If at first you don't succeed...

Hello again and here's to a second try at Week 5's post,

Not to be outdone by last week, this week brought some new form of crazy with each new day. When I left you last Saturday, a bit of sickness had begun to settle somewhere deep in my throat. Unlike any cold I've experienced before my symptoms consisted of mostly chest tightness and pain in swallowing. The difficulty in swallowing in turn kept me from consuming very much food on Sunday and by Monday I found myself completely weak and unwell. I left the house only once Monday morning to purchase water enough for several days and a supply of chicken soup, and I returned home shortly thereafter to rest, sip water, read, sip soup and rest again in ongoing rotation until Tuesday morning. The sleep and liquids provided enough healing to return me to work for the remainder of the week. And despite waning illness, return to work I did. As has become my routine, travel continued to and from clinics, Ndola and various other locations in and around Kitwe. This week also included another maternal mortality meeting, continued laps up, down and around the three levels of Kitwe Central Hospital and the completion of my second Stieg Larsson novel (which I stayed up much too late on Wednesday evening/Thursday morning to finish).

Now, while the motions of this position may seem repetitive, please don’t be fooled. The experiences tied to this role are ever changing and so counter-cultural to my limited American reality that this country manages to surprise me on a daily basis. With that said, a few eccentricities from this week:

I learned within my first few days at the hospital that it is respectful tradition to mourn the dead with agonized and prolonged wailing. These cries echo through the halls of various hospital wards each day between 4:30 and 5:30 in the evening, the designated visiting hours. What I did not realize is that it is also considered the responsibility of the family to deliver the bodies of their deceased to the hospital to be pronounced dead. It turns out the backside of Kitwe Central Hospital is also the site of the local mortuary. Apart from my grandmother’s funeral many years ago and one semester in an Anatomy cadaver lab, I’ve had very little experience with those no longer living. This week I observed the delivery of two listless bodies, carried between two or three family members. It felt so idiosyncratic, but I know I was the only one to find it uncommon.

On wards this week I encountered one maternal psych patient, who sang a few tuneless notes through her contractions. It was very eerie, but she didn’t seem to be bothering the laboring patients behind the curtains around her. I also came upon a very full special care baby unit without any nurse. I remained until someone returned. The midwife who slipped back into the room a few minutes later had taken a restroom break. There wasn’t anyone to cover.

Finally, the highlight of my week was also among those things entirely uncharacteristic of anything that would ever occur in the States…to my tremendous advantage. This past Friday, on my final clinic visit, I had my first assisted delivery. My arrival at this particular clinic happened just as two patients were on the verge of their delivery. The first had her baby within less than five minutes of my entrance and was attended to, single-handedly, by one of the only two midwives on duty at the time. The second mother was close behind the first and quickly called out to the other “Sister” on duty as a newborn breathed his first cry one bed over. This second delivery was not, however, so clearly anticipated as the first and nothing was yet prepared, which meant the midwife immediately enlisted my assistance. I was there and, without really contemplating anything but the most immediate need, I drew up a needle and syringe for a shot of postpartum oxytocin (used on every patient to induce uterine contraction after delivery), then donned gloves and flocked to the mother’s side. In turn we three (the midwife, the mother and I) counted breaths and alternately pushed through contractions. I held the woman’s legs and encouraged her to bear down. Within very little time the midwife pulled a newborn girl into my own hands, where I held the baby as she cut and clamped the cord. We then toweled the crying infant and I placed her on mom’s chest. Just as I did so I remembered that in Zambia it is considered unclean for a woman to touch her baby while it is still covered in birth fluids, but the newborn quieted as soon as she contacted mom, so I held her there for a moment more before handing her off to be wrapped by the midwife. I then returned to the mother with tearful praise. She was also crying. Looking back in reflection the most beautiful moment throughout this process was not actually delivery, but when the mother’s deep, pained groans gave way to flooding relief and murmurs of gratitude. On Friday I learned to say congratulations in Bemba, “Mabo bene.”

