Merry Christmas

This month, instead of telling you all how much I miss you, how different the weather is, or how it is impossible to find a turkey in Zambia, I’ll instead share with you some Christmas cheer – things that have/are making us happy, and why this year has been so important and amazing for us.

Discovery. Entering a different culture is exciting. Sharing knowledge and experiences is so rewarding, and eventually, after a LOT of learning, you reach a point where you can finally relax and (almost) fit in with the people around you. Things aren’t as hard as they were, and little things like not hesitating to greet everyone you pass on your way to work, and drawing water every day for your bath are just another great part of your day. Yesternight (a Zambian saying), a co-worker told me how impressed he was with my language, and said, “you even speak like a Zambian now”. That made my day. You also discover things about a different prace and people (like constantly mixing up ‘l’s and ‘r’s), that are hirarious, and you eventually do the same things without lealizing it, only until someone from home catches you.

Patience. Is a common name here. But also, it really IS a virtue, and no one knows it better than Africans. Take it easy, relax, things will be okay. Though I do think this can be a bit detrimental in some situations, Ben and I have learned a lot about this word. I waited months and months to finally be registered with the nursing council. As I write this, we’re waiting for our neighbours to come by so we can go help them buy school uniforms. They’re already an hour late. Nothing comes on time, and you just deal with it. If things don’t fall into place like you have planned, it will still be okay. Maybe even “better than okay” (another Zambian saying).

Laughter. Say something remotely funny, and you’ll get roaring laughter and hand slaps, especially from old women. Show any sort of interest in a group of kids, and you’ll have an entourage of under-10’s wherever you go, ready to turn and run screaming if you give in and play with them.

Community. Walk anywhere at any time of the day, and you’ll see people sitting in the shade on their reed mats, chatting as their hands busily shell groundnuts or maize. Walk past a church group practicing their music, with drums and shakers and dancers – and they gladly welcome you to join or just listen. Visit anyone, anytime, and always receive the warmest welcome. Have 40 neighbour kids know your name as Uncle/Aunty Stephan, every elderly person is grandma/grandpa, and your closest neighbours treat you like a brother and sister. It’s more than community, it’s family.

Hope. Another common name here, along with Mercy, Gift, Joy, Peace, …Fatness (not kidding). There is poverty and malnourished babies, young people die from AIDS, and things really are stacked against people who want to have a better life than this. Despite all the obstacles and adversity, there is a lot of hope. A lot of determination and tenacity as people try to overcome corruption, disease, financial hardship, gender inequalities, and traditional expectations. People have innovative ideas, ambition, and a lot of optimism about the future of their country, despite the struggles of their past/present. It’s so encouraging and wonderful.

We’re both so lucky and happy to be here, words and pictures aren’t enough to tell you what it’s like for us. Thank you for all your support and thoughts and prayers while we’ve been in Zambia, we both really appreciate it and always look forward to even the smallest email or facebook message.

This Christmas, we’re celebrating in Lusaka. A friend has graciously let us stay in their house and look after their dog and cat and pool while they are traveling. So we’ve been “out on the town” here, going to the movie theatre to see Harry Potter, eating ice cream and muzungu food, and enjoying the sun by the pool. On Christmas Eve, Ben and I and a friend had a nice lamb dinner here, then joined two friends and went midnight mass (at 9pm) at a huge Catholic church with 500+ other people. It was so great, we sang carols, there were 2 choirs, and we danced our way out of the church 2.5 hours later. Ben and I came home and watched a bit of The Polar Express and opened one gift. On Christmas day, we were happy to see that Santa had come, then we relaxed by the pool. We had 9 people over for Christmas dinner, and we ate and ate and ate and played games and drank wine. It was nice to celebrate with friends and have a traditional Christmas. Zambians do celebrate Christmas, but there aren’t any big traditions, and to most people, especially in rural areas, it’s not a big celebration at all. Only when you get to Lusaka and enter the big new fancy mall will you see decorations and hear Christmas music. It’s nice if you don’t like the commercial part of Christmas, even though you lose some of that Christmas-y feeling. The tropical surroundings don’t help that either, but I’m not complaining!

