Here and There

I am so proud of this kid...

We ask a lot of her.

We ask her to maintain understanding and relationships across two continents and an ocean, to know the faces and voices attached to the names of MeMe and Grandpa and Nanna and a couple dozen other people. We ask her to be distinctly Other and simultaneously blend and fit, because that’s what it is to be a third culture kid. She’ll never really be American. And she’ll never really be Zambian. But that Third Culture, the one that is some blend of the first two with her own distinct pizazz and personal experiences thrown in, that’s the one that’s the most difficult for us as her parents to wrestle with.

Because both the country we left behind and the one we landed in possess cultural tendencies that are venerable, along with some that should be allowed to die (or forcefully stamped out). And in between those two extremes are quite a few norms that are neither here nor there, neither Godly nor reprehensible, but merely expressions of human societal existence.

For example, there’s the issue of culturally-bound virtues, like manners and modesty. Last summer we attended a church camp where the straps on your tank top have to be at least 2 finger-widths wide. Here, shirts are basically optional, but ladies don’t you dare show those knee caps. I frequently think of a story told by Elizabeth Elliot in which, while they were living with the Auca people, her young daughter Val corrected something she had said in a manner that would have been considered extremely rude and inappropriate by American standards. But Val wasn’t functionally American. She lived among the Auca. And in that context, her tone and vernacular were perfectly acceptable. And Elizabeth let it be.

So there’s a very real sense in which when Teresa’s actions are a bit more Zam than USA, I’m relieved. It means she’s adapting, fitting, thriving. But at the same time, T’s situation is not the same as baby Val’s. Teresa lives in a world of media and air travel, a world in which she will be periodically exposed to (and thus expected to function in) the Western world even though “home” is a sprawling little village in the sub Saharan. She needs to be simultaneously completely at ease with hiking up her skirt to pee in the bushes or sitting in the dirt with her friends to eat ubwali, and politely asking to be accompanied to the potty or excused from the table. ALSO, LET’S NOT FORGET THAT SHE’S ONLY TWO.

And let’s face it: we all know that missionary kid, the one who is totally socially screwed up from their experiences, the one who lived 18 years in a foreign country and never learned the language or the culture, because the country stayed foreign to them, the one who holds little love and few genuine relationships with the people and the world they left behind when they were finally mercifully old enough to leave and go to college. And I fully understand the situations and decisions that may have contributed to that outcome—because sometimes our neighbor kids are none-too-kind in pointing out Teresa’s Otherness, or trying to filch her stuff. And full integration into her peers’ world would mean attending a sub-par school (yes, I’m stressing about decisions that are literally years away), instead of the typical home-school or international school or boarding school options that would prepare her excellently academically but edge her out socially.

It is a constant battle of priorities—do we make the decision that is better for her socially, or academically? The decision that allows for close supervision and protection, or the decision that catalyzes cultural integration and independence?

(I also know of fully-functional, well-adapted, bright and brilliant missionary kids who came from a variety of backgrounds and whose parents made a myriad of different decisions that ultimately contributed to well-rounded little members of society. But I’m not angst-y about THAT possibility. So.)

I read a story when I was in high school about a girl with a disability who walked with a cane. She was walking home in the ice and snow and slipped, and she was unable to get enough traction with her cane to life herself out of the slush. The girl’s mother watched all of this from the porch, together with a schoolmate of the daughter’s. When the schoolmate started to go help, the mother stopped her and emotionally explained to the schoolmate that the daughter needed to figure this out. And in a few moments, the girl in the snow calmly examined the end of her cane, removed the slick, soft, rubber end, and jammed the metal end into the snow to anchor herself as she stood to her feet.

The other morning on the way home from church, we walked up alongside 11-year-old Mpundu. Aside from being Teresa’s best friend in the entire world, she is also Teresa’s sitter during the day when David and I are at work. She keeps her for a few hours each morning. Teresa saw her ahead of us on the road and immediately began yelling her name. “Mpundu! Mpundu! Mama, Mpundu! Mama, I want Mpundu!” and proceeded to continue begging to be with her dear friend (who eventually parted ways with us) until we finally got home. Teresa adores her.

But it wasn’t always like that.

