((The internet here is pay per gig, so uploading videos would not be respectful to my host! Once I get to a main city I will try.
Also. Understand I do make some broad generalizations. Of course there are exceptions, and of course there are different perspectives than this one. But these are my personal experiences and take-aways from immersing myself in this culture for the short time that I have. I am also not naive to the incredible struggles that Zimbabwe has faced, nor the struggles it faces now. This is what God has revealed to me to share, in spite of those things. That being said, enjoy my long overdue update.))
Greetings from Chidamoyo, Zimbabwe!
You can look up Chidamoyo on Google maps to get an idea of where I’m at, but it won’t show the kilometers of rock strewn, washboard roads, the hundreds of round straw-roofed dwellings, the many walking travelers, the dozens of combies covered in dusty holographic bumper stickers we passed, or the one tire we blew, on the way here.
The area is hilly, grassy and full of various kinds of greenish brown trees that line the roads and hill tops. Some with bright yellow flowers, some red. Occasionally you will see the balancing rock formations unique to the Zimbabwe bush. It appears like God Himself made cairns with gigantic boulders.
Chidamoyo is hot, dry and dusty. The mornings and evenings are kissed with a cool wind that blows the periwinkle flowers off of the Jacaranda trees, welcoming us in the morning with a soft purple carpet. By evening the grounds keepers have swept them all up, but the trees persist with their delicate snow each morning.
I stay in a modest guest house, about the size of a typical village home. Straw roofed, with a cement floor polished to shine, my only roommates are pale pink and orange geckos and large wall spiders, all of whom keep to themselves. My shower is outside, behind a concrete wall, where at night I can hear the drums beating in the distance and frogs sing as the sun goes down. Another tree nearby often loses it’s beautiful white flowers as they float down at my feet. It’s quite surreal; like something from a movie.
Breakfast is at 7am, tea time at 11:00, lunch at 1:00 and dinner at 6:30. Zimbabweans love their meal time and never spare on breaks. They love to make sure you are well rested and well fed, at all times. (To be called fat or big is a high complement, believe it or not! It indicates good health and that someone takes good care of you.) They always ask about your rest the night before and how much sadza you ate for dinner. “Hello” in Shona actually means “how are you”, so when I say hello in English they say “I am fine!”
You never pass someone in the hall without greeting them, and there are unique greetings and responses for the morning, afternoon, and night times.
Zimbabweans exist at such a level of peace here which is unnerving to me in the hospital setting, but comforting to me everywhere else. No one rushes to move, speak, or respond quickly.
That part of the culture difference has been the hardest for me to adapt to; coming from high intensity, talk fast-work fast American hospital life where time is short and duties are forever piling up, and even if I finish and my patients are stable, there’s always someone else to help. Here, nurses are calm, patients are, well, patient, waiting to be seen, waiting for the nurses to read the doctors orders or construct their chart. No one looks distressed, even the sickest of patients. Nurses calmly take turns with duties when a patient arrives and the patients take turn being seen. I still have a lot to learn (as I jump up from the table, knocking a million things to the ground every time someone comes through the unit door.)
**
Chidamoyo Christian Hospital is a mission hospital. One patient I was speaking with says he will travel many kilometers and several hours to come here, because he knows the nurses and doctors are compassionate, and that the hospital will do whatever it can to provide at least some care, if not the best possible.
In contrast, government hospitals in Harare (Zim’s capital), and elsewhere, are severely understaffed and under resourced, where there may be one nurse for an entire unit, and only one set of gloves for three patients. Medications are few and far between. “You only go there if you want an infection, or to die” my Zimbabwean nurse friend says to me as she describes the devastating conditions. Private pay hospitals are a different story, but there are few who can afford to even receive a consultation let alone diagnostic exams or treatment.
The unemployment rate here is well over 85%, and I believe the latest figure was closer to 92%. People sell produce, clothes, trinkets, and physical currency on the street to make money. In the rural areas, farming is more common.
In order to assist with fees, Chidamoyo accepts offers other than cash. My host, and Sister-in-charge at Chidamoyo, Kathy, says “not everyone has money, but everyone has something”, so they will often accept things like livestock or produce (like a bag of beans) as payment for hospital admission, medications, tests and treatment. Chidamoyo only charges for medication what they paid from the distributer. Patients are grateful to have a place to go that where they have a better chance at getting treatment they need.