I suppose this is beyond enough for one week, and besides it is growing dark on Sunday evening here in Kitwe.

Temporarily signing off and hoping, as always, these words find you well.

With love,

Jess

Wit

A few of the week's highlights via pics

Hello all,

So sorry to say that just as I was completing this week's blog I essentially lost all of my post. In lieu of rewriting everything now, I hope you enjoy the following photos sporadically taken over the course of this past week. I'll be working from home to reassemble the stories I had planned to share, so please excuse a few days delay... and stay tuned.

In the meantime, you all remain in my thoughts and prayers,

Jess...in my new frames, because I did manage to break my glasses within the first month!

Blogshots...

To my delight, the Iced Cream Coffee is actually made with ice cream!

Some resourceful ingenuity. The Zambian wheelchair.

This is Hope. She loves Hannah Montana. She also enjoys an occasional game of Scrabble on my ipad. Finally, she far prefers sweeping to washing dishes, although both are counted among her chores at Auntie Sue's guest house.

Something to look at...

Sorry for the quality of this picture, but hopefully you get the idea. Just a few goats on the side of the road. I told the taxi driver, whom I asked to stop so I could get a picture, that I was likely enamored by the peculiarity of the goats in the same way so many local children were in awe of my own white presence along a rural Zambian road. He thought this was a very funny observation.

This is Chanda and I didn't solicit this expression. I suppose it was her first instinct when I asked to take Chanda's picture.

Chanda spends the weekends with us. A girl after my own heart, this three-year-old is fearless.

Victory

Where to even begin...

This week has marked many a monumental moment, not the least of which includes, as promised, the extraordinary end to the African Cup. That is Zambia's astonishing victory over Cote D'Ivoire (Ivory Coast). The Sunday evening game, fought in pouring rain for over 130 tireless minutes, made definitive history. How very serendipitous that I arrived in time to witness it. In order to relate the true gravity of this win, I need first to correct my former statement regarding the emotions of Zambia's president in 1993 (the single prior time Zambia qualified for the finals at the African cup). It remains true the former Head of State did cry before the Zambian nation following the team's acceptance into the finals. However, the tears fell for the very terrible death of nearly the entire Zambian futbol (i.e. soccer) team in a fluke plane accident en route to the 1993 finals. (A slew of conspiracy theories surrounds the abrupt accident, but little conclusive evidence could ever explain the team's untimely demise.) This clearly crushed the nation, who, to this day, boasts of the fallen team as their very best...until now.

Therefore, it was with unparalleled anticipation and a great spirit of redemption that Zambia's team entered the African Cup Finals 19 years later, only to play perhaps the most thrilling and historic game of their careers. And I observed, into the wee hours of Monday morning, every last minute of the four additions of over/extra time, as well as each of eight nerve-racking penalty kicks. Without a single score until these penalty kicks, it was on the third Ivory Coast kick that Zambia thought they had finally won. Their superhuman goalie, Mweene, made a perfect save. With bated breath the entire country waited for the score board to note the missed goal until we all nearly collapsed to learn the save was disqualified. If you ask a Zambian for the next ten years Mweene and the entire team was unequivocally robbed. The save was disqualified because the keeper theoretically moved before the opposing player made contact with the ball. Thus it was Mweene's second penalty save and a subsequent Zambian goal that ultimately ended the game and achieved this country's awe-inspiring glory.

After such an epic game, reflection on other notable moments from the week feel rather less significant. Nonetheless...

With victory this week also came difficulty and even tragedy. First, this past Thursday marked the unfortunate departure of my supervisor from both the study and the country. I truly congratulate her next exciting venture, but will certainly miss her. Work has also grown very heavy in the wake of her absence. The days are absorbed by so much to do that I could hardly believe it was already Friday when it arrived. This week, particularly, held three maternal mortalities here in Kitwe. Beyond the burden of additional and expedited data collection, it was just so sad to learn of this loss of life. Two of the women died of complications of obstetric hemorrhage (OH), and the third stopped breathing in transit (on the ambulance ride). She was formally diagnosed with CVA, cardiovascular accident. The two OH cases related directly to our study, so I quickly became very intimate with the circumstances. I was even invited to the maternal death review meeting this past Friday morning, where I listened to a conference room of physicians discuss the details of the last minutes of their patient's life. Ultimately I am reminded that our days are numbered. It was a great blessing to wake up this morning!

