Home!

After many airports and long flights, we are home in the U.S.! (Most of us, that is. Kristin is visiting friends in South Africa and Hannah & Lily are in Swaziland). Please continue to pray for us as we transition back and process through the last several months.

Here are a few pictures of our time in Livingstone this last weekend! :)

On the Zambezi, getting ready to swim at the bottom of Victoria Falls!

Group shot before jumping in

We were fortunate enough to stumble upon giraffes and zebras after swimming!

Santa Baby... :)

Hey ya’ll!

So, we’re coming down to the wire. Most of us are feeling a little bit CRAZY at this point in time – with only 9 days left before we get on the airplane, way too much sugar in our blood from Shelli’s wonderful Halloween candy, and just a wee bit of senioritis kicking in…could you pray for us as we study for finals?? Thanks. J

This last week has been incredibly busy, but also encouraging and refreshing. We’ve finished our classes, given our final presentations, and finally nailed down those last clinical hours. AND on Wednesday, President Smith from IWU arrived to visit along with his lovely wife Teresa, Shelli Rowley (our amazing and talented Global Studies Supervisor for the School of Nursing – she’s been our team’s biggest support ever since we started planning for the trip!), and Dr. Rob Dawson (the Chair of Pre-licensure School of Nursing)!! While we might have been a bit nervous before they arrived, as soon as they arrived we were immediately put at ease. They have been such a joy to have here! There is definitely a new excitement and energy in our team ever since they arrived. They have brought a whole new dimension of fun to the trip. In fact, the night they arrived we got a visit from Santa Clause! Well, it was a Santa wearing red scrubs, a red towel on HER head, and a fantastic beard/white hand towel on her chin. “Children, children, gather ‘round. Come to Santa!” And as we obediently sat down around Shelli, she pulled out our magical gifts from her Mary Poppins-like pillowcase of treats.

To all our family and friends who helped Shelli plan this surprise: thank you so much! It will definitely be one of my favorite memories from our trip. :D

On a more serious note, let me share about the Helping Babies Breathe (HBB) conference that we put on this week. HBB is a program developed by the American Academy of Pediatrics for teaching birthing attendants how to resuscitate babies. 1 in 10 babies has difficulty breathing when born, and usually if a resuscitator and suctioning is available, it is not difficult to help these babies begin breathing on their own. Before we left IWU in August we were trained in HBB so that we could teach it in Zambia, which has a relatively high infant mortality rate in certain provinces.

Many of us have spent the whole trip planning a conference to teach HBB to traditional birth attendants (TBAs) as our semester project. It was a bit nerve-racking when the day of the conference actually arrived on November 1st. We had planned for all the worst-case scenarios, and the TBAs arriving late or throughout the day was our biggest concern. If you don’t know already, Zambian time is…not prompt. :D We had previously put on a conference for nurse midwives, and the first person showed up a half hour late while the last person got there a half hour before the end of the conference. Naturally, with the TBAs travelling to Zimba from rural villages, we figured people would arrive throughout the morning and we would need several venues and teaching groups to make things run smoothly. With many other concerns, we were really praying that the teaching would go well.

I need to back up a bit in my explanation. TBAs are the birth attendants in rural areas of Zambia. Many women live so far from the hospital that to travel there for their delivery would take anywhere from a day to several days of walking. While TBAs do not have any formal education, they are the respected authorities on birth outside of the hospital setting, and they are very respected in their communities. However, they do not have the emergency supplies available to hospitals. By attending this conference, they would both learn how to use these sorts of supplies and receive their own set (a bulb syringe and a resuscitation bag) that they could use in their rural work. 

God answered our prayers more fully than we could have ever expected! The TBAs (who we found out had all been instructed by the hospital to arrive at 8 am, two hours early) were all on time at 10 am! And while we had been expecting 12 TBAs (we really didn’t think everyone would come), 16 people showed up and were excited to learn the material! Nurse midwives from the hospital translated for us, and even did an impromptu skit demonstrating the material (the women loved it). Overall things went smoothly. We had periods of “lecture” and hands-on practice resuscitating our mannequin baby (Neo-Natalie). :D Throughout the day we heard lots of laughter as the women practiced and helped one other improve their skills.

