OUR TRIP TO ZAMBIA – OCTOBER 2007 (SUMMARY)

Dr. Kari

INTRODUCTION

Several people have asked us “How did your trip go?” in reference to our most recent trip to Zimba, Zambia. I find myself unable to say much of anything -- there is so much to say. While I cannot possibly tell you everything, this is an effort to begin to answer the question, tell you what we did, how we were impacted, how we impacted the people there, the things we learned and perhaps how you might pray for the people there and explore how God might be leading you to partner with Him in His work there.

REGIONAL BACKGROUND
Zimba is a community of CisTonga speaking people (although most also speak varying degrees of English) in southern Zambia (formerly Southern Rhodesia), about 1 hr. drive from Livingstone, the location of Victoria Falls (one of the 7 wonders of the world). About 50 years ago a local chief visited a Livingstone missionary stating his people’s need for 3 things: a church, a school and a hospital. When the missionary told a Wesleyan church in the U. S. of the need, a parishioner stepped forward and funded all three projects. Nakowa primary school, Nakowa Pilgrim Wesleyan church and the Zimba Missionary Hospital were built soon after. The school and hospital were nationalized after Zambian independence from the British; however, the hospital in particular, remains dependent on the Wesleyans and other churches for many critical supplies, medications and support. Many of the staff members’ educations were supported by the Wesleyan Medical Fellowship. Wesleyan missionaries (currently a nurse and, as of a few months ago, 2 doctors) are stationed there.

Zambia is a poor country but politically stable with some natural resources. The Tonga people were displaced into poor, arid areas like Zimba by the building of a power dam several decades ago. Like so many places in Africa, AIDS, malaria, malnutrition, schistosomiasis, TB and other diseases are common. The government bureaucracy, poor roads, lack of supplies, unemployment, unclean water, and corruption are realities in the everyday life of the people. However, most are Christians, at least in name, thanks to the work of decades of missionaries (starting with Dr. David Livingstone). Traditional beliefs about healing and potions are used by the people. Polygamy is common. Children orphaned by AIDS are a major tragedy with many already poverty stricken families trying to support these children. 25% of children cannot afford to go to school. Many (even near the mission house) are forced into prostitution in order to eat.

FIRST WESLEYAN CHURCH (of Battle Creek) INVOLVEMENT

This was our church’s 3rd team to be sent to Zimba. The first, in July, 2006, was composed of both medical and construction personnel. A new operating room (“theatre”) was started by a team from another American church and our group worked with a Zambian team to further the work. At that time there had been no long-term physician at the hospital for a few years. While we were there, emergency surgeries were performed (instead of being sent another hour away to Livingstone), medications were made available, and care was provided that exceeded what could have been done had we not gone. We learned about the people, got to know some of our partners (nationals and missionaries), began to learn about the needs and establish relationships. We were deeply moved by the overwhelming medical and material need and the kindness and joy of the people (despite their poverty). Many of us fell in love with the people there. We were told the hospital water system itself was contaminated and there was a suspicion some children, in particular, may become even sicker due to the water while at the hospital. Also we learned that the critical lack of nursing staff was largely due to the lack of housing for them.

The next First Wes trip was in Feb, 2007, with mostly a medical team. This time we performed many lifesaving surgeries, thanks to a short term missionary doctor there in December who directed appropriate patients to come at the time we were going to be there. Also, now that we were starting to understand the needs, research was conducted that confirmed the contamination of the water system, explored sources of contamination and began to figure out ways to solve the problem. Discussions were held with the administrative staff as to their priorities and needs. “Reconnaissance” was conducted on the electrical problems and other physical plant needs to plan for the next steps. We continued to develop relationships with the local people.