The first couple weeks that Mpundu was watching Teresa, there were some really hard mornings. Mornings where Teresa clung to us and cried because she didn’t want to go. Mornings where Mpundu seemed totally at a loss. Mornings where my mama-heart screamed that maybe I should find a different way, a way that kept Teresa at our house around her familiar environment, or just a few feet away from her mother or father at all times-- a way that didn’t dunk her headfirst into a language and a culture that was entirely unfamiliar to her.

Oh, praise God, I am so glad I didn’t.

Because now, Teresa loves ubwali and relish (thank you, Mpundu).

Now, Teresa points to Mpundu’s house and informs me that she wants to play with Mpundu every blessed time we walk down that particular place on the road (thank you, Mpundu).

Now, Teresa dances and sings songs I’ve never heard and can’t place, until a few days later when Mpundu starts absentmindedly singing that same Bemba song while coloring at my coffee table. And now, Teresa keeps coming home with new Bemba vocabulary words. And now, when Teresa eats breakfast in the morning, she emphatically insists that Mpundu be allowed to share with her. And now, Teresa informs me that braziers are “Pye pye!” (hot/burn!) every time she sees one, even though we’ve never even cooked on one, and now Teresa expertly pops an entire groundnut in her mouth, de-shells it with her teeth, and casually spits out the shell, because Mpundu teaches her those things (thank you, dear sweet Mpundu).

(Make no mistake—Mpundu & Company has also taught Teresa some things that had to be, ahem, un-taught).

I know I’m twisting my metaphors a bit here. I’m not sure what exactly correlates to the slippery snow and what correlates to the challenge of walking and what correlates to the cane. I certainly don’t mean to insinuate in any way that a Third Culture kid is inherently disabled.

But they do face challenges. And sometimes, I’m the mom on the porch, watching her slip and trying to decide whether to help her up or let that brilliant resilient mind of hers figure it out.

And you know that old adage that every kid is different? Can we just multiply that times bajillion for the current situation???

Because there’s no point for comparison here. I can’t look around and see how other parents are handling their two-year-olds at mom’s club. I can’t casually notice whether the other toddlers at daycare are more physically or verbally adept than T, because malnutrition and other factors mean that many kids here are stunted and delayed. Teresa is also in the exact opposite situation from her peers linguistically—they speak Bemba and are picking up a bit of English here and there, but she speaks English and absolutely must learn Bemba if she hopes to ever have a conversation that consists of more than pointing and grunting.

She is the only strong-willed, rough-house-loving, ubwali-eating, shoe-despising, Bemblish-babbling, nkoko-chasing, Lego-Movie-addicted, incredibly-hard-headed-toddler-of-partial-Italian-descent living in the Luapulan bush around here. I know other missionary kids, and I know other 2-year-olds, and I fully believe that no challenge has accosted us as parents except that which is common to all men. (Bethany assures me several times a week that Teresa is normal and that eventually she will speak in intelligible sentences and consistently consent to wear underwear. And Bronwyn’s undying love for her buddies Mulenga and Timo gives me hope that Mpundu won’t just outgrow her. And baby Leonie is perfect in every way and thus the embodiment of hope for the next generation. So we are, blessedly, not alone in the journey of Third Culture kid-raising.)
 
I also understand, full well, that there is such a thing as pushing a kid too hard. Just as there is such a thing as sheltering a kid too much. And I know that this Otherness that she must contend with here is never going to truly go away. Not even if she becomes fluent in Bemba. Not even if the customs and niceties of Luapula become second-nature to her.  She’ll always live in that Third Culture.

I think we’re just grappling with the fact that we do have some influence on what her Third Culture looks like. Whether it’s more Zam than American Expat. Whether her--our-- Otherness is reinforced by our choices, or calmly acknowledged but not Deified. We have an intense, painful awareness of every decision we make and every amenity we possess that sets us apart from our neighbors. Even when we believe those decisions to be the “best” thing for our family. But especially when we realize that the harder, more tedious, less comfortable way is the choice we should or could have made.

A big part of that awareness stems from the knowledge that someday, she will realize it too.

But for now, darling Teresa, the biggest tragedy in your life is when Mpundu has to go home for the night.

For now, my sweet dear, you’re only two.

Where the Kiddos Go

I have an affinity for loosely organized chaos.  I also have an affinity for attempting to loosely organize said chaos.  There is a wonderful event here that allows me to participate in both—Under-5 Clinics.

