And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom.
- Anais Nin




Saturday, September 8, 2007

The Last Word

It's happening again.

This time, I am at Logan Airport in Boston, about to embark on the penultimate leg of my journey home. I'm going to Vegas to hang out with my Auntie Beth for a couple of days and to pick up my car for the road-trip back to Denver. I've purchased a snack and a bottle of water and have settled in to a chair with my book, since – as it turns out – I actually have lots of time to kill (we were worried for a while, Lisa and me, that I wouldn't make it; we'd lost track of time, as we often do, when a cursory glance at my mother's kitchen clock had us scurrying to her car, hurling all 60 kilos of my stuff into the back seat, and white-knuckling it down the Mass Pike all the way to the airport shuttle drop-off). Soon enough, though, the gate attendant's voice is crackling over the PA and it's my turn to board, so I hoist my backpack onto my shoulder, tuck my bottle of water under my arm, and fall in with the other weary travelers shuffling towards the gate.

I am rifling through the pages of my book (it's called Gilead, incidentally – and it's fabulous; you should all read it) for my bookmark-slash-boarding pass when I feel it – a faint but urgent ache, swelling and pressing against my throat like a small but steadily growing tumor. My eyes sting, and the pretty, artificially cheerful gate attendant – her blond hair a golden helmet framing her bright face - blurs in front of me. I blink furiously – I can't believe I'm crying again, and I'm not even sure yet why I am – and I swallow. And then text Lisa. "I'm crying," I type. "I'm getting on the plane and I'm crying. This is it. It's all over now. I'm finally going home."

I take a breath and clutch my backpack closer. I am suddenly tempted to turn around, to hop back onto the shuttle, and retrace the steps I've taken – to go back to New York, back to London, back to Venice and Bore and Paris and London again; back to Joburg and Lusaka, then Saint Francis and Mwandi; back to Zanzibar, Vic Falls, Mukinge, and Chilonga. I could go back, I think, just for a little while, and live it all over again – just so I don't forget.

*****

Except that that's been the point of this blog, I guess. To write it all down so I don't forget. To chart the course of my grand adventure and leave you, now, with a final thought. But where to begin? I mean, the truth is, nothing about the last eight months went as I expected it would – or, frankly, as I thought it should. And I spent a lot of time while I was over there – indeed, too much time – lamenting this fact. I was embarrassed, even, that I didn't have better stories to tell, or more tales from the trenches. But now that it's over, none of that seems to matter very much.

There were challenges, to be sure, and frustrations and disappointments. And there were times, I will tell you, when I felt more lost and more alone than I have ever felt in my entire life. But when I think back on these last eight months, it is not feeling frustrated that I remember; it is not feeling embarrassed or lost or alone.

When I think back on these last eight months, I think of Victoria Falls, and of soaring – weightless and free – for four gloriously insane seconds; or of the Tanzanian countryside, the dappled sunlight reflecting off acres of sunflowers and shining black faces smiling up at me as the train blurs past; or of Maggie, and her Irish husband who-loves-her-so-much, and the 40,000 kwacha she collected to buy two tired and hungry muzungu strangers lunch. I think of Robb and Sanjiv and the rest of the IHV team; the missionaries at Mwandi; and the med students at St Francis.

I think of Dorica, clapping and screeching with joy when comprehension dawns on her face; and of Jonathan bowing his head and saying thank you; and of Thomas and Temba and Jakob and Stan; and the way dawn and dusk always came on so quickly it was like God just flipped a switch.

And then I think of Kondwani and her perfect pink lips, her mocha skin, and her tiny fingers clutching at the neckline of my shirt; and of the way my brother – who has always been my rock, the one on whom I've counted to carry me and help me find my way – finally allowed himself to need me, and dared to trust me, for even a little while, with the care of his most treasured gift.

I think of all these things – and so many, many more – and I know that I am blessed. And I am deeply, profoundly grateful – and I haven't even started talking about Europe yet. :-)

"Do you even realize what you've gotten to experience these last eight months?" my father asked me last week, shaking his head and squinting at my computer monitor. We were looking at some of the pictures I'd taken while I'd been gone. Do I realize what I've gotten to experience?? I'm almost offended that he's even asked. Does he really think I don't?

I bungee-jumped off the second highest bungee-jump in the world. I saw more of Zambia than most Zambians do; stared a lion straight in his limpid, amber eyes (from the safety of a Jeep, of course, with a trained game driver at the wheel); and lived for two weeks in Tanzania and Zanzibar on less than $15 US a day.

I watched the changing of the guard at Buckingham Palace; stood where Anne Boleyn was beheaded; took a train through the French Alps; and stumbled into Sacre Coeur Рcompletely and totally by accident, I should point out (I'd gotten lost on my way to dinner) Рand was so overcome by the beauty of it, I literally sat down and wept. I saw Notre Dame, Doge's Palace, the Mus̩e D'Orsay, and the Tate Modern. I watched a show at the Old Vic and a concert in the Palazzo di San Marco. I saw the Paris Opera, London Bridge, the Eiffel Tower and Saint Chappelle.

I drank homemade wine with every meal in Bore; kissed a Frenchman on the streets of Montmartre; danced with an Italian under a starlit sky at San Rocco; and got drunk with a bunch of Aussies, a couple Germans, two Canadians, and a Dane in London.

I had the time of my friggin' life.

But now it's over. And I'm boarding the plane for Vegas, where I'll pick up my car and head home. And just as it did when I left Lusaka, London, Bore and Paris, the ache presses against my throat and I falter. I look behind me. I could go back, I think, just for a little while, and live it all over again – just so I don't forget…

*****

To all of you who sent emails or comments while I was away, or who simply stood beside me and labored through the reading of this blog as I labored through the writing of it – from the bottom of my full-to-bursting heart, I thank you.

Uishi salama.


Picture: Me and Stan

Monday, August 6, 2007

Dear Diary, Part 3

Day 15 – Monday

Ugh. So I was leaving the hospital late last night and saw a man, dead as a doornail, lying in a pool of his own blood in the back of a truck. Just lying there, with about a half a dozen people milling about like he was no more than a sack of potatoes. Gave me the willies.

I found out today he’d been one of two casualties from a horrific traffic accident. There were four guys involved: one was killed instantly (the guy in the back of the truck); two others were rushed to the hospital and saved by the doctors on call; the fourth was left to die in his car because they couldn’t get him out. Can you imagine? They literally had to look this guy in the eye and be like “Sorry, mate. You’re just gonna have to lie there all twisted and trapped and bleed to death while we take these other two to the hospital.” Ugh. Ugh ugh ugh. Seems so senseless to me. But then they don’t exactly have the jaws of life here. Ugh.


Day 16 – Tuesday

It was another long day today. Spent most of it with Thomas in the main store room trying to make headway on an actual physical count of the entire store room inventory. Somebody had the grand idea that we needed to import the entire formulary with stock counts, which frankly doesn’t make sense to me since those counts are going to change (several times) before anybody knows how to modify the data in the system. But this is what I’ve been asked to do so I’m doing it. At the rate we’re going, though, we’ll be counting well into next week. Only I’m meant to leave on Friday and I’ve got a good three days worth of stuff to do after we’ve finished the physical count. On the plus side, I did get to hang with Thomas (he’s a close second to my other favorite, Stan), which was cool. He’s a totally sharp guy (confounding devotion to Benny Hinn notwithstanding) and a blast to be around. In addition to pursuing scholarship opportunities for further study in Canada, he’s going to school right now for psychosocial counseling so that he can be more effective when dispensing ARVs to HIV patients (pharmacy folks spend a really long time with each patient explaining the oft-mentioned complicated regimens that require strict adherence and he thought taking a course in counseling would help him). He also shows real enthusiasm for this new system I’m trying to implement and seems to be grasping the big picture business process concepts better than any of the other guys. I think I’m going to recommend that he gets added as one of the project leaders.

Oh, and just because this made me giggle: I was leaving the hospital last night after checking email for word from mSupply and there was the hospital guard, bundled within an inch of his life (Zambians hate to be cold and will wear turtlenecks in 80-degree weather) in a giant poofy ski parka, a scarf, two pairs of gloves…and a Santa hat. :-P And me without my camera.


