A Day to Celebrate Children

This child was born at 28 weeks gestation (normal is 40). It has survived 5 weeks with no medical intervention and being fed by a syringe. The mother died in childbirth, but this child shows how miraculous life can be.

At the beginning of this journey Jessica and I were given Angel Cards (Oracle Cards) by our friend Sandy that we met at a non-violent communication workshop. These cards have different messages and answers on them that are suppose to guide you and your feelings. Everyday Jessica and I pulled a card from the deck to boost our moral for the day. So many times the cards would ring true about how we were feeling or to what we have discussed the previous day. The week before we went to Malawi both of us pulled the “ocean” card multiple times…I know Malawi is not on the Ocean, but Lake Malawi was the closest thing to an ocean we had been near in a long time. We have not pulled a card for almost a month because we have been away. Yesterday we decided to pull one. It was the day that I was supposed to go to the pediatric ward. I have to admit I was feeling apprehensive because I am new to pediatrics and had never been to this ward before. That day I pulled the “child” card. The card read, “You care deeply about children, and they readily respond to your love. All children, including your inner child, require love, affection, and attention. Clear and open your heart and schedule so that you can give more time and energy to the children that need you.” If that was not a sign that I needed to go to the pediatric ward I don’t know what is!!

So our main focus right now is to be clinical instructors to the students. I found first year students on the floor, green and ready to learn. I orientated myself and said hello to the family and children and student nurses. I quizzed them on a few things and we started the day.

The first sad case of the day: a one month old baby in severe respiratory distress, has not had a bowel movement in 3 weeks, and has tested positive for Malaria. 3 doctors come in, each one saying the condition is something different. Either way, one suggests the family should go to Lusaka to be treated in the intensive care unit. I plead with the other doctors to let the family go as well (as I know the outcome at Lewanika due to the lack of resources will probably be fatal). The doctors agree, however, they needed much convincing.

Case number 2: protein energy malnutrition (lack of protein or all nutrients from the diet). Almost every child in the ward was being treated for malnutrition. There was one boy who stole my heart. This child was under 3 years of age with severe Kwashiorkor, a type of protein deficiency. He had puffy cheeks, belly, and feet from the lack of protein in his diet. When I sat down with the mother to ask what the child eats on a normal day she responded, “we don’t have money for breakfast, when we can he eats nshima (a carbohydrate) sometimes with cabbage if we have it). Almost no protein in his diet and very little of other nutrients as well. He is 1 of 5 children in this family. I taught the mother simple affordable ways to include protein in her children’s diet. I hope it was something that she could incorporate into her children’s diet….

Note the round face and belly. Despite the malnutrition, he was a typical 3 year old, flirting and playing with the nurse!

The next case was heartbreaking. There was a small child that had marasmus (malnutrition where the child is lacking all nutrients) resting with his grandmother. The child was crying and crying, so I picked the child up and tried to console it. The grandmother looked at me and said something in Lozi. When I asked someone who spoke English what she had said they replied, “she says you are an angel sent from heaven.” Wow, I almost broke down and cried right then and there. The child, who weighed less than 8 kg, looked to be about 3 months old. It was very shocking when I saw the child had teeth, which indicated that it was much older. The grandmother told me that the mother had a mental illness and she would often find the child laying in the dirt with no one else around. So the grandmother started to take care of the baby feeding it milk when she could. I wish I could describe how vivacious this grandmother was, she had to be a mother again and she was smiling and dancing with no worries in her mind.

It is hard to believe this child is 8 months old. I think we all need to appreciate grandmothers more after seeing this picture!

My experience here has really taught me to be an advocate for the patient. I have also learned to question things and really use my creative cap. There was a 13 year old child (HIV positive) with pneumonia. She had difficulty breathing so we propped her bed up with a piece of Styrofoam we found on the ward. This is one of the many tools that I have learned in Africa. I can not begin to express how grateful I am for my time here. Yes it is difficult to deal with emotionally, but it has made us much stronger individuals. So please don’t worry about us, we are doing fine here, and will be home shortly!!

Lianne

Meet “Big Boss” Max

Occupation: taxi driver
Favourite Colour: Green (after being told that Lianne’s favourite color was green)
Marital Status: Single
Age: 29

We first met Max in a maze of at least 30 other cab drivers. What made us choose Max? Probably the huge sticker across his windshield that said, “Big Boss.” We thought it was funny. After driving for a total of 1 minute, we heard Backstreet Boys Blaring from his tape deck. We knew instantly that this was our cab driver in Mongu.