MERRY CHRISTMAS!!

Flying Ants!

It’s the first big rain of the season, and I try (unsuccessfully) to stay dry on my walk home, jumping over puddles like a not-so-graceful kangaroo mouse. I arrive home completely drenched and muddy, but entirely happy. I was the kid who had to be pulled out of her rubber boots in the middle of the biggest puddle on the farm.

Later that evening, I’m called from my house by my neighbor, Katie. “Staphy!! Come and see the ants!” I’m puzzled as to why she sounds so excited – ants are everywhere, always, and there are plenty of fascinating insects to take your attention away from an ordinary ant.

Regardless, I am intrigued, and dash outside to see what the excitement is all about. I’m met with millions of flying ants zipping through the air, and Katie in the middle of them, a huge smile across her face. All you can see is flying ants, all you can hear is flying ants, all you can feel is flying ants! I nervously venture out my door to join her in this amazing flying frenzy, and feel as though these insects could at any moment coordinate an organized attack and lift the both of us right off the ground. I resist the urge to run inside and hide under my net. Katie explains to me that this happens once a year, after the first big rain, and everyone is so happy to see these little creatures. I ask if she eats them. “No, these are just the small ones, but I’m still happy to see them!” “Do they bite?” I ask. She assures me they don’t. We chat a bit more then go back to preparing supper.

A few minutes later, Katie calls again, this time not really making any words because she is running and laughing. I run outside, and she is awkwardly trying to catch some flying thing outside my door. She is successful, and brings her trophy to show me. “This is the one you eat”, she explains breathlessly as she shows me the inch-long flying ant (termite) in her hand. She tells me that she personally doesn’t like them, but makes them for her husband (it’s his favourite). This is followed by a sharp yelp, as the “non-biting” flying ant bites her thumb. She throws it on the ground, and we both burst out laughing.

Attitudes

I often start my morning at 0730 on St. Monica, the female medical ward, helping out the nurses and tagging along on the ward rounds with the doctors to ask questions, learn, and offer any input I may have on patients. Mornings are usually quite busy until 11, which can be a great way to start a day if you are efficient and have a good team working with you. Sometimes, it can be a bit overwhelming, if you’re short-staffed, or have staff that would rather sit at the desk and watch things not happen.

Often in the mornings I come across things that have been missed from the previous shifts, so I try to organize a bit and bring everyone up to speed. It may be a diabetic patient who has not had any glucose checks since admission, and is now nearly unconscious after her morning insulin, it may be a young woman in renal failure who is hugely edematous and currently receiving her third liter of fluid, it may be a gasping pneumonia patient lying flat on her back with no oxygen in sight; any of these situations (and more) are possible when you report for the early shift. So you quickly prioritize and send for the oxygen concentrator, draw up some IV dextrose, and stop the fluids, then survey the ward again to see if there’s anything else you missed. After/during this, I pull the first year students aside, drag them with me, and quiz them on nursing care, and help them out with some lacking information. ‘What do you think is our top priority here?’ ‘Tell me about diabetic management’ ‘Why is fluid balance important in renal failure?’ Really, some days I just want to yell at them and the night nurse for missing such obvious, basic things, and failing to call for help when a patient is deathly sick…
Which brings me to a question. What motivates us? I’m asking this because I’d really like to know the answer. I’m not sure how many people read this, but please offer any insights you have on this.

Why do we do things the way we do? What makes us want to do things well; what drives our pursuit of excellence? Why do some of us always strive for more, while some of us are more than happy to settle with ‘enough’ or average’?
Are our motivations based solely on incentives, or is there some greater, more noble reason? Or perhaps some balance of the two?