Day 17 – Wednesday

It’s hard to express the gratitude I’m feeling today. I mean, we lost power again and two days before I’m meant to leave I’ve had to throw out the whole plan for the next phase of the implementation and start on a new one which is going to accelerate the timetable and the things I’ve got to do before I go, but – I don’t know…I’ve just – I’ve got that Wes-Bentley-and-the-plastic-bag-from-American-Beauty thing going on right now.

Maybe it’s as simple as feeling like I’ve got a purpose here; or the fact that I was recently the beneficiary of the proverbial “kindness of strangers”. Maybe it’s because I managed to squeeze in a run before dinner tonight or because I’m figuring out this mSupply thing and I’m enjoying the satisfaction that comes with learning something new. Or maybe it’s just because the weather has been really nice. I don’t know. But it’s there, and it’s kind of overwhelming, which means I haven’t the first clue how to write about it.


Day 18 – Thursday

Lost power again today. Water, too.

Watched a toddler splash happily (and obliviously) in a puddle of her own pee while she waited to be seen by the doctor.

Ate lunch with blood-splattered mid-wives who looked (and sounded, frankly) as though they were fresh from battle.

And I found out that someone in the pharmacy’s been pilfering drugs. I don’t know who, but I have a sinking feeling I might.


Day 19 – Friday

So it was my last official day at Saint Francis today. I was supposed to have left this morning but I ended up staying an extra day to wrap up a few things, so I’ll leave tomorrow – bright and early on the 5.45am bus.

I feel good, I guess – I accomplished what I came to do and then some: I turned in a project plan; I left the guys with detailed next steps; I even managed to get the formulary imported and got the guys trained and starting to do a few of the more basic tasks in the system, which was more than I ever dreamed – but I feel sad, too.

I dug it here. For all of its frustrations and for all of the setbacks, I totally dug it. I dug the people, I dug the work, I even dug taking a bath with a bucket (although I’ll be thrilled to finally shave my legs…). I don’t know. I’m a sentimental mush, so it should surprise no one that my leaving feels so bittersweet.

Oh, and I found out who’s been pilfering the drugs from the store room. It was not, as I had suspected, Stanislas. I’m both relieved that it’s not and embarrassed that I jumped so quickly to that conclusion.

He was sweet today, Stanislas. It was the end of the day and everyone was knocking off but Thomas and me. Stan came in to the office where we were working. “So I’ll see you on Monday,” he said, grinning and extending his hand.

“Monday!” I said, taking it and giving him the traditional three-part handshake. “But I will not be here. I am leaving tomorrow, Stanislas. You know that.”

“Ok,” he said and nodded, his hand still firmly grasping mine. “So I will just see you on Monday then.”

“Stanislas! What do you mean, ‘See you on Monday,’” Jeremiah laughs. “But she cannot be here on Monday if she is leaving tomorrow!”

“I am just saying she can’t go,” Stan says.

“Ah, but I must,” I tell him.

“Ok, then you will just have to come back,” he says. Then, “You will come back?”

“I hope so,” I say.

“When,” he asks.

“I don’t know,” I tell him truthfully. “Soon, I hope. But we will see.”


Anyway, so that’s that. I’ve got one week left in Lusaka to pack and ship stuff home and write thank you notes and get ready for my Europe trip, and then my little adventure will come to an end. I feel in some ways like I’ve been here for years, in others like I just got here yesterday. Either way, though, I can’t believe it’s over.



Yeah, I’m kinda really sad. :-(

Sunday, July 29, 2007

Dear Diary, Part 2

Day 9 – Tuesday

I cannot believe I’ve been here a week already – more than a week, actually! Man, time is fuh-lyin’ here. Or at least it seems that way, I’m so stinkin’ busy. But, better busy than bored, I always say.

I spent most of today holed up in my house on the computer, further fleshing out the project plan and analyzing the mSupply system in the context of the pharmacy’s business processes. Although I did pop by the dispensary for a couple hours in the morning to help pack pills and whatnot. Stan was missing again (he went to Chipata yesterday) and I found out he’s been admitted to the hospital. Apparently, he was on quite a bender over the weekend and got himself into a fight at a bar; split his face open pretty good.

“In Chipata?” I asked Temba.

“No, in Katete stores,” he told me, spreading the latest batch of scrips on the counter. Katete is the boma, or main town, closest to Saint Francis; it’s maybe 8 – 10 kilometers from the hospital, but there is a modest “shopping district” just about 2 or 3 kilometers away called Katete stores. There are some small groceries carrying only non-perishables, a couple bars, a few small take-away restaurants serving mainly nshima and chicken, a petrol station, and other “general dealers” carrying basic household items.

“But I thought he was in Chipata yesterday,” I say. “Was this last night then?”

“Yes,” nods Temba, counting pills.

“But he will be ok?” I ask.

“He will be fine,” Temba says.

“Poor Stanislas,” I say, shaking my head. “That is not good.”

Temba laughs. “Ah, but don’t worry. Stanislas – he will be fine. He just sometimes likes too much to enjoy – to, to have a drink. And then he gets very…talkative.”

“Talkative?”

“Yes, talkative.”

“Ah, gotcha,” I nod. “But…he will be ok?” I ask.

“He will be fine,” Temba says.

I wonder to myself if I should go visit him and ultimately decide against it – I tell myself it’s because I’m afraid my showing up might embarrass him, but I think the truth is I’m still slightly uncomfortable about our encounter on Saturday. Maybe I will go tomorrow.


Day 10 – Wednesday

So…kind of a weird day today. I spent part of the morning at pharmacy (where I learned that Stan is on the mend and will be discharged soon), and then a few hours back at my house modifying the ARV dispensing tool that I built back in February (I’ve managed to convince the guys that they should start using it again - at least until mSupply is fully implemented - but there’s a drug regimen that needs to be added to it and, consequently, the formulas for all of the related cells across all 72 worksheets need to be updated). Anyhoo, so I was back at my house working on that but, for some reason, I couldn’t focus. So I did this really silly thing where I started reading through old (I mean really old – years old) journal entries and suddenly found myself wrestling some old ghosts – ones I thought I’d long since vanquished – and it kinda threw me. Funny how that stuff can just come up out of nowhere and bite you in the ass.

Anyway, so I wrestled. And, of course, prayed – which for me, most of the time, is just another form of wrestling. But, as a pastor once told me, that is pretty much the way it should be. “Do you know,” he asked, “that Israel, the name God gave his people, literally means struggles with God?” I looked at him. “Yeah, y’know – Jacob and the angel and the hip socket?” I nodded. “‘You shall no longer be called Jacob but Israel, because you have struggled with God,’” he quoted. “So go on and struggle, Katie. As a Christian, it’s kind of your job – your birthright, even. And anyway, God’s big enough.”

So I struggled with God today. Quite a bit, I might add. Even did a little fist-shaking. And I cried, too – big snotty, wailing tears. But it was good.

Except that now I’m behind on my work.


Day 11 – Thursday

Stan was discharged today. He popped by pharmacy for a bit and seemed in good spirits. He’ll be back on the clock tomorrow.

I did another brief tour in the dispensary in the morning and added at least three more Chinyanja phrases to my repertoire: Tubili ngat vamvela kupweteka for “Take two whenever you feel pain”; Mumwe yonse for “Take all of these at once”; and Kupanga, which apparently means “Mix this packet of oral rehydration salts with one liter of water and drink.” Yeah, no, that can’t be right.

Kupanga?” I ask Temba, holding out the packet of salts.

He nods. “Kupanga.”

“And they know what that means?” I ask, scratching the word into my notebook.

“Yes, it means make, to make,” he assures me.

“And that’s all you say? Kupanga?”

“Koo-PAIN-ga,” Jacob pipes in from the counter.

“Koo-PAIN-ga,” I repeat to myself, reading from the notebook.

Temba looks at me as I recite. “I think now you can even dispense without the notebook,” he says, then gestures at the new pile of completed scrips by the dispensing window.

“Oh, I don’t know about that,” I protest. “I think I probably still need the notebook.”

“Ah, but you can do it!” he insists.

“No, seriously, Temba. I don’t want to mess it up. I need the notebook.”