Under-5 Clinics are monthly clinics held at designated sites throughout a Rural Health Clinic’s catchment area.  Fimpulu has 10 zones with an U-5 occurring once monthly in each zone (well, roughly—a couple of the zones are combined into one meeting place for simplicity’s sake). Depending on how you get there, our furthest zone is 35km away from the clinic.

U-5 Clinics serve the primary purpose of growth monitoring and vaccine administration.  Ideally, family planning and antenatal services should also happen then.  For our furthest zones, this is often the only time people are seen by a “clinic worker” (because do YOU want to tie your sick 5-year-old on your back and walk or bike 10 or 20 or 30 kilometers to the nearest health facility? Um me neither). With that in mind, there is obvious potential to expand the services offered at U-5s, manpower and resources providing.

So a couple of weeks ago, Meg the Wimpy White Girl (that’s my superhero name) hopped on her bicycle and pedaled all the relatively short way to Fitobolo. It’s mostly tarmac the whole way there, which puts it in the “easy” category as far as bike rides go, but Meg is super duper out of shape. Holy thigh cramps, Batman! I arrived at a completely deserted shelter, inhabited only by a hanging UNICEF baby scale which convinced me I was in fact in the right place.  30 minutes passed.  Then an hour.  When my clinic colleague finally arrived on his motorbike, everyone heard the engine coming and popped out of the bush grass like children of the corn, but cuter and less creepy.

Then we got started.

First, we collect everyone’s U-5 cards.  I taped back together the ones that were falling apart.  Everyone gets weighed and charted. Cards are then sorted into 4 piles:

Needs vaccination, growing well

Needs vaccination, not growing

No vaccination, growing well

No vaccination, not growing well

The Needs Vacc group line up and get poked. Much wailing and gnashing of teeth ensues. The Not Growing families are, theoretically and ideally, identified, interviewed, and an appropriate intervention put in place. I say “theoretically” because sadly, this group usually consists of repeat offenders.  Nutrition intervention is not as simple as just telling people to eat better, or even giving them food.  But that’s for a different blogpost. 

In order to encourage a change in the normal way of handling patients here, which seems to be based around public verbal bludgeoning and punishment, I also make a point of calling out to mothers whose kids are doing particularly well-- children who have started gaining weight after a drop, or who have started retaining U-5s after a few months absence-- and profusely praising and encouraging them in front of their peers.

Then all the preggo mommies line up for antenatal (palpation, exam if necessary, distribution of vitamins, screening for complications), followed by all the moms who don’t want another baby right now for family planning.  Most women opt for DepoProvera here, which is an injection they get once every 3 months. It doesn’t require the daily vigilance of the pill or the visible evidence (scar) of the implant. Recently, I’ve asked each zone’s Community Health Worker (individuals trained to provide very basic diagnoses and treatment on the community level) to come and set up shop in the corner, testing for and treating uncomplicated malaria and/or pneumonia. The CHW’s attend their zone’s U-5s anyway, so it’s a logical service to provide.

I weave my way through the crowd cooing at babies and looking for any problems that might have been missed. I carry basic supplies with me (like sterile dressings, burn cream, antibiotic ointment, etc.) to deal with the inevitable owies I come across. It's not uncommon to find a child with a half-healed injury that was never treated at the clinic and needs some serious attention.

While all of this is going on, every blessed thing we do has to be charted on a tallysheet or in a register.

I know that all of that sounds relatively simple and systematic.

But it’s not.

It’s a giant cluster of screaming, hungry babies and tired, hot mommas.  It’s chronically sick and underweight kids whose vaccination records are all over the place.  It’s a beautiful churning mass of persistent, unquenchable humanity.

For the moms and kids of Fimpulu, it is life-protecting and health-encouraging.

For me, it is soul-filling and God-honoring.

I’m gonna just call that a win-win.

Master Plan for Avoiding Malaria

So I’ve had a couple of personal run-ins with malaria recently—not particularly enjoyable encounters, I might add. I’m in good company. Of the roughly 50 people we see a day at the clinic, probably upwards of 90% of them go home with malaria medicine. My sympathy meter has increased dramatically after experiencing it myself. And so, on behalf of all the people of Fimpulu,* I present for your consideration my Master Plan for Avoiding Malaria.

