HALLO MR. CHINESE LADY BABY!

 HALLO MR. CHINESE LADY BABY

There is a bicycle táxi driver in town that greets me everyday. He screams out, “ Hallo Mr. Chinese Lady Baby” as he passes me, giving me a fright every time.  Surely he is using every English word he knows and he compacts them all in one exuberant salutation.  My neighbors have a cadre of names for me as well.  The adults call me Mama Hobin, Mama a term of respect here in Mozambique.  Robin seems a hard name for them to either hear or say.  Hobin is the result.   The children call me Rubin, Robini and other more or less similar versions. 

I don’t correct anyone.  I answer to them all.  It isn’t the words or the sounds that matter, but the communication intent.  And that, any language instructor would say, is the central obstacle to language proficiency.  Diction, sentence structure and conjugation are key elements, and shouldn’t be ignored.  Yet, as with most things, I go about my language learning differently.

Walking down the hospital corridor last week, I tried to side-step an area of the just washed floor.  Making eye contact with the maintenance man, I smiled.  He smiled back and said, “F—k you”.   It wasn’t until I turned the corner that I realized he had spoken to me in English.  And, I realized just what he had said.   I returned to find him in a huddle with the cook, both of them giggling like naughty children. 

Mary, the cook, and the maintenance man, have been practicing various English words and phrases.  The maintenance man told me he hadn’t meant to say this out loud.  He had been repeating the phrase to himself and it just popped out when he saw me.  They were both embarrassed.  He had no intention to offend,  he just desperately wanted to try out a little English.   They happily accepted my offer to share more useful phrases.  Our friendship was cemented with that exchange.

Mary, the kitchen worker.  Who could imagine this sweet face
saying such things?

It wasn’t their choice of words that mattered, they simply wanted to communicate.  Like my neighbors and the bicycle taxi man, people use the words they know, even if the words aren’t the best choice, are pronounced wrong, or make no sense at all.  The intent is to communicate, to connect.

Since my arrival, I have stumbled with Portuguese.  I found myself responding in Ukrainian, or with bits of French and Spanish.  My talkative and expressive self was mute, held captive by this language I simply couldn’t seem to speak.   So, I decided not to speak at all, but to listen.  But even this proved difficult, as I couldn’t decipher the sounds.

Most Mozambicans, when they speak, are barely audible.  Their voices are quieter than a whisper.  I am not sure if this is a remaining effect of colonialism, but when posing a question to a Mozambican, it is not uncommon to receive no answer at all, or at best, a hushed response.  For someone trying to learn the language, and having a hearing deficiency, it was maddening. 

My language learning needed a new strategy. I couldn’t rely on learning from my colleagues when I wasn’t able to understand   them, let alone hear them.   I realized I first had to listen to myself.   I had to hear my own anxieties and my needs.  I had to put first things first.  This included making a comfortable home, learning how to do all the new daily activities, and integrating into my surroundings, regardless of the language.  I had to settle. 

It probably took me longer than other Peace Corps Volunteers, but I was able to find a way to communicate more comfortably.  I sought out quieter environments, conducive to personal or small group conversations.  I read Portuguese Peace Corps manuals at night to increase my vocabulary and to better understand sentence structure.    But most importantly, I let go of the constructs of language success, constructs that I had allowed others to define.   

My language has improved these past weeks, as if by mere chance.  I still fumble with pronunciation and sentence structure, but staying true to my belief that it is the intent of communication that matters, and not the specifics, allows me to relax.   Being non-judgmental with my own use of language, as I am to others, seems to have opened the gateway of my brain’s language receptors.   And, in this state of mind, connecting to others is easier.  I am not sure if I have strung together phrases as strange as, “Hallo Mr. Chinese Lady Baby", but if so, I hope others enjoyed it.

The Mobile Clinic

I love the efficiency of the Mobile Clinic, sponsored by Columbia University, PEPFAR, the CDC and the Mozambican government.  My colleagues normally insist that I sit up front to enjoy the air conditioning and the area views from on high.  But, I prefer to sit in the back of the vehicle.

Mobile Clinic - side door for vaccinations

The small chairs fold down and we strap ourselves in for the bumpy journey.   The drawers latch shut, keeping medicines and stethoscopes and log books in place.  Folding chairs supplied by a major USA camping outfit are stored neatly in between the cabinets.  The heavy metal ladders that allow us to exit and enter the side and rear of the van lock into the floor.