“No, no! You can even – ”

“She needs the notebook,” Jacob says from the counter. They laugh.

*****

I spent the afternoon at home studying the user manual and working on the project plan and tonight I got the email reply I’d been waiting for from the mSupply developers in Nepal.

Oof.

Yeah, it’s gonna be a reeeaally busy weekend. And not just for me, incidentally – the hospital lost two more doctors today. And by “lost” I mean that two of the volunteers finished their tour. I swear, this place is hemorrhaging personnel. But then, they depend mostly on volunteers to staff the place and no volunteer can stay on indefinitely. That makes eight that have gone in just the last week, though (there were a bunch of Irish medical students who left last week), and no replacements have arrived - nor do there appear to be any on the horizon. Plus another one of the doctors has been in Lusaka at a training workshop so the burden has shifted to the three remaining docs (all but one of whom are volunteers) and a handful of medical students. These guys are exhausted – I am awed by their commitment and, frankly, their stamina. I really don’t know how they do it.


Day 12 – Friday

So there was a chicken in the hospital post today. Moffat’s dinner, I suspect (Moffat is the sweet elderly man who mans the post office). I was in the office emailing my reply back to mSupply when Moffat came in with the thing, its feet bound with string, and placed it in a shallow cardboard box in the corner whence it began squawking in protest and flapping its wings, hopping and stumbling in a vain attempt to escape. I must have looked stricken, because Moffat laughed and chided me “You can just keep working! It will not harm you!” Pshaw. As if I thought it would.

And Stan was officially back to work today – and still in good spirits – although he tried to tell me that the wounds on his face were the result of a bike accident. I was glad to see him smiling, though.

Oh, and Chris and Amy are back in the States now. Er, they left yesterday, so they should have arrived by now. I talked to them a couple days ago. Apparently Kondwani is developing at lightening speed – she’s making new sounds and is more engaged than ever. And a Fatty McCheeks now, too! Chris says she’s up to – oh, shoot I forget how many kilos he said… Seven, maybe? I don’t know. I can’t believe it’s been almost two weeks since I’ve seen her. Feels like it’s been months.

Aw, man – now I’m all mushy. :-(


Day 13 – Saturday

Had an unexpectedly productive day today. I love when that happens! I spent most of last night trying (unsuccessfully) to reason my way through a concept that I couldn’t wrap my brain around – an incredibly simple concept, I should add, to do with units and pack sizes of drug products, but one that is critical because the whole mSupply system sort of hinges on it (units and pack sizes are what the system uses to calculate the total stock of a particular drug item). Anyways, I was trying to figure it out so I could put the data in the right format for the import file but I kept getting stuck. I finally gave up about midnight and decided I’d just wander over to pharmacy in the morning and see if looking at the actual stock and having a visual representation would help me grasp it.

Well, I got lucky, because Jeremiah (who doesn’t typically work on weekends) just happened to be at the hospital casting out a demon that was troubling a patient who’d been admitted to the wards (yep, you read that right) and popped by the pharmacy when he was through. I spent a couple hours with him picking his brain and made serious headway on the import file; even managed, based on some of the things we discussed, to finally reason my way to understanding the concept that had been eluding me. Weee! Anyways, I got so much more done in the morning than I expected that I decided to take the afternoon off and go for a gorgeous hike up a nearby escarpment with some of the other volunteers. It was a bit overcast so the pics I took didn’t really come out, but it was fantastic!

After the hike, though, it was back to the salt mines and another late night on the computer. I am in bed now, scribbling this entry in my notebook by the light of my headlamp and I am, I must say, plumb tuckered.

Monday, July 23, 2007

Dear Diary

Day 1 (er, 2…) – Tuesday

So I’m at Saint Francis now. Got here yesterday after saying my goodbyes to Chris, Amy and Kondwani (they were headed to Katondwe for a week and will leave for the US while I’m here) and hopping a bus for the torturous seven-hour ride to Katete. I’d have slept (I’d only gotten about two hours the night before) but I managed to find myself on the only bus you’re supposed to avoid when traveling to Katete and I was too busy hanging on for dear life.

Anyhoo, but I made it. And I’m not staying with Shelagh this time. This time, I’m like a real, honest-to-goodness volunteer (weee!), which means I’m staying in one of the short-term volunteer houses (got a roommate, even – an older Canadian mid-wifery teacher who’s here for a couple weeks with her students) and taking meals at the mess. The house is small and spare, but it’s got running water (although not hot), power (although not all the time), a stove (although it doesn’t turn off unless you unplug it and then sometimes it won’t turn back on) and even a fridge. We could cook, if we were so inclined, except that the closest grocery store is nearly two hours away. And there’s no shower, so we boil water (when there’s power, which there wasn’t tonight, which also meant there was no dinner) and “take a bucket”, crouching, in the tub. It’s a total pain in the ass, but I kinda friggin’ love it (although ask me again in three weeks how I feel…).

This morning, I attended the weekly Tuesday morning clinician’s meeting where I met Jeremiah, the head pharmacist (and my new best friend), and then spent the day in the dispensary; my sole aim was to begin building relationships with the guys and to start to understand the general workflow process. But they were short-staffed (no surprise there) so I got a crash course in pharmacy tech and was soon counting pills, fetching stock, and even dispensing scrips to patients (Tubili tubili katatu pa tsiku, if you’re interested, is Chinyanja for “Take two pills three times a day”). It wasn’t terribly complicated (although I have to say, I suck at doing math in my head), but it was terribly chaotic. Open pill bottles scattered randomly across the counter, half-filled prescriptions strewn about, pharmacy assistants running around, stock movement sheets sliding out of the three-ring binders where they're kept… So far, it seems, the only system in pharmacy is that there is no system. But given the number of patients to be seen and the number of pharmacy staff to see them, I’m just amazed that anyone walks away with a scrip filled at all.

From managing the stock to moving the stock to dispensing the stock, every single process is done manually – and only if there’s time – which generally means that, with the exception of the last part (dispensing to patients), it doesn’t get done at all (or at least not with any accuracy or timeliness). One could argue, I suppose, that they’re at least attending to the most important piece, and one would be right…sorta. Except that now there is an even bigger issue – drug shortages. When you don’t have time to manage your stock, you don’t always know how much you’re using or realize when it’s time to order more. And if you don’t order more, you can’t (duh) get more, which means – ultimately – neither can the patients. This is an especially critical matter when it comes to ARVs, which require strict adherence not only to work effectively but to reduce the chances that a patient will develop resistance. At Saint Francis, they’re having particular trouble managing their stock of Truvada, the drug that is the government-recommended first-line therapy for all HIV patients. They ran out of it a few months ago, so they stopped prescribing it, which meant that their reported consumption of it was artificially low and, since future drug orders are typically based on historical consumption, they haven’t been able to order as much of it as they really need so they keep falling deeper into the hole – all of which means that the folks who really need it, the patients, aren’t getting it.

Which is where this new software that I’m meant to implement comes in. Shelagh and Ian (her husband, who is also the hospital administrator) are hoping that if we can put something in place that will help to automate some of the processes, we might more effectively manage them. My plan, then, is to spend the rest of this week working alongside the guys and learning more about the way it all works so that I can evaluate whether or not mSupply is indeed the best solution and, if it is, begin developing the implementation plan for it and banging out the tasks.

Day 3 – Wednesday

Spent the day in pharmacy again. Met with Jeremiah briefly in the morning, and then the sh*t hit the fan and they were still short-staffed so I got to literally get my hands dirty again (I was covered, head to foot, in the bitter, powdery residue of the pills) helping to fill and dispense scrips. Then the truck came from medical stores (the government supplier) with the monthly delivery (although no Nevirapine, another important ARV; and still no Truvada). I helped unload and pack the storeroom and by the time we finished I was a complete mess. It was fantastic! My shoulders ache and my feet are killing me, but I finally feel like I’m doing something. Something tangible anyway, something I can see and measure.

I also met the hospital’s purchasing officer and learned about how they procure the drugs (and other medical supplies) that are not provided by the government or donor countries and how they receive and track those (manually, of course, in triplicate, in a carbon copy Goods Received notebook which frequently disappears, along with the invoices that are meant to be entered into it). mSupply, in addition to being a general stock management tool, also tracks supplier quotes, purchase orders and invoices, so this is another area where we could improve processes.