Here are some observations I’ve made, and I have to stress that these are personal opinions, and you are more than free to disagree with me, as I realize that I still have a lot to learn.


a) 49 first-year nursing students. On the whole, this group shows a lot of ambition and enthusiasm for the nursing profession. They are eager to learn, always looking for opportunities to apply theory in practice, asking questions constantly, and studying in their spare time. They are super inquisitive and absorb as much as they can in this short time they have of being students. When the students are in the hospital, the wards are spotless, the patients are bathed, and treatments and orders are done (usually) on time. They are starting to think outside their procedure manual, asking me thoughtful ‘why’ questions, showing that they are beginning to think critically.

b) Staff Nurses. Although there are wonderful shining exceptions to this, on the whole staff nurses couldn’t be any more opposite. They trudge through their shift, taking 2 hour breaks, falling asleep with head in hands at the nursing station, getting up to give medications or take a couple blood tests. I hear a lot of complaints about nursing care (from other hospital staff), lack of clinical judgment and reasoning. It seems as though once you have completed school, once you are a qualified nurse and have your white uniform, you don’t have to learn anymore (after all, you already know everything), you don’t really have to try anymore. You’ve landed a government job, and even if you occasionally miss something (even if that something is BIG), you won’t suffer any major consequences, and you definitely won’t get fired.


I asked a student about this, after she finished telling me how she wakes up at 3 or 4am to study every day, then works a full shift and comes back later to do extra procedures. “Maybe nursing isn’t their calling,” she told me, “maybe they just don’t have a passion for it.”

Okay, that makes a bit of sense to me, though I still struggle with the fact that human lives are in play here. But maybe that’s because I care about my job, I have a passion for it. Maybe if I was stuck in an office typing Excel spreadsheets all day, I’d do the absolute minimum I had to, because I really don’t care about Excel spreadsheets, even if the success of your business depended on it.

As Mrs. Seya, our nursing administrator, keeps telling me while we hammer out an Action Plan for nursing workshops and try to overcome the incentive obstacle, “Attitudes are hard to change.” Hard to change, hard to understand.

Bike Taxis

How is it that I always seem to get the drunk bicycle taxis?

I sometimes take a bicycle taxi (jinga) home from work if I miss the hospital transport, or if I’m traveling somewhere far enough to dissuade walking but close enough not to need a vehicle. It’s a great way to get around. Usually…

Most of the time, the drivers are not too bad – they work hard for their 50 cents and get you to your destination safely. The interesting bit comes some afternoons, especially on the weekends (Sundays are the worst), when your bicycle guy has had too much Shake-Shake. A usually calm, scenic 2 km bike ride becomes a harrowing near-death experience as you dodge and dive dogs, goats, women carrying water or produce on their heads, other cyclists, and the dreaded passenger buses careering by at 120 km/h. The bicycle that is normally a rickety old contraption is even more shaky as you swerve and hit potholes and bumps, and your stomach is sore at the end of the trip from keeping your balance for the past 30 minutes.

Sometimes, however, the opposite can be true. Instead of an exhilarating trip, your driver can be as slow as the old women carrying their goods to the market. You are being passed by kids, women, men, even oxcarts, and this doesn’t bother your driver in the least. I now take these moments in stride, forget about why I’m in a hurry (usually doesn’t matter anyway), and take a good look at the scenery around me. I see Mphangwe mountain in the distance, the setting sun reflecting bright oranges and pinks and reds off distant rain clouds. Beside me is a heron fishing in a puddle in the middle of a wide open field of tall grass. Six small kids are running at me from a village on the other side of the road, huge smiles on their beautiful faces, shouting “How are you?!” at the top of their lungs. All these things are part of this beautiful country, this beautiful town – and though there is poverty and death and suffering, it is good to be here. Life is simpler in many ways, happiness is easier to find.

Student Reflections

Below is one of the first-year student’s reflections after a particularly tough clinical day. I was impressed with his honesty and would like to share his thoughts with you. Feel free to leave any comments or feedback if you have any thoughts, I can share them with the class.