Enter here to begin with consults 

I look out the window and see only the tops of coconut trees and blue skies that are full of puffy white clouds, the kind of clouds that make you feel like an eight year old girl, the kind of girl that dreams of unicorns and fairies and purple ponies.  The litter-lined streets and the mud houses and the throngs of people moving along the side of the road don’t exist for the moment.  The chaos of Mozambique is far, far away when I sit inside this well-organized, expensive and sterile mobile medical unit.

The place we are travelling to, and where we will dispense medicines and provide consults for the day, has been built in a cleared area.  Trees have been felled to make room for hundreds of tents.   Severed trees and stumps sharply stick out of the land, fooling one to believe that the flood had violently torn them away.  But this area is above the flood zone.  The damage to the land was made by man, for man.  Cooking fires smoke in front of the heavy canvas and plastic tents as the residents sit languidly on tree limbs, their gaze lost to the smoke and embers.  The scene is straight out of a low budget apocalypse film.

Outdoor Cooking Station

Surveying local families

Our team of five visits a handful of tents to survey them about their conditions.  We ask if they received mosquito nets, and if so, we request to look inside to verify that they are in use and hung properly.  We quiz the residents on the use of the water purifier and ask if anyone in the household has had malaria in the past two weeks.  Half of the families are not using the nets.  They tell us their daughter has taken the net to the river for washing.  We explain that the nets do not have to be washed for the first three months.  They were distributed only a few weeks ago.  Likely the nets are being safe-guarded by the family, as a prized possession, or they have been sold.  Only a handful of those asked know how to use the water sanitizer.  Most of the bottles are yet unopened.

Raised bed with mosquito netting

Tent wtih no flooring, mosquito netting tied to tent posts

Mosquito netting over straw mat

Wordly Possessions

The tents have no flooring and no ventilation.  For those using the nets, they sleep on straw mats and tuck the sides of the netting underneath them.  One family built a raised bed, meant for four, with the net hanging from the ceiling rafter.  Plastic water jugs and plastic plates and cups sit to the side of the tent.  The blankets are used as doors.  Some families drag large pieces of trees indoors to try to keep them dry from the rain that continues, almost daily.  Three stones make up the outdoor fire-pit, most of them burning throughout the day.  Dishes are washed outside and dried on a table made from sticks.

Drying Rack

Firewood stored inside the tent

Crews have built latrines throughout the camp, each providing six individual stalls.  Three- sided shower areas, sheeted in the same heavy black plastic as the tents, dot the landscape.  World Vision and US AID use these temporary homes and shower stalls as billboards, their names printed larger than life on the material, as if this is the latest trend in humanitarian advertising.

Women's Latrine with hand-washing station, called Tippy Taps ( yellow buckets )

I think of all the camping trips I have enjoyed, and those I haven’t, usually due to rain.  My mind flips through the pages of the L.L. Bean catalog, imagining all of the fancy gadgets available to our American need to tame the outdoor experience with luxury.  And, I realize that these people aren’t in these tents as a choice, or for recreation.  They are there with families, some with small children, up to eight people living in one tent.  They will live in these tents for up to four months, at which time the government will be able to supply them with metal roofs and cement to build a proper home. 

But for now, as the rains continue to pour down, life in these camps will continue.  Roughly 90% of those who come to our clinic are sick with malaria, in addition to respiratory illness and stomach malaise.  We hand out malaria meds like candy and offer paracetamol and other benign pills to attempt to counter their discomfort.  It is surely not camping like I have known and I doubt that I will ever think of camping in much the same way.  But at least, for a few moments, we can offer these people a clean and somewhat hi-tech experience.

KWASHIORKOR

KWASHIORKOR

Last week, when visiting a nearby community that had been severely impacted by the recent floods, we came upon a child with a serious case of Kwashiorkor, a common nutritional problem caused by a serious lack of proteins.  The effects of Kwashiorkor are as bad as the word sounds.  These are the children with the distended bellies.  Edema swells up their legs and arms and even their faces.  Skin rashes often cover the body.  Left untreated, this nutritional deficit can cause damage to the immune system, mental and physical disorders, coma, shock and death. 

The mother had come to our clinic with two other children, suffering with malaria.  She mentioned having another child at home that also needed care.  She did not share any information about the symptoms or severity.  She disappeared into the crowd after being given the malaria medication for the children. 

Once we had distributed all of our medicine and packed up our remaining supplies, we made our way back to the center of the village.  There almost everyone was gathered under the large mango tree, sitting in the dirt.  Children ran about playing with sticks and the refuse from our consults; scraps of paper, a few empty boxes and small round pieces of plastic that had encased the syringes.  The men were off to one side, sitting on what looked like handmade wooden bleachers.