OCTOBER 2007 TRIP

On this trip, we took 2 electricians, a construction worker, a “computer guy”, 2 nurses, a nurse anesthetist and myself, a gynecologist as well as my husband, Larry, who by this time was becoming an “expert” on the hospital water problems.
Once again we were profoundly impacted by the material needs of the people and hospital. For the first surgery (before we had unpacked the supplies we had brought), I was handed a used suction tube that had been soaked in a disinfectant and still had old blood in it from a prior surgery and gray surgical sponges that were being reused because no others were available. In an area with 17 % HIV positive patients, this was horrifying, but they are doing with what they have. The Zambian nursing staff was constantly turning down I.V. fluids (in very dehydrated patients) in order to conserve the fluids. They knew that after the I.V. fluids we had brought were gone, there would be no more for who knows how long (months, most likely). Children die there regularly from dehydration. A 2 yr old died our first day there due to gastroenteritis (stomach flu) when we could not get an I.V. started. Often we have seen the staff decline to start I.V.’s until the child is so dehydrated it cannot be inserted, so then the child dies. We have never been to Zimba when we have not seen the death of at least one child. (The usual pediatric census is 13-16.) People dying for lack of adequate supplies of I.V. fluids – in the US, we never even consider this could happen.

We were silent at the amazing endurance of the people when faced with what must be unbelievable pain. 2 of the women on whom we did surgery had extensive pelvic abscesses. They only had reported, what seemed to be, minimal complaints of pain. One of these abscesses was the size of a small soccer ball and must have been painful for quite some time. Then after surgery, we gave the patients a few doses of a morphine- like drug, then they had to handle the rest of their pain with ibuprofen (Motrin) and acetaminophen (Tylenol). Like-wise for the burned children and woman after a home fire – very little to provide pain relief. We compare this to all the complaints we American’s have about our aches and pains of everyday life.
The profound lack of resources includes the lack of nursing staff. The whole hospital is staffed by 2 nurses a shift. They pass medications, arrange for labs to be drawn, monitor I.V.’s, and are responsible for all nursing care. They have time to take a temperature once a day on each patient – that’s all. No blood pressures, pulse or respiration are evaluated. The lack of staff (especially well-trained nurses) is directly responsible for the inability to adequately care for patients. For instance, while we were there a patient with a breast abscess developed sepsis and died without a single pulse or blood pressure taken in the 24 hours prior or notification of the doctors about her condition. (She was a young wife and a mother of 2 little girls.) A couple of times we have been told newborn infants “just died” in the night without anyone being aware they were sick. Until adequate staff comes on board, this “place of last hope” for many ill people, will be the place they come to die. This is horrifying for the medical staff on the team, knowing so many of those we see die there would never die like this in the US.

The main reason for the severity of the nursing shortage is the lack of adequate housing for nurses. It is the hospital’s obligation to provide housing in Zambia. What they have now is tiny buildings, even by Zambian standards, with 2 room houses for up to 9 extended family members (remember most families care for orphans) often without regular running water. Many nurses won’t come to work in Zimba under these conditions. A church in Memphis is funding/supervising construction of 5 more houses but this still will not be enough. Also, until the new water/sewer system is complete, they will not have water. While it may seem a little dramatic to say it, it is true that building nursing housing will definitely save lives by attracting staff. Currently over 60% of the hospital budget is used to pay rent for the staff – money that is badly needed for medication and supplies. New housing will not only bring more staff, it will free up money for other much needed items.

As I said, on the first trip we were told the hospital had been cited by the inspectors in the past for having contaminated water. You see, people come and essentially camp out on the hospital grounds waiting for care or staying to be with family members who are in the hospital. There is also a “Woman’s Temporary Shelter” where women await labor. The toilet facilities for these people (and all the patients) are at the back of the hospital and are filthy and decrepit. We think there is direct contamination into the water system. Furthermore, hospitalized patients must walk 50-100 yds. to the facility, no matter how ill. There is nowhere for patients to bathe so we take dirty patients to surgery. During the 2nd trip, Larry was able to verify the contaminated system and investigate the problem and hospital needs. In discussing this with appropriate people on return to the US, it was decided that the only way to solve the problem was to replace the entire system. Glen Harris has spearheaded the effort to design a new system. Larry, with help from Larry E., did some additional on-site research this trip including the arduous task of doing a “percolation” test to plan for the new water and sewer system. This involved spending hours in the 100 degree heat digging a hole, hauling water and making measurements. We now are praying for a solution to the next step: a detailed survey and then a contractor who can stay on site to supervise construction of the system. Until then, people who are already weakened by disease will continue to be exposed to the unclean water.

