HIV/AIDS: Death and Dying

September 24, 2009

Today we finished our HIV education course. All of the students passed with 80% or better with 6 of the 8 that showed up for the final exam scoring 20/20. Admittedly the test was pretty easy, but I think they still learned a lot. One of the questions that they struggled with was whether or not HIV was a punishment from God. They are a very religious people and believe that all is in accordance to God’s plan.

We had started the class by talking about the proper way to use a condom and since no one else would do it, I ended up demonstrating to the class how to correctly open and put a condom on a practice penis. (I wonder what the Catholic Church thinks about that…) Brave then followed with a very detailed description, which I got a very good video of. We finished off the session with the presentation of certificates and plenty of pictures. I am on strict orders to print these out and send them back so that the women that graduated the course can have a picture of themselves with their teachers.

Although I have seen a lot of sick people since I have been here, I was lucky for the first few months to not have to deal with death. Or at least be oblivious to it. There was one time about three weeks ago where a patient we were supposed to see at home-based care had died the night before, but I did not know the patient so her death had a minimal impact on me.

This past week though it seems to be everywhere. We ran into some women crying in the street this morning at Maramba HBC. I knew that something big had happened since it is very rare that Zambian women, men and even children can be seen crying. It turns out that their older sister had died that morning. At another home-based care this morning, Claudia found out that a patient she had been seeing fairly regularly had died. To top it off a patient that I had seen last week passed away yesterday. He had cancer and had large tumors and sores on his legs. We tended to the sores but there wasn’t much else we could do. He looked sick but not on the verge of dying and the news came as quite a shock to those that had helped with his treatment.

One of the driver’s at the house took the monster truck out this morning to carry the mourners for the funeral of a friend’s son. I’m not sure what an actual funeral is like here but I saw the funeral procession driving through town today. They fill up the back of big trucks and divide up between men and women. Then they drive through town singing songs, but not sad sounding songs, just African songs.

They deal with death a lot more here than we could ever imagine. It’s not just old people that die or the occasional freak accident. It’s children and parents and young men and women that have these horrible diseases. The treatment for HIV/AIDS, TB and malaria have gotten much better in the past years but there are still people we see that don’t have the means to get to the clinic or run out their medication and find out that the clinic has run out as well. To top it all off many of them don’t have enough money to buy the right amount and kinds of food to keep themselves healthy.

Africa is a tough place to visit and to work. It’s an even tougher place to live. I am continuously surprised by the strength of character that the people here show. The projects we are doing have their faults but I hope that we are making a positive impact.

The Devil's Armchair

Edge of the Falls
Jumping into Angel's Pool
Sunset Cruise
Sweet tan/dirt lines
Devil's Armchair

September 19, 2009

Last Saturday a group of fellow volunteers and I headed out to Victoria Falls to swim in the much-heralded Devil’s Pool. Turns out that it costs $50 to see the actual Devil’s pool. The take you across the top of the falls in a boat out to Livingstone Island and you can spend the day seeing the pool and hanging out on top of the falls. We went for a cheaper option. There are local guides that will take you across the falls to the edge of the falls and a pool called the Devil's Armchair (or Angel's Pool).

The guides are actually illegal but will take you out for as little as K10,000 a person (around $2) if you bargain with them. The water is quite low at the moment so crossing the falls is fairly safe. We stopped once on the way to the pool to take pictures near the cliff. The pool itself was a fair size. Earnest, our knowledgeable guide showed us where it was safe to jump in and then took some pictures for us. I jumped in twice and got some sweet action pictures and videos from the edge of the pool.

I spent the rest of the weekend on a sunset cruise, going to mass, relaxing and cleaning my room. The power system here in Livingstone is sketchy at best. When I first got here Thursdays were power cut nights and we would eat and play card games by candlelight until the lights came on again around bedtime. This week however, the power decided to cut out for a few hours on Tuesday and again for four hours on Wednesday. This isn’t a big deal except that I had plans to talk to my dad on Skype. I did eventually get a hold of him on Thursday evening.

On Wednesday Annaleen and I were filmed for a documentary. The film crew was from France and was taping a group traveling across Africa. They wanted to include a bit about what African Impact is doing in the community, so they came by to tape us doing a home-based care visit with a woman named Agnes. I’d seen her a few times before. She is bedridden and paralyzed on her left side due to a stroke a few years ago. The family has been instructed to do exercises to increase her range of motion and circulation and prevent bedsores.

The film crew taped us entering the house, taking Agnes’s vitals, interviewing her and the family to see how she was doing and giving her some medication to help with the pain. They also taped a bit of us walking around the community, interacting with the kids, and interviewed Annaleen. They told Annaleen that they didn’t want an American to do the interview. I guess the French really don’t like us.