Clearly it has been a whirlwind week, characterized by sadness and also elated joy. To be completely honest I haven't yet processed all the emotions I've recently experienced. The most pressing need by Friday evening was rest, and I remained in bed until past 10:00am this morning. So I will leave you with some yet undrawn conclusions, but also with the assurance I am well and still abundantly grateful for this journey. Again and always, I truly appreciate the support you continue to show me along the way. It is really wonderful to share this with you all...the good and the challenges.

Sending so much love and many well wishes for the happenings in your own lives,

Jess

Zam - Bee - Uh! Zam - Bee - Uh!

Greetings!

We have now completed three weeks, and today I am reporting from my ideal spot at the usual internet cafe, but to make it that much better, with a one month-old in my arms. His name is Daniel and he is resting with me while his mom cleans the cafe. I encountered her carrying the baby in her "Chitenge," the most versatile of lengths of colorful cloth, which I've seen used as skirt, infant carrier, or hair wrap among other things. When I offered to hold him for a bit while she worked, she readily agreed. Needless to say I am very much enjoying the arrangement. She seems pleased as well.

As to this past week, may I just say, you might have the superbowl, but we have the African cup. And did I mention, Zambia made it into the finals! This has not happened since 1993, and if I ever surmised this was a God-fearing country I could not be so certain until Wednesday evening when I heard more praise and thanks to "Sweet Jesus" and "Jehova Jirah" than I even heard from inside a Zambian church. I also witnessed all other forms of celebration from jumping to dancing to shrieking to fireworks! And this was only the semi-finals. I am told the president cried on national television when Zambia ultimately lost the finals in 1993. So you can be sure I'll be tuned in for the game this Sunday afternoon and perhaps for some emotional outpouring by the president to follow. Let this be incentive to check in with the blog next week.

On other fronts, the busyness continues. This week held another trip to Ndola and with it my first experience with a popped tire on the bus ride home. We all disembarked, but were fortunate to be picked up by another bus eventually. We only endured about 40 minutes of delay, which I've learned is rather reasonable relative to Zambian time. I also visited all clinics again this week, which additionally held its share of of travel troubles. One particular taxi ride along a very tortured route engendered some anxiety when our car spun out in an especially sloshy stretch of thick mud. With great luck/blessing, though, I happened to be travelling with my Zambian clinic coordinator, who was quick to reprimand our driver for his speedy carelessness. Consequently we continued a very belabored, albeit safe drive to our destination.

This past week also included my first formal training for a group of seven new midwives on protocol for NASG use. With the exception of a few technical difficulties (i.e. an LCD with no screen and no way to dim the lights in the room), we successfully taught all seven women how and when to place the garment. I even donned the "big blue suit" for example's sake. Turns out it's not so uncomfortable, although I imagine this is less true for a woman with a ruptured uterus.

Finally this was my last with my supervisor. Her end date is next Tuesday, so I will direct any questions or challenges to Lusaka during the interim weeks until a new supervisor is hired and trained. (Lusaka is Zambia's capitol and also the site of the largest hospital involved in our study.) It is daunting to think of taking on more responsibility in addition to what I can already barely maintain. However, my short time has already taught me an amazing truth about Zambia. There is a capacity here to accomplish what appears utterly impossible. While many goals seem improbable, they are nonetheless attained. Despite all the best efforts of lacking resources, women are saved every day. Thus far I have seen mother after mother revived from hypovolemic shock, even when blood isn't available for transfusion, or when she has waited hours (4-6) for "emergency" transport to a hospital. Babies are born and live at only 28 weeks of age. And midwives work 14-hour night shifts five nights in a row, and still stand! These realities encourage me and my work, and I hope they can do the same for all of you. With much experience to draw from I know it is not only in Africa that days can feel long and tasks insurmountable. Still know, if it can be done here in the face of rather abismal odds, it can certainly be done! So may this next week be filled with great possibility.