The hospital itself is a square arrangement of brick buildings with a large courtyard in the middle, which has cross shaped pathways that connect each building. Mother hens, baby chicks, and goats often peruse the grass and decorative flower beds in search for a quick meal. The center hosts a flagpole displaying the Zimbabwean flag, and is where each morning a devotional is read by the administrator or chaplain.
Nurses, patients, employees line the outer hall of the courtyard each morning at 7:30 to sing worship songs and listen to the Word. Work commences around 8:00. Nurses arrive in waves, wearing their crisp white uniforms, adorned with leather and metal shoulder aplets which signify their nursing education. If not in white, they don sky blue scrub shirts and pants. However female nurses are often in skirts, heels and nylons, and I often marvel at their God given talent to stay spotless, even when most walk the dirt roads to work!
On the inpatient side, the doctor makes rounds, accompanied by a nurse who reports on each patient and records changes of orders in the nurses “Doctors Order” book. Each inpatient is given a yellow paper booklet with admission info on the front, doctors write orders and nurses record vital signs, blood sugars and labs inside. The patients often have their own medical record in the form of a brown 72 page booklet. They are expected to (and do) carry this with them wherever they go.
After rounds, the doctor proceeds to the theater (in American: operating room) and performs whatever procedures he ordered during rounds. So far I have seen several C-sections, one finger amputation, several I&Ds, two or three MUAs (manipulation under anesthesia, where broken limbs are stretched so the pieces will realign), and foreign body removal (a stick from a kid’s foot). There is a nurse anesthetist, theater nurse, and scrub tech present. They have an anesthesia machine and ability to intubate, but they use sub-general doses of ketamine or propofol where only a small dose of O2 suffice. No analgesia (except spinal anesthesia for C sections), and the only meds they use for blood pressure support are fluids, epinephrine, and ephedrine.
After the procedure they are taken to the Duty Room, which is also the nurses station and recovery room. Patients are monitored after procedures for a short time, and the initial doses are so low that the patients are awake in minutes.
The Duty Room is a building, which js the main hub for everything that the inpatients need. Patients, after being seen by the outpatient doctor, come here to be admitted. They all buy their medications from pharmacy, and come to the Duty room with the vials of IV/IM meds to be administered. Inpatients manage their oral meds on their own. Also they come for daily dressings as ordered, IV placement and removal, fluids, etc. This is also where the oxygen tank lives, and where the sickest of patients are admitted to for close observation.
Adjacent to the Duty Room on the left is the post-natal ward, where women who have had babies stay for a day to several days depending on their condition. Ten to fifteen women and infants are lined up in metal twin beds with foam mattresses and fleece blankets. Some mattresses are on the floor if there’s no space. Even if it’s 95 degrees outside, babies are bundled up with full hats, socks and jackets. (It was probably 100 today, and I DID see some baby feet however!) Belongings in suitcases, rubber shoes, and bags of loose cotton material (used for pads) are scattered on the floor. Pairs of beds share a tiny tiled shelf which are usually full of used plates, soda bottles and baby supplies. Through the Post Natal Ward is a closed room for moms with premies, and further on is the delivery suite. Five black leather beds line the back wall, where at any time are full of women in the final stage of labor; most, extremely stoic in their pain.
Just outside the gate of the hospital, Chidamoyo offers an “Expecting Mother’s Shelter”, where women from all over come to in order to be close to the hospital when they are nearing delivery. I believe it can house up to 50, maybe more. An equally hysterical and beautiful tradition that I both laughed and cried though happens each Sunday night, where during the evening church session all the pregnant ladies dance at the flagpole to help “make their babies come.” The sweet lady who sat next to me said “I dance, my baby is coming!!” (Yes I absolutely have video, and yes I will post it when I can.)
Next to the Post Natal ward is the women’s ward, and across the way is the men’s. Adjacent to the Duty Room on the right is the pediatric ward.
In between are several isolation rooms with a single bed.
Wards all look similar. Metal twin beds, fleece blankets, and bundled blue mosquito nets that hang from the ceiling line each side of the room. There is just enough space to walk comfortably between the two rows and beds. No curtains in sight, which means no privacy during rounds. Everyone listens to everyone else’s report. However, regardless of MY American HIPPA trained discomfort, the patients actually develop a comradery this way, and look out for one another. Often family members hang out and chat with each other and other patients outside in the hall. I sometimes get confused about who is related to who because they’re all “hanging out” together on the various beds. The neighbors of the patient always looks on with interest during report, which so far doesn’t seem to bother anyone (except me).
