Bad Day

African Dancers at Linda Clinic
Charlotte teaching Life Skills
Maanu Mbwami School
Kids at Mwandi School
Maramba farm

October 24, 2009

This last week has been by far the toughest of my time here in Zambia. I have seen projects fail due to a lack of community support and I have been greatly disappointed in my own ability to help others. I have had some of my own ideas shot down and witnessed how some people within the organization don’t seem to care about the people we are working with.

On Monday I helped out with a building project at Maanu Mbwami School. They used to be taught in thatched roof mud huts that leaked during the rainy season and made learning difficult. They also lacked adequate classroom space for their pupils and, as a result, different class levels were forced to rotate classroom time and spent only a few hours a day in school.

We have already completed a one-room schoolhouse and are currently in the process of creating another two-room classroom block next to it. The leader of the school, Pastor Smokes, has recently been complaining that we were not working fast enough, but the biggest problem we have is that the community is not helping us build the school. There are only nine volunteers currently at the house and we are therefore unable to send more than two or three to the building project a day. When we were working at the last building site, Malota School, we had three or four men from the community helping us everyday. We need the support from the community not only for the sheer man power but also because if they take part in the building they will feel a sort of ownership towards it and take more pride in the building.

On Tuesday I was supposed to go to Mwandi community and help with home-based care, but the caretaker did not show up. This is one of the only projects I had not done here and I was excited to finally get the chance to do it. It is a poorer community, much like Nakatindi, and lies on the outskirts of Livingstone. Unfortunately the community support for the farming project and home-based care initiative is not there. A man named David had been running the farm and home-based care, but no one else was stepping forward to help. Last month David started taking classes at the local college. This meant that there was no one to take us out on home-based care and no one to tend to the farm. We have temporarily pulled out of the farming project and home-based care is receiving their final warning before we also pull out of that.

On Wednesday afternoon I helped out with a Life Skills Class for adolescents. During the course they learn about how to write a resume, interview skills, first aid, drugs and alcohol awareness and HIV prevention and awareness. I think it is a great class but we started late and were forced to end early when the kids were being pulled from the class to play in the nearby netball and football games. I did not teach the class the next day but a similar thing happened with the class ending early so the children could practice marching for the upcoming Independence Day festivities.

Thursday was a particularly depressing day. In the morning I went to Nakatindi community home-based care. One of the patients was a single mother of two. Her husband had left while she was pregnant with her second child and never returned. Both her and her 3-year-old daughter Elizabeth were HIV+ and taking ART, meaning that their CD4 counts were already below 300. The baby was 11 months old and his HIV status is currently unknown. He had tested negative at the age of 5 months but tested positive 3 months later. They took a third test but because the test samples for children under the age of 1 have to be sent to Lusaka they have to wait another two months for the results.

There is a chance that an HIV+ mother can transmit the virus to her child during childbirth, during birth or when breastfeeding. The mother can take medication right before birth to help prevent transmission and the baby takes medication soon after birth that is supposed to impart partial immunity for the first few months of life. Since almost no one around here can afford formula and the nutrients in breast milk are so important for the baby’s growth and development, mothers are advised to exclusively breastfeed for the first 6 months. Giving the baby other foods while breastfeeding may weaken the immune system and allow HIV transmission. After 6 months HIV+ mothers are told to stop breastfeeding and look into other food options for their baby.

Now try explaining this to a woman who is unable to afford enough food for herself, let alone her two children and has no source of income. When Elizabeth was a baby a group of nuns from the Catholic Church had brought formula and other food to the house but when those nuns went back home there was no one to continue the program. The baby had also just finished a round of TB treatment while the mother and Elizabeth still had a month left of theirs. They had been treated for a cough but it was still present while the mother also suffered from severe chest pain.

We advised them to go to the clinic, although they had already been there many times and have run into problems with either the clinic not having the medications they needed in stock or just not being able to help them. We gave them some Panadol but there was not much else we could do. It is so hard to see a family in a situation like that and be so powerless to help them.

Sure, I could give them money or buy them food, but what good is that going to do them when I leave? Like the nuns it would be a short-term solution to a long-term problem. The children will most likely be orphans soon and being HIV+ and on ART so young, their future is bleak. I could sponsor one of the children (which I have thought about) but then I think about all of the other children out there in the same situation and it all seems so hopeless. What good am I really doing here? I give someone Panadol for a few days or a week of multivitamins or clean and dress their bedsores once and then what happens? What if we aren’t able to send someone to home-based care? Do the caretakers go out in the field without us? They have no supplies of their own and although they are supposed to be trained to handle and treat the things we see, when we go out in the field with them they just translate and show us to the next patient.

I agreed that home-based care needed to be changed. The patients, the caretakers and the community are too dependent on us. If we are not able to be in the field, there is no one left to do it. I was involved in the writing up of the new home-based care sheets and I agree with some of it, but I think we went too far in the other direction. They cannot help themselves as much as we want them to be able to. They cannot go to the clinic every few days to get painkillers and vitamins and they cannot afford to buy dressings for their wounds or to buy antibacterial creams. Our new policy of limiting medication and telling everyone to go to the clinic seems both uncaring and naïve. It makes it seem as if African Impact has no idea what life must be like for them.

And it is not just during home-based care that I wonder what good I am doing. In the clinics, what good does taking someone’s vitals do if the doctor isn’t going to look at it? We are supposed to help ease the load on understaffed clinics, but when a nurse asks me to come help her with baby weighing and then leaves in the middle because she is tired, or I go to find a nurse to man the pharmacy and find three staff workers hanging out in the back room, I find it hard to see how we are helping. I could say similar things about many of our other projects as well, like when the teacher sends her class over to art club because she is tired and wants to take a nap.

Things aren’t all bad here. The Maramba farm and home-based care projects are excellent. There is a dedicated group of community members that run the farm and go out to visit patients in the morning. The food from the farm is either given to patients in the community or sold at the market. The proceeds then go to maintain the home-based care program and also to help orphans in the community. Adult Literacy and HIV education classes are also held at Maramba farm and are excellent programs that promote lifetime learning and sharing of knowledge in the community.

Another excellent program is the home-based care course. This 10-week course is designed to train the next group of caretakers. They learn about a large range of topics including wound care, counseling, physical therapy and medications. The hope is that we can work together with them as a team and that they can function on their own when we are not around.

We also have some new project ideas in the works. One idea is to do health talks in the mornings at the clinics instead of just helping with vitals and filing. The topics of the talks range from nutrition and hygiene to HIV and opportunistic infections. The nine volunteers at the house have all taken a topic and will prepare two pages worth of notes for future volunteers to use for these talks. My friend, Sam, is working on another idea. He wants to contact Food International and see if we can work as a referral company for them. We would identify patients that are in desperate need of food and give Food International the name and address. They would take care of the rest.

I think as you get to know an organization better it gets easier to see the flaws in their philosophy and their programs. Sometimes it also gets harder to see their good points. A major problem for the organization is consistency. With such a high turnover of volunteers every month it is difficult to make sure that every one stays consistent with the guidelines. It also makes progress within projects difficult. For example, the sports volunteers have had some great programs in the past including one called Come Play Girl that encouraged girls to become more involved in athletics. Eventually though the volunteers that started the program left and the program stopped.

I believe in a lot of things that African Impact is doing for the community. I see a willingness to fix programs that do not work and put on hold projects that are not helping the community or are not sustainable. I really have enjoyed my time here and I feel like I have learned a lot. I am still sorting out in my mind how much good I have done but if nothing else, at least I have had this experience and will hopefully be able to use what I have learned.