Keeping Busy in Zambia

Amy's Class

Jim and I had the pleasure of teaching at Justo Mwale Theological College University from April to June. I had 12 students in the first year Pastoral Counseling course (one woman).  Jim taught a counseling course on AIDS to 4th year students. We both enjoyed discussing various Biblical passages regarding gender equality. Not surprisingly the Christianity brought to Africa by colonialist was a male dominant leadership model. Thinking about human beings made in the image of God and the feminine characteristics of God was challenging for many. I arranged for a tea just for female seminary students to meet and share their challenges and experiences and to encourage one another.

President and Mrs. Bush with Zambian
First Lady Dr. Christine Kaseba

At the end of June President and Mrs. Bush made another trip to Zambia to encourage cervical cancer prevention and treatment. During the week they were in Livingston Jim organized many local volunteers to paint a health center and I watercolor painted in the hotel room. President Bush has taken up painting (oil) as well and is doing a series on world leaders he has met. I thought I could do the same and have a series of one (him).

In July Jim attended the African First Lady's Conference in Tanzania, to encourage other countries to bring women's health issues, specifically cervical cancer, forward in their countries. You may recall Jim was tasked with reducing maternal mortality by 50% in one year, a task many said was impossible. Results from the project are coming in and through the combined efforts of CDC, USAID, and many others it looks like we may actually hit our target. Now to expand country wide!

Terra

In July Terra, an almost 8 week old female German Shepherd joined our household. This was just days before Molly Crane's month long visit. Our socks, pants and skirts have small holes as do our legs from Terra teething.

I left in early August for a month in the US ostensibly to visit my parents and three of the kids. My dad has had several surgeries and hospitalizations and it looked like a good time to visit. It turned out I needed foot surgery and then a molar extraction for a large abscess I had failed to notice until Bob LoCascio took routine wing bite films. I wasn't even planning on getting my teeth cleaned until January but then there was a cancellation and I took it. As the oral surgeon said, "Someone is looking out for you." "Yes, you are right. God is" I responded.  

In August, Ruth began courses at Oakton including acting, creative writing, and a design art course. She seems to be thriving and has recently dyed her hair blonde for a role (check her out on facebook).

In September, Miriam adopted a lovely black cat, Magic, from Heartland shelter.  

Miriam continues to thrive living independently and participating in the PACE program. She put her guardian angel to the test recently, when she was struck by a car while crossing a busy road. Typical of Miriam, she flew and tumbled, broke her glasses, but told the police and paramedics, "I am fine, no need to go to the hospital..."  She is resilient!

Perhaps we won't drive this way...

John visited us for two weeks in September, following his summer as a camp counselor at Phantom Ranch and before he headed back to Seattle Pacific University. We took an adventuresome drive to the Lower Zambezi National Park. Typically one drives around the escarpment to remain on paved roads for as long as possible. Instead Jim suggested a short cut out Leopard's Hill Road 'through the bush' - only about 90 miles, but really off the beaten path. Jim spoke to others who had made the trip, and they said, "No worries, as long as you don't encounter another vehicle while in the mountains, and bring food, water, extra fuel, a satellite phone, and a winch ..." We did pretty well, using every bit of the 4-wheel capability of our Land Cruiser, until we encountered a truck coming at us in the mountain pass. Fortunately we got to climb the wall of the mountain while he got to inch along the edge - we exchanged looks of terror as we passed, and a big thumbs up when it became clear we would both live!

John and Chris fishing

The Park was awesome - amazing encounters with elephants, including a juvenile bull charging Jim as he scrambled to get into the tent - if only the elephant knew how flimsy that canvas was he might have kept coming. I helpfully pointed out to Jim that there was a large elephant charging at him as he struggled with the tent zipper. We tried our luck fishing for tiger fish on the Zambezi, always with an eye on the nearby crocodiles. No bites from either.

Thank you all for praying for the food situation in the prison. Just a few weeks ago, while I was in the US, the women and children incarcerated with them, were again allowed to have food brought in by their families. Prior to this they had only some dried fish and nshima provided by the prison.

Tumekutana 2014 Planning Committee

After returning to Zambia, I flew to Ghana to meet up with Caryl Weinberg and Rev Erica Rader and the Tumekutana team to begin working on the 2014 conference "Freedom in Christ: From Slavery to Empowerment." You can be in prayer as plans move forward.

Back in Lusaka Chris is busy with the school musical (Shakespeare's Pericles, Prince of Tyre, set to Fleetwood Mac!) and the IB program (large amounts of homework every day).  Chris worked this summer at the Embassy - in IT. Jim regularly meets people who comment on how great a worker Chris was and how they want him back next summer.