Directly across from the Duty room is Sister in Charge, and the ART med room. Anti-Retroviral Treatment (ART) drugs are distributed to HIV positive patients on a routine basis. Their viral loads are taken as needed, and their progress is tracked in a green paper register.
Down the hall from the drug room are examination rooms where patients are seen on an outpatient basis, the public health nurse’s office, the lab, pharmacy, and admitting (cashier) are located. There is also a chapel, kitchen, dining hall, and sterilization room.
Chidamoyo also performs two public health outreaches in nearby villiages. Nearby being within two hours drive, over the same washboard roads.
Once a week, the public health nurse along with 2 other nurses and a nurses aid, load a 4×4 LandRover with tables, chairs, birth control, condoms, and vaccines. On a predetermined date, they meet mothers and their children (up to five years old) at a school up to two hours drive away. The children are weighed and measured, and their health cards are check to see if they are due for vaccinations. If they are due, the nurse registers the child, records the weight and treatment on the child’s health card and the child receives the necessary vaccinations free of charge. Mothers are offered three months supply of oral birth control for $1.00, and condoms for free.
Personally, I have had the pleasure of assisting the eye health of Zimbabwe’s children by cutting the tips off of Vitamin A capsules and squirting them into the mouths of hesitant children, who are always surprised that it’s not painful or foul tasting. The public health crew will visit the same location again every 2 months.
The other outreach is the ART clinic. Once a week, different nurses load the same LandRover and head for the hills. For HIV positive patients who cannot easily travel to Chidamoyo to pick up their ART drugs and get labs, this service visits them at more proximal location. Patients are weighed and registered in the green books that the nurses bring. Labs are drawn and taken back to the hospital to be sent for reading. A supply of three months of ART drugs are given to the patients, as well as condoms. Patients are happy to wait hours even in the dusty, sweaty heat….and lab results indicate that patients are extremely compliant with the regimine and viral loads are often low or nondetectible!
My first ART clinic I helped weigh patients, and I am kind of always shocked when an adult hands me the green chart and a child steps on the scale. It’s a reality we don’t often think about in the US…but there are millions of kids living with HIV. Thanks to God and programs like these, they are able to live normal, healthy lives.
**
Zimbabweans love to joke and laugh. During rounds I don’t understand what is being said, but the doctor makes nearly every patient or family member laugh at some point, or vise versa.
I do ask for a translation on particularly hilarious occasions.
When examining a patient who was approaching delivery, the family, nurse and doctor started to chuckle.
“What did you ask her?”
“Well this is her fifth child. I asked her why she needs so many children.” (I am initially a little surprised by the frankness)
“She replied : ‘I’m a farmer….I need the manpower.'” (She was not surprised as she volleyed back, deadpan).
**
Amongst the humor and peace, there is a kindness, meekness, and joy in their eyes and I am often overtaken with emotion when I make eye contact with a patient or family member, nurse or orderly. Gratitude and glory to God pours from them, even though from the Western perspective, they may have nothing, or nothing “desireable”.
I have seen Mathew 5:3-10 come alive.
I mourn when I think many of these people desire to come to the US, to leave this world and enter our rat race. I would be ignorant to overlook the many advantages that we have been blessed with in the States, yes, but spiritually, they are abundantly more wealthy.
They live simple lives that may seem archaic to some; but are indeed pure, uneasily corrupted, and built on faith.
I am grateful for each day I have the privilege to wake up here, experience and learn from Zim’s truly beautiful people and God through them.
Even on hard days, when nothing goes right, it still feels like a miracle that I am where I am: smack dab in the middle of no where Zimbabwe bush, experiencing God.
“Blessed are the poor in spirit, for theirs is the Kingdom of Heaven.
Blessed are those who mourn, for they will be comforted.
Blessed are the meek, for they will inherit the earth.
Blessed are those who hunger and thirst for righteousness, for they will be filled.
Blessed are the merciful, for they will be shown mercy.
Blessed are the pure in heart, for they will see God.
Blessed are the peacemakers, for they will be called children of God.
Blessed are those who are persecuted because of righteousness, because theirs is the Kingdom of Heaven.”
xx~