Nursing, a noble career that demands one’s commitment in enhancing proper way of living of the people. It is paramount to note that Nursing is involved in all aspects of life, thus from birth till death of an individual. Being on the wards has been a great experience despite the challenges faced along the way. This journal however depicts a scenario that I fully participated in trying to save the life of an innocent woman named Yaona.

It was a Friday during the late shift when Yaona was brought to Mukasa gynae ward as a trans-in from St. Monica’s female ward with the history of per vaginal bleeding. This patient was pregnant in her 7th month when she miscarried, she bled for two days and suddenly stopped. History recorded that she later continued bleeding yet the family hesitated to seek medical advice. Yaona was brought to St. Francis Hospital when the condition was actually worsening. Fact still remains that her life was in danger because she lost nearly 1000mLs of blood. I could see her gasping and I said a little prayer to God to have mercy in her. It was unfortunate that the in-charge nurse was out for her tea break.

Bearing in mind that my role was to check her vitals, I quickly checked her blood pressure, temperature, pulse, and respiration, everything was abnormal. I could sense death yet I realized my duty was to save her life. I then decided to take up the roles of my in-charge; I got the Doctor’s orders. The orders were for an oxygen concentrator and withdrawal of blood for cross-match and haemoglobin.

I gathered courage and withdrew blood and rushed to the laboratory. I managed to find the oxygen concentrator and, for the first time, administered oxygen. I could see Yaona slightly relieved though she still seemed dyspnoeic. She spoke in a local language “Nalema ine”, translated as “I am tired”. I felt like I was not doing the right thing yet I was. I could see her dextrose drip finishing. Then I decided to rush back to the laboratory for her blood; it was not ready then, I was helpless, my mouth was numb but my mind told me I could do something.

All what my reasoning could tell me was God was in control and that she will live. May Her Soul Rest in Peace. Yaona died at exactly 9pm, I was broken-hearted and the only thing I could do was to pray for God to welcome her.

I’m listening to a group of eight girls singing and laughing outside. They must be around 8-12 years old, and they even have choreographed steps to the different songs they’re singing. The sun is setting and everything is so peaceful, simple, beautiful.

When you move to a different place, at first it’s all so new, so different, even overwhelming at times. After some time, this foreign place begins to feel like home. You begin to dread all those adjustments you’ll have to make when you move back, and things that used to shock you and amaze you are more normal. You look around at the people beside you and you realize you’ve become part of a community, part of a family, and you love these people. This place and these people have made a bigger difference on you than you could have imagined, and as you think about all these things and look back to where you were even 6 months ago, you realize that you’ve changed. You’re still the same person essentially, but you’ve become shaped by everything around you, and you look at the world in a whole new way. It’s quite the thing.

I walked into the classroom to the group of 50 first year nursing students, notes in one hand, projector and laptop in the other, and readied myself for the exhilarating fluid therapy lecture I was about to give. As I organized myself and my notes, I heard quite a bit of shuffling from behind me. A great way to start, I thought, they’re already distracted. As I turned around to greet them and start the class, I realized that every single one of them was standing, now quiet as I face them. Surprised, I ask why everyone is standing. “To show you respect, madam” came the reply from one of the girls in the front. A bit embarrassed now, trying to hide my blush, I quickly tell them to sit down and we begin the class.

After another class, as I tidy up my demo equipment, a student comes up to me, apologizing for the giggle she let out during the class. She explained herself and that she was rude to do that, it won’t happen again. I’m again surprised, and can’t even remember the event; it certainly was not disruptive by any means. I laugh and tell her it’s not a problem, but thank you. I think about how often I would daydream in class and not pay attention, or doze off during a boring lecture, and I look at the concentration in these faces, pens on paper, busily scribbling down any bit of information I throw at them. Here is a chance to get an education and a proper job to make a proper living, and these students aren’t wasting a single second.