In the distance, I saw this same woman arrive on the back of a bicycle with a fairly large child on her lap.  She placed the child on the ground and repeatedly tried to pull the girl’s t-shirt over her belly.  They made their way towards us, the child walking as if she had prosthetic legs.  It wasn’t until they were in front of us that I saw the suffering of this child.  I have witnessed Kwashiorkor before, and probably cases as serious, or even more serious, than this one.  Yet, this was the child in front of me here and now.  Having experienced this before seemed not to matter.  It was this child who mattered.

We asked questions about the child’s diet and food habits.  We inquired about other illnesses and symptoms.  Had the child had an HIV test?  The parents?  Often the body is unable to absorb nutrients if it is battling with another disease.  We asked if any medical assistance had been attempted.  What about a father or husband?  The woman pointed towards the crowd of men.  His wife went to him to request that he join the consult.  When asked why this child hadn’t been brought to the hospital, he said that he had been away, working at the garden, and was unaware of the problem.  When he returned, due to the flooding, the roads were inaccessible.

It is so easy to allow one’s anger to quickly place blame.  My mind instantly raced with accusations. “How had the mother allowed this child to become so sick?  Why had the neighbors and others in the community stood by silently?  How can it be that compassion is so absent in this place?”  But, of course, it is never that simple.  There are many layers to understand, and being an outsider, unraveling the threads that are the details, the ethos, the challenges, and the beliefs, well, that is a complex process.

Women in rural Africa expect some of their children to become sick and die.   Should they choose to use a local healer, and see little to no results, they accept that the illness is not curable.  Or, if they seek medical attention, often at a late stage, it is likely that they will not follow the suggested regime.  This is so for many reasons, culturally and logistically.  Possibly the medicines initially make the child sicker.  Maybe they do not have the foods that the medical technician suggests, or that the foods suggested are simply not accessible or customary.  The hours of giving the prescribed medicine might be forgotten or not in sync with the daily schedule.  If parents are in the fields all day, they may not take the medicines with them.  Maybe there isn’t a sufficient supply of water, or clean water.  The list of challenges is a long one. 

A mother might seek medical attention at a local clinic, and possibly more than once.  Often, the help is too little too late.  The result is that there is doubt in the medical system.  And, if a sick person is sent to the district hospital, usually as a last resort, the person often dies while admitted.  This family, and their neighbors, aren’t apt to use the local clinics and hospital again.  But, none of this means that the parents are uncaring.  There is simply a way of life here, maybe even a value of life here, that is different.  It exhibits itself as acceptance, almost non-chalance.  For generations of people who have not had the resources, or the power or position, usually resulting from a lack of education, a way of life is developed... and perpetuated.   It is a tough cycle to break.

Many women are left in the village, without the support of their husbands or fathers of the children.  There is often no money. Literally, a woman may have no money.  Women and children survive by eating the food from their gardens.  Some families get donations.  If a woman could gather the few coins to hire a bicycle taxi, or get a ride from one of the scarce vehicles passing through these rural places, there is the question of who will care for the other children while the mother is away.  

If a person is admitted to the hospital a family member must accompany them to provide care.  There are no bed railings, or cribs for small children or babies, no laundry care (there are no sheets on the rubber mattresses), and no staff to attend to patients during the evening hours.  The hospital staff do not give baths or feed patients.  It is the responsibility of the family member, who sleeps in, or under, the bed of the patient.

And, the hospital staff have their challenges as well.  Most hospitals do not have running water.  Large rubber buckets of water stand in the corner of most rooms.  There is no air conditioning and often the ceiling fans do not work.  Furniture is old and rusty and usually broken.  Due to the dust and dirt, it is difficult to keep the hospital clean.  There is never enough supplies like paper and pens. And there are crowds of patients needing care each day.

What is possible to us, as Americans, doesn’t exist here. 

Our framework and context to address problems is useless in these places.  What might seem simple and straightforward is actually complex and complicated, murky, at best.

We had another child, from the same village, admitted with Kwashiokor the week before.  In a matter of days, the swelling in the little girl’s arms and legs had noticeably improved.  Her face had been so swollen that she was unable to open her eyes. Her body was expelling the fluids, and she was losing weight appropriately.  Her diet is therapeutic milk, given every three hours.  It will be some time before other foods can be introduced to her diet.  She has also recovered from severe malaria.  She is improving, slowly, but surely.

There is hope for these cases.  Each day I check the ward to see if the other child from this village has been admitted.  I haven’t seen her yet.  Maybe her parents could only take her to the local clinic and not make their way to our district hospital.  If not, maybe when we go out there again next week we will convince the parents to return with us in the ambulance.  I can only hope.  Meanwhile, I know that I can’t always understand the life here.  But, I can surely feel the struggle.

