Cameron

As we wind down our trip (and this blog) on our last evening in Zambia I wanted to dedicate this post to my son Cameron who has lived this adventure with me.

I used to say that skiing/boarding was the perfect family activity because you have your children captive audience for parent-child interaction for a whole 10 minutes up the chair. I now realize that that is a far distant second to a one month mission trip with your son. What an amazing experience it has been sharing this trip with Cameron! It was great sharing with him in the medical end of things – to show him my world (with a Zambian flavor of course). I love teaching and so being able to share medical knowledge and experience with my son has been tremendous. To see him go from someone who got lightheaded at the sight of blood to someone who was drawing blood numerous times in the lab, and doing a thoracentecis (draining fluid through the chest wall) was exhilarating for his physician Dad, as is his interest in a medical career as a possible path for himself.

It was also great just living life together for the month. Life is fairly slow on the mission field and we often found ourselves in the evenings sitting together (talking, reading, playing DS or watching The Office season 2). We had times of reading the word together and praying for each other. We shared a lot of laughs together and some real adventure (hiking around Mukinge, sharing the wonder of the safari, flipping a boat white water rafting down a level 5 rapid on the Zambezi). Watching him develop a friendship with Humphrey (clerk at the hospital) and patiently teach him some guitar was also very cool. Overall, it was neat to get to know each other at a deeper level. It has reaffirmed my pride in, and love for, Cameron – he is an intelligent, sensitive, good natured guy with a great, fun personality – it is exciting to be not only his father but also his friend and confidant (hopefully he also feels that I qualify for that designation).

I would highly recommend a similar adventure for anyone - beats the chairlift hands down!

Risk

Touching a leper, being within coughing distance of someone with presumed TB, drawing blood or doing an LP on a known HIV carrier, traveling the roads in Zambia, walking in snake territory at night – all of these are risks that we have encountered here that we would not ordinarily face in Langley.

Just one week ago, the missionary couple next door to us was subjected to a home invasion and was held with their 3 young children at gunpoint (AK 47) while all their cash and their vehicle was stolen. Thankfully, no one was hurt and they seem to have been spared major psychological trauma.

When Marguerite and I were here 20 years ago we heard stories (some of which we saw first hand) of hardships that the missionaries had undergone for their commitment to their calling. One physician had lost wife and child to illness (cerebral malaria and another illness), 1 couple had lost their 16-year-old son to a crocodile attack. While we were here an American missionary teacher lost his life in a car accident and his wife sustained a spinal cord injury. He left 3 small children behind.

One may argue that similar things can happen in Canada and I would grant you that, but the fact remains that there are many more health and safety perils here than in our part of the world. To say nothing of the “risk” as a missionary of loss of prestige, career advancement, financial security and the like.

Why would people expose themselves to such risk? We live in a world of risk management where one is always trying to minimize potential harm to self and loved ones. To go to Africa with your family seems, on the surface, to be naive at best and foolhardy at worst.

What I have found almost universally about the missionaries I have encountered is a holy recklessness and disregard for self that is motivated by a higher calling – that of pouring out their lives to meet the physical and spiritual needs of the poor and less privileged. They take as their model our missionary God, who, saw us in our poverty and depravity and entered a foreign and unwelcoming world and dimension, our world/human history, to live and die for those in need. They take as their mantras the apparent recklessness of scripture – the calling to be “living sacrifices” and to “find one’s life by losing it”.

It is only by having a clear sense of God’s calling to such a life, and only by clear trust in his ability to ultimately take care of us no matter what happens, that such a self sacrificing lifestyle can be considered. While we are to do all that we can to protect ourselves and our family from adverse outcomes, we also need to realize that our lives and health are in the hands of one much more powerful than us and one that cares for us more deeply than we can imagine. True joy and security comes not in safe roads, or powerful medicine or the size of our RRSP but in being in the center of God’s will. It is only with that knowledge that I can set foot outside my door in the morning whether it is here at Mukinge or at home.

We are not promised a carefree, stress free, danger free life as Christians. In fact, we are assure that ”in the world you will have troubles” but we are also assured of Jesus’ ongoing presence with us and our ultimate hope of eternal life – indeed in this sense, Jesus has overcome the world.

Alarmed!

Woke up at what I thought was 6:05 this am and couldn’t figure out why my alarm hadn’t gone off since I had set it for 6:00 am to ensure I had enough time to get ready for my 6:15 run. The reason I thought it was 6:05 was because that is what my watch said. Had my pre-run visit to the washroom and glass of water and got my gear on hurriedly, and, as I was stepping out the door, looked up at the kitchen clock – 3:10 am !!!!!