Oh, and I think I’ve solved the Truvada crisis for the hospital. Nothing particularly imaginative or creative – I just made a phone call. Called Robb (my brother’s boss at AIDSRelief) and asked him if he knew where we could get our hands on some. He said that AIDSRelief was sitting on so much that they were afraid it was going to expire and that he’d email Lameck (the procurement officer for AR) that night and authorize the immediate release of 1000 bottles (roughly a three-month supply) for SF. J Given the number of patients already on it and how many more are being enrolled in therapy every day, they will more than likely burn through this supply in little more than a month. But – the good news is that this increased consumption will be reflected in their reports, which means they’ll be able to order more, which means that (at least theoretically) they’ll get more and they’ll be back on track.

Day 4 – Thursday

Started today counting pills for pre-packs in the OPD (outpatient) dispensary, then got bumped to the ART dispensary working with Stanislas. He dispensed the ARVS and I recorded each scrip in the computer (in the spreadsheet I built for them when I was here last February – their interim solution until mSupply is up and running – but which apparently they haven’t been using. Sigh…). I dig Stanislaus, although I am a little worried about him. He’s kind of crotchety (totally atypical for a Zambian, as they are generally a really happy people) and he always smells vaguely of alcohol. And today I noticed a tremor in his leg when he was dispensing to a patient and saw him try to cover it. I don’t know – maybe it’s nothing. There’s just something about him that makes me sad, though, so it’s kind of my sole aim to make him laugh as much as I can every day.

We were slammed, though (again) and worked straight through lunch. I spent the day swinging wildly between feeling frustrated by the way things (don’t) get done here and being totally awed that they do at all. It never stops being overwhelming, the stuff these people have to deal with. And it’s always the sh*t you take for granted, too. Like having a reliable power or water supply; or a car to get you where you need to go; or, I don’t know, tech support. I mean, if your cell phone breaks you have to take an entire day off work so you can ride the nearly two hours to Chipata to get it fixed (or buy a new one). If your computer crashes or your internet goes down, it’s literally weeks before anyone can take a look at it. If the patient information system that the really nice Dutch (wait, is it Dutch?) volunteer built for you bugs out, well, you’re pretty much SOL – even if you really need the reports it’s meant to generate – because he’s back in Holland now and not exactly available to provide ongoing system maintenance and so you’ll just have to manually generate them now.

Not to mention what the patients themselves face. Most of them can’t speak, never mind read, English and yet they’re expected to strictly adhere to complicated treatment regimens with only written instructions in English to guide them. And then there are the meds that require refrigeration to keep from spoiling, except – oh wait – the average villager doesn’t even have electricity, never mind a fridge (the pharmacists don’t even bother telling them that they need to be refrigerated which initially pissed me off – until I realized how pointless telling them would be). Or how ‘bout something as simple as the mother who’s expected to split a tiny 5mg pill into quarters for her child. Do you think she owns a pill cutter? The pharmacy doesn’t even have a pill cutter. I almost cried when I was filling a scrip for this one kid and I realized that we didn’t have the dose the doc had prescribed. He was supposed to get 100mg but the caps only come in these tiny 200mg rounded tabs (in other words, not the flat, pre-scored tabs that are conducive to splitting). “How will this mother give her child his medicine?” I asked Stan.

“Ah, but I think the mother knows how to break in half,” he told me.

“Right. Of course,” I said, nodding. “Sooo…can you do it?” I asked, holding out the pill. I didn’t mean to be cheeky, and I know it was “just” ibuprofen and not, say, life-saving ARVs or anti-malarials, but it wasn’t the first time I’d seen a patient handed a scrip with a dose they were essentially going to have to figure out on their own and it was starting to frustrate me.

He took it from my hand and tried to break the rounded pill to no avail. “Ah, but she will just use a knife,” he said, then set it aside and went back to counting the pills for the fifty other scrips he was trying to fill at the same time.

“But…will she have a knife sharp enough to cut it without smashing it?” I persisted. He looked at me for a second then disappeared, then was back a minute later with a surgical blade he’d scavenged from the storeroom. “This’ll do,” I said, and then sliced every single one of those pills as close to in half as I could manage.

It’s maddening. And I imagine if Stan thought he had time to cut every single pill for every mother that needed him to he would; or that Temba would explain, to each patient that needed to know, how they might create a small refrigerator out of a clay pot, sand, and water. But there’s no time for that here. Or anywhere, for that matter. Every hospital I’ve visited since I’ve come here has been wildly understaffed and stretched almost to the breaking point, although Saint Francis is among the worst (if only for how huge it is – their catchment area is ginormous). I honestly don’t know how it’s still functioning – except that there really is always someone who puts forth some Herculean effort to get you over the hump, to get you through to the next day. Because, I mean, who wants to be the guy that tells the patient who was brought to the hospital in the middle of the night in the back of a pick-up truck, bleeding from the head, “Yeah, sorry. I’m just too tired – I’ve already been on call three nights this week” – even if you have? Who wants to tell the patient who just walked seven hours just to get their next three-month supply of meds, “Sorry, my friend. Pharmacy’s closed now – come back tomorrow” – even if you have been on the clock for almost ten hours already and you still have however many kilometers to walk back to your own house?

There’s a quote that I’ve read before, which has been attributed to a million different people, that I keep thinking about: “Do all you can with what you have in the time you have in the place that you are.”

That really is as much as you can hope for.

Day 5 – Friday

Ok, I’m pooped. Spent almost the entire day helping Thomas move and shelve the stock that we unloaded on Wednesday. Scarcely had time to break for lunch or even pee. I loved it, though. I feel like I’m finally, I don’t know, “earning my keep”; like I’m finally doing what I came to do. But I’m pooped.

Oh, and my roommate left today, so now I’ve got the house all to myself.

Day 6 – Saturday

So it was just Thomas and me in pharmacy today. It was the weekend, and it was slow, so we spent much of the day cleaning and organizing and pre-packing meds for the coming week. And Stan came by, drunk as a skunk, and wanted to “talk.” About what, I couldn’t determine. “America,” he said, leading me out into the hospital courtyard. “I want to ask you questions about America.”

“Ok…” I said, slightly apprehensive. It was not yet 10 o’clock in the morning and he was blitzed. “What would you like to know?” I asked. But he couldn’t really say, or if he did, I couldn’t understand him through his slurred speech. “But I must get back to work, Stanislas. Maybe we can talk on Monday when we are working together?” I suggested.

“Or maybe we can talk some other time, when you are not working, and I can ask you some questions,” he fumbled.

“Ah, but I’m afraid I will be working every day,” I said. “And I really must get back now. I’ve left Thomas all alone. I will see you on Monday?”

“Yah, ok, I will see you on Monday.”

“Be careful,” I said, then wagged my finger. “Don’t get into any trouble.”

“No trouble!” he grinned, and staggered away.

Sigh… poor Stanislas. Sometimes I hate when I’m right.

****

I worked until five, then went for a run before dinner; then worked until about 11pm on the mSupply project plan. Now that I’ve spent a week packing pills and dispensing scrips and shelving stock and whatnot, I feel like I’ve got a fairly good handle on the way things work. Now I’ll start digging more deeply into the actual software and figuring out the nuts and bolts of how each of the processes it manages works, what modules we’ll employ, what import files I’ll need to prep, and blah blah blah.