There is a bit of a language barrier with Max, so it is usually a one way conversation with Max adding, “sure sure,” every now and then. However, he is a great driver and very trustworthy. We usually see him everyday when we are out and about and will hear the familiar sound of his horn as he drives by.

He is now our official taxi driver and we call him whenever we need him. We wanted to choose one cab driver that we could help out financially while we are here in Mongu. Max’s physical appearance gives us the impression that he is struggling with his health, although we have never asked him about it.

Max’s tape deck was broken for almost 2 months. It broke our hearts not being able to hear Backstreet Boys. However, the other day he gave us a ride and his tape deck was fixed. We gave him Kenny Rogers, Christmas Classics, and The Real Nitty Gritty tape cassettes that Lianne’s mom was holding on to for some reason and she graciously donated them to a good cause. Max will always be our “big boss.”

Nursing at Mayukwayukwa

Patients waiting to see us in the Out-Patient Department of one of the clinics

With our students we worked in 4 different rural health centers around Mayukwayukwa. Almost all of them are staffed by members of the community who have minimal training in health care. The whole time we were there, we did not see one doctor, they simply don't exist there. At the main clinic there is one enrolled nurse who works night and day. When she is not at the clinic, the housekeepers and other support staff are delivering the babies. Seriously. In our experience here we have witnessed a lot of disease and death due to the lack of proper health care. In fact while we were here, one day we ended up running a clinic..on our own! Seriously…it was just Jessica and Lianne running this thing. We were diagnosing and prescribing treatment for about 50 patients. Conditions we treated included malaria, mastitis, gastroenteritis, diarrhoea, threatened abortion, dysentery, ophthalmologic conditions, splenomegally, dysentery..and many more. We diagnosed and treated patients of all ages (although mainly pediatric patients) with no diagnositic tests or laboratory tests, we didn’t even have a thermometer!

Jess drawing up a tetanus immunization

Working as clinical instructors with our students at the Mayukwayukwa health centers involved teaching our students to operate clinics. The running of a primary health care facility is not just seeing patients in the outpatient department (similar to the emergency department). A rural clinic usually focuses on maternal child health. This means that they run programs on certain days each month to monitor the health of children and women at different stages. With our students we ran clinics for children under the age of five where we monitored the growth of the child, gave immunisations, and health talks on nutrition and common childhood ailments. The students also ran antenatal clinics where the progress of the mother and baby is monitored. The mother also receives a tetnus immunisation, malaria prophylaxis treatment, and teaching regarding healthy pregnancies. These are the three main areas in a rural setting, but anything can happen at anytime as in any health care setting!

Lianne getting ready to weigh the 200 children who came to one of our child health clinics

Our students giving a health talk to pupils at one of the schools (1000 children attend this school!)

Our role was to train our nursing students so that they will one day be able to run clinics of their own. We noticed that there is a lack of critical thinking from our students and we are working to teach them to make judgement calls on their own. It is a tough job, half the time we feel like we don’t know what the right thing to do is because we don’t work in sub-saharan Africa! However, we do know how to ask questions, and the importance of reference books as well. We are shocked by how much we actually do know and have learned just by working and teaching at Lewanika. We are thankful for the training we have had at UBCO as we feel that they really did prepare us for working in all situations, anywhere in the world.

The Fate of Mayukwayukwa....

We have met other workers here, one group is working for the Zambian government regarding Land Mine Awareness. To be honest we never really considered that Zambia would have landmines, as this country does have a history of peace. But as we have learned from these government workers, there was fighting before the post-colonial days between Zambia (Northern Rhodesia) and Zimbabwe (Southern Rhodesia). Landmines are also all over the Zambian borders near Angola, Democratic Republic of Congo, Mozambique, and Namibia. Some of these countries are actively in conflict, others have not seen conflict in a while. There have been an estimated 400 deaths from Landmines in Zambia. They even said one month ago someone in our Southern Province from accidentally stepping on a landmine. Angola has the second highest amount of landlines in the world (second to Cambodia). There are new landmines still being laid in areas of fighting such as Angola, Sudan, and Niger. We have noticed many people with amputations around the camps and can only assume that many of these injuries are due to land mines or as a result of fighting.