I have one of those cool Timex watches that has the ability to have 2 times at once – I have one set to Langley time and somehow it got switched to this – so got up at 6:05 pm pst (or 3:05 am Zambian time).

I was wondering why it was so dark out! It was kind of nice to know that I had another 3 hours to sleep before my run!

Longing

(Written Aug 20 before our internet went out for 4 days!)

I was out for another run with David Friend this morning, as is my practice here – around Mukinge hill at 6:15. We stopped to watch the sun break over the African horizon at 6:31 - a majestic orange/red orb at first tentatively peaking and then, over 2-3 minutes, breaking completely free of its terrestrial tethering. What a sight! Well worth getting up early for. It’s hard not to erupt in praise for my Creator as I stand in awe of his wonderful creation.

I had another good time of reflection after the run as I tried to catch my breath and reclaim my resting heart rate. I usually have some good time in prayer as I wander around the yard listening to the songbirds and the occasional rooster’s impudent crow (no scene is perfect!). I was thinking about how much I appreciate my wife and family and how absence truly does make the heart grow fonder. I didn’t know it was possible to miss someone so much. It seems that speaking with Marguerite on skype, while wonderful, only intensifies the longing to be in her presence again – a deep, visceral longing like an ache in the depth of my being. I love just looking at her. When I see her beautiful face on skype and hear her voice, I want to reach out and hug her only to realize that she is thousands of miles (and 9 days 14 hours 36 minutes and 17 seconds) away. Skype truly is an imperfect way to carry out a relationship (have you ever tried kissing an isight webcam? - I have).

In the midst of these thoughts this morning, God, clear as day, planted this thought in my brain – “Your relationship with me is like skype”. The light went on for me. I am often frustrated with my relationship with God – the imperfect communication in prayer and bible study. I have sometimes expressed my frustration to God in these terms: “why did you set up this weird situation where you communicate through a book and I talk to the sky and often feel like my words are going nowhere?” My relationship is like skyping with my Heavenly Father – somewhat removed, with all sorts of interference and miscommunication, fuzziness and sometimes garbledness. I long for the day when the Son will break through, erupt though the horizon of this transient existence and I will see him face to face – when I will sit on the knee of my Heavenly Abba (“Daddy”) Father and give him a big hug, basking in his presence. Telling him face to face how much I love him and fully receiving his love in return. Face to face!

I think God uses the marriage relationship in scripture for a good reason as a picture of our relationship with him as his church – his people. Just as I intensely, achingly long for the day when I will see my loved one, Marguerite face to face and be reunited with her in every sense of the word; and just as I am completely frustrated with our current skype relationship, so it should be with my relationship with God – a frustration with the current state of affairs and a deep longing for more – more here and now, but ultimately, the culmination of the more “on the other side”.

___________________

As a deer pants for flowing streams so pants my soul for you, O God. My soul thirsts for God, for the living God. When shall I come and appear before my God? (David in Psalm 42:1-2)

…but when the perfect comes, the partial will pass away….For now we see in a mirror dimly, but then face to face. Now I know in part; then I shall know fully, even as I have been fully known. (Paul in 1 Corinthians 13:10,12)

So we do not lose heart….. For this slight momentary affliction is preparing for us an eternal weight of glory beyond all comparison as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal. For we know that if the tent which is our earthly home, is destroyed, we have a building from God, a house not made with hands, eternal in the heavens. For in this tent we groan, longing to put on our heavenly dwelling. For while we are still in this tent we groan, being burdened – not that we would be unclothed, but that we would be further clothed, so that what is mortal may be swallowed up by life. (Paul in 2 Corinthians 4:16-5:4)

Communication 2009 Style

One of the wonderful things about technological advances since we were here 20 yrs ago is access to the Internet now at Mukinge – wireless even! When we were here in ‘88-89, Marguerite and I only had the postal service (as in mail….. as in writing on paper with pen, putting it in an envelope and sending it off ) at our disposal to communicate with loved ones back home. The problem was that while we were here from October to January, we really needed to send off all our correspondence within the first month or so if we had any hope of hearing back from home. Then there was the phenomenon of so-called letters “crossing in the mail” where the communication would be muddled by a not so straightforward give and take exchange.

