5 for polio. This is no easy task for a country that has one of the largest land to people ratio, and most of the country is desert. Every year it is a major government campaign and they require a great number of volunteers from the community to help. So we were ready to jump on board.

Daryl and I went to a training day to become “Quality Monitors”. This role involves monitoring the vaccination teams to make sure that they are doing everything as told (correct dosage, proper storage of meds, proper tallying, and so forth) and also going into the villages to do home visits once the vaccination teams had gone through to see if there were any children that were missed. Seem simple? Well, not in Namibia.

The first major problem was the selection of volunteers. We have heard from many foreign workers the challenge of education in Namibia and we got to see some of it first hand. Most of the volunteers looked like they were in their early 20’s but it ranged to a few who were middle aged. The training was done in English, which was helpful for us, but one of the many barriers for them. Yet the problem seemed much more complex then basic English language issues as I was astounded by the lack of comprehension for very basic instructions. After a FULL day of training (when we could learned what we needed in a short session) the volunteers where called upon to review different sections, but many would decline saying they still were not clear, even though we were going out the next day. The crazy thing is that the statistics of how many kids were vaccinated’ collected by these so called “Quality Monitors” were going to become the World Health Organization statistics!!!!!

On the actual day, it was no surprise that things were running behind, as they were struggling to find drivers to take the monitors and vaccination teams into the field. Everything was chaos but I was finally teamed up with another girl and we hopped into the back of a very beaten up truck. We were off to the boonies for the day and it was quite a lot of fun. We had to drive through extremely thick sand (it is a miracle we didn’t get stuck on numerous occasions) into areas with no real road - so to get directions we had to ask the few random walkers where to go and they would point and we would drive. The “roads” were sometimes so narrow that our car barely fit between two trees!

It was a long day of walking between huts and driving crazy roads but we worked hard to do as many home visits as we could. When we got back at 6:30pm, and we collected our data, I was told I needed to stay for the oral report, which ended up taking anther 3 hours. Every group had to discuss their statistics, in English which is already a problem for most of them. The statistics were often interesting. My group was the only one to have come across children who missed the vaccine, which seems unlikely to me that every child was vaccinated in the whole region accept for the ones we came across. Another group said they had visited 51 children and 56 were vaccinated… Even with the head nurse explaining the impossibility of these statistics in their first language they could not comprehend what was wrong. Next time I see a WHO stat, I will take it with a grain of salt.

It was a very interesting experience.

(Photo is of the caregivers and kids under 5 lining up for their oral vaccine).

Rehabilitation at Rundu State Hospital

Three mornings a week I work in the Orthopaedic Rehabilitation ward at the hospital. I work with 3 others, a physical therapist and an occupational therapist (both from Zimbabwe), and a ‘rehab therapist’ who is Namibian and has been there for 10 years.

When I first arrived, I was very curious to see what my life as a therapist would look like in a hospital setting. My first morning I was welcomed and right off the bat was given my first patient without even having a tour of the facilities. I had to ask where the sheets were, was there lotion available, where the assessment sheets were (there are none), along with many questions as my patient stood beside me waiting. There is only one communal treatment room with no privacy, and I have found in general that patients here have a lot less privacy needs than back at home!

The OT and PT both watched as I did my assessment and they didn’t seem to have any patients, until around 10 am when all the patients showed up at the same time. I was confused by this and quickly figured out that the therapists don’t have a schedule (one reason I heard was because they didn’t think patients would show up for them so why bother). Well, I knew that system wasn’t going to work with me so I did some trial runs with a schedule and have been booked solid for 4 months, with my patients all showing up on time! Funny that even after 4 months, I am still the only one doing it. I think a big reason is because they tell their patients to show up sometime the next week, and usually the patient doesn’t show up, which means less work for them. So they sit around a lot and get paid for it while I work (happily) non-stop for no money at all!

My Namibian co-worker has been a particularly big challenge for our rehab team. In four months, I have only seen him treat a handful of patients. The OT and PT really struggle with it because he is constantly pushing his responsibilities on to them. He is suppose to be available to us to help translate, but most of the time he is not there, and when he is he asks other patients to do it for him!! When he is called on it he gets very upset and uses his authority as the Supervisor of the ward to get out of personal responsibility. I am fortunate that I only have one Namibian in my ward, compared to Daryl and my other AIM colleagues because sadly apathy runs rampant in the local work ethic here and has a poisonous effect in the work place.

One joy I have working here compared to the private setting at home, is that I don’t have to handle any money. Patients pay their small hospital fee and if they have been referred to our ward, I can treat them for however long, and however often I want without having to feel that money is a barrier to patients receiving treatment. It makes everything a whole lot less complicated. From what I can see, patients have been very appreciative for the time that I give.