Day 7 – Sunday

Kind of a frustrating day today. Worked the morning at pharmacy, with Thomas again, which was cool, then met with Shelagh, which is always a hoot, because you never just “meet with Shelagh” when you go over there – you meet with Shelagh and Chiko and Jim and Josh, and play “What’s Your Favorite Movie” and “Can You Fix My Leggo Gun” while Love Actually plays on loop in the background (yep, aGAIN – or no wait, maybe that was yesterday…). Anyway, so I met with Shelagh to update her on where I am with the project and then spent the rest of the afternoon and the whole of the evening doing battle with the friggin’ internet. It’s only dial-up here (and at 500 kwacha a minute, friggin’ highway robbery), and I had to re-download the nearly 10MB user manual for the mSupply software because the one I had downloaded back in Lusaka disappeared off my laptop. Or expired or something, I don’t know. All I know is I clicked on the link for it on my desktop only to get a message that said “Sorry, this is not the user manual... To download a copy, visit our website” and blah blah blah. Anyway, so I needed the internet and it took me, I sh*t you not, no fewer than three hours to track down the key for the room, find a power adaptor (I managed to lose mine somewhere in the 50 yards between my house and the hospital), and configure my laptop for the connection. When I finally got it all set up, it took almost 25 minutes to load the first web page and then nearly five hours to download the damn manual and by then it was too late to do any work.

Tomorrow I meet with Shelagh, Ian and Jeremiah to review the workflow process as I’ve understood it and fill in any gaps, suss out the priorities for the next two weeks (I think I will end up staying for three total, instead of two – there’s just too much to do), and talk the issues/potential obstacles I’ve identified and brainstorm possible solutions. I’d hoped to have more prepared for them, but I’ll have to work it out in the morning, I guess.


Day 8 – Monday

Ok, it’s friggin’ cold here. I mean really friggin’ cold. Have I mentioned the cold yet? It’s freezing! I know it’s winter (and didn’t I say once that we’re at about 4,000 feet here?) but it’s sub-Saharan Africa, man – it’s not supposed to be this cold.

Anyhoo, so I met with Shelagh, Ian and Jeremiah and it went really well. I also managed to connect to the internet and shoot off the draft project plan to the mSupply developers in Nepal to get their feedback and their input on the best next steps to take, so it looks like we’re on our way. I’ll spend less time in the pharmacy this week and more time holed up at my house banging away at the plan. Weee!

Ooh, and I’ll also, when time allows, be doing some writing work for a small, newly-incorporated independent record label in New York – West Avenue Records. Their first artist is set to release his album at the end of July and I’ve been hired to help with copywriting and PR and whatnot. Check him out at http://www.michaelnappi.com/!

Sunday, July 8, 2007

Lions, and hippos, and zebras! Oh my!

A few pics from my safari in South Luangwa National Park... :-)














Wednesday, June 13, 2007

Ok, NOW it’s (kind of) like Colorado

So it’s the dry season now, which means the rich, red earth has turned a dusty, terra-cotta brown. The grasses are turning too. And some of the trees. And the air is different – sharper, crisper, more acrid (the dry season is also the burning season); the wind more insistent and less predictable. These days, whenever I go on one of my walks (or, more recently, runs – the all-carbs-all-the-time diet is doing, as our housekeeper was good enough to point out last week, quite a number on my already ample behind, so I thought maybe I oughtta step it up a bit), I return, eyes stinging, with the bitter smell of charred wood (which smells curiously like burnt coffee to me) clinging to my clothes. But I’m enjoying the cool, crisp evenings and the warm, bright days which – excepting the smoke – do remind me of Colorado. Oh, and the flowers! Goodness, they are extraordinary. There are new ones every day, it seems. There’re bougainvillea trees and geraniums (gerania?) and these amazing orange droopy lily-looking things that I can’t for my life find the name of and - get this! - poinsettia bushes (I know! Poinsettia bushes!)! Our street is awash in color: vibrant purples, brilliant fuscias, velvety reds, golden yellows, dazzling pinks, bright oranges, stunning peaches... Kondwani and I take walks sometimes just to look at them. Although usually, within a few minutes, she is fast asleep – perfect pink lips forming a perfect pink heart, her tiny head snuggled against my chest, her little fingers grasping the neckline of my shirt, like she’s afraid if she let’s go, I will too. Oh, if she only knew...

A few of you have sent emails or MySpace messages recently (bless you, by the way – I’m desperately homesick and I miss you all madly so your messages, even if I can’t always reply, do my lonely little heart good) wondering what’s up. The truth is – not much, actually. Most of the time, I’m helping Chris and Amy with the baby (who, I have to say, is pretty much the coolest effing thing EVER) so they can work. And while I worship the hallowed ground the wee one does not yet walk (or even crawl) on, and would happily give a dissertation on her every developmental milestone (she found her hands recently, and we are endlessly fascinated – as is she – by this discovery, and will watch her for hours as she clasps and unclasps them; but then, we watch her sleep, too), her pooping and burping proclivities (for someone so tiny she sure does manage some earth-rattlers), and how her smile is, hands down, the most awe-inspiring wonder in the history of planet earth, I scarcely think that’s what you guys are interested in when you’re asking how it’s going in Africa – even if it is my favorite part.

When I’m not helping to take care of Kondwani, I spend my time (still) trying (unsuccessfully) to secure myself more volunteer work. And writing – although obviously not (insert sheepish grin) my blog. Short stories, though. And film scenes and descriptive paragraphs and whatnot – y’know, “creative” stuff. In fact, I’m supposed to be writing right now (I’m behind on my weekly self-imposed deadline) but, like any good procrastinator, I’ve decided what I really need to be doing right now is something else – so I’m writing my blog!

Anyhoo, so yeah – “how it’s going in Africa.” Much like it’s going for many of you back home, I imagine – there are good days (like any day spent with the baby or driving through the Zambian countryside, for example) and there are not so good days (like when I learn about the unexpected death of an AIDSRelief employee’s young daughter or encounter the bureaucratic obstacles to doing work here – or just miss home). I did get my visa issues worked out (the doctor at St. Francis Mission Hospital got the head of the Zambian Anglican Council – the priest I mentioned in my last blog – to secure me a work permit) so I was able to (finally!) meet up with Chris and Amy in Macha for a quick spell then turn around and travel with them to Mwandi a couple days later. Oh, and we almost died on our way home from Mwandi when BAV’s back right wheel broke off – and I mean literally broke off – and went zooming off into the ditch across the road. I watched it, too, for a good prolly ten or fifteen seconds before I realized it was actually our wheel bouncing merrily along beside us. I mean, I heard the thump and the attendant shrill screech of metal on asphalt, felt the car jerk, and saw Chris’s hands tighten around the steering wheel as he Formula-Oned us safely to a stop on the side of the road; while we were skidding, I even did one of those “Wait, is that…?” trail-off things, my finger pointing limply towards the skipping rubber wheel. But somehow, while it was happening, it never really registered. The really freaky thing, though? It happened at the exact same spot where we’d come upon a fatal accident on our way to Mwandi (a flat-bed lorry had lost the container load it was carrying, careened out of control, flipped over the container and landed upside down in the ditch on the side of the road, completely crushing the cab; unfortunately, by the time we got there, it was too late for the driver, who’d been thrown from the cab and killed instantly). Amy was literally mid-sentence saying, “Y’know, I can see why this is such a dangerous stretch of - ” when our tire flew off. In other words, we were very, very lucky.

Besides that, though, there’s not too much to report. I am, if you can believe it, already halfway through my sixth month here, which has prompted a couple of you to ask if I’m ready to come home. I mentioned the homesick thing, so a part of me wishes I were there already. But I also mentioned my continuing frustration with being unable to secure consistent volunteer work (my visa issues put the kibosh on my trip to Mozambique with Sam, I haven’t been able to coordinate my return to St. Francis with Shelagh, and despite repeated visits to the Lusaka Teachers’ Association and a letter expressing my intent to help out, there seems to be no end to the hoops I must jump through before I can actually do any work for them), so I often feel like I’ve not yet done what I came to Africa to do. Consequently, I’m not quite ready to go (that, and I’m gonna really really reeaally miss Kondwani…).

But then, as a purported person of faith, I should know that the plans we have for ourselves don’t always shake out the way we hope they will or think they ought. And I imagine that, in due time, I’ll come to learn that no matter what I expected I would learn or experience over here, no matter what it was that I had hoped to do, whatever God’s purpose was in bringing me here was perfectly fulfilled.