So, the Internet is great but it too has a few issues. First of all, the upload time here leaves a little to be desired. Opening websites is reminiscent of dial up connection days (click on the address and go cook supper). This varies from day to day and with the time of day in a seemingly random pattern. My family back home and I have found though that the best time to skype is at 7 am my time (10 pm in Langley). Even then the images are 1 frame per 5 seconds and often look like the identity of the person you are conversing with is being protected. Voices sometimes sound like that little blue creature Stitch – electronisized – which makes for an interesting conversation.

Then there is the issue of the delay in transmission. This makes communicating fun especially when “chatting”. A message posted can take from 5-10 seconds to minutes to arrive and often one is responding to something the other person posted several lines back – talk about things “crossing in the mail”.

I also find saying goodbye while chatting difficult. Being relatively new to this all, I’m not sure of the proper etiquette. When ready to sign off I might say – “gotta go, bye” but it seems so abrupt to just close the program – sort of like hanging up without hearing the other person say goodbye. A message like “bye, love you” might come back. Then I feel obligated to raise the ante – “Love you too and miss you a lot”. Then “bff” might come back and….well… you get the picture.

I don’t know if any of you have tried praying over skype. I was having a conversation with my pastor Darren back home (using audio only, not video) about some church business and I felt that it would be the elderly/pastorly thing to do to close off with an internet/skype audio prayer. I went first and was really getting going and, I was, I must say, getting to the best part of my prayer. I was not being thrown off by the delays in “amen”s from Darren (that seemed to me to be coming at most inappropriate inopportune times due to the 5 second delay) but I just kept plowing ahead in my spiritual missionary status fervor. I was in the midst, in fact, of doing something very impressive - quoting a passage of scripture from 2 Chronicles while praying! – something that usually is only done by those of us that are highly spiritual. I was feeling quite impressed with myself when all of a sudden, in the midst of the biblical quote, I heard Darren starting in to his prayer. For some reason he couldn’t hear my prayer (either that or he wasn’t as impressed with my prayer as I was). I had been cut off! In reflecting on it, however, I think God shut the audio off as my “prayer pride” was mounting, in order to take me down at least a notch or 2. I had a good chuckle knowing that God can use defective technology to serve his purposes.

20 Dollars US Currency

"But when you give to the needy, do not let your left hand know what your right hand is doing, so that your giving may be in secret. And your Father who sees in secret will reward you"

(Jesus quoted in Matthew 6:3-4)

More on the church service yesterday - Cameron and I were the only "people of pallor" there amongst 100+ people. We were quite the item of interest for the preschool kids. One of the things that they do in their service when they are taking the offering is, they all go forward to the altar one by one during a song and place their money in the bucket, returning to their seat. Since I had forgotten my wallet it was left to Cameron to make a donation. He made a generous donation of $20 US dollars. At the end of the service the treasurer got up to make announcements, part of it being to give an up to date report about the financial situation including the giving for the day. There was a several minute report of which I could only understand a few words like "156,000 kwacha" which I assume was the giving for the day (about $30). Punctuated several times amongst the report was the phrase "20 dollars US currency". It seemed it was clear to all just how much this tall blond Canadian had placed in the bucket. I leaned over and whispered in Cameron's ear "I guess you won't be getting any reward in heaven for that one!"

A Bit of Heaven

Last week Humphrey, a 28-year-old Zambian who works as a clerk in OPD (outpatients) and often translates for us, invited us to his church on Sunday. I quickly agreed. As the week drew to a close I was trying to get details. It was a little unclear what time exactly we were expected and where exactly his church was located – “the main service is at 1015 but Sunday school is at 8 and I usually go at 9”….”it is down the path by the Hard Lucky shop”. We ended up texting each other Sunday morning at 8:30 not really knowing what we had signed up for. It felt like a bit of a scavenger hunt but we eventually met up with him and he guided us for the 20-minute walk through the woods on a small path to his village church arriving at 9 am.

It seems these churches all had the same designer – they are basically 1 room, 30x60 ft, open raftered, metal-sheeting roofed boxes with a podium at the front, “choir seats” facing each other on either side at the front (takes up half the seating) and the rest of the seating is oriented toward the front in 3 sections with 2 aisles. The seats are wood benches, not exactly the most comfortable.

When we arrived, there were only 2 other people there and it became clear that we were to sit in on a private showing of a choir rehearsal before the main service. Humphrey is involved in one of the choirs (there are 5 in this church of 100-150 people!) and plays guitar for worship – (that’s why he arrives early). What a treat, though, to sit in on this rehearsal! One thing I love about Zambia is the music – specifically the singing (their other instruments are not a strong point). Wonderful rich full harmonies and rhythms. I was in heaven (other than the sore butt from the hard bench which I’m sure will not be part of the heavenly package).