In the middle of the conference we treated all of the women to lunch at a local restaurant, and then returned to have more practice time. One of my favorite parts of the day was the end when we presented each of the TBAs with a certificate of completion. Dr. Rob Dawson handed each TBA their certificate amidst enthusiastic applause, and many of the women danced and sang on their way up to receive their certificates. It was a hoot. :D

At the end of the day, many of the women said, “Thank you for this knowledge! We are so happy to get more education. And you must come visit us in our villages to see how we are using it!” The women were so thankful and excited to go home with their certificates and supplies.

We think that this will be a really sustainable program here in Zimba, and after watching the nurse midwives get excited about teaching the program, we hope they will continue to use it in the following years. And we pray that through HBB and the help of these TBAs, many more babies will be given the precious gift of life.

Thanks for your prayers. :D

In Christ,

Andie Rempel

At the girls school! 9 of us are in the picture... try to spot the white arms in the back! :)

lately in Zambia...

Did you know… that we have discovered every possible way that cabbage can be prepared? During our adventures in Macha, we consumed cabbage raw with lots of mayo, cabbage cooked in oil, boiled with TONS of pepper, raw and plain, raw with mystery vinegar sauce, or raw with pepper… everyday. : )     Now, whenever anyone mentions cabbage, we all laugh and groan simultaneously……  

Though exhausting, the end of our 3 weeks in Macha was really positive. 9 of us had the opportunity to teach at the local all-girls boarding school on our final Tuesday there. Hannah, Andie, and I (Elisabeth) decided to do a talk on purity, which is especially applicable with the high prevalence of HIV/AIDS.  However, purity is such a holistic topic, and so I was thrilled that we had the freedom to talk about mental, emotional, and spiritual purity as well as the physical aspect. We talked to about 100 tenth graders (in groups of about 20 at a time) and had lots of questions and interaction with the girls afterwards.  I was definitely blessed through our challenging experience at the school. I hate speaking in front of people, but absolutely love one-one-one conversations. Right after we finished teaching, the girls rushed up to all of us, requesting to touch our hair! : ) after mingling in the excited chaos for awhile and meeting, talking, and laughing with lots of the girls, a quiet girl in a grey, knitted winter hat came up to me. She timidly asked if she could speak to me in private. As we walked towards the corner, she said “you remind me so much of my mother—she had the same name as you, but she died two years ago.” We talked for quite some time, and I am really thankful for the opportunity to connect with and encourage her. Most of us came away from this neat experience with several pen-pals : )  

There is a Malaria institute in Macha that was set up through John Hopkins doing groundbreaking research in Malaria, and we had the opportunity participate in some of their initiatives. Hannah, Mim, and I went out on a longitudinal study with 3 research staff, visiting 3 households and taking 9 people’s blood samples… and it took us a whopping 5 hours to drive through the bumpy, bumpy trails (sometimes just walking paths) way way out into the bush. In true African fashion, we drove about almost an hour out before we received a phone call saying that the staff had forgotten some equipment back in Macha… so we had to turn around and drive back again. I was pretty car sick for 2 hours, but had a fun time after that. We had some amusing conversations with the 3 Zambian staff members while we bumped along the trails, and enjoyed interacting with the people we tested for malaria. One lady spoke no English but was SO thrilled to have us come to her home (even though we were there just poke her and get blood samples…) She gave us a bag of groundnuts (peanuts) that she had grown and shelled and told us (through translation) that she wished she had known we were coming because she would have made us N’Shima (a starchy cornmeal dish that is a Zambian staple). Over and over on this trip we have been so humbled and touched by the extreme joy and utter graciousness of the friendly Zambian people—they are so quick to extend love, generosity, and hospitality, even if they are very poor. 

Our final morning in Macha was spent out in a nearby village getting a small, small taste of “African village life.” Ms Mukonde (a retired Zambian nurse who has traveled with us and helped with clinicals and lots of other things) set up a village that we could visit for a few hours. We took gifts of cooking oil, kapenta (teeny fish), and BOOM (soap) to give to the village chief and several other families. We had a small village tour and then split up to try our hands at different tasks. Ashley and Abby went to pump water and carried several gallons of water back on their heads! They said that pumping the water was really hard work, and Ashley had a humorous experience where she almost lost her chitenge and Ms Mukonde came to the rescue and walked alongside her holding it up. Several of us plucked dried corn kernels off the cob (it was hard!) and then Andie single-handedly used a mill to grind all of the corn. Hannah and Marguax washed pots with clay and soap – the Zambian women told us several times that we had “soft hands” – meaning we didn’t do a lot of hard work. After finishing the corn, the rest of us cracked open groundnuts (mini peanuts) and learned how to pound them with a big mortar and pestle and sift the fine protein powder. We laughed with and were laughed at by the Zambian ladies for most of the morning as we experienced a tiny piece of their daily lives. I absolutely love how smiles and laughter cross all linguistic and cultural barriers.