PRACTICAL HELP and HOPE

The electricians and construction team did an awesome job this trip, accomplishing many large and small tasks. Before they could get too far they had to investigate the needs and find materials. A day trip to Livingstone only turned up a few of the needed items despite much looking. After a team meeting, we decided to authorize a trip to Lusaka, the capital city 5 hours away to the north. Our dilemma, based on the Livingstone expedition, was that they did not know where to start to find the items in a strange country. Fortunately, God foresaw the need. Janet, the missionary supervisor from the Tennessee church building the nursing housing, had met a contractor supplier at the US embassy. He is a Moslem man born in Sudan but who had escaped to the US and was educated here – the perfect match: understands what our electricians were talking about but knew the Zambian sources. A call from Janet and it was arranged. They met in Lusaka, acquired most of what they needed and established a friendly contact with a “pre-Christian” (well, maybe). He was a generous man with a good heart and willing to help.

The electricians installed a backup generator for the operating room, and just in time as the power went out when a major surgery was planned. As it was, we had to do a minor surgery with flashlights the night before the generator was hooked up. They ran wire and conduit, installed receptacles, hooked up the electrical panel, breakers and the O.R. lights. They purchased and installed a water heater for the new O.R. sink, purchased the new O.R. window panes, and installed receptacles in the lab for the expected new CD4 counter (needed to appropriately treat HIV patients). They repaired the cautery for surgery, fixed a suction pump, incubator, infant warmer, oxygen tank, air condition, O.R. light and probably other stuff I forgot about. Joan Wallace, the nurse missionary there, said several babies had died last rainy (cold) season due to cold, so the infant warmer repair likely saved more lives than any other thing we did there!

Our nurses organized and distributed the hundreds of surgical and medical supplies and medications we brought with us. The Zambian staff is so appreciative of these items as they are completely out of lifesaving supplies much of the time. They also worked with the Zambian O.R. tech to help organize and identify ongoing supply needs. They took vital signs of ward patients so we could appropriately assess them. While each of the nurses was ill (minor illnesses but enough to need extra rest) part of the time, this actually gave them more time to continue the friendship they had started with Joan Wallace who was also our hostess. Joan has children and grandchildren back in the US and has made the sacrifice to spend this season of her life in Zimba. Despite the friendships she has developed in Zambia, it can get lonely away from family and the culture you know. She has expressed great appreciation for the friendship offered, in particular, by Ann and Diana. Ann also had the thrill of her trip getting to see a child (Bless) who had been near death with pneumonia in July 06 whom Ann had tenderly cared for and treated at that time. The child is now growing well and essentially healthy. I didn’t think Ann would ever stop smiling after seeing Bless again! Diana, after her first Zimba trip, had done research on treatment of burn patients. She was able to swing into action when 2 small children and their mother were burned the day before we left. She also found the key to keeping the Zambian children from crying each time we approached them (a major problem the first trip) – candy suckers! (She brought more than a few!).