Students are becoming more relaxed around me, taking me up on my offer to come see me if they have questions or just want to talk. One afternoon, I escape to my small lime green office after a particularly difficult morning on the wards. I bury myself in the pile of papers to mark on my desk to busy my mind. A few students are gathered outside, and soon make their way in and sit down to chat with me. I ask one why he decided to go into nursing. I’ve asked this before, and the main response is “to save lives” or because it’s a decent-paying steady job and they can provide for their family. This one was different. He told me that he grew up with his aunt and uncle, who was chronically sick and constantly in and out of hospital. He would do basic care for his uncle – bathing, feeding, even toileting. He described how he could see the difference it made to his uncle, and the relief it provided his aunt. He felt satisfaction and joy in helping out as much as he could, and he started thinking about how he could do this for more people, bring this comfort and relief to more families in their difficult times. He was so sincere as he told me this and, after the morning I had just had, I was fighting to hold back tears. It gave me a burst of hope and renewal to hear such a real, well-thought, from-the-heart answer.

A woman I know was in the female medical ward, looking after her younger sister. She was there all the time – when I left in the late afternoon she was there, and when I arrived early the next morning, she was still there. She looked tired - she had slept there, on the floor, but was up all night with here breathless sister. I commended her on her dedication, told her she was a good sister. She just shook her head and said it’s just what she should do. “I’m the older sister, so if she falls sick, who should care for her? If she can’t walk, who will help her? If she soils the bed, it is me that is embarrassed, not her.”
Often it is easier to just walk by, or throw a rope down, or tell someone else to do it, than to get down in the mud yourself to help someone else up.

Grace

I’ve had many days like this one. I’ve cared for many sick patients, many sick young patients, and seen many of them die. So why was today so different?

Grace was about my age, HIV positive, and was in renal failure. This morning she was very sick. Sicker than yesterday; sicker than ever. There was nothing else we could do, fluids wouldn’t help, and no medication could heal her body. Her mother had been by her side constantly since admission, and diligently and lovingly had cared for this young woman, feeding her, dressing her, doing all the things Grace needed her to do, without a moment of hesitation or objection, and not one utterance of complaint. This morning, we had to tell Grace’s mother that there was nothing more we could do, and that Grace is most likely going to die. I’ve been here before, heard this story many times. What got me was the look on Grace’s mother’s face. I saw the moment of realization that her child was going to die. I felt like I could physically feel her heart breaking, and I felt so much sorrow and helplessness in that moment. She was looking from side to side, like she was looking for someone to help her, someone to tell her this wasn’t real. She clutched her heart, asking how? why? As a few tears rolled down her cheek, she looked pleadingly at us and then back at her daughter. There is nothing I can say in this moment, and I reach for her, touch her arm, and mumble something like “I’m so sorry”. As we move on from her bedside, Grace’s mother begins to cry. She leans near her and starts to pray. Though I don’t understand her prayers, I join her silently from where I am standing, asking for comfort and peace for them, and a bit of strength for myself right now, and I let a tear fall.

Not quite 2 hours later, I am helping to prepare Grace’s body and we walk down the long outdoor corridor to the mortuary, mother and fellow bedsiders following behind, wailing for her loss.

Later that day, I think about what would have happened in Canada. Well, first, Grace would have had more medical support available to her, but aside from that, I think things would have been slightly different. When someone dies in the hospital at home, it is very private. For starters, patients often have their own rooms, not just a mobile cloth screen separating them from the 40 other patients on the ward. Family is present, but not as constantly, not as actively. When the deceased is taken away from the ward, it’s done very discreetly, often waiting for a quiet time when no one is in the halls. Here, we make an announcement for the other bedsiders to join the family as we travel to the mortuary together. These other women have been with Grace’s mother since she arrived, caring for their own relatives, chatting about family, health, and other daily things. There is no judgment, whether someone has HIV or not, whether they are rich or poor, they are all here for the same reason, someone is sick and needs their help. And when someone dies, they don’t turn away, not for a moment.

My chains are gone, I’ve been set free
My God my Saviour has ransomed me
And like a flood, His mercy reigns
Unending love, Amazing Grace