One night in Macha after coming back from an evening shift at the hospital, Abby randomly suggested that we go surprise Christmas caroling. So we all grabbed some little Tonga hymnals (simulating caroling books), used our chitenges as scarves (it was only about 90 F outside….) and I grabbed the bells that hung on our entrance door. We piled out of our hostel and snuck through the darkness to the Bence’s house. We burst out into “silent night,” followed by “jingle bells” and “we wish you a merry Christmas.” Unfortunately our hosts did not have any cookies or hot cocoa ready for our arrival, and I’m sure that our Zambian neighbors thought that we were totally crazy. Grabbing Dr Bee’s new African drum, a few new carolers, and a bunch candles, we headed over to Aunt Judy and Uncle Bud’s house and caroled for them. Sometimes the most fun times happen in those random spontaneous moments :) We had a total blast that night. 

To catch you a bit up-to-date on our lives, the last 10 days back here at our home base in Zimba have been absolutely packed as we wrap up our classes, prepare for finals (this coming Monday and Tuesday!), and finish up papers and projects. We had the joy of spending all day last Monday out in a rural village doing home-based care with some Zambian ladies from the church here – I believe Ashley will be writing an update for that, and yesterday (Nov 1) we put on a conference for midwives and Traditional Birth Attendants – stay tuned for and update from Andie : )

IWU’s very own President Henry Smith and his wife Theresa arrived on Wednesday to visit us for a few days, along with Dr. Rob Dawson and Shelli Rawleigh from the nursing division. We have enjoyed interacting with them. Last night we walked out to our favorite sun-set viewing spot, and Dr. Dawson joined in a game of football (soccer!) with some of our team and a TON of little Zambian boys who were absolutely thrilled to play with a bunch of Muzungus (white people.) It’s been fun to interact with our American visitors and exchange stories. 

We were absolutely delighted to discover that SANTA himself had also come all the way from America, wearing red scrubs and a white-towel beard, and bringing gifts and cards from our families and TONS of candy from home! A HUGE “twalumba” (thank-you!) to all of you who sent us stuff – we feel so cared for and special.  

Today (Friday) we spent several hours doing presentations to our profs and the President & company, recapping our 2 leadership projects and all of our community health initiatives. We had some teary moments as a team (with several tears from the audience) as we recounted our many memories of the joys and difficulties that we have encountered this semester – even though we were doing “academic” presentations, I felt like our team was further able to grow and process through some of the hard things as we shared our experiences. This coming week (Wednesday onwards) we will begin the long process of debriefing and processing through our time in Zambia, and we will also talk about how to transition back to the USA. We would LOVE your prayers that we would process through these things in a healthy way. 

Tonight we will have a “kick-back” evening of fun just hanging out with President Henry, having a traditional Zambian meal for dinner, making homemade pretzels, and having him taste Maui fruit!

Happy Friday from Zimba, Zambia!

~ Elisabeth / Lily (aka Lil, Lils, Lilith, Lillian, or Lithotripsy as the team calls me…) 

p.s. many of the Zambians have awesome names that are much more fun than the many nicknames names I have accumulated on the trip. Some of our new friends include Office, Fax, Pelvis, Happy and Happiness (husband and wife!), Rocket, a little boy literally named Trouble, Severe, Moderate, Family, Hitler, Clever, Fridge (short for Refrigerator), Family, Memory, Fortune, Hipower, Elite, Progress…. I could go on and on. :)

Andie and Kristin trying the infamous Maui fruit -  A sour, extremely slimy seed that you suck off and spit back out.  Kristin, Jamie, and Lily all played chubby bunny afterwards. They also double quite well as bowling balls....

The female ward in Macha - about 40 patients to 2 nurses

 

Nothing beats these beautiful African sunsets!