Oh, and we’re going on safari this weekend! It’s my birthday present from Chris & Amy, which we didn’t get to celebrate in May since we were at Mwandi, and I’m really looking forward to it. Hopefully, I’ll have some cool new pictures to post next week! Until then, lots of love to you all…

PS Some of you have asked about the baby’s name. Kondwani is a Nyanja name (Nyanja is one of the over 70 tribal languages spoken in Zambia - it is also one of the most common). It was given to her by the social workers who picked her up from the hospital where she was abandoned. It means “happiness.” :-)

Picture 1: Bougainvillea and poinsettia bushes on our street
Picture 2: The amazing orange droopy lily-looking things that I can’t for my life find the name of
Picture 3: Me and the wee one at Mwandi
Picture 4: The wee one
Picture 5: BAVs, post-wheel-pop-off; if you look closely you can see how close to a couple inches of steel were sanded off the brake drum during our perilous, wheel-less descent
Picture 6: More bougainvillea (er, I think...)

Sunday, May 6, 2007

Kondwani (or, You can’t even get a work permit this fast)

So this one, I'll admit, I didn't see coming.

I mean, I’ve known for a while that Chris and Amy want to have a family. And I’ve known that, in the wake of their struggle to conceive, they’ve been exploring other options. I also know that, two weeks ago, they made an impromptu visit to an orphanage here in Lusaka – I even went with them on a follow-up visit a week later and of course fell immediately and helplessly in love with every single precious little bundle there. I mean, these kids… I know I’m a mush but, man… They are so desperate to be held that your shadow has only to darken their tiny faces before their little hands are reaching out for you to pick them up. And then, once in your arms, they're literally climbing up your body, hanging on to you with these desperate, don't-let-go death grips, burrowing their tiny faces in to your chest, your neck. All I could think when I looked around was, “Man, how do you choose?”

But then, maybe it’s like my friend Marcelle says – maybe they choose you.

I don’t know. All I know is that this place never ceases to surprise me. You can’t get a work permit (15 months and counting and Amy still hasn’t gotten hers) or a driver’s license (the waiting list has over 10,000 people on it) but a kid? Oh, hey, no – here you go! Seriously. When Chris and Amy decided a few days after visiting the orphanage that they'd swing by social services to register and at least "get the ball rolling" they expected that they'd only be, well, getting the ball rolling. Instead, they were pretty much told that - if they wanted - they could take the baby that day. That day! Chris was like, "Um, yeah – most people get nine months to prepare for this – I need more than nine hours!”

In the end, it took them less than nine days to decide and now – drum roll please – I’M AN AUNTIE!!!! Er, well, technically a “foster auntie” as Chris has asked me to point out. Her name is Kondwani Middle-Name-Yet-to-Be-Determined Bositis. She’s 19 inches long, 7.5 pounds, and approximately 10 weeks old (she was abandoned, so they don't know her exact date of birth, but they believe she was at least a couple months premature). She is also, if I may say so, absolutely positively exquisite. See?

The plan right now is to foster her for a roughly three-month period, after which – if they, in the words of the Zambian social worker, “decide they can love her” (“Decide they can love her??” Seriously, have they met us?) – the adoption will become final. She’s with them now at Macha Mission Hospital, a rural hospital in Southern Province where they’re currently providing medical technical support, and she’ll travel with them to Mwandi Mission Hospital after that. If I get my visa issues worked out (oh yeah, I forgot to mention: I’ve got a whole new set of visa issues and I might actually have to leave the country for really reals this time – and for good. on saturday. unless, of course, our mwa-ha-ha evil plan, which – God forgive me – involves lying to a priest, works out.) I’ll be joining them sometime in the next couple days to serve as their full-time nanny while they're out at the sites for the next few weeks.

I am still hoping to go to Mozambique with my Tanzanian adventure pal, Sam (we’re gonna go to the coast for a couple weeks to rebuild houses destroyed by a storm), and volunteer at the Lusaka Teachers’ Resource Center (a new gig I lined up for myself last week), and go on safari, but the clock is ticking on my little adventure so we shall see!



Sunday, April 22, 2007

If it’s not ok, it’s not the end

It is dusk. The train is moving at a solid clip, its steel wheels beating a steady snare beneath us as we peer out into the grayish green light, our tired eyes alight with new excitement. We are passing through the Selous Game reserve and we’ve been told by The Sylvias (the two Zambian women with whom we are sharing our compartment) that we might catch a glimpse of some animals.
We are crowded closely around the small table bolted to the floor next to the window between us, our chins resting in our hands and our eyes raking the fast-darkening brush. It is not long before we spy a herd of impala, who regard the passing train with vague disinterest, and we point and giggle and squeal like schoolgirls. Sylvia 2 laughs and rolls her eyes, then heads for the lounge car – she’s over the whole wild animal thing – but moments later, Sylvia 1 spots an elephant through the opposite window and we scramble to our feet, stumbling over our bags and each other in our haste to catch it. Sam sees it – a flash, and then we are past it – but I am not fast enough. So I settle myself on a fold-down chair at the far end of our coach and keep my fingers crossed that another will venture out, but too soon it is night and the sky black as pitch so I return to our compartment and my seat across the table from Sam. She is quiet, idly trailing the fingers of her left hand out the window.

“Dude,” she says, after a few minutes, and turns to me. “Does it ever just…hit you, from time to time, the fact that we’re in Africa?”

I laugh. “Only about every 37 seconds,” I want to say. Instead I smile, take a long, slow breath and tuck in for the rest of the ride.

*****

This was, I should mention, somewhere around Hour 58 of our journey to Tanzania (or Tan-ZAHN-ya, as the locals here call it). We’d been traveling for nearly three days at that point (four for Sam, who’d ridden six hours from Katete to meet me in Lusaka the day before we left), having first taken a bus to Kapiri Mposhi (three hours) then a cab (three minutes) to the TAZARA train station where we waited (for five hours) to board the train and set off.

At the advice of more seasoned travelers – and despite our very tiny budget – we sprung for first class tickets. As delays are common and theft frequent, the extra $5 US for a secure sleeper compartment that we’d share with just two other travelers seemed worth it. Not that this is a luxury car by any stretch – the quarters are tight, the vinyl benches double as unforgiving beds, and we wage an ongoing battle with the army of cockroaches that marches steadily across our table, over our floor, and up our compartment walls. But when the immigration officer bangs on our door at 4am (I swear to God, I thought I was being arrested) to stamp our passports, I am grateful that I can snuggle back under the blankets and fall back to sleep; and when my back aches from hunching over our umpteenth game of Sh*thead, I know I can lock my bag in the room and wander around to stretch my legs; there’s even a shower (a very cold, very tiny shower, but a shower) under which – well, when there’s water – we can cool our hot, sticky skin.

We snake, herky-jerky like (the locomotive powering our train is beset with mechanical troubles and is the reason for our frequent, jarring stops and interminable delays) through miles of high green plateaus and endless acres of maize; over muddy brown rivers and hilly prairies dotted with enormous sunflowers and fragrant groves of fruit and flat-topped acacia trees; and past tiny villages nestled in tall grasses from which children emerge running, hands outstretched, yelling “Mzungu! Mzungu! Gimme sahm-ting!” laughing and waving, pink tongues licking out from the wide smiles creasing their shining black faces.

We arrive in Dar Es Salaam at 12.30am Monday morning, fully twelve hours later than we are supposed to (and 65 hours after we leave Lusaka), and hop into the first cab we see. The driver quotes us a ridiculously high fare and we half-heartedly counter with a marginally lower one before agreeing to something somewhere in the middle. We know we’re being swindled, but we’re so exhausted we don’t care. We just want to get to the youth hostel where we’ve planned to stay for the next two nights and make sure they’ll still let us in. They do, but the reservation I made the week before is in none of the three books the guard rustles up from the office. We look at him helplessly and tell him again, and very politely, that we are sure that we called last week and even, for good measure, offer the price we were quoted. He shrugs and hands us a key.

“Try this one,” he says. “Flat #3.”

“Asante,” we say, expressing our gratitude with the Swahili we crammed on the train, then trudge slowly up the stairs to the dorms and do battle with the lock on our door for a good five minutes before we realize that this is actually Room #3 and not Flat #3 and apologize profusely to the poor unsuspecting fellow we’ve startled from slumber and whose thumping heart we can almost hear through the thin walls. “This is fanTAStic!” I think. “Now I can add B&E to my growing list of criminal offenses!”