The cases that I treat are mainly patients with chronic pain that have been coming for treatments at this hospital or others for some time with no resolve. It is especially challenging because there are literally no resources available for me to look things up and cross reference. I am in the process of trying to order some text books in order to help me, but also to help stimulate and challenge my co-workers. I have done a number of training sessions with my OT and PT colleagues but it hard when there is not even a muscle chart to refer them to and to teach from. I hope to see some change in this area before we leave.

So there is a basic review of what my hospital life looks like. I have many sad and interesting stories that I will have to post some other time, so stay tuned!

This afternoon at Home Based Care

Every Thursday we go into the village of Kaisosi with our volunteers and do home visits with the orphans at our project. We primarily check their health and the volunteers have a medical bag full of supplies for wound care, cough syrup, thermometers, and some other random things. Normally kids complain of headaches (the sun shines all day without a cloud in the sky and they don’t drink water - a good recipe for a headache), or they have a cough (viruses run rampant in the community due to poor hygiene and low immune systems).

But today was a unique experience.

Our time started out with a conversation with one of the volunteers who informed us of some major issues that are currently in the local church we attend. We will need to tread carefully as to not take sides and burn bridges. There is obviously a lot we don’t understand.

Soon after we ran into a situation where an Auntie was beating her 6 year old nephew with sticks. We (the volunteer, Shelley and I) ran over to step into the situation and take the boy away. The little boy, Jacob, is in a family well known to us due to the many issues that have been raised in the past. We had already removed his 12 year old sister for the same reasons of abuse. The Auntie is an alcoholic with no children of her own, and of course the beatings get more severe as the alcohol intake increases. The siblings’ parents are no longer in the picture (the father abused the girl when he was around) and so extended family now “care” for them. The community has tried to deal with the situation by talking to the Auntie and reasoning with her, but they don’t seem to understand that an alcoholic who is sober for a day will claim many things until the next bought of alcohol when the cycle starts again. So, Jacob held Shelley’s hand for the rest of our home visits until we were done (Jacob is the one on the far right).

Walking along, gathering more and more kids who all wanted to hold our hands, we came across a group of young girls who were all standing in a row with the sand all marked out in a big T in front of them. I asked if they were about to play some sort of game and the response was that they were practicing being in a beauty pageant! So I asked them for a show, pulled out my camera and we had fun “make believing”.

Carrying on we ran into a huge commotion with people running and crowd’s gathering. We found out that a man had just been caught for stealing 5 cows. In this culture, it is considered very bad and along with catching the thief comes beating him to a pulp. We still had little Jacob along with us and so weren’t interested in sticking around to have him observe another round of physical violence.

When we were wrapping up we needed to come up with some short term solutions for our little dude, who when I stopped him to look him in the eyes nearly burst into tears. We held a meeting with some of his distant relatives who agreed to temporarily house Jacob, and we have an appointment with a social worker on Monday about the situation. I haven’t seen a lot of first hand abuse. It’s not easy. We pray for wisdom in the days ahead.

My Life in a Namibian Pharmacy

I am volunteering five mornings and two afternoons a week at the pharmacy in the referral hospital in Rundu. As with most health care positions in the area, the pharmacy is grossly understaffed when it comes to pharmacists. I work with one other pharmacist, Chakanyuka (pictured), who hails from Zimbabwe, and we have 5 pharmacy assistants. We are to manage the medications for a 300 bed hospital, plus all the state outpatients (usually over 300 daily), plus administer and manage all the HIV medications for the thousands of patients in the area.

There are many challenges, as you might expect, but the nature of these challenges actually surprised me. Due to the generosity of foreign donors and programs such as USAID, there are sufficient supplies of antiretroviral medications (ARV) to treat the HIV/AIDS patients in the area. I was also surprised to find the pharmacy was actually quite well stocked with most of the basic medication, as well as secondary therapies for treatment. What I hadn’t counted on was the lack of empathy and poor work ethic that pervades the staff of the pharmacy, and most of the hospital as well. Even though we are chronically understaffed, the assistants routinely disappear from the dispensary without notice or warning. Two or three hour lunches seem to be the norm, and there is this unspoken idea that I am not there to assist the staff in there work as we try to improve the poor standard of care, but rather that I am there to do their work so that they can leave to go shopping or other stuff. I have often returned to the dispensary from an errand to find the outpatient window abandoned with a huge queue unattended to, and have had no option but to try my best in broken Rukwangali/charades to assist the patients. My attempts to address these problems have proved to be unsuccessful up to this point.