During the actual service, we were treated to another 4 choirs and some wonderful congregational singing. Singing is such a part of their lives here. It is rare to hear a bad vocal note hit. You often hear people singing as you pass them on the path or road. Humphrey tells me that each of the choirs in his church practices 3 times a week.

After church we went to Humphrey's village nearby and had lunch (eaten with fingers only) of nshima and salted fish and kale in his small house. His wife Joyce served us but did not eat with us. He proudly talked about his house which he built himself out of bricks (self manufactured) and a thatched roof. He has a solar panel which is on the blink right now so they have no electricity, which must be a challenge (no lights in a place where the sun goes down at 6 pm, no fridge). He introduced us to his parents who live in an adjacent house and to 2 of his 6 siblings (average sized family by Zambian standards). All in all a very enjoyable day. It was wonderful to partake in some real Zambian life. They were incredibly gracious and pleased to have us at their house. I felt incredibly honored.

Chicken?

While at Langley Memorial Hospital you might notice signs warning about the consequences of parking your car in the wrong location (ticket, towing). While at Mukinge Hospital the warnings are of a more rural nature. If you bring your chicken to the hospital it may well end up cordon bleu or kiev!

Chickens here are mostly free range and are apparently prized dead or alive. While we have been here 2 separate missionary households have had their chickens stolen – Jan Matthews had 4 of her live chickens taken in the middle of the night and the Tompkins had several frozen chickens lifted from their freezer in broad daylight!

I think the moral of all this is that while in Zambia, one really needs to keep a close reign on one’s chickens.

True Religion

"Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows (and I’m sure lepers) in their distress….” James 1:26

Had an interesting trip Tuesday afternoon. Cameron and David Friend (Kiwi surgeon here) and the hospital physio (I can’t for the life of me remember his name – I have enough trouble retaining western names like John and Mary! I think it is Mr. Chilimunda) and I set out on a 20 minute trek over the hill and into an incredibly beautiful valley where a leper village is situated. The government has built about 15 simple brick one-room homes where those disabled from this disease live. David (who is a modern day saint by the way – and would be the last one to want someone to acknowledge him in this way) takes his Tuesday afternoon off once every 2 weeks to go to the village with Mr. Chilimunda for “a social visit” and to hear about their aches and pains and bring them a gift. He goes to the Boma weekly (30-40 minute walk) with his backpack to pick up oil or flour or sugar or salt or soap for the visit. Each visit he takes a gift to each household of a different staple (this week was soap).

The people obviously are anticipating the visit and are each sitting outside their home in their Sunday best. We go through the wonderful Kaonde greeting “byepe mwane” with a bit of a genuflex and handshake followed by several cupped handclaps then repeat. The reply is “twasanta mwane” (we are well) or “pecheeche mwane” (“a little bit” – a wonderfully vague term meaning a bit unwell or a bit better, etc). He then settles in to speak with them – showing care and compassion and a gentle spirit. They usually complain about their pains, or their cough or their eyes; he does a rudimentary exam, reassures them, gives them medicine or advises follow up at the hospital. He presents them with their soap and moves on with a Kaonde farewell.

Like the lepers in Jesus’ time these people are often missing digits or limbs and have all the psychological issues that go along with chronic illness and deformity along with the social stigma of their disease. Despite this, they had broad ready smiles and an appreciative spirit for the most part. David thinks they most appreciate knowing that they “are not forgotten”.

He tells me that there is a donor in the US that has for years been providing funding so that each household can have a monthly allotment of maize meal. It apparently costs $2500 U$ to fund feeding the whole village for the year. For some reason this funding is coming to an end. Any takers for practicing some pure and faultless religion?

HIV

As you know HIV/AIDS has had a devastating effect on this continent. The prevalence is high. A huge proportion of Mukinge's hospitalized patients are HIV positive. ARV's (antiretroviral drugs) have been readily available for several years and are having a huge positive impact in decreasing the human suffering related to this disease. Unfortunately, when people see the positive impact in others, it lessens the sense of dread and motivation to prevent the disease (no sex outside of marriage). There is a risk of an even more casual attitude with regard to sex.

There is significant fractionating of care with regard to treatment. The government has established a system of clinics for aids testing, counseling and treatment. These are run by clinical officers and there is one at Mukinge. If we want to start someone on ARV's we send them to the HAART clinic (highly active antiretroviral treatment - usually a cocktail of several drugs). The CO's will then start them on the drugs and do the cd4 testing, etc. Unfortunately there is no effective communication back about what they are on and what their cd4 counts are, etc. Again causing us to be "shooting in the dark" (somewhat unnecessarily in this situation).

