Letter from Zambia
by Loren Roth M'04
"Eye-opening" was the adjective I used to describe the type of experience I
was looking to have when I approached Dr. David Hamer, an infectious
diseases specialist at NEMC, about ideas for possible abroad rotations. The
traveling I had done so far had only been to Europe; I had never been to a
developing country, to a place where Caucasians are in the minority. Before
I had to face the real world, and an un-&*%$-believably high debt, I had to
take advantage of my last few months as a student to travel somewhere new.
I am embarrassed to say I had never even heard of Zambia before Dr. Hamer
enthusiastically spoke about it. Don't quote me on the historical stuff
here, but it goes something like this: the country was colonialized by the
British and was previously called Northern Rhodesia. They peacefully gained
independence in 1964, when the country was established as the Republic of
Zambia. English is spoken universally here, except by the poorest
townspeople; there are also 72 tribes, each with their own native dialect.
It's hard to put into words my first impression of the pediatrics department
at the University Teaching Hospital here in the capital of Lusaka. I'll
begin with the malnutrition ward, a large room with 68 beds, some of which
were being shared by multiple patients to accommodate the 84 children that
were currently there. The stench is so strong when you enter, you never
quite get accustomed to it like you do to the stench of the anatomy lab.
The mother stays with her child the ENTIRE duration of the inpatient stay.
Children are admitted for malnutrition when they are below three to four
standard deviations below the mean; they go through graduated stages of
feeding until their tiny bodies are closer to "underweight" as opposed to
"severe marasmus kwashiorkor", which most of them have on admission. Want
some numbers to see what I mean? Today I saw a 9 month-old baby who weighed
under ten pounds, and a 21 month-old baby who weighed the same amount today
that she weighed one year ago.
Did you ever see that movie "The Cider House Rules"? Remember the kind of
medicine that was practiced by the main character? That's what the PICU is
like. Oxygen is given to a patient through a nasal cannula that was
previously used by other patients. There are no cribs there, so a one-month
old baby was tucked under the blanket in an adult size bed, giving the
illusion that she was even smaller than she actually was. Most of the PICU
patients were those with malaria that had gotten severe enough to lead to
coma, although one was an 11-year-old girl who had tried to commit suicide
by ingesting rat poison (sadly, I guess some things are universal).
Here are some excerpts from emails I've written:
I've only been here for less than 48 hrs, and I already feel like I could
write a whole book on this. I'm constantly thinking about all the stuff I
want to write to you all about.
Definitely one of the most lasting images will be looking out the window of
the plane as we landed. When we first broke through the clouds, I was like,
"Wow, that's African grass and African trees I'm looking at." The airport
for this city, the capital of a country with 10 million people, is a small
building with a terrace where people wait and watch the plane land -
there's only one runway. There's a sign inside that says "Zambia Stock
Exchange . . . An Investor's Haven!" [uh, not!] I got picked up by some
Americans who work in the medical community here; one of them will be my
flatmate.
The house reminds me of cement houses you see in
lower-middle-class sections of Miami or LA. - a square cement building with
a tile front porch. Anyone who has any money here has a cement wall with
barbed wire around their house, high enough to obstruct the view completely.
In order to get in, by foot or in a car, you need to be let in by the guards
[every such house has them]. Our guards, who are also our gardeners,
laundry guys, and housekeepers - Jack and Godwell - live here on our grounds
in two shack-type things with their wives and various kids/nieces/nephews.
It's a pretty decent job they have, relatively speaking, in that they live
within the cement walls, they get an o.k. income, and their kids are put
through school by some of the Americans here. Jack's wife is Loveness, his
daughters are Romance, Violet, Erin, Iznot [or at least that's how you
pronounce it] and others. They speak English fluently, as do most educated
[and some not educated] Zambians.
I was talking to my roommate, Stephanie, about how I should have brought
children's clothes from the US to give to Jack's and Godwell's kids, but she
reminded me that people have different values here, and that having your kid
run around in dirty, old, ripped dresses with broken zippers is not a bad
thing to be down about. These kids have great fun with things like chasing
each other, waving at people, holding hands, and throwing a twig against a
wall - who cares about how new your baby's dress is?
They recently got a new strip mall here, the 2nd one in the city, so we went
there last night to the spanking new restaurant and then to see a movie. The
restaurant seriously looked like it could have been in Cambridgeside
Galleria... --except there were no menus, and the only food they were serving
was, like, chicken kabobs, half a chicken, and something else chicken. We
saw "Out of Time", a movie with Denzel Washington. People find things in
the movie funnier here than we find; maybe it's the American slang that's
novel to them. Oh, earlier yesterday, I saw a guy wearing a shirt with "50
Cent" on it [i.e., the rap guy], and our taxi driver on the way to the
movies told us he likes Luther Vandross and R. Kelly a lot better than
Zambian music. In fact, he's an accountant and is planning a trip to the US
to see Chicago, NY, LA, and other cities which, from what I gather, he's
heard about in rap songs.
Tomorrow I'm starting at the hospital. I'm nervous. I'm only slightly
nervous about the emotional aspect of seeing dozens of kids in a big open
ward in squalor-conditions, with terrible illnesses and stuff, because I
don't think you can really prepare yourself for that or imagine it until
you're there, so it's hard to be really horrified at something that you
can't even fathom. But I'll fathom it tomorrow, and then I'll try to put it
into words...
Going around the city, which is really just more like a big spread-out town,
I really feel like I'm watching a National Geographic show. There are a lot
of Caucasian foreigners here, so the native Zambians are used to us
"mazunga" [white people], but still, sometimes when a bunch of us are in a
car together, Zambians will stare at us as we drive by, and that's when it
feels like a real National Geographic moment. I just can't believe I'm in
Africa. Can't believe it.