There are also challenges with the medical staff and physicians, who hail from a number of countries, including the old Soviet Union and Cuba (Cuba apparently has some program whereby they exchange doctors for food, and so these Cuban doctors come for 2 year terms to Africa). While I can speak and communicate in Spanish, that doesn’t mean I understand what some of these Cubans are attempting to do, as many of their approaches to medicine are not based on evidence or good practice or rationality. Fortunately the majority of my suggestions about ways to advance patient care have been received positively, and improvement in prescribing patterns have been noticed.

There still remains a lot to do, especially when we are so occupied with the basic tasks and there isn’t enough time to address all that we should be. I realize that my training and expertise and experience will probably go underutilized due to the “tyranny of the immediate”, but that change can be introduced, even if it is done very slowly. I am continuing to build friendships with my colleagues, which enhances communication and allows me to make more of an impact. I do feel that my presence is appreciated, and there are small victories along the way.

Daryl

Pizza Party!

On Saturday night we decided to honour our twelve OVC volunteers by hosting a surprise pizza party and movie night. We told everyone that there was going to be a project meeting at our house, so after choir practice we were going to drive all of them back to our place for the “meeting” then drive them all home. They entered into our house to find the furniture rearranged and a projector that we borrowed from the hospital projecting up on our wall. The kitchen was a flurry of activity as the four of us aimers had been working all day to produce homemade pizza (definitely what they call white peoples food)! The dinner was well received and we made fresh popcorn, cookies, fudge and cinnamon rolls - so desert was also a hit.

We showed them the first of the Lord of the Rings Trilogy, The Fellowship of the Ring. All but one had seen a movie before but most could count on one hand the number of times. At the beginning of the movie we were concerned that they weren’t going to understand it as they were all busy chatting amongst themselves and not paying attention, but sure enough as the tension started to build they were sucked in! It was so much fun to hear them shout with excitement and in agreement during the action scenes and grow to love Frodo.

The next day at church they were all talking about the movie and were anxious to see the second part. They were all intrigued by the fact that the Orcs took the wrong Halflings, and what would be the result of evil King Sauruman. It was a great night and we were happy to bless them in a fun and unexpected way.

Leaving home.

After having been in Rundu for just over 2 months, last weekend we had the opportunity to leave this small town for the first time.

Our first destination was Etosha National Game Park. It is considered one of the top safari’s in Africa. This particular safari is one in which you can drive through in your own vehicle (or go on tour groups), and there is no fence separating you from the wild animals. We had an extraordinary first of three days in Etosha, and Kimmie (one of the nurses from AIM who we travelled with) who has been a dozen times was blown away by the number of animals we saw. On the first day we saw 23 elephants, 13 lions (!!!), a black rhino, a very rare spotting of a leopard and hundreds of zebra, giraffe and antelope.

But despite the first time seeing some of these stunning animals in the wild, it was also our first time seeing so many white people congregated in one place in quite some time. Most of these were European tourists, especially from Germany, lugging around cameras that cost more than some people’s cars. It was odd to see these families in their matching safari hats and huge rugged hiking boots (very necessary when you are sitting in your car for 12 hours unable to leave) staying in fancy hotels, ready to really experience “wild Africa“. Most of the kids at the project have never even seen any of the animals that we just assume local Africans live with, and yet here we are living in both worlds.

After a spectacular few days of being glued to the camera (to see some of our photos click on this link: http://www.facebook.com/album.php?aid=29884&l=40188&id=518018255), we headed off to Windhoek for a couple of days. Traveling there meant driving through a number of small towns and it was very obvious to me that “Todo, we’re not in Kansas anymore”. Rundu is a different place altogether. Rundu is the major town (actually, more of a collection of connected villages) in the poorest region of Namibia, and so in many ways it is unlike the rest of the country.

These other small towns we drove through had paved streets and sidewalks (not sand) - imagine! We even saw a little section of grass that people were lounging on. We rarely saw any mud huts on the side of the road, and instead there were lots of flashy shops and restaurants, especially in Windhoek (which you would never imagine is an African city). There are many more people, and as a result more crime - we had our car broken into with windows smashed and stuff stolen, which was a nuisance.

Language was another aspect. We have worked hard to learn some of the basic greetings in Rukwangali, the trade language spoken here - but only here. As each region and tribe speaks different languages, it was such an uncomfortable feeling to be in these other cities and having no idea how to say “please” and “thank-you” except in English, hence feeling like an insensitive foreigner.

As we were returning from Windhoek, Daryl and I noticed a strong sense that we were coming home. It’s amazing that after only 2 months we could feel an attachment to a place that we still don’t understand on so many levels. The dogs just about ploughed us over with excitement to see us again, and it was so easy to hop right back into life here. The kids at the project all missed us when we were gone, and it was really great to be back. Home, for now at least, but home none the less.