We wander aimlessly for a bit, clumsily slamming the door with the big-ass PLEASE DON'T SLAM THE DOORS sign behind us (yeah, we’re AWEsome) and wake the rest of the hostel, before we manage to find Flat #3. For a minute we are certain we’ve broken in to another room and half expect someone to come leaping out of the wardrobe brandishing a bat: the sheets on both beds are rumpled from someone else’s sleep, the trash cans are full, and there’s a tub of half-eaten margarine on the table and a used bar of soap in the bathroom. I look at Sam and shrug. “Well, it’s a good thing we brought our own sheets!”

Despite our exhaustion, we sleep fitfully and awake shortly after dawn when work begins on the construction site next to the hostel. And we’re grateful, really. I mean, we wouldn’t want to miss the hostel’s free breakfast (one stale bun and all the watery coffee or tea you can drink). And who’s to say the alarm clock we set would have even gone off those two hours later anyway? Yeah, no – this is good. Really.

After breakfast we set out to run errands – we switch to a new, clean (and cheaper!) room at the hostel (and find out from the desk clerk that our reservation was indeed recorded but mistakenly given away to another Katie who’d arrived earlier, ostensibly by more reliable transportation than the TAZARA train), buy a local map for Dar and Zanzibar, check email, change our kwacha to shilling, stock up on snacks for the next week, and purchase a SIM card for my cell phone which is then promptly stolen by a slippery little pick-pocketer scarcely an hour later. Weeeeee!

By the time we collapse into bed that night we’re pretty much over Dar – despite the fact that we never got to any of the beaches or made our way to Bagamoyo, a small town northwest of the city steeped in the country’s rich history that we’d tentatively planned to visit – and anxious to get to Zanzibar.

We awake the next morning, after another fitful night of sleep, to more construction and another meager but – this is important – free breakfast (still all the watery coffee or tea we want, but this time two – count ‘em, two! – slices of stale bread and a piece of watermelon), then pack up our stuff and start off for the port to catch the ferry. We are summarily accosted by a hostile tout attempting to sell us bogus tickets, whose harassment begins as mildly annoying but shifts suddenly and rather alarmingly to borderline abusive, and then rescued by a kindly guard who swoops in and ushers us, all back-alley-drug-deal like, into the side entrance of the ferry office where we purchase the tickets for $5 less than we’d expected. Given the six hours we’d spent the night before agonizing over the allotment of every last shilling in our possession (do we really need taxi fare, or would we maybe rather eat today…?), this is no minor victory. I’d celebrate but I’m still shaking from my encounter with Captain Aggressive.

It’s hot as Hades and by the time we board, Sam’s fair skin is pink from the heat and I have sweat pooling behind my knees. But the ferry ride is gorgeous. We purchased first-class tickets (as “foreigners”, they won’t sell us anything else), which buy us each a seat in an overstuffed armchair in a moldy, musty-smelling-but-air-conditioned cabin, but we opt instead for a hard plastic chair on the deck in the open air. I’m nervous about the ride as historically I haven’t managed very well on the high seas, but the water is like glass, a deep cerulean blue, and we glide smoothly the whole way there, the salt air blowing our hair. We play cards (Sh*thead again), learn more Swahili from our new pal Roja, and ooh and ah when a school of dolphin appear – leaping and diving, singly and in perfectly-synchronized pairs – in the ferry’s foamy wake.

*****

We spend a week in Zanzibar (six days, actually), at the Annex of Abdullah, a small guesthouse in the heart of Stone Town (the island’s capital) nestled among dilapidated buildings with crumbling stone facades that stand in stark contrast to their ornate, intricately-carved brass-studded doors. There’s no hot water and we share the bathroom with the staff but our room has a fan, mosquito nets and a TV, and the free breakfast – infinitely superior to the hostel breakfast in Dar – is so generous that it is often also our lunch. Not bad for roughly $7.50 a night.

Our guidebook tells us that “no single attraction can beat an afternoon strolling through the narrow streets and winding alleys” of Stone Town, so we spend a couple, wandering from shop to tiny shop, playfully bargaining with Arab, Indian and African shopkeepers as much for the fun of it as for the trinkets themselves.

Jambo!” they sing, as we stroll idly by.

Sijambo!” we chorus back.

Habari?” they ask.

Nzuri. Mambo?” we counter.

Poa, poa. Karibuni,” they reply, delighted at our command of the informal greeting ritual.

Asante,” we thank them.

Asante sana. You ah most well-come. Come and take a look, sista. Just a look, looking is flee. I give you good plice. Jambo, jambo!”

And so it begins, at every stall, in every shop. In the end, though, we buy only two things the whole week (not including the bad-ass henna tattoos I got on our last day) – a traditional beaded Masai anklet for Sam and toe rings for me.

We get lost more than a few times, tripping our way over ancient beveled cobblestones, past chattering Muslim women wrapped head to foot in black bui-buis or brightly-colored kangas, past barefoot children and countless mosques with men lying prostrate in prayer. We keep our eyes out for Jaw’s Corner, the only landmark we can ever remember – where the men gather nightly for conversation over a game of checkers or bao or to crowd around the tiny television and cheer on their favorite European League football team – and when we stumble upon it, almost always by accident, we know we are almost home.

On our third day, we schedule a Spice Tour (these are, after all, the “Spice Islands”) and take a mini-bus to a local plantation where we rub fragrant cinnamon bark, ginger root, lemon grass, and clove leaves between our fingers; learn about nutmeg as both a painkiller and an aphrodisiac (hmmm….); and savor freshly-made coconut curried kingfish over sweet pilau rice on straw mats with twenty strangers. We visit the ruined baths of a sultana called, poetically, Scheherazade, and then walk the slave caves at Mwangapani beach where Arab traders hid illegal slaves after abolition before dipping our toes in the jeweled, turquoise water. On our fourth day, we take a rickety dalla-dalla (think pick-up truck) two hours to Jambiani, a sleepy fishing village on the east coast of the island, nearly 40 of us crammed on benches that might comfortably (if I’m being generous) seat 25, sand pelting our sunburned skin and bundles of rolled straw mats, precariously stacked cartons of eggs and a TV (!) crowding our feet. At Jambiani, we watch stooped, wrinkled women gather seaweed to sell and small, wiry men cast fishing nets from creaking boats. And then we sit for a lazy hour and a half – just because we can – with a dozen local village children who giggle and dance and play and pose for my pictures, screaming with delight when I show them their likeness on the tiny LCD.

We wake every morning, just before dawn, to the muezzin’s lyrical adhan, echoing solemnly over the nearby mosque’s PA, intruding in our dreams and calling the faithful to prayer. We attend Easter Mass in Swahili; wander through an art exhibit at the cultural center; visit the site of the old slave market; and eat like kings on a pauper’s budget – Indian thali and spiced pilau rice and toasted coconut bread and endless plates of tender, freshly-grilled fish from the Forodhani Gardens Fish Market (me! eating fish! and enjoying it!) – although one night after splurging for a special meal at a fancy rooftop restaurant I become so suddenly and so violently ill that I nearly collapse, staggering blindly (literally, actually; I couldn’t see), tripping and scraping both knees on a bench or a planter or who-knows-what, stumbling behind Sam as she sprints ahead for the nearest restroom, pleading “Please! My friend, she’s really sick!” It’s only later that I consider that, for perhaps the only time in my life, everyone that saw me was probably thinking, “Wow – that girl’s reeeaallly drunk.”

It’s an extraordinary place, Zanzibar. We are assaulted, wherever we go, by bright colors and pungent smells and squawking vendors and persistent locals who follow us incessantly, pushing tours and tickets and taxi-rides but claim only to covet our friendship (“Wheeyah ah you flom, sista? Ah, Austlalia?? Hahaha! Austlalia!! Kangaloo!! Hahaha!!”). I am struck, more than once, at how like life this place is – messy and beautiful, smelly and colorful, beset with its own set of troubles but full of wonder and countless joys, it is scarred by its history but moving on – as I should learn to do. Our histories shape us, to be sure, but they don’t need to define us. Like Zanzibar’s white sand beaches endlessly chafed by rolling blue waves, we are new every morning, and wouldn’t life be different if we lived it that way?