1.) Assault Approach: Hire village kids to follow me around with fly-swatters and kill all mosquitos that approach me.

     Pros: Cuteness factor.

     Cons: Kids are easily distractible. This is likely to devolve into a friend-swatting war amongst children.

2.) Unattractive Tactic: Mosquitoes are attracted to CO2. Erego I will hold my breath during high mosquito prevalency time (dusk to dawn).

     Pros: Current scientific knowledge suggests less CO2 would be good for the environment, so this is eco-friendly.

     Cons: Current scientific knowledge suggests that breathing is necessary for survival.

3.) Drought Endeavor: Malaria parasite lives in human blood. Drain all blood from my body,.

     Pros: Mosquitos relying on my blood for survival or sustenance will starve.

     Cons: Unsightly pallor related to blood loss. Also certain death.

4.) Russian Doll System: Sleep inside of a mosquito net inside of a mosquito net inside of a mosquito net.... etc.

     Pros: Increased barriers between myself and mosquitoes.

     Cons: My cat will tear holes in all of them to get to me.

5.) Iron Man Method: Create impermeable full-body suit.

     Pros: Coolness factor. Superheroes are awesome.

     Cons: Limited access to pilatium in the village, which is necessary to power an Iron Man suit.

6.) Predator Plot: Fill house with geckos, spiders, bats, and other mosquito-eating creatures.

     Pros: Lots of new creepy crawly friends.

     Cons: I don’t actually want creepy crawly friends.

7.) Mole Woman Scheme: Live underground. FOREVER.

     Pros: I get to pretend I’m a hobbit.

     Cons: Danger of cave-in.

8.) Human Glue Trap Technique: Wrap body in double sided sticky tape to catch and trap mosquitoes.

     Pros: I get to kill all the mosquitoes that stick to me.

     Cons: Daily full-body wax might become uncomfortable.

9.) Bored to Tears Policy: Read boring academic book aloud at all times to annoy mosquitoes into leaving.

     Pros: Appears to be working for my husband. Also, fairly enjoyable for my little nerdy self.

     Cons: May be ineffective on highly intellectual mosquitoes or those who don’t speak English.

10.) Superhero Experiment: Expose self to high levels of radiation in hopes of acquiring superpower of malaria immunity.

     Pros: See pros for “Iron Man Approach.”
     Cons: Possibility of acquiring unwanted or undesirable superpower, such as irreversible invisibility.

*No locals have endorsed any of these methods, for reasons that I assume are obvious.

Spaces

We find Him in the spaces. We share Him in the spaces.

David and I have relatively secular jobs. I’m a nurse. He’s a teacher. And while I find nursing, the act of healing and ministering to tired and sick bodies (and by connection to tired and sick souls) to be one of the most spiritual things I ever do, no one labeled me a “missionary” when I worked 12-hour shifts as a nurse for sick foster care kids in Chicago.
 

Our ministry here in Fimpulu is of the subtle daily grind variety, not the door-to-door evangelism or Jesus Film Conference variety. Choshen as a whole does do a significant amount of more obvious evangelism-- they hold training conferences for pastors and teach Bible stories at preschool and a myriad of other awesome things. We love and wholeheartedly support that work and have truly treasured the times we’ve been able to contribute to it in tangential ways, like when David helped build the conference center for the aforementioned pastoral trainings. Nonetheless, we often feel pressure (real or imagined) from those back home to emphasize the “Jesus” in what we do, to share stories of overt evangelism or conversions or whatever. 

And if I’m honest, sometimes that gets to me. Sometimes it makes me feel like I’m not missionary-ish enough.

So I could tell you stories about how Mwewa and Robert come to my door and ask if they can sit on my couch and read the Bible (duh, of course you can, whenever you want to), and I could let you think that these two teenage boys are totally on fire for Jesus and that’s why they’re foregoing the opportunity to play with my soccer ball in favor of the opportunity to read scripture.

And I hope that’s part of it. I do. I hope there’s a little curiosity and wonder brewing in their mischievous little souls, and that they’re absorbing some of the words that they read aloud to me, their cadence painfully choppy and halting the way that it is when one is still trying to grapple with the art of reading. 

But honestly, I think a lot of it is just that they love reading something in Bemba. They love the praise they get from me when they finish a chapter.  They love that I pull that sacred book down from the top shelf where it normally rests, away from the more sturdy children’s books that everyone is allowed play with. I think they feel a little important because I won’t let preschoolers play with the book that they get to read out of. They’re special.