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Note:  I did not take any photos of these children or their families.  If you would like to learn more about Kwashiorkor, there is plenty of information and photos available by a simple Google search.

Namitamguirine

 Dirt road to Namitamguirine, note drop off tarmac!

Our jeep bounced off the tarmac onto a worn dirt path. Ceaseless foot travels of the local people carve these trails out of the thick vegetation or pound them into the hard earth.   It seems that everywhere in Africa people are always moving; moving at all hours, moving to and from.  The dirt paths leading off the highway are endless, all leading to a village that looks just like the countless others.

The rains from the past two weeks had flooded the area.  Like the NGO vehicles we passed on the highway, we were trying to reach these areas to deliver medicines, water purification products and medical care.  The first response organizations had provided large canvas sheets for tents to be erected as temporary housing.  Bags of flour and cornmeal, along with boxes of oil, were being distributed by a religious charity when we arrived.

Temporary Housing for Flood Victims

Instructions for food and medical distribution  

As there were no gardens to work the villagers gathered daily under the large mango tree.  All the crops had been washed away and the land too flooded to replant.  The people sat in the dirt, retelling their stories of the heavy rains and floods, as if the retelling might somehow remove their sense of incomprehension and futility. 

Kids carrying our medical supplies and table and chairs

We unloaded our boxes of supplies and stacked them in the dirt.   Three children ran to us, picked up our supplies, and on their heads carried them, along with a plastic table and chairs.  This was to be our office for the day.  We headed down a sandy path to be closer to the temporary housing.

We were ready for consults and to dispense medicines and vitamins.  Children were given Vitamin B and a de-worming pill. Sweet tasting, the pill leaves a chalky outline around the mouth, ensuring we wouldn’t miss any child.  Mothers crowded around our table, seeing no need to form an orderly line though we repeatedly requested them to do so.   

The Doctor Is In: Malaria Tests, Medicines, Water Purifier
 and Birth Control

One side of the table was arranged for consults, the other for family planning.  The consults were with our hospital pharmacist, the family planning with a technician.  The consults went a bit like this:

Techinician: “How do you feel?”

Patient: (covering their mouth with their hand, whispering and leaning in towards the technician, desperately attempting some sense of privacy though their neighbors were packed up against them.)  “Cough, headache, blisters.”

Technician: “Where do you live?”

Patient: “La” (there) They don’t point to any direction or provide any landmark.  “There” is the only word they utter.

Technician:  “ Age?”

Patient:  No response.  Sometimes a soft giggle.

Technician: “You don’t know.  It’s normal.”

The technician instructs me to count out three to ten pills.  We have three types of pills, various forms of aspirin.  Using square scraps of paper that had served as hospital admission slips the previous day, I try to fold the paper like my colleagues, making small flaps that tuck in, safeguarding any tablets from falling out of either end.  Never having been good at origami, I simply twist the ends, and hand what looks like a wrapped piece of candy to the patient.  The consult is over.

The patients report more or less the same thing and no one is very descriptive. Two or three words at most are offered up to assist the technician in understanding their maladies.  Some patients self-diagnose, telling us they, or their children, have malaria.  Mosquitos are breeding in the standing water near the homes, increasing the already high level of cases in what is now malaria season.  Simple malaria tests are given to the children, all but one positive.

A few patients are instructed to go to the District Hospital, something that is unlikely as the distance and cost of transport is difficult for these people.  After three hours under the hot sun, the crowds are starting to thin out.  Two women come to the table a second time.  They noticed some people were given yellow tablets, not white ones like theirs.  They ask if they can have the yellow ones.

Only woman and children approach us for medical care.  The children are dressed in rags, clothing torn and filthy.  Their faces are coated in snot and spit, flies rest in their spittle.  They could be the African children in the iconic photos used to garner sympathy for donations.  Many of the mothers have one breast hanging outside of their blouse, a baby or small child sucking or grabbing onto the end.  Having breast-fed children before this one, their breasts hang low and heavy, functional and worn.

We’ll return here for the next few weeks or months, trying to do what we can as this community rebuilds.  Now, there is too much rain and not enough sun to make more mud blocks to build the houses.  It will be some time before these people move out of the tents.  And cultivation can’t begin again until the rains stop and the land dries. 

More Temporary Housing

I often wonder why it is such hardship exists in these places.  And, I am saddened and confused and angry to witness the suffering.  At times I engage in mental gymnastics trying to ascertain some logic, a shred of understanding.   But it doesn’t come.  And I don’t think it ever will.