Zooming In: Healthcare

This post is the second in our “Zooming In” series, which focuses on the environment we are entering and the population we intend to serve and learn from in Zambia. We will focus specifically on our skills and philosophy and how those relate to particular needs on the ground. Finally, as a disclaimer, we have not worked in or visited Fimpulu before, so we are primarily reflecting on our own study and past experiences in the larger village Mwansabombwe. That said, even though every community and village is different, there are some similar trends and challenges that we will almost certainly encounter. 

Writing about healthcare in Zambia is tough for me.

It’s tough because statistics are a wily beast that can be misleading and discouraging, and in the process of explaining the struggles and shortcomings of healthcare in rural Zambia, I do not want to minimize the progress the country has made in the past couple of decades, or the hard and dedicated work being done by the local healthcare workers on the ground. It’s tough because the battle is overwhelming, and the challenges are complex, and we don’t have all the answers.

These are the statistics. Officially, the HIV infection rate in Luapula Province, Zambia, is about 1 in 6 for men and 1 in 8 for women.  Moms have a 1 in 59 chance of dying during childbirth during their lifetime. The top causes of under-5 mortality are largely preventable:

Neonatal  – 34% (includes preterm or intrapartum related complications, sepsis/infection, and congenital conditions)

Malaria – 16%

Pneumonia – 13%

Diarrhoea – 9%

HIV/AIDS – 6%

Access to care is a very real issue for many Zambians. I vividly remember scouring a clinic for a healthcare worker when a toddler was poisoned and I didn’t know how to respond. No one was available—the usual staff were out on house visits. On another occasion, the clinic had nothing except Tylenol to offer a child who, along with his siblings, was almost certainly suffering from whooping cough. Well-meaning healthcare workers often give malaria medication to anyone with a headache and fever, and I have so much sympathy, because if it’s your kid that’s sick, then the possibility of contributing to the development of drug-resistant strains takes a temporary backseat. The same kind of over-treatment often happens with antibiotics, when they’re available. For rural folks, the clinic may be a long way away, and the lines are most certainly very long. The vaccination rate in Luapula is the lowest in Zambia, with 40% of kids missing some or all of their vaccinations. Burns are common, especially among children, and proper treatment is often simply not available or even understood.

Complexity arises with the fact that healthcare must be holistic. Meds and docs aren’t enough. Half of all child deaths worldwide can in some way be linked to malnutrition-- tired and malnourished bodies don’t fight off infection well. Effective farming techniques and a solid understanding of nutrition are some of the best medicine in the world. Traditional practices have a very tight hold on many rural Zambians. It is not uncommon to see a child with a charm tied around some part of their body to ward off illness, or an arm cut and rubbed with “medicine” powder to cure pain, or the same powder packed in the ears of a child with an earache. A woman once shared with me her fear that her family would disown or attack her because an in-law she didn’t get along with had died without any seeming explanation, and they believed a curse to be at blame. More than one Zambian expat has related to me the practice that some locals have of giving Fanta to their babies, because it’s just fruit juice.

But Zambia is strong, and Zambia is loved. I once knew a remarkable Zambian woman who had taken the initiative to be trained at the local clinic as a “malaria officer” of sorts. I often heard her educate her coworkers about how to prevent and properly treat the condition. A Zambian farmer who, with the help of Peace Corps, was successfully cultivating a variety of sustainable crops and a fruit orchard, was beginning to catch the eyes of his neighbors who saw his success and the vibrant health of his family. Choshen Farm is involved both directly and indirectly with healthcare in Fimpulu. Their Home-BasedCare program (which you can and should read more about on their site) includes community outreach, education, and provision in areas of nutrition, food security, and community orphan care. They also work with volunteer caregivers from Fimpulu who serve the chronically ill in the community “by learning and teaching about HIV/AIDS, nutrition, personal hygiene, disease progression, treatment options, stigma, and positive living.” And the Gospel of Christ seeps through it all, sharing a promise of love and hope and a power greater than any medicinal charm.