I was working in Maramba Clinic yesterday morning. Normally this is a very busy place, but the morning was slow and I spent half of the time reading. About midmorning a ten-year-old boy came in wearing an old man farmer outfit. His ears stuck out under a big-brimmed baseball hat and he wore a plaid, collared, short-sleeve button-up shirt. He had on dark blue pants with a belt and black dress shoes. As I took his vitals I found out that his name was Zefania and that although he seems to be a normal height for his age he weighed only 16 kg, 3 kg lighter than when he came to the clinic last time. He was all skin and bones and seemed shy, although if you smiled at him his slight grin would turn into a big toothy smile. I’m not sure if he had some sort of genetic disease or if he was just really sick and unable to maintain his body weight. It’s hard to see cases like that where the young are so sick and it feels like there’s nothing you can do to help.

The rest of the week has been pretty quiet. Yesterday afternoon I taught the Adult Literacy Class and realized how hard the English language can be. I also realized how much I am not an English teacher. Most of the group went to Jungle Junction this weekend, but I opted to stay back, save some money and prepare for Malawi.

Zimbabwe

Tombi, Tawanda and me
Me and a lion cub
Ostrich
Head wound a few days ago
Head wound right after it happened

September 10, 2009

I have managed to give myself a Harry Potter like scar above my right eye. Although not exactly lightening bolt shaped it is about an inch and a half long and begins at my hairline. I was thinking about doing something different with my hair anyway. Why not bangs?

How did I manage to do this to myself? Fortunately for me I at least have a good story to back it up. Last Friday fourteen other volunteers and I loaded into the monster truck and started the long haul toward Antelope Park. We got as far as Miombo Lodge the first day where we went on a game drive. We saw a giraffe with her baby, an ostrich crossing the road in front of us, and a herd of elephants at the watering hole. That night a group of Zimbabwean dancers came to the lodge to entertain us with their singing, dancing and animal impressions.

After the dancers left I went back to my room for a short bit before heading back over to the campfire. Martin was the only one there but informed me that the rest were over by the huts watching some bull elephants at the watering hole. I joined them on the steps of a small, elevated hut. Four of the elephants finished drinking and continued on their way, but one particularly curious one stayed behind. He had one tusk and was most likely the weakest member of the group since he was drinking last. He knew we were there and turned toward us on numerous occasions, particularly when someone would get up and leave.

Soon only our driver, Chris, and I were left on the steps. A few other people had just left and the elephant had noticed. He took a few steps towards us and started flapping his ears and trumpeting. Chris saw these as warning signs that the elephant was going to charge and took off running. I froze for a second debating what to do. I could stay on the stairs and wait to see what happened. Michelle had told us that the elephant couldn’t distinguish us from the building and would not charge us as long as we stayed on the steps. But at the moment I did not want to stay and find out if that was true.

I jumped off the stairs and took off at full speed. I could see the vertical support column on the other side of the hut and aimed to go just around it. Unfortunately it was quite dark and I didn’t see the horizontal beam that stuck out a foot or so further than the edge of the hut. I hit it. Hard. I stumbled a bit then remembered why I was running. I ran a few more steps and put my hand up to my forehead. I could feel the blood on my hand and running down my face.

Michelle heard me hit the beam, as did many of the other people around the fire. I was soon seated next to the table with a napkin held firmly against the wound. People spread out looking for fellow medical volunteers that may have brought a medical kit with them. I was told that the cut was quite deep but that under the circumstances it would be very difficult to get me to a hospital. The nearest healthcare center was four hours away, it was late at night and travel was difficult.

Luckily, one of the fellow volunteers, Owen, had his first aid kit. He also had a job in a hospital back home and had experience with wound cleaning and stitches. The bleeding had pretty much stopped. Guess I bashed it in a good place and avoided the major arteries. We decided against stitches due to lack of proper equipment and instead closed the wound with steri-strips. I stayed up for another hour or so to make sure that the bleeding was under control and I did not have a concussion.

I slept well and when I woke up the next morning the bandage was clean, the swelling was gone and I did not have a headache. We drove to Antelope Park the next day and set up camp. The original plan was to head to the clinic that day but the wound was doing well and Roy, the coordinator of the lion-breeding project, said he would look at it in the morning. He dealt with wounds like this all the time.

The next morning he took a look at the wound but suggested we go into the clinic to get the steri-strips taken off just in case the wound opened again. Michelle and I went into town while the rest of the group went on elephant rides and saw a lion feeding. We went to a 24-hour clinic in downtown Gweru, which is where Michelle spent a lot of her childhood. The steri-strips came off nicely and the wound was closed. They put a fresh bandage on, gave me some antibiotics and we headed back to camp.

The rest of the time at Antelope Park was spent walking with lion cubs, seeing the lion-breeding program and going on a bush walk where we learned about the medicinal properties of the trees and bushes. I also had a chance to go on an elephant ride. This elephant had one tusk, just like the one we had seen at Miombo, but her name was Tombi and she was a very gentle giant. The elephant behind me kept giving me gifts such as rocks and sticks in exchange for food.

We slept in tents and were cooked three huge meals daily. Monday morning we drove to The Great Zimbabwe Ruins. The drive took about twice as long as expected (over 4 hours) but the ruins were really cool to see. Tuesday we headed back to Victoria Falls. The fifteen of us spent the night at a hostel called Shoestrings and spent the next morning seeing the falls from the Zimbabwean side.