Can that just be okay? Can it just be okay for exposure to the Gospel to wind its way into the little spaces between the normal of their lives? Can it just seep in between discussions of whose turn it is to hold the book and arguments over what an unfamiliar word means and humor over their desire to skip the genealogies because snore? And can it just be okay that those spaces minister to me too, that my own soul is never more at rest than when it shares an ordinary and mundane and undefined space with some village kid and that Still Small Voice?

The simultaneous allegiance to and fear of animism and witchcraft exists simultaneously alongside profession of belief in Christianity for most locals here. Mother’s tie (or allow other’s to tie) charms and “medicines” around their children’s necks or waists. These witchcraft charms are meant to do everything from preventing convulsions to warding off curses. And so when I’m checking over tiny bodies, listening to fevered hearts or percussing consolidated lungs or trying to get a read from my portable pulse oximeter as it dangles from a wiggly and uncooperative finger… When I’m scrubbing burned escar off of mangled limbs or sitting on an uncooperative 2-year-old while I force him to take his medicine or cutting out stitches or cleaning off ill-kept umbilical cords… These little interactions, they create spaces. They create spaces where the breath of Aslan sweeps through. They create spaces that are somehow exactly the shape of my soul, like I was made to fit into it. They create spaces of trust, spaces where momma’s tell me why they don’t feel safe taking off that charm because they fear this or that or the other, spaces for me to talk through how much bigger our God is than all of those other things. Spaces to voice fear, and spaces to drive it out with the Perfect Love that is our Jesus.

I don’t mean to insinuate that all of the charm-loving parents of Fimpulu have started renouncing their traditional ways because of my pleading (they haven’t). If it were that easy, Choshen would have tied the bow on that box a long time ago. But every once in a while, I hear a mom “educate” one of her peers as they wait in the long clinic queue using words that I’ve previously spoken to her. “Don’t dress him. His body is too hot, so wash him with this cool water and fan him. The clothes are like a blanket that make him hot.” Or a co-worker tells a mother that she mustn’t fear the spirits but must put her trust fully in God, because if she knows the power of the blood of Jesus and trusts fully in Him, then no other power has dominion. Or a young momma brings her baby boy in just to say hi, because we fought for him when he was so so so tiny and new and every auntie and grandma in the village was whispering in her ear, but she listened to us instead. And he lived. And we celebrate every ounce of gained weight with a dance and a laugh and Joy— you know, the kind of Joy that fills those kinds of Spaces.

But can it just be okay if the first mom covers her baby up anyway? If the second mom leaves the charm on for now? I mean, obviously it’s not “okay” in the sense that it’s “okay” for all of eternity, but for just the right now, can it just be okay that that they’re still working through the Spaces? 

Those spaces where He finds me.

Those spaces where I find Him.

Those spaces where I yearn to take Him to them.

Those spaces where He whispers to me that He is already there.

Perspective

At Fimpulu Rural Health Center, there is a separate log book or register or tally sheet for pretty much everything. Visits to the outpatient department. Prenatal appointments. Family planning patients. Revisits or follow-ups of any and every kind. HIV drug dispension. TB patient visits. Kids identified as being nutritional deficient. Meds dispensed to the out-patient department, or maternity wing, or counseling/testing room. Malaria tests given.

Ya’ll. There’s probably 50+ registers. No joke. 

This week, a very official-looking woman came and basically audited our registers. After several hours of pouring over cramped and messy handwriting, she came into the screening room where I was working and, with a big smile on her face, proclaimed that “we are not doing well.” 

Turns out, there is yet another register (or three) that we should be keeping, and a line of protocol that goes along with it, that we’re lagging a bit behind in. Specifically, all children should be HIV tested after they are weened, and that test should be recorded in a register so that there is some record that it happened. Because the reality is that right now, it’s not actually happening. And that’s really not okay, in a place where the HIV rate is officially 13% but probably actually painfully higher.

Audit Lady was actually extremely kind and obviously cares about her job and the kids she hopes to help through it. We chatted for several minutes about ways to implement the proposed strategies and protocols. She took my phone number and gave me hers, saying that she had some written resources at her office that she thought would help me out and inviting me to stop by next time I’m in Mansa and pick them up. 