The creative approaches to Zambia’s healthcare situation are as multifaceted as the problems. Personally, my time in Fimpulu will likely be largely engaged with the following:

 

• Volunteering as relief or regular staff at the local clinic
• Serving as an on-call midwife
• Home healthcare nurse for chronically ill members of the community
• Assist in the regular under-5 growth monitoring clinics, including immunizations and health education
• Advising on community health initiatives involving food security, nutrition, HIV/TB/Malaria care, safe motherhood, etc
• Investigating opportunities around the region with the national Ministry of Health

If I could add a bullet-point (and I suppose I can… it’s my blog, after all…), it would be “Learning a whole lot about healthcare in the bush.” A bit over four months from now, I imagine that’s exactly what I’ll be doing.

***For a more "official" look at Zambia's current health status and the progress made, 

as well as the source for the above statistics, see the Countdown to 2015 Country Profile for Zambia***

Out of the Pockets of Babes

A quick break from our Zooming In series to reflect on recent events...

Fundraising is a full-time job—at least mentally, if not also in hours dedicated. We travel and share our call and our plans with old friends and new. We compile email lists and write letters and thank-you notes.  We fill up social media in an attempt to remain present and make the process at least somewhat enjoyable for all involved. We methodically try to widen our circle through “shares” and remain current with “likes,” and we are often bewildered with the new Facebook design that has still left many of our closest supporters asking “are you guys going to have a social media campaign” or “how can we donate?”

(The answer to both of those questions can be found on this blog or on our YouCaring page…)

Beyond this, we feel that things are made more complicated by our relative inexperience. We are new to missionary service, and we are new to community development; we are learning, finding our place in the world, figuring out how to use our experience and training, and trying to explore that exciting horizon of potentialities. Fundraising is partially a process of convincing other people that we, or the work we are doing, is a good investment. Of course, we fully believe that God has called us to go, and that the work is good, and that therefore the financial cost is absolutely worth any sacrifice. Now we find ourselves in the position of trying to convince others with our refrain: “This service is important; God is in this; please be a part of it too.”

Nonetheless, our fundraising experience has been a testament to the “divine economy”-- that is, the way in which money has appeared without explanation from sources we never expected or in quantities we never imagined, keeping us eerily calm throughout the process.

This last week we were incredibly humbled to receive our most valuable donation yet (catalyzing this blog post), in the form of two dollars from a little girl, L, at our church here in Chicago. L earned some money and had the whole world of opportunity before her in regards to how she could spend that money. After some thought, she told her mom that she wanted to give some of it to help people in need; we are honored that her mom thought of our cause as worthy to be the recipient of this teachable moment. When her mom explained that Meg would be working with sick kids, L pulled out her markers and construction paper and channeled her remarkable love and compassion into making two beautiful “get well soon” cards, then tucked a dollar bill inside each one. I know that when we were children, saving money was difficult and giving that money to anyone but the ice cream man was rare. But the heart of the Savior and the divine economy were at work in this little girl, motivating a selfless and beautiful act of sacrifice in the name of Christ.

Friends, be both encouraged and challenged by this today—the economic adjustments and corrections of the divine economy that work through the body of Christ will always intervene to undo the logic and systems of this world. The widow’s mite has been exchanged for an American child’s dollar (you know, inflation), but Aslan is ever and always on the move.

Zooming In: Intro to Education

This post is the first in our “Zooming In” series, which focuses on the environment we are entering and the population we intend to serve and learn from in Zambia. We will focus specifically on our skills and philosophy and how those relate to particular needs on the ground. Finally, as a disclaimer, we have not worked in or visited Fimpulu before, so we are primarily reflecting on our own study and past experiences in the larger village Mwansabombwe. That said, even though every community and village is different, there are some similar trends and challenges that we will almost certainly encounter.

David here, signing on for the first time to our family blog!

This first post is dedicated to the rural Zambian educational environment and our planned place within it. Our direct contact with the public education system came with the 9^th grade class at Kazembe Basic School in 2012. Meg taught science and I taught math and civics to a total of about 120 kids, 30ish at a time. We spent most of this time in a formal classroom setting, but also spent some hours tutoring small groups as they prepared for their year-end exams. The whole experience was both enlightening and incredibly rewarding, and we were so grateful for the opportunity to help and learn.

The most striking education problem the rural population faces is access. Most villages have one or more primary schools (lower and sometimes middle school years), but secondary schools are more rare. Those seeking secondary education often have to either travel great distances or board with family or friends in another village entirely just to be close enough to attend. This problem on the individual level is exacerbated by a lack of teachers/funding that causes class sizes to be large and largely non-participatory. During our last visit, we worked with some very dedicated and capable faculty and staff who were, nevertheless, only able to do so much in an overburdened system. As a result, the students are chronically underprepared to meet the national standards that allow them to move on to the next grade level. 