If HIV testing is desired, we send them for ctc (counseling, testing and care). If they chose to have the testing done the result is sent back to the chart in the form of an even number (positive) or an odd number (negative). They go to great ends to protect privacy and you will not see the acronym HIV on any chart - they talk about people being "retroviral disease" positive or negative (rvd+ or rvd-). It is all a little odd since they have simply created another word which patients will soon understand to mean HIV.

There are some interesting cultural /societal issues around HIV too. When I was here 20 years ago the whole AIDS thing was attributed to a myth perpetuated by america (I saw some graffiti back then that said American Idea to Discourage Sex (AIDS)). Initially the government buried their head in the sand. In the last decade or more though there has been an active education program and in the last several years the ARV treatment is widely available.

One other odd cultural idea is that you can rid yourself of AIDS if you sleep with a virgin. Unfortunately young girls have been sexually abused because of this myth and bear the psychological and medical consequences.

Shooting in the Dark

This installment is in answer to a request for more information about the medical aspect of things here at Mukinge. This will likely be of most interest to medical types but all are welcome to read!

It is certainly different than medicine practiced in Canada. There is much more emphasis on clinical diagnoses and empirical treatment. Resources are limited and the nurses in general have more responsibility re diagnosis and treatment.

The hospital is approximately 200 beds and there is an active OPD that services approximately 160 patients per day. There is a pharmacy, lab, xray and ultasound, 2 theater OR, physio services and a 2 year practical nurse training program. Mr. Fumpa – a clinical officer trained in cataract surgery, deals with eye care. Dentistry (mostly teeth extractions) is done by another clinical officer (think goodness – when I was here before I had to do extractions and I could never quite get the local anesthetic blocks right consistently). There are several wards - men’s, female, pediatrics, tb, and obstetrics. Mukinge is a referral center and services a huge area – it is not unusual for people to come from 5 hours away. Currently there 6 doctors – myself, 2 Zambians, 1 Dutch, 1 from New Zealand (surgeon) and 1 American.

History taking – while English is the official language in Zambia and kids learn it in school and upper level classes are conducted in English, the reality is that most people have limited grasp of the language and are more comfortable in their native Kaonde tongue. Therefore, an interpreter is needed for taking a history - we use either one of the clinical officer or student nurses. Often when asking a question to clarify history (is the pain achey, burning or sharp), there is a long back and forth conversation and the result at the end of it is something like “she says she has pain”. Also, I get the impression that the essential element of the history that I am trying to elicit is lost in the translation often and that I am left with far from perfect information to go on. People commonly come in with tbp (total body pain), headache, and palpitations. Everyone says yes to questions about fever chills and night sweats. Of course the differential diagnosis is much different than in Canada with malaria and TB and opportunistic infections much more prevalent. The incidence of HIV/aids in the 15-49 year old population is estimated at 15-17% and in the pregnant female population in the same age group was 24% in 2004 and 30% in 1994. With this incidence of HIV it shifts the whole differential diagnostic consideration to the rare and exotic. Crytospiridium, Cryptococcus, pcp, TB (including extrapulmonary – bone, pericardial and pleural disease, etc) are run of the mill here. In the pediatric age group PEM (protein energy malnutrition) is surprisingly common thought not as much as when I was here last (although part of that may be seasonal since we are not yet into the “hungry season” when crops run out (novemberish).

Investigations – these are generally limited. There is a lab and an xray and ultrasound department (the ultasound is a nice addition since I was here last time). One area where Mukinge is ahead of medical care in Langley is the promptness with which these tests come back. When working in OPD, I send people for xrays and they are back within an hour with the xray film or the ultrasound report! (Compare with 4-6 weeks for an ultrasound in Langley). There are limited labs and I get the impression that the results are not always to be trusted. I heard a story of a child that was sent home to die with leukemia when her wbc had come back at 70,000 (normal 11,000). She was back several months later alive and well – it turns out that the machine was misreading sickle cells as wbc’s causing a falsely elevated result. There are lots of opportunities to stick needles into body cavities. I have done a LP per day (on hiv+ patients) in the last 2 workdays. Pleurocentesis and peritoneal taps are also common. The tests that are available are somewhat odd – one can get a crag (Cryptococcus antigen test) on blood or csf or a cd4 count but creatinines are not currently available and potassium levels are not available (ever?). It makes it a challenge when treating our CHF patients with meds like lasix, ace inhibitors and spironolactone. Diabetic care and monitoring is atrocious. There is essentially no self-monitoring by patients once discharged and even in the hospital there are limited resources with regard to availability of test strips (too expensive). As one of my Zambian colleagues said the other day when I was doing a presentation on managing diabetes “I often feel like I am shooting in the dark” when it comes to making med adjustments (I think this would be a good motto for medicine here in general). I saw a 14-year-old type 1 diabetic patient in the opd the other day. He had come in for his monthly refills of his lente and regular insulin. He had not done any monitoring and I tried to get a history regarding whether he was having any hypoglycemic episodes and all I could get was that he was feeling unwell “when my blood sugars are high”. How he would know they were high and how he was feeling at the time I have no idea. I refilled the meds with a sense of foreboding. Even A1c’s are unavailable so one truly is shooting in the dark.