To speak my truth, I deeply passionately dislike the part of nursing that is charting. I don’t enjoy spending literally half of my time on the job just writing in books. I don’t know many nurses who do. It is the bane of nursing existence.

And 6 months ago, if you had told me that there are several dozen books that should be charted in on a daily basis at every rural health clinic in Zambia, I would have scoffed at the inefficient waste of time and the definite double-charting (writing the same information twice, or sometimes 3 or 4 times, in different books) that is surely taking place in such a system.

But then I jumped face first into hot water (that is to say, I started actually working at one such clinic), and my know-it-all-ness has toned down a squeak or two. There’s that old adage that you shouldn’t judge someone until you’ve walked a mile in their shoes. I think it is all too easy to walk a mile in similar shoes (i.e., a nurse who has relatively significant related experience but hasn’t actually worked as a nurse in this particular kind of clinic) and go ahead and cast judgment.

Because yesterday, an HIV+ mom came in to pick up ARV drugs for her HIV+ kids, and we didn’t know what meds to dispense, because their names weren’t on the register. She went home empty-handed with instructions to bring back their paperwork so we can try again.

At the end of every week, I pull about a dozen scraps of paper out of my nursing bag on which I have hastily scrawled the names and identifying information of every clearly malnourished child that I saw that week. I’ve been here long enough that I’m starting to get repeats, and that’s frustrating, because no follow-up is happening. I just keep writing down their names. Last week I found a register that is supposed to be used for that purpose, so that their names can’t be forgotten and dismissed as easily as little scraps of paper that end up left in my pocket and scrubbed to death in the laundry.

So that register of meds? That register is crucial. It means that we know exactly what medication a patient needs, and what medications they may have been on in the past, and what day they picked up their meds last time (and therefore whether they picked this batch up in time to keep from running out). It means that we can calculate how many of each kind of ARV in what doses we are going through in a month to avoid running out. 

And that register of under-5s malnutrition that I found forgotten in a stack of nonsense by the refrigerator? That means that when I encounter a malnourished kid, I can go back and see if they’ve been identified as such before. I can see if follow-up has happened with them. I can tell if they managed to slip under the radar somehow, or if they were fully on the radar and just not addressed.

And the birth register means that if a mom doesn’t show up with her newborn for postnatal within a week of going home, we know who and where and can try to figure out why. 

And when folks come through for the umpteenth time but we can’t find any history of them in any of our registers, it’s a sign to us that the flow of things is failing, and that we as practitioners are letting people slip through the cracks.

So it’s all in perspective. 

Of course, the system isn’t perfect. In the above examples, oftentimes the problem is actually caused by someone's failure to fully or appropriately utilize the registers. Writing it down doesn’t guarantee that anyone will do anything about it. With the frequency of staff turnover and building renovation that has reportedly happened in the last few years, some registers have been neglected or forgotten completely. There are stacks of old registers from years past that I honestly have no idea what to do with and have ceased to become very useful simply because of age and the sheer difficulty of locating anything within them. 

Nonetheless, all of these registers exist for a reason. Sometimes a functional reasoning, and sometimes merely a data-reporting reason, but a reason nonetheless. On more than one occasion, I have thought to myself that this and that procedure or log book or whatever could be consolidated to be more efficient, but the pattern so far has pretty consistently been that when I do some asking and digging, there’s a decent reason for why it is the way it is (even if that reason is just that the people who give the money… USAid, for example… require data to be recorded in a particular way).

For me, it poses an interesting challenge because of my unique position at the clinic. I am functioning pretty much like a full-time employee of the Ministry of Health in terms of my responsibilities, but of course, I am not that thing. We’re here through Choshen Farm, not the government. And there are a host of services and activities I would love to offer that are related but tangential to the services offered by the clinic. I both have a lot of freedom and take a lot of liberty in my position as it currently stands, but I am still functionally beholden to some of the daily doldrums. 

Like the registers.

But until digitalization (and reliable electricity, and computer literacy) sweep the sub-Saharan, I pray that God will keep me humble (and knock me down when I need it) in regards to the way it is and what I might initially perceive to be a “better” or “right” way.  There’s probably a list of ways that I personally could improve in this area. Feel free to send me your suggestions.

Maybe I could write them all down in a register.