One of our favourite past times - sunset watching!

Abby and Haley with a Zambian midwife the baby the girls delivered!

Jamie A. and Ashley all ready to catch a baby after a C-section

Chipego breathing on his own :)

“Shall we accept good from God, and not trouble?”

The bright African sun beat down from its perch in the cloudless blue sky as the usual haze of red dust circulated about my feet and clung to my shoes and scrub pants. I smiled as I pondered the irony that every day I was blessed to walk in 90 degree weather on a rocky, dusty path through the African bush to get to clinicals, while my American counterparts were driving their cars through the chilly Indiana rain. Despite the many difficulties of living life and participating in health care here in rural Africa, it is a huge, huge privilege for us to be in Zambia. 

On our first day of clinicals in Macha over three weeks ago, I was doing rounds with the doctor in the morning and we came to a young patient who the doctor explained was 24 weeks pregnant and diagnosed with an “inevitable abortion” (miscarriage). He then asked me, “What is an abortion?” I replied that in Zambia, the word “abortion” was generally used to refer to either the unintentional death of the baby (miscarriage) or the intentional termination of an unborn baby. (Only recently legal in Zambia). The doctor rather indignantly replied, “why do you keep saying ‘baby’?? At 24 weeks it is a fetus. You can’t keep calling it ‘baby’—only after 28 weeks can you say ‘baby’. This is just a fetus. What do you think?”  It took me a second to realize what he was saying. I was a bit shocked at his forwardness about this topic, but firmly replied “No, I disagree – I believe this is a baby from day one. On day one there are living, human cells, and I believe that they are always babies from the moment of conception.” Laughing at me, the doctor moved on to examine the next patient. 

Later that night, a nurse walked into the Maternity ward that I had rotated to for the evening, carrying a tiny little baby that wasn’t breathing. The baby turned out to be that very same 24-week-old “fetus” that I discussed with the doctor earlier that day. The nurse placed him on the scale to weigh him and kept standing there. His tiny lifeless form was quite blue, and I asked her several times if he was breathing. She did not really respond, and eventually stepped aside. Immediately I checked his heart rate—and his little heard was beating hard and fast—he was still alive! I put him on the warmer and Jamie and Marguax helped as we began to try to stimulate his tiny body and get him to start breathing. I kept getting a bunch of meconium-stained fluid out of his airway (basically poopy, amniotic fluid). We ambu-bagged him (emergency resuscitation), prayed and prayed, stimulated, suctioned, ambu-bagged, put in a bit of oxygen, and kept repeating the cycle. Finally, I will never forget the moment that he gave a tiny gasp, his skin retracted against his tiny rib cage, and he took a breath! What a miracle! Preemie babies do not have a big chance at life here in Zambia, but life is definitely gift from God. God gives and He takes away. Blessed be His name. I am thankful that even for just a little while we could give this baby life. Almost this exact situation happened to 2 girls of our team just a few weeks ago and so it was an unreal situation to walk through, and difficult to process and sort out in my heart and head.            

 I hope that the doctor came around the next morning and saw the living, precious little human life. Over the next several days,  we checked in on the baby, rejoicing at the miracle of this little life. One day I went in, and he was no longer in the warmer. I searched every room, and he was gone. We asked the nurse and she said that he had “expired.” Originally I had my hopes up that he would make it, but knew his chances were slim. His internal organs were so underdeveloped and no sophisticated machines exist over here to help keep him alive. The father never showed up to name the baby before he passed away, so, (at least for my own sake) I named him Chipego, which means “gift” in Tonga. God graciously gave Chipo a few days of life, and in His wisdom decided to let Chipego’s human body die. I have been encouraged by reminders from Isaiah, recognizing that God’s ways are higher and far above what I often think would be best, and I have been challenged by Job’s assertion, “Shall we accept good from God, and not trouble?” God is good, always. 

On another evening shift later that week, we had an incident where the victims of a car crash were brought in to the hospital, several already dead and one lady in a critical condition… she ended up coding and a Zambian doctor and Haley, Kristin, and Abby rotated doing CPR on her, but she passed away. A week ago, while pushing a patient to Surgery, a procession of women, wailing loudly, wheeled the covered body of a small child out to the morgue. I have seen more death here than in my entire life combined. In the West, death is viewed as the ultimate enemy, and we do everything we can (especially in the medical world) to fight it, avoid it, and delay it. For the people here in Zambia, the idea and concept of death is so much nearer and tangibly real—people are almost fatalistic about it all. I struggle to reconcile these differing cultural views, remembering the fact that we live life in a broken world, and yet simultaneously clinging to the truth that Jesus won victory over sin, suffering, and death through His perfect sacrifice—and that as believers we have ultimate hope beyond the grave. 