*****

And now, finally, we are on our way home. The air is crisp and cool and a faint, early morning breeze ruffles the pages of our open Africa on a Shoestring guidebook. The train has stopped again and I am curled under the fleece blanket, my head pounding, my belly hollow with hunger and my body shivering with fever.

We’d left Zanzibar four days earlier – after one final, glorious, dirt-cheap meal at the fish market – on the overnight ferry back to Dar. It was actually the same one we rode on the way out but this time it docked for a few hours while its passengers slept – in chairs, on mattresses, in corners and on countertops – before trundling on to the mainland at dawn. We weren’t allowed to sit on the deck so the moldy, mildewed, air-conditioned cabin with the over-stuffed armchairs it was. Ordinarily, I don’t suffer from allergies, but within ten minutes of boarding I was sneezing uncontrollably and my throat had swollen shut. By the time we reached Dar I had a full-on head cold. Or a sinus infection. Or maybe the flu.

Now, on the stalled train, I have had it. I haven’t slept in days, I ache from head to foot, and I’m starving – we’d only brought enough food to last us for a two-day train ride, not four. We could buy meals on the train, but our funds have dwindled and we’re saving every last penny for the visas we’re expecting to purchase for re-entry to Zambia and the bus ride from Kapiri to Lusaka. I suppose we should have known better – I mean, the train is not exactly known for its strict adherence to schedule – but we’d been assured that the excessive delays we’d experienced on the way out were an anomaly and we, in a fit of new traveler’s naiveté, well, believed it.

“This is ridiculous,” I whine to Sam. “What is the hold-up now?” It’s a rhetorical question, really. There’s no one around to answer it and, even if there were, we’d get a different response from every person we asked. But I pull myself up out of bed and shuffle to our neighbor’s compartment to take a chance with them anyway.

“Good morning,” I say, tentatively knocking on the open door. Three Zambian women take in my bed-head hair, my chapped red nose, my labored gait. “How are you all today?”

We murmur the ritual pleasantries necessary for beginning any conversation in Africa before I ask, “I am wondering…do any of you know why the train has stopped again?”

The women say that a goods train had derailed the night before – which I knew – but that it had taken so long to clear the accident that the rest of the rail system got backed up and we now had to wait for another train to pass before we could move on ourselves.

“Do they know what time we will reach Kapiri, then? I am not feeling well and I am anxious to get home.”

“Ah, maybe 23:00? Maybe 24:00?” one of the women hazards. “If we start off in the next hour…” she trails off. In other words, her guess is as good as mine. I grimace.

“How have you enjoyed the food?” another one of them asks.

“I’m – the food? Oh, on the train. We actually, um – we’re not…well, I bought dinner last night, but we’re not really eating on the train. Er, we hadn’t planned on it.”

“You are not eating?” she asks, surprised.

“No. Well, yes. Er, I mean, we brought our own food,” I fumble. “See we didn’t – well, we don’t really have enough money to purchase meals so we brought some snacks but now that we’ve been so delayed, we’ve run out. We just – well, we had expected we would be home by now…” I laugh self-consciously then, vaguely aware of the desperation in my voice, and feel my face color. “It’s ok,” I say quickly. “We will just be glad when we finally arrive home.”

“Ah, yes,” she says kindly. “Well, I think we will be starting off soon.”

I shuffle back to my own compartment, and flop down on to the bed.

“We have to wait for another train to pass?” asks Sam, who’s been eavesdropping. I nod forlornly and Sam exhales. “Yeah, dude,” she offers. “This sucks.”

Less than an hour has passed when there is a knock at our door. I am half asleep and before I can even ask who it is, a round, smiling black woman walks in and sits, uninvited, on the edge of Sam’s bed. Sam and I share a confused, mildly annoyed look. We hadn’t exactly asked her in.

“So we have gotten an update,” she says, and then points at me. “You are the one, yes? That we were talking to earlier?”

“Yes…” I say, struggling to sit up. I think I remember her from the neighboring compartment but my head is thumping and so congested that everything looks fuzzy.

“They have come and told us we will be starting off in one hour, and that from here it is four hours to Kasama – that is my stop – and then maybe ten hours to Kapiri after that.”

We are about to thank her for the update – it’s not good news, but it’s news, which is hard to come by on this train – when she stands and unfolds two bills.

“Also,” she says, “I wanted to tell you – we have been talking, me and the others, and we know that traveling is difficult and that sometimes you cannot always plan and so you don’t always bring enough money with you, but we think you should eat lunch. So we have collected some money for you. And maybe also you can have dinner as well.”

Sam and I are speechless. We look at each other and both begin to cry, a fruitless protest forming on our lips. We don’t want to take it – partly because we know they probably need it more than we do and partly because we do have enough, if we are that desperate, to buy at least one meal each (I have forgotten about the kwacha Sam tucked away for the journey home and the shilling I have yet to change and am mortified that I’ve painted such a picture of our state) – but we know we risk committing an unforgivable cultural gaffe if we refuse it. I snuffle through my tears and my blocked up, snotty nose but Maggie – that’s her name, we soon learn – will have none of it. And without further ceremony, she tucks the money under the guidebook on the table, then sits back down and begins to tell us about her life.

When she leaves an hour and a half later, we sit in humbled silence, marveling at this extraordinary woman. At 17, she married a Ghanaian man and bore him five children before losing one of them and then, after 18 years of marriage, him. “Oh, he loved me, my husband! He loved me so much! And I was bitt-ah – oh I was so bitt-ah! – and so angry with God for taking him ay-way.” Her life has been marked by profound loss but she lives as one redeemed by hope. “God has blessed me,” she says, more than once. “And I want to share that with you. I am so happy now! You know, I have just gotten married!” she beams and proudly displays the tiny diamond on her left hand. “I never knew I could be happy again. My husband, he is Irish, and I first met him ten years ago. We were just friends then – I never knew I could capture his heart – but God has blessed me. My husband, he cherishes me. He says, ‘Maggie, I love you! I love you so much!’ And I am so happy! I want everyone to know – God can bless you! God has blessed me.”

We decide right then, that even if it means we go hungry, we will not spend the 40,000 kwacha she has given us on ourselves and we will donate it instead to a couple I know from Mukinge Mission Hospital who are building an orphanage. We also, since returning the money is not an option, forage through our bags, desperate for some token of appreciation – a gift of our own – to give to Maggie and her companions. Outside of our clothes, we have nothing except my toe rings and Sam’s anklet – and three small bags of loose spiced tea I purchased on our spice tour for Chris and Amy.

“It is not much,” I say bowing my head and extending the bags to Maggie, “but we are profoundly grateful for your generosity and we want to give you even just this small token of our appreciation. They are from Zanzibar. We know your honeymoon to Zanzibar was cut short, so we hope you will enjoy this. And please,” I add, turning to the two other women, “share it with your friends who were also so generous.” We thank them again and then bolt from the compartment before we lose it completely.

*****

And in the end, of course, it all worked out. We polished off the last of our peanut butter for lunch and then bought ourselves dinner (although we’d have probably been better off without it – it was dreadful) using Sam’s “trip home” stash and my leftover shilling that I finally changed on the train. And we didn’t end up having to pay for the re-entry visas or even the bus back to Lusaka (when we finally arrived at Kapiri Mposhi at 3am, fully 17 hours later than scheduled, we hitched a ride with a lovely South African family we’d befriended on our journey – they were on the train with us both ways – whose driver met them at the station and took us all safely home).

I’ve lost count how many times this sort of thing has happened here. Because it happens all the time. And not just here. “It will all be ok in the end,” the saying goes. “If it’s not ok, it’s not the end.”

You’d think that, by now, I’d remember that.

Picture 1: Sunset reflected on the train
Picture 2: The Tan-ZAHN-yan countryside
Picture 3: Village children at one of the train stops
Picture 4: Pulling in to Zanzibar port
Picture 5: Brass-studded door
Picture 6: Stone Town
Picture 7: Fisherman at Jambiani beach
Picture 8: Children playing in Jambiani village
Picture 9: St. Joseph's Cathedral, where we attended Mass
Picture 10: The beach near town
Picture 11: Sunset from the train