Tenacious

I  put five of my paintings into an exhibit and sold three (2 to Jim - he couldn't stand to see them go) to benefit wildlife conservation in Zambia.

Behemoth

We have home leave this December-January and so are looking forward to time with family and friends. We will try to look at a few colleges with Chris during the time, but mostly we hope to rest and enjoy running water, electricity, internet, and paved roads...

Eulogy for Rascal

Rascal in Zambia 2012

Rascal, nee Milkyway, died in Lusaka Zambia on May 11th 2013 at the age of about 15 years. He is remembered for his faithful companionship and incredibly soft fur and beauty. He was born into a litter of three kittens in Oak Park, Illinois. His parents both were free range cats with a love of wanderlust. His owners spread the story that he and his littermates would be taken to the forest reserve in River Forest and dropped off to fend for themsleves.

The McAuley children brought this woeful tale home and their parents succumbed to their pleas. Within a very short time it was clear that Milkyway had been misnamed. In his first few weeks he crossed a freshly oil painted floor and tracked grey paint through the house and all over Amy's blue sweater. Even turpentine could not remove all traces of paint.When he discovered the sticky mouse traps under the kitchen sink and came out covered in them a quick call to the vet revealed that mineral oil could be used to remove them. Cleaning off the mineral oil was more difficult as Milkway was so slick and greasy that soaping him up and keeping him under a stream of water was almost impossible. About this time Amy decided he should be rebaptized Trouble however not wanting to brand him for life he was instead named Rascal. Rascal quickly bonded to Christopher who carried his kitten wrapped around his neck. We wish we had a picture of the night Chris came to dinner just wearing Rascal but we failed to get this photo. Rascal was young and often terrorized Christopher trapping him on the stairs and clawing him up and down his legs so Rascal was sent for declawing and neutering at an early age. This did not deter his playful nature.


Rascal and Chris 2002

He grew up with Mundy our lab-mix, thinking Mundy was his mother. Mundy took on the role of mother with grace. Although Rascal lurked on the stairs and pounced on Mundy from the banisters, Mundy would willingly play. Often she saw Rascal coming and would look sideways with a wag of the tail. Even when she had Rascal's head in her jaws, she was gentle and never growled. If Rascal began to get a bit fierce she would send him across the floor with a shove of a paw. Unlike Mundy, Rascal never led anyone into a Wisconsin cornfield, got picked up by the police on Christmas Day or ended up at the pound after being a little too friendly on the corner of Church and Wesley. Rascal's worst adventure was being dried in a dryer and left there for several days. This occurred at a busy time, when the washer and dryer where located in the basement. Amy noticed the clothes were still damp and turned the dryer on for a quick 15min more. She thought the clunking sound she heard was probably some tennis shoes.....three days later the family was in mourning, notices and photos had been put up around the neighborhood but there was no sign of Rascal. When he was finally discovered it was not a pretty sight!

Rascal's best qualities were his doglike desire to be close to family; sleeping every night on someone's bed usually Christopher's, sitting on the keyboard as you attempted to type, climbing into a lap during a quiet time, curling up next to you when you came home exhausted from school, running across the yard when called and meowing when meowed to (really only Chris and John were able to get him to do this), sitting next to Amy while she stretched her neck in the cervical collar or under her feet as she painted.

Rascal and Chris 2013

When the family moved to Zambia we thought it would be difficult for him to remain in the US. In his final two years of life he was allowed outside and enjoyed the breeze, the birds, lizards, grass and gardens. Sometimes he just sat and smelled the flowers.

Having grown up with a dog he was curious and excited but a bit fearful of Gambol the German Shepherd we had last year for a few months. Gambol treed him several times which amazed all of us since the tree he routinely climbed (without claws) was almost a 90 degree climb.

Rascal is survived by his beloved family and two refugee cats Gus and Mama who could not return to the US with their previous family. We will all miss him.

Wedding Anniversary Celebration

May 4th Jim, Ruth, Chris and I headed out for dinner at a local restaurant. You may not have realized that an orchid is the gift for the 28th wedding anniversary. Ruth managed to find a lovely white, rose and purple orchid! I'm now the proud owner of a Zambian recipe book and can make caterpillar soup, mouse fritters, roast termite, moringa porridge and nshima with relish.

Thanking God for another year!
 