Children collecting water at a local bore hole

We have been talking with many staff members at the refugee camp. Here are some things we have learned. UNHCR, the United Nations organization that is funding this camp, will be pulling out of here at the end of this year. The UN has deemed the country of Angola as ‘no longer in conflict’. Therefore Angolans can no longer consider themselves refugees. To be classified as a ‘refugee’, you must meet a list of critieria, and one of those criteria is that you are fleeing a country that is considered in conflict. Unfortunately the Angolans at Mayukwayukwa refugee camp are being told they have to go back to Angola. Many of them say they will be killed as they belong to the opposite party that is currently in government. Angola is also right in the middle of elections right now. Mayukwayukwa also has refugees from DRC, and Burundi, these refugees must also leave. But they cannot go back to their countries either, as they are still in conflict. Therefore these refugees must be resettled into another refugee camp, or they can be resettled in another country…such as Canada, Germany, the Netherlands, USA etc. Imagine the cost it would take to move a person or family to a new country (resettlement). Not to mention how difficult it would be for those refugees to integrate themselves into a “Western” society where they come from living a very different lifestyle. Where will they work? How will they afford to live? How do they deal with the cultural differences?

At this time Mayukwayukwa has over 10, 000 refugees. There is no way they will be able to clear all of these people out of here. Realistically what will happen is the UNHCR will pull out of here in December, leaving so many of these refugees behind. While the UNHCR pulls out, so do all the other NGO’s working here (e.g. Red Cross, African Humanitarian Association). There used to be many NGO’s working here at Mayukwayukwa, but once they heard word that UNHCR was pulling out, so did they. The World Food Programme (WFP) currently supplies food (and by food I mean maize meal) to the majority of the people here. Some of the refugees are able to supplement this by farming, but not all are capable. The WFP had a meeting last week in Lusaka and made the decision to pull out at the end of October. I asked one of the workers here what are all the people going to do that depend on this food for survival? He said to me ‘They will starve’.

Here is a tent containing food from the World Food Programme...looking very empty




To sum it up, most Angolans will be “voluntarily” repatriated back to Angola. A few, maybe 100 if they are lucky, will be resettled overseas to developed countries. The rest are going to be without food by the end of this month. The remaining refugees will be staying at the camp while all the developmental and humanitarian aid pulls out leaving them helpless.

The Life of a Refugee

Children of the camp

Mayukwayukwa was established in the 1970’s and has over 10, 000 refugees from Rwanda, Burundi, Democratic Republic of Congo (DRC), and Angola. The camp is divided into 53 Sectors, with most refugees living with people from their own country. An interesting fact is that not only have we had to deal with multiple tribal languages, but most of these countries don’t even speak English. Rwanda, Burundi and DRC all speak French as their first language, whereas Angola speaks Portuguese. Jessica is loving that she can once again practice her once fluent Francais, and Lianne is in love with the Portuguese as it is so similar to Spanish. We have come with 12 of our nursing students, and two other instructors (Mr. Mumbuwa and Mrs. Ngwila). The purpose of this experience is so that the students really get to learn what nursing in a rural setting really means. Therefore they have had to plan and cook all of their meals on charcoal stoves, and sleep all together in two tiny rooms. Not to mention they have to cook for very demanding instructors! (NOT us by the way….we have been eating the food like good little girls) Jessica and Lianne have really had to ‘go with the flow’…and eat truly Zambian dishes. This means eating the Zambian staple food ‘Nshima’ (a maize porridge) twice a day! The students have had a hard time dealing with Lianne’s vegetarianism, so she pretty much gets 4 eggs a day. We have the hugest portion sizes, because they worry we don’t eat enough. One lump of Nshima has the caloric intake of two big macs, how do these people eat it everyday????

Over 80% of the refugees are women and children in refugee camps all over the world. That is because it is often the men who are left behind to fight, or end up dying in war.
It has been interesting talking to the refugees; the women have really opened up to us. The one topic that comes up when we talk to the refugees is ‘suffering’. Everyone expresses how much they have suffered, they feel trapped in this whole cycle of poverty. For them they don’t see hope to escape the refugee camp, and make a new life for themselves. Many of the refugees have been here for years. They can’t go back to their own countries for various reasons, some belong to the opposition party and will be killed if they return, others have no family or homes left to return to. The sad truth is that these refugees don’t have access to proper health care, food security, safe water…all the basic things for life. But this is better than what they had in their home countries. So what are they to do?

A woman and her cute baby at one of our clinics

Many refugees also left their jobs when they left their countries. But in Mayuwayukwa there is little opportunity for work. So many refugees have skills, and were once working professionals..they want to work, they need money for their families to survive! But yet again in the refugee camp there is no opportunity,. And then if they get the chance to get into a town in Zambia, they have a hard time integrating into the Zambian society. Meaning some the locals do not want refugees, or people of another nationality coming to live in their country. It must be hard to feel like an outsider wherever you go. Again comes the question ‘What do these people do?’. They are stuck in this vicious cycle of poverty.

This is Abdul, he is a refugee from Burundi. Jessica was able to practice her French with him..lots