One of my friends in the States put it well—“nursing itself is hard enough [emotionally], let alone doing nursing IN Africa.” I have never seen so much physical suffering in my life. As a team we covet your prayers that God would help us to process through things well, and that lessons and themes would emerge out of the weeks and months that we have been through so far. Every day is so full of so many new experiences it is so hard to sort things out and make sense of all of the pain and suffering we witness. I have been so encouraged by 1 John 3:20: “For God is greater than our hearts, and He knows everything.” When my heart flails for answers and I can’t figure things out or make sense of them, I can rest assured in the understanding that GOD knows everything. HE is in control, and He has reasons and purposes.

Please also pray that, as we wrap up our final 15 days left in Africa, that we would still be present and make the most of our days, hours, and opportunities while we are still here.

love,

~Elisabeth

It's a Bug's Life! (Musings from Macha)

Hello friends & family!

Well, no one has updated the blog since we’ve been in Macha, so I figured it was about time. I’ll give a brief review of some of what we’ve been up to.  It’s been a challenge processing through some of the difficulties, so here are just some of the experiences of daily life here.

Macha is a much more rural area than our previous locations. We’ve been doing our clinicals at the Macha Mission Hospital, a teaching hospital associated with a nursing school here. We’ve also had good learning experiences from the Macha Malaria Institute, and many of us have been able to go on field outings with the researchers. In 1998, malaria was the #1 admitting diagnosis at the hospital, and the #1 cause of death in 2000. Through the Malaria Institute’s work, malaria has been 97% reduced here. Pretty amazing!  

The hospital is quite a bit larger than Zimba or Choma, so we’ve had some more interesting clinical experiences. Many of us have gotten to deliver babies! We have particularly enjoyed one of the midwives, Gladys, who encourages us to jump right in. Whenever it’s time for a baby to come she asks, “Who’s delivering this one?” and one of us enthusiastically (or maybe not so enthusiastically if it’s 3 am) puts on an apron and mask and has the incredible opportunity of assisting brand new life into the world.

One thing we will NOT miss about Macha are the creatures. Evenings are often filled with the shrieks and screams of girls tormented by spiders. ENORMOUS does not come close to describing these fuzzy, fanged devils. Abby, Hannah, Jamie A. and Lily also saw the first snake of the trip (a spitting cobra) one evening at the hospital, and they watched from a few feet away as a brave woman hurled large rocks at its head.  

Personally, one of my favorite things about Macha is being able to walk through the rugged, African landscape and experience the beauty of this country. I enjoy passing by the little villages and seeing the faces of people who live so differently than me. A few of us climbed a nearby water tower and soaked in the view as children below yelled repeatedly, "How are you?! How are youuuuuuu?!" We stand out enough as it is, so I can only imagine how humorous it looks for a group of “mzungus” (white people) to congregate on top of a water tower!

One of our projects for our community health class is to do a teaching initiative. On Tuesday, a group of us  are going to a local girls school to teach the tenth grade class (about 100 girls) various topics including nutrition, hygiene, how to handle stress, and purity. We’re also planning a conference, “Helping Babies Breathe,” coming up in several weeks for 12 traditional birth attendants. HBB is a curriculum that teaches neonatal resuscitation. It will be neat to educate the birth attendants, and we are even providing them with ambu bags (bag-mask resuscitating equipment). We were trained in HBB back in the states and have, ourselves, been able to use what we’ve learned in clinicals. Please pray for both of these initiatives!

Tonight we are going to a nearby restaurant and a local band is going to play for us. It will be a nice break from the rice, cabbage, and mystery sausage that we frequently have here!  (Who knew you could eat cabbage in so many different forms?!)

We appreciate your continued prayers for our team, and we are eager to see our friends and families in a few weeks!  

-Lauren

Cute, isn't he?!

Andie, Hannah, Lily, & Jamie enjoying the view from the water tower!