Swimming with the Sharks

Getting the shark's attention

The family went to Cape Town for Chris' spring break in early April. It was so beautiful, and of course Chris and Jim just had to go swimming with the Great White Sharks!. For those of you who are You Tube followers (we are not - no band width) there was a video of a shark getting into the protective cage just a few days before we went - yes, same cage, same place (http://live.wsj.com/video/raw-video-great-white-gets-into-shark-cage/)! But truthfully, there were many more wonderful things in Cape Town than sharks - beautiful coast line, stunning sunsets, an amazing botanical garden, great birds, and good food. Definitely a place I would recommend for a visit. Visiting Robben Island was a moving experience, as one can imagine. We suspect we were one of the few tourists to Cape Town who went to see sewage treatment ponds - naturally it is birding hot-spot - flamingos, pelicans, grebes...


Jim in cage counting shark teeth,
trying to remember the warning:
"Never touch the sharks"

The family has been busy with both Jim and Amy having trips back to the US in the last month or so. It was great to see family and friends. Miriam and John both seem to be doing well.
 
Amy applied for a mission co-worker position with PC-USA based in Malawi in community health. We were hoping that PC-USA would be creative in thinking about the possibility of her working from Zambia. We were not too optimistic given our previous experince with PC-USA and informal feedback. We tried to point out that it would have been so cost-effective - as she is already here, speaks the local language, has housing and health insurance, is trained in public health, etc. We knew from previous inquiries that PCUSA is not inclined to hire  physicians, but of course we know that physicians can actually do public health, teaching, and prevention (example - CDC)!

African penguins

I (Jim) recently attended a meeting to discuss the way forward for one of my main activities - reducing maternal mortality (http://savingmothersgivinglife.org/). One person representing a donor-partner commented that we needed to aim more for a Fiat rather than a Mercedes, as our intervention appears to cost about $100 per pregnant woman. If it weren't so sad I would have laughed - women in clinics sleeping on the floor, being delivered by an environmental health technician because no trained midwife is present...while in the US a delivery typically costs $10,000-20,000. Listening to the language from donors (including the church) I have decided that "partnership" and "leveraging" and "sustainability" are ways to say, "Sorry, no money." Two highlights though - the US government is steadfast in its support, and the Zambia team decided we would forge ahead anyway - a country led, grass roots conspiracy to save pregnant women's lives!

Amy and me start teaching for ten weeks next week at Justo Mwale Theological Seminary. Amy teaches Pastoral Counseling and I teach HIV and the Church's Response. It will be a busy time - so prayers for our family, as well as the students we teach, are greatly appreciated. It look slike we will not be traveling back to the US as a family until Christmas time. We will keep you posted.




News Flash

Last week, Amy travelled with Nancy Collins, PCUSA regional liaison and Rev Rob Weingartner, director of the Outreach Foundation to visit several ministries where US Presbyterians are engaged with Zambian Christians. We drove south from Lusaka to Siavonga on Lake Kariba to Namumu Orphanage Centre where supporters funded the construction of two dormitories, kitchen, dining hall, staff houses, a clinic and chapel  As happens the world over when "moth and rust" break in (or an attic full of bats) as the case may be, there are repairs to be made.

Mwandi First Ambulance

Namumu Dorm with squeeky bats in the ceiling

The following day we moved on to Mwandi Mission 10 hours west along the Zambezi river, about 150 kilometers northwest of Livingston.


Nancy drove most of the way. During our visit we met with the chief, walked through the village, saw the United Church of Zambia Orphan and Vulnerable Children(OVC) program as well as the Mwandi Hospital which I had heard about from Medical Benevolence Trustees (MBF) who'd volunteered there. The OVC program is expansive with a supportive income generating agricultural program of fishponds raising tilapia, beef cattle, pigs and egg-laying chickens.

Pastors leading Devotion and Songs

Income generating fish ponds

We were told that HIV rates are one in four, alcoholism and sexual abuse are major problems and people still drink river water.

The hospital has fallen into some disrepair with a very low census, but there are plans for renovation.

We met a local pastor excited about evangelism and training, a lovely couple from Australia who work with the OVC program and a trustee from the OF who was doing training with villagers in microenterprise, savings and loan as well as a group of medical students and residents on a short term mission trip. The day Nancy and I left, Salvadore de la Torres (and his wife Irma), the PCUSA missionary doctor who was there for 10 years beginning in the 90's arrived for a visit. Salvadore and I met yesterday to talk about what could be done to support the church and community. Pray that God gives wisdom and that the hearts of the community, chief, American hospital board members, missionaries and staff working at Mwandi Mission would be open to His leading and transformation.

Family news: Jim's in the States for two weeks so if you see him, give him a hug.