Barb, the nurse anesthetist, did the anesthesia for most of the surgeries as well as multiple other nursing related tasks. However, near the end of the visit, the Zimba anesthetist (who started a few months ago) came home from an out of town training session and they were able to share notes and work together. She and Wedon hit it off and she was able to give him several pointers on safer surgery. Wedon is a true blessing for this hospital and we are all very excited to see him there. He is well trained and conscientious. He has high standards for himself. In him we see a great hope for the hospital in that he advocates for great medical practices. For example, we were alarmed in the past that no one seemed to be trained/ interested in standard newborn resuscitation – he does it routinely in a manner consistent with the best Western standards. He monitors patients carefully with great documentation. He fully participated in a “code” while we were there when no other Zambian staff seemed able/ willing. On top of this, he has a heart of gold. He preached one of the morning chapel services quite ably, insists on praying with the O.R. personnel before each surgery, and leads a church youth group. A young teenager singled him out as the person who most helped her in her walk with Christ. Please thank God for his presence there. (He was educated with a Wesleyan Medical Fellowship).

One of the chronic problems we have seen is that is if difficult for the people at the hospital to keep track of the supplies and medications and what they need. Andy was able to do training on computers for this purpose with several people. He installed some programs that should help them. Hopefully these ultimately will make it easier for them to acquire what is needed and for outsiders to help bring what is needed most.

Another chronic problem we have seen is communication difficulties. For instance, in the past, if there was an emergency at the hospital, the only way to get help was to send a precious staff member to the needed person’s home. This meant extra delay’s for cesarean sections or other emergencies. We had suggested providing a cell phone for nursing staff to use to contact people. This is now in place! Also a new cell tower right in Zimba was installed since our last visit so communication is much better. This has made more of an improvement in use of time than you can imagine. Hopefully this will continue to improve as right now the nurse has to go to the lab or pharmacy to notify about or pick up what is needed – time that she could otherwise spend taking care of patients.

On the Feb 07 team trip, we did lots of surgeries including many hysterectomies. I was able to work with the “medical licensee” (sort of a junior surgeon who is trained to do emergency and common surgeries like C–sections and appendectomies), Ken Siabowa. One of my goals was to teach him how to do a hysterectomy in an emergency as this can be a lifesaving surgery for a hemorrhaging patient after a delivery. I was pleased to learn he had continued to perform some after I had left so that he now feels he can handle it in an emergency. While Ken was sick much of the time during this visit, we at least got to ‘scrub’ together on a couple of cases. Please pray for him as he was ill enough to need to leave before the end of one of our surgeries. They really need him there.

DRS. JONES’

Dr. Dan and Dr. Joan Jones arrived in Zimba a few months prior to our last visit as long-term medical missionaries. The hospital has not had a long-term physician for several years. Dan is a Family Practice physician and Joan is an Internal Medicine physician. For two months, they had been waiting for their permanent medical licenses and work permits which were finalized the same week we arrived. They are very patient-centered in their care and committed to working with the Zambians in a culturally sensitive manner. They are excited but somewhat frustrated by the difficult task of being a guest and yet faced with being change agents. It will be a challenge and they definitely need to be in our prayers. It is hard professionally and personally to go from an environment where you basically have every resource to care for a patient to one where you have very little -- knowing you could be a better provider for the patient in a different place and time.

I especially enjoyed doing rounds in the wards with Dr. Joan. She knew so much more than I did about the patients’ illnesses and I learned a lot. I can’t tell you how much more I enjoyed this trip than the others just knowing that there was another doctor there to talk to about the things I did not understand. I have felt such a burden in the past about how inadequate I was to meet the needs of the patients and so in the dark about many of their conditions, that I have always left quite heavy-hearted. This trip was much more positive for this reason for me. Also, it was gratifying to me that I could teach some gynecology to the Jones’s. Dan and I did several D and C’s together so that he is ready to take care of emergency hemorrhaging from miscarriages, for instance. We discussed diagnosis and management of ectopic pregnancies and other female problems. This trip, while I know things are still not as good as they will be (God willing), I know that the patients will be getting so much better care after we have left, compared to the past. I am very hopeful that as long as churches come along side the missionaries now in Zimba, things are looking up.

We delivered donated children’s books and some school supplies. We also delivered devotionals to the pastor for use by the parishioners.