A small group study session leading up to finals.

We saw this first-hand while preparing students for their standardized tests. While reviewing a practice-test with her science students, Meg found that it was full of questions based on experiments that the kids “should” have completed that year in class but could not due to lack of resources. The questions were worded in a way that made them impossible to reason through—for instance, a question about an experiment to demonstrate photosynthesis could not be answered based on one’s knowledge about photosynthesis, but only by knowing whether a specific chemical agent aids or inhibits photosynthesis. We never did figure out the answer to some of the questions, even with all of Google at our disposal.

Meg explaining something science-y that I don't know anything about.

Another major problem related to access is the inability to pay for or effectively engage with what educational resources are provided. Besides the basic materials like pens/pencils and paper, students also must have school uniforms or else be excluded from class. Costs increase during secondary school, when students must begin paying tuition. Even those in school must struggle to engage with educational materials. For example, textbooks are rationed and distributed to schools, making them a rare commodity to which students don’t have direct access. Instead, we saw that teachers had to spend part of their class time simply dictating from their copy. When Meg and I were given textbooks in our respective subjects to work out of, the kids caught on quickly and often copied down paragraphs out of our books during tutoring sessions.

Trig is not for the faint of heart. Neither is chalk.

The costs are only made more difficult by the fact that, for families in rural areas, maintaining one of their children as a student means losing a hand around the house. On multiple occasions we saw kids pulled out of classes because the family needed them elsewhere (farming, caring for a sick sibling, etc.). These factors combine to make the investment of education high risk while it results in little tangible reward, perpetuating cycles of hopelessness and poverty.

We are grateful that, in Fimpulu, Choshen Farm creates a positive and targeted impact through their programs, which include providing a head start to kids through a (rapidly-growing) preschool program, enabling access to education by sponsoring secondary and college students who work for their tuition during breaks, and increasing access to informal resources through their Learning Resource Center and library. As our “Fimpulu” page explains further, I will serve both in formal classroom settings and informal tutoring and mentorship programs. Though it is a systemic problem, lack of education in rural areas can be alleviated on the ground in part through these holistic approaches that not only address the problem of access but also make that education worthwhile both for students and their families.

The Peace of the City

The joy of being at this stage of preparing (and networking and fundraising) to move to Zambia for a year is that we are constantly given the opportunity to express our hearts and desires to people who ask.

The difficulty of being at this stage of preparing to move to Zambia for a year is that we are constantly wrestling with the challenge of how to adequately express our hearts and desires to the people who ask.

We have found that sometimes the things you care the most about are the things that are hardest to speak most clearly about. The emotions that run deepest are the most difficult to articulate.

During our first discussion with Bethany and Jeremy, the directors of Choshen Farm, they shared with us how Jeremiah 29:7 serves as a guide for the work that they do at Choshen:

“And seek the peace of the city where I have caused you to be carried away, and pray unto the Lord for it: for in its peace shall you have peace.”

They explained that the word “peace” in that verse is “shalom” in Hebrew, which-- if I may borrow their phrasing-- “refers to the total flourishing of every dimension of society, and is only achieved through the fulfillment of God’s perfect law in Jesus Christ.”

Friends, that’s it. The peace of the city. The emotional, physical, familial, spiritual peace of the city. That’s how nurses and teachers and preachers all work together to further the Kingdom. That’s what we’re up to; that’s what we desire.

Last Sunday, we had the beautiful privilege of sharing with our home church in Chicago the call that we believe God has placed on our heart and our plans to answer that call in the coming months. In a couple of weeks we will be speaking at a church in Effingham, IL.  We’ve spent what feel like countless hours creating letters and info packets and updating this blog, and we are constantly in conversation with someone about what God is doing in our lives or the work to be done in Fimpulu. Some folks are more interested in logistics; others want to talk missions philosophy and sustainability practices; still others are mostly curious about the dynamics of preparing to move around the world with a 1 year old.

And we are so thankful and enthusiastic about all of those things, because another aspect about the things you care most deeply about is that you really want to share it with anyone who will listen.

We want to share this with you.

So let’s get coffee and chat. Let’s be pen pals. Shoot us an email, or drop a comment at the end of this post. Take this journey with us.