As always these words are sent with so much love and appreciation for each one of you.

Warmly,
Jess

Babies, babies, babies & "The Little Stove That Could"

S

Feeding with a "cup."

A very little one. (28-9 weeks)

These are our "Ceasar" babies. All in a row and ready to be transported to moms. 

These two are about 28 weeks old. They are fed by "cup."

And now you see..."The Little Stove that Could"

Two weeks down...

Hi All,

We made it...I'm sure I'm not the only one whose had a busy week, so here's a shout out to the much anticipated weekend. Hoping this finds each of you truly well. Please know how extraordinarily grateful I am to have such a supportive network of family and friends surrounding me in prayer and encouragement through this journey. So thank you for your outpouring of loving emails, affirming letters and inspiring verses and recipes!

In Zambia this week I was afforded much opportunity for local travel, which has consequently provided me a pretty thorough tour of Kitwe and its surrounding districts. Additionally I commuted into Ndola (about 50 minutes by bus) for my first rotation at Ndola Central Hospital (NCH), where I will be filling in for my supervisor in the interim between her departure from the study and the hiring of her successor. Ndola, apart from its notably clean and pleasant community, boasts one particular lunch spot with a full "gourmet coffee" menu! I delightedly finished two "Mocha Cocoa Nut Freezachinos" this past Thursday, and needless to say, am looking forward to my next visit to NCH. My travels around Kitwe were rather less enjobale, but most certainly character building. For a bit of background, one of my responsibilities in this position is to visit each of the rural labour clinics which feed cases into our central hospital. These clinics include a randomized selection of control (no NASG garments placed) and intervention (NASG garments placed) locations. My job is to follow up with every site as frequently as possible (there are seven total), in order to track any new or potentially missed cases. This brings me back to my character building trip to four of the aforementioned sites. My commute involved a combination of routes by foot, taxi and bus, which unfortunately proved quite confusing on my first attempt. I found the the first clinic a relatively easy walk from the hospital, passing merely a funeral procession on my way. And my next two bus rides and taxi trip went off without a hitch. It was my third bus ride, however, that I disembarked one stop too early and found myself thoroughly lost along a particularly unfriendly stretch of Kitwe bus station. With great fortune I met an exceedingly kind local school teacher, who directed me to the correct spot, and my final two bus trips were back on track. I even made it to my last clinic in time to observe my first Zambian delivery; breathtaking!
...
With no option of epidural, or any other pain medication, the woman laboured alone on her wool blanket, holding her own legs apart and swallowing her cries. When I ultimately congratulated her on the success of such hard work she could hardly respond, but gave the faintest role of her eyes. That small gesture deflated all my romantic notions of the wild beauty of natural delivery, but helped me realize something even more incredible about this process: a painful balance. There was a certain miracle in the power that came from so much weakness. This woman was broken and exhausted, but all her exertion culminated in the birth of a perfect new hope. And hope seems to be a resource in short supply around here.
...

Other highlights of this week included some indulgent time at the Special Baby Care Unit ("SCUB"). I helped to feed with a cup and cradled newborns to my heart's content. I even got to assist with some baby transport, as the elevator broke down and we needed to deliver all our "Caesar" babies (i.e. Caesarian-born infants) to their mothers on another ward. While the midwife and an available janitor shared one basket of about four newborns I carried a second basket with one "big baby," who wouldn't quite fit with the rest. They made me promise not to fall down the stairs. I kept my promise.

One last highlight...my bus trips offered some interesting local insight. A few stickers read:

"Don't force me to drive fast, because you are late!"
"It's over when God says so!"
"If you are a passenger, don't cause a problem!"

That is all for now, but be sure to tune in again. Same place, same time (relatively) next week, my friends...