Final Days

---

Pictures! They're all just going on this entry because that's easier! I also added 1 to the Livingstone Island entry (very beginning of Zambia) and a couple to Zimbabwe part 2. More from Halloween and recent events hopefully to come soon...

First off... woohoo for Obama! When I woke up Wednesday morning I turned on the news to watch the results come in, but the decision was already made! Obama won! Definitely made my day! Everybody was kind of amused that I was so excited but I think everyone was happy. Apparently in Kenya they made Wednesday a National holiday to celebrate Obama (because his dad is Kenyan).

Wednesday I was at Linda in the morning. It was REALLY slow! Not many patients at all. I'm not sure why... I saw the first patient turned away for not having money. Usually if a patient doesn’t have money they’re allowed to go in anyway. There’s a poster in Maramba clinic that explains who gets free healthcare and one category is people who can’t afford to pay. One person actually got turned away. I don’t know if maybe she did have enough money and just had to go home to get it or if she actually was denied care (since I can’t understand Nyanje I’m not sure). Hopefully she just went to get money. She didn’t come back though; at least not before we left. In the afternoon I had hospice. It was my first time there and I was really impressed! It's really high quality! The outside and inside both look really nice and they have pretty good technology. It's pretty new so they only have 7 patients so far but it's in the process of expanding. The patients don't pay anything but there are pretty strict requirements to get in because hospice has to pay for funerals. There was one little baby who volunteers at African Impact managed to get into hospice. She was one of the home-based care patients. 11 months and only 4 kg. That's ridiculous! She's doing a lot better now. She can sit by herself for a little while but her legs are still tiny so she can't stand at all. She looks about 5 months old. I played with her for most of the afternoon trying to get her to use her muscles a little bit and move around. She is absolutely adorable! Sad story though. But getting her into hospice almost definitely saved her life. It's nice when us volunteers can have a real impact like that.

Thursday I had Maramba home-based care in the morning for the last time. I think I'm going to miss it! We got done with home-based care early so Jane and I went to the TB lab at Maramba Clinic. They weren’t ready to look at the new slides yet, but one of the technicians showed us some slides from the day before so that we could at least see what TB looks like. It was pretty interesting to see! There are 2 different ways of staining. The main one is fluorescence. It’s easier to see as well. The TB show up as bright yellow/green flecks on a black background. The other method they’re reddish flecks on white but they’re harder to see. The severity of the TB is determined by the amount of TB per high-powered field. You don’t get this kind of opportunity at home so I’m really glad that I got to see it! In the afternoon I had HIVE. We were talking about what HIV does to your body, how the immune system works (both healthy and with HIV) and VCT (testing for HIV). We were also supposed to cover ARV's but we ran out of time. Brave was especially long-winded in his translations! We started really late as well because the women were really late showing up. There were 16 though which is good!

Today I was at Linda again in the morning. Probably my last time unless that’s where I’m assigned on Monday. I sat in with the clinical officer for most of the time. There were a couple malaria and HIV tests, all negative. They’re both really simple procedures! Just a little blood (from the finger for malaria, from the vein for HIV) that is mixed with some sort of chemical. On the reaction paper if one line appears it is negative, if 2 appear it is positive. It only takes about 10 minutes, usually less. I thought that for HIV the diagnosis depended on the CD4 (white blood cell) count but I guess that determines the severity. Everyone that comes in with a fever gets a malaria test. Malaria is extremely common (not as much anymore with increased net use, but still there) and the test is easy so it’s worthwhile to eliminate that possibility. Most of the appointments were really short! I’ve never been to a community clinic in the States but I guess it’s probably the same. Not much time is taken to look at all the possibilities or to establish any sort of a relationship with the patient. There are so many patients that it’s not really plausible and they all just want an easy fix. Most patients got a prescription for paracetemol (similar to ibuprofen) or some sort of antibiotics or told to come back in a couple days and that was it.

There was one woman who was advised to get an HIV test because of her symptoms but she wouldn’t because she said it wasn’t necessary. It seems ridiculous not to because the test is so easy, but when you actually think about it, it makes sense to not want it. If she took the test and found she was HIV+, first of all that’s a scary thing in-and-of-itself. There’s all the treatment to worry about and it definitely changes your life. Plus it could screw up her marriage if her husband thought she was cheating on him (many men here refuse to believe that they might have it so the only logical solution is that their wife got it from another man). And of course there’s all the stigma and discrimination that goes along with being HIV+ so I can understand why people would be reluctant to get tested. They still need to though because it’s beneficial in the long run because there’s treatment.
Our last patient was a young boy whose feet had been burnt. He had massive blisters all over the tops of them and his heels. It looked like when you cook a tortilla and the dough bubbles up. Some of them had already burst. It looked extremely painful!
Another patient was 18 years old in grade 8. She probably had to stop for a while either to help at home or to get money for school. The fact that she’s still trying is quite commendable! It’s great when people really want to better their situation in life!

In the afternoon I was supposed to be farming but ended up doing adult literacy instead. The other 2 volunteers didn’t really understand the topic and English is their second language so it was hard for them to explain. I ended up looking through a couple books as we went along to come up with things to talk about. We talked about population, deforestation and why trees are important, water and sanitation (and pollution), and a couple other similar topics. Honestly though, I’m not sure why that’s in the syllabus because it seems like there are more important topics to be covered. All the students write down EVERYTHING that we put on the board. Finally we stopped writing on the board and just talked because when they’re writing the don’t really pay attention and don’t really learn anything. I think it turned out alright for not having any preparation!

We also went to see the baby lion cubs a couple days ago! They looked like they would be fun to play with! They’re a lot bigger than I was expecting but still smaller than the ones we walked with. More like big playful cats. The oldest were 6 months, youngest, 4. There were 6 of them total. We didn’t get to play with them because they’re new, but we did go into the enclosure to watch them eat. More playful with their food than the big ones.

Tomorrow is a relaxing day at Zambezi Sun and then Sunday some of us are going rafting! Supposedly it’s some of the best rafting in the world! Hopefully it will be good… Then Monday is my last day at projects before I join my overland group Tuesday morning. Once I start that trip internet will probably become mostly non-existent so all those stories might have to wait until I’m back in Alaska and have some time to type them all up. We’ll see…

---