In general one relies on clinical acumen and some limited testing and a trial and error treatment scheme balancing potential risks with benefits.

Therapeutics – in general the available meds are greater than when I was here before – there is a good array of basic iv and oral antibiotics, 1 ace inhibitor, 1 beta blocker, 1 calcium channel blocker, etc. Interestingly chloramphenical is used quite often (a drug that is very effective but has a rare bone marrow side effect and is not used in the west). Antiretrovirals for AIDs are now readily available and this is making a huge impact on the quality and duration of life for AIDs sufferers. All the drugs are dispensed from the pharmacy at the hospital and for chronic conditions people generally get 1-2 months at a time. I have noticed when people come in for their regular meds (like antihypertensives) all complain of something else – generally tbp (total body pain), headaches or palpitations. I asked one of the nursing students about this and she said that they feel they had to come up with some symptoms or they wouldn’t get their refills.

Hopefully this gives a glimpse into the challenges and issues dealt with in a bush hospital setting in the developing world.

Mabvuto

Finally! A day off! After 3.5 days straight of working, we get time off!

After doing rounds this am Cameron and I set off to explore the area. Unfortunately my gps which I had packed for just such a occasion was in the suitcase still in transit. We got directions from our neighbour (unfortunately I have developed a significant defect in my ability to hear and retain directions since Marguerite is usually with me and tells me where to go - literally) and set out on our adventure. Our mission was to conquer a local hill from which we would have a good view of Mukinge hospital and surroundings below. After several false starts that ended up in someone's back yard, and after asking directions on a number of occasions, we came upon the "village just 300-400 meters down the road after you reach the junction of the foot path to the Boma (Kasempa "business district") and the road to the Boma which is just up the steep path after you cross the concrete bridge over the river....".

The "village" turned out to be comprised of a couple of thatched roof houses, an outdoor kitchen, a goat pen and a latrine. We were intending to pass through and make our way up the hill but one of the 7 inhabitants of the village, a 21 year old guy named Mabvuto Simfukwe, after greeting us warmly, offered to escort us up the hill. He took off up the hill at quite a pace (in bare feet) and after 10-15 minutes of traveling straight up we had a wonderful view of the valley and Mukinge. The area around here really is lush and beautiful.

Our new friend Mabvuto told us a bit about himself - he is the oldest of 6 siblings, and they and their mother (his father died when he was young) comprise the full population of his village. He finished grade 12 in 2006 but still has to rewrite some exams since "I didn't do too well in them". His goal is to finish and get to college. He wants to go to the nursing school at Mukinge hospital "but I can't because I have no money and I don't have a sponsor". He told us a bit about his life working the maize fields and showed us his crop from this year. They sell their maize at the Boma. They also have goats and chickens which they raise for meat. He gets his water from a stream and walks 20-30 minutes to the Boma when they need oil and soap and other necessities. Despite being obviously very poor, he has a boom box and a cell phone (standard issue in Zambia). He was very gracious and friendly and initially declined my offer of a few dollars for the tour. We exchanged addresses and he promised to write (I'm sure at least in part because he is interested in seeking "sponsorship" for his studies - and who can blame him - his existence seems very bleak by our standards)

We returned to Mukinge and had some nshima (maize meal doughy dumpling which is the staple food in Zambia) with cabbage relish and a indian spice like dipping sauce from the local corner take out restaurant by the hospital. No utensils - eat with your hand. The ash on my fingers from a fall on the hill (the grass and leaves were burned recently where we were climbing) made for an splendid earthy finish. Cameron had a cup of banana ice cream. The total bill for our feast...... $9500 Kwacha (about $2)

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Flying Things

1. Mosquitos:

If anyone didn't know, there are many mosquitos in Zambia.