It’s good to be back at the house. My head is healing nicely and it doesn’t hurt. I’m thankful that it wasn’t more serious than it was. All in all it was a very exciting weekend. A special shout out to Russ Peterson. I saw you were a follower of my blog. I have meant to email you. Just haven’t. Well, hope all is well with everyone who is reading this.

The problem with Livingstone

September 3, 2009

This morning I spent the morning doing home-based care in Nakatindi. Nakatindi is among the poorest communities in Livingstone. Instead of the brick houses that are typical in other areas, almost all the homes are built of sticks and clay. Michael, one of the volunteer caregivers, met us at Nakatindi School and we set off into the community. We saw around ten patients, most of who were doing well. Their major complaint was simply a lack of food. As I mentioned earlier, 1 in every 3 people in Livingstone is HIV positive. Once their CD4+ count drops below 300 they are put on anti-retroviral treatment (ARTs). ARTs are supposed to be taken with food. Unfortunately when food is not available and the drugs are taken the patient becomes nauseous. When vomiting occurs, the drugs cannot do their job.

I started asking Michael about his family as we walked back to the school to be picked up. He said that he has six children. The oldest boy completed secondary school but because he cannot find a job, he still lives at home. His oldest daughter completed the 9th grade but is unable to attend school anymore because Michael can’t afford the school fees ($165 a year). His wife sells fish products at the local market and he spends his time volunteering to help his community. Jobs are scarce here especially for those that do not have a good education. The money his wife brings in is spent on food for the next day’s meals. The children eat first and if there is enough left the parents will eat too.

It is hard to comprehend sometimes how little they have. They buy their food with 2500 kwatcha. This is equal to about $0.50. Some healthcare is free. HIV treatment, medication and testing are free as well as Malaria and TB treatments. Children under 5 are seen for free as are people over the age of 65. Any other treatment incurs a clinic fee of 5000 Kw. They also need to have a book to write their medical history, vitals and appointment notes. This costs them 1000 Kw. Transportation to the clinics can also be very difficult. Those that cannot walk must save up money to pay for a taxi. To top it all off, the clinics may refuse to treat the elderly or those that are severely ill.

All of this leads to a lack of quality medical treatment of those that need it the most. Clinics run out of ARTs and TB meds regularly. The waiting rooms are full of people waiting to see the doctor, if there even is a doctor at the clinic. A lot of clinics are staffed with only a few nurses with insufficient training.

I had a discussion today with one of my fellow volunteers. Lately male circumcision has been promoted as a way of preventing the spread of HIV. It sounds like an absurd thing to be promoting when it may cause a decrease in the use of condoms, but it turns out that it can decrease the transmission of HIV by up to 50%. The problem seems to be more in how the clinics are promoting it. It should not be presented as a cure but rather as another preventative measure that should be used in conjunction with other preventative measures like condoms. The other volunteer said that no one should promote male circumcision because the people here are not smart enough to understand the difference between a cure and something that decreases the risk of transmission. I was in favor of telling people the truth and letting them apply the knowledge. Just because these people aren’t educated doesn’t mean they are stupid. And despite everything that they have to deal with here, they are quite a happy bunch of people.

Botswana

Elephant crossing the river
Hippos!
Lion!
Elephants crossing the river behind me
Water pump

August 31, 2009

Last week Mathias and I taught our first of five HIV classes. Topics covered include what HIV/AIDS is, how it attacks the body, how it is and is not spread, condom use, positive living, and treatment options. One of the local African Impact employees, Brave, assists us and translates for those that do not understand English well. I am really excited about this project because Mathias and I will be teaching the class the whole way through and will be able to see the progress the students make and see what information they learn from the course.

Last weekend the group headed out to Chobe National Park in Botswana. We stopped in town to pick up a few supplies and I was surprised by how much more developed Botswana was than Zambia. The roads were paved and free of potholes and the storefronts resembled those of home. While waiting in the monster truck for the rest of the group to get back we saw some warthogs and a random woman decided to stop and pee on the side of our truck. Very strange indeed. Friday night we camped out by the fire and ate a hearty meal of steak, sausage, potatoes and corn on the cob. After dinner we talked around the campfire and then headed to bed early.

Saturday morning we got up at 5, had breakfast and drove out to Chobe National Park. During the morning safari we saw water buffalo, impala, giraffes, an elephant and a lion. There are only twelve lions in the entire park so seeing one was really cool. After brunch back at the campsite we hopped on a boat for a three-hour river cruise. We saw crocodiles and water buffalo. There was a large group of hippos, half of which were grazing on land, which is a very rare sight when it is so hot out. The highlight of the cruise was seeing a heard of male elephants cross the river right in front of us, which is also a very rare sighting.

We got back Saturday night and Sunday was spent relaxing at Zambezi Sun. This morning I took vitals at Dambwa clinic and this afternoon was spent farming at Maramba. It took us about an hour to get the water pump (stair-stepper) working but I had some great conversations with Robbie and Ollie. Next week’s post will be a bit late. We are planning a week-long trip to Zimbabwe, which I will tell you about when I get back.