THE ZIMBA WESLEYAN CHURCH

The Zimba Pilgrim Wesleyan Church is at a crossroads in its life. As I stated, the church was started by American missionaries, but has now come of age in that, for the first time, they are seeking to be a sending church, sending missionaries to other countries. What a privilege to be there when the pastor first announced this new phase in the church’s life at the Sunday service!
They have outgrown the building and are building a new one but the work is slow due to the lack of funds. In the last 18 months they have gone from a foundation, to a poured floor and foundation, and now to having the walls built to the lower window edge level. As funds become available, another round of bricks is added. Poverty stricken as the church is with poor parishioners, they have a heart to send missionaries to save others. Amazing.

One of the most profound experiences of each trip, and this one was no exception, has been the Sunday church service. The music is wonderful and spirited. The church is filled with people, including children crowded into the front. Everyone sings wholeheartedly. The choir is committed and enthusiastic. The preaching is pointed but with the content Bible-based. Amazingly, despite significant cultural differences, it is relevant to us and the leaders could be preaching anywhere in America (or elsewhere in the world). The universality of the Biblical truths never seems so real. There is a point in each service we have attended where the music plays but all are invited to pray and most do so out loud. The Holy Spirit fills the church and there is a cacophony of voices praising and pleading with the Lord. It is totally awesome and brings me to tears each time.

When I asked the pastor about the greatest problem facing his church, I was surprised by his answer. He said it was the orphans in their community. Many of these children, just a few hundreds of yards from the mission house, are being molested/ prostituted for money for food. After the tragedy of losing their parents, they suffer malnutrition, hunger, illness, and living in homes (if they are lucky) of relatives who often cannot afford to feed or clothe them, much less send them to school. (I guess I thought he would say they needed a new church building – how blind of me and I’m ashamed of that blindness). When I asked what he would like to tell/ask of the American church, again I was surprised. He did not ask for help for his parishioners or church, but for help in learning how to do missions. It is his passion that more be brought to Christ. These are astounding people, fellow believers, who struggle in unbelievable circumstances, not of their own doing, but who somehow manage to maintain an outward focus. While we in America complain about our minor inconveniences and troubles, our self-centered needs and wants, our illnesses, stresses and depressions that are largely brought about by our own deeds and habits, they live lives so on the edge of disaster and they lean on the Lord.

WHAT THEN…

There is not a person from Battle Creek that has not been changed by their experience in Zimba. For me, it is learning not to dramatize the minor inconveniences or annoyances – they pale in comparison to what the people of Zimba deal with daily-- no, hourly. I more fully appreciate just how good we have it here. Even the most poor or difficult circumstance in the U. S. is not anything like what the Zambians face. Any hospital in America, even in the most remote area, gives golden and wonderful care compared to what these people get at Zimba, a “referral” hospital for the more rural areas. I much more fully appreciate just how fine an education I have been privileged to have and how much good we actually do every day in health care in America. (Sometimes it seems we really don’t make a difference – but trust me, we do. I see now just how bad it can be without everyday care we expect and take for granted – clean water, antibiotics, clean O.R., good nursing care, etc.).

Finally, you cannot go to Zimba and think it is okay NOT to help. Yes, we all have seen those sad looking people on TV or in magazines. However, you cannot meet them face to face, and not be changed. It becomes very clear that it is morally unacceptable to live in such relative luxury (even the poorest American is rich in comparison), and pretend places like Zimba do not exist.
Jesus says the same thing in the book of Matthew in the Bible. To the people who ask the following, he says. . .

...”When did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick and in prison and go to visit you?”

The King will reply, “I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.” Then he will say to those on his left, “Depart from me, you who are cursed into the eternal fire prepared for the devil and his angels. For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.”

They also will answer, “Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?”

He will reply, “I tell you the truth, whatever you did not do for one of the least of these, you did not do for me. “ Then they will go away to eternal punishment, but the righteous to eternal life.

No, I cannot change the entire world. But I CAN make a big difference in lives in Zimba. And so can you.