When Cameron and I arrived in Lusaka our bags didn't and neither did our deet 30% mosquito repellant. I was under the impression that in urban areas mosquitos and therefore malaria were not an issue. I was corrected on both counts by fellow missionaries at the Chamba Valley guest house where we were staying. The first night wasn't bad due, I think, to the utter exhaustion, and we slept well. The second night I couldn't sleep due to the cacophony of high pitched buzzing in my ears. In the dark I could picture the little

critters coming in for a landing and a bloody meal. I spent the wee hours trying to stay under the covers and intermittently opening them for air without letting any miniscule friends in. It was less than satisfactory. There were no mosquito nets to be had on the compound so the next night we resorted to a combination of kamikaze mosquito wacking and a mosquito coil. We slept peacefully but I couldn't help but wonder which was worse - a few parasite laden bites or the smoke inhalation of a toxic insecticide.

2. Small planes:

We got up bright and early yesterday am to fly to Mukinge. We went on a Flying Mission plane piloted by Don Amborski - a wonderful guy that Marguerite and I had the pleasure of getting to know on our last trip to Zambia 20 years ago when Cameron was a fetus (there... I got it in - Cameron hates it when I say that!). Security at the airport was comical - we first loaded our multiple grocery bags and large baggage (3 of the 4 bags had finally arrived) into the plane at the hangar with no one around. We then entered the airport and went through "security" with our carry-ons. Cameron triggered an electronic alarm consistent with some metal on his body when going through the scanner but no one seemed interested in checking it out. They seemed to be more concerned with getting their $8 US each for the domestic flight charge. The flight was great - 1.5 hours over mostly flat treed terrain segmented by streams and rivers. Don buzzed the farm of a friend of his close to Mukinge and that's when the nausea began. For Cameron, unfortunately this progressed to full on vomiting (another thing that flies!). We arrived at Mukinge in time for Cameron to wipe off his mouth and were greeted by a large contingent of Zambians (I think more intrigued with the plane than the new mukingeites) and our new missionary friends. Had a couple of hours in the out patient deptartment yesterday afternoon and a wonderful meal at the Tompkins' (full time doctor Daren and nurse wife Elissa) last night.

3. Thoughts:

I don't know if it was the Starbucks coffee (after 3-4 days of withdrawal) or all the culture shock and adjustments but my thoughts were working overtime and I couldn't get to sleep until about 3 this am. I kept ruminating about the patients I had seen in OPD and whether I had done the right thing. It will take a bit of getting used to - different diseases and treatment protocols, different drug and test names (acetaminophen = paracetamol). There is a lot of empirical treatment here since testing is unavailable and expensive. Often people are "jollied along" with vitamins and analgesics. (It is hard to tell someone who has traveled for days and has sat in the OPD for 8 hours that they have a viral illness and no treatment is needed). Finally to sleep at about 3 and up for a wonderful sunrise run with David Friend (surgeon from New Zealand) and Daren Tompkins.

PAIN PROGRESS

Aug 2, 2008

We’ve arrived in Zambia…. Finally, after 8-9 months of planning and anticipation, and after a 30+ hour sojourn we are here. We left July 31 from home at 2:30 am (note to self – when it says on your ticket that it is recommended to get to the airport 3 hours before the flight time don’t believe it – 1.5 hours would have been more than adequate). After an emotional fairwell with Marguerite and Mckinley we were off. Vancouver to Chicago to Washington DC (Cameron puked on these 2 flights but other than that it was good) to Dakar, Senegal to Johannesburg to Lusaka. Arrived in Lusaka at 2100 hours Aug 1 to find that (predictably) our luggage had not kept up with us. Fortunately we had planned by packing a toothbrush and extra pair of clothes (will remember a change of underwear next time) in our carry-on.

The South Africa Air flights from Washington onwards were great – multiple meals and individual entertainment (movies, TV shows, games) at your seat. When an announcement was being made by the pilot or flight attendants, the screen in front would freeze and along the bottom was printed “PA IN PROGRESS”. Being, by that point in time somewhat jet lagged and sore and cranky, I thought it said “Pain progress”, which I thought suitable given how I was feeling about our marathon journey. Having said that, it is now a distant memory, we had a great sleep last night, and have had a quiet day on the SIM Zambia 40 acre (walled and barbed wired) compound. Kathy Reimer (Ken and Kathy are missionaries here in Lusaka doing administrative work for SIM) had bought us groceries for our guesthouse room so we are all set.

As we wandered around I got to try out my new telephoto lens. There are a lot of opportunities for great photos here. I think the Zambians that we encountered thought us somewhat odd – a couple of whities walking around in shorts (most are more formal being a Sunday - suit and tie not unusual) with camera gear around our necks (talk about not blending in!).

We hope to get our bags tonight if they arrive, will do some grocery shopping tomorrow and then head off on Tuesday morning for Mukinge.

The vine reading today was in Matthew 25 – (the parable of the giving of the talents) and we were again reminded that God gives us an awesome responsibility to use the gifts he has given to further his kingdom. We were challenged to not think of “the mission” beginning on Wednesday when we arrive in Mukinge or ending when we leave Zambia but rather the mission being an ongoing responsibility for each of us abroad or at home. It is a challenge to think in terms of “what does God have in mind for me right now in this situation, with this person before me, with the resources he has given me?” (Eph 2:10).

Drivel

I'm kind of new to this blogging thing so I've been asking for feedback about my first entry - someone very close to me said "no one wants to read that drivel... at least wait til you've gone away before you start blogging!" Those words have been echoing in my head these last couple of days. They have caused no small amount of insecurity for me - a neophyte blogger. They also got me wondering about the origin and meaning of the word drivel.

One online definition is:

Noun:

1. saliva flowing from the mouth, or mucus from the nose; slaver

2. childish, silly, or meaningless talk or thinking; nonsense; twaddle

As I pondered this I wondered if my previous entry really qualified as a childish, mucoid excretion from the upper respiratory tract. I wasn't sure about the answer to that but I thought that I would write about my experience. I thought that maybe if I "got it out there" by blogging, healing could take place. I also realized as I started proofreading what I am now writing that it indeed might qualify under the above-mentioned definition.

As a result of this experience, I have decided to not drivel (drivel can be used as a verb as well as a noun) any more. At least not until I start my trip.......

Fish and Loaves?

Many have asked me about the title of this blog (ok that's not really true - no one has shown much interest in the title at all). I wanted to go for something much more trendy like 5L2F (5 loaves 2 fish) but a) it was already taken and b) my teenage daughters rolled their eyes when I suggested it.

The reference to fish and loaves is the story from Matthew 14 of the feeding of the 5000 - an amazing miracle performed by Jesus. As I have been preparing for this trip to Zambia to work in a mission hospital for the month of August I have been feeling a strange mix of excitement and anxiety. Excitement for the adventure and the newness and the thought of sharing such a potentially life changing experience with Cameron; and anxiety primarily about my own lack of resources - do I know enough tropical medicine? Will it be safe? Have I got everything ready? Will I really make a difference in the midst of so much need? etc, etc.

In the midst of this potpourri of feelings, I was reading in Matthew about the feeding of the 5000 (actually 5000 men not including women and children). Jesus' ministry had been growing in popularity and the people had followed him to "a desolate place" that he had withdrawn to by boat. After a day of Jesus meeting the crowd's needs (healing the sick), the disciples encourage him to send the people away. The thought of dealing with a sick, hungry crowd in a desolate, resource poor place was overwhelming to them. Jesus says to them "you give them something to eat". I'm sure as they heard these words, their hearts dropped and they acutely felt their own inadequacy. Jesus was asking them to do the impossible. He had given them a task beyond their own resources.

To their credit, they did the appropriate thing and brought what little they had to Jesus. As it happened, it was 5 loaves and 2 fish. I'm sure that they brought them tentatively and with more than a little embarrassment thinking their offering much too small and inadequate to be used in the face of such a great need. Then Jesus steps in and does the impossible. He blesses and magnified their offering. The crowd ate and was satisfied and there was much more remaining than they had begun with (12 baskets of left overs!).

This has become a powerful image for me as I embark on this mission trip. In the midst of my feelings of inadequacy (mostly appropriate since I am inadequate), Jesus says "you feed them - you meet the needs that you are confronted with". I think he does this to help me see my inadequacy, to marinate in it and to turn to him, offering what little I have and trusting him to do with it what he will. He is able to bless and magnify my knowledge, my skills, my personality, my energy, my love. He wants me to offer myself (the apostle Paul would say as a living sacrifice), acknowledge my utter dependence on him and sit back and watch as he blesses and magnifies. What a privilege to be a part of that!

So... on the eve of heading out on this trip, I want that to be the theme. In fact, I want that to be the theme of my life......thus the title (I still think 5L2F would have been cooler...)