 

Tuesday night we celebrated Chris' induction into the National Honor Society



Gus Lounging



One of our new cats, Gus has given us fleas. His mother, Mama briefly eats and departs for the day. Rascal is tolerating it all.  

Amy is painting again

 

Luke 7:22 "... the lame walk..."

Paralysis was the admitting diagnosis. "Can you review the child? Could he have polio?" Just six days before admission 3 year old Tamandani and his mother had been in Mozambique attending his father's funeral. His father had had a brief, febrile illness, with body pains, headache, gastrointestinal bleeding, prostration and death. Now less than a week later he was ill too. He lay on the exam table without moving his arms or legs, unable to hold up his trunk or head. Olive, the head nurse, coaxed him to take her cell phone in his left hand and after some time he passed it to his right. When supported under the arms, with his head held upright, he was able to bear some weight, even making a clumsy, "dough-boy" step forward desperately trying to escape my grip to reach his mother.  Pushing on the bottom of his foot back toward his body brought out clonus, a repetitive downward flapping movement of the foot. Additionally he had hyperactive knee reflexes and his cheeks appeared swollen. These were signs not of a flaccid paralysis like polio but a spastic paraparesis. Spastic paralysis has a wide differential; TB, HIV, lymphoma, herpes, cryptococcus, B12 deficiency. Transverse myelitis, inflammation of the spinal cord, can be due to a variety of causes including schistosomiasis, typhoid, and Burkett's lymphoma.

His mother reported he had not urinated all day and would not eat or drink. So a catheter was placed to drain obstructed urine. The parasite schistosomiasis was not found in the urine, the abdominal ultrasound , CXR and spine films were normal and an HIV test was negative.  

In my reading I discovered that typhoid can cause parotitis (swelling of the parotid glands in the cheeks) just like mumps. Typhoid fever occurs when food or water contaminated with feces is ingested. The World Health Organization estimates there are 20 million infections and over 200,000 deaths each year from typhoid. Humans are the only known reservoir.

Treatment included antibiotics, prayer and physical therapy. After a week he was able to hold up his head.  Mulungu akumuchilitsa ("God is healing him") I encouraged the mother. A few days later Tamandani was sitting up on his own, then standing up and 2 weeks after admission he was able to walk slowly, holding on to one of his mother's hands.  
In John 14: 12 Jesus told his disciples "I tell you the truth anyone  who has faith in me will do what I have been doing. He will do even greater things than these..." What a blessing to be the hands and feet of Jesus, a pencil in God's hand as Mother Teresa would have said, through the ministry of healing and pointing people toward God.  Thank you for praying for me during my time in Malawi!

Mark 16:18 "...they will place their hands on sick people and they will get well. "

Resurrections Still Happen

Today is Ash Wednesday, the beginning of Lent. It's a time of preparation before Easter when out of love for the world, God sacrificed His son Jesus who took the punishment for all our sins, died on a cross so that we would not perish but instead be given eternal life. Three days later on Easter, He was resurrected from the dead. In the Bible, we read about a number of others who were also raised from the dead (unlike Jesus all of them eventually died a second final death). Remember Elijah raising the son of the widow at Zarephath (I Kings 17:22), Elisha raising the Shunammite's son (2 Kings 4:34), Jesus raising Lazarus, Jairus' daughter and the only son of the widow of Nain (Luke 7:15). And who can forget Paul raising the sleepy teen Eutychus (Acts 20:9-10) who fell out the window and died during a long sermon?

I don't tend to think about the possibility of someone being raised from the dead or a resurrection happening these days. Yet just as Elisha "prayed to the Lord...got on the bed and lay upon the boy, mouth to mouth, eyes to eyes, hands to hands.... and the boy's body grew warm" God raised a young girl from the dead while I was at Nkhoma. As it is written in Hebrews 11:35, "Women received back their dead, raised to life again."

She arrived on the ward from the outpatient department, without a pulse or respirations. We immediately started CPR, gave a bolus of fluids, glucose and epinephrine. Blood had been ordered but had not arrived. No one knew when she had stopped breathing or how long she had been without oxygen. The anxious mother stood nearby watching as we ran for equipment, felt for a pulse, gave chest compressions, felt for a pulse and gave breathes to the child with an ambu bag trying to assure oxygenation.  After about thirty minutes Dr Sohil, a volunteer 3rd year pediatric resident from California said he felt a pulse. Although I had been praying continuously and asking for a miracle, I was surprised. Yet the heart rate registered over 230 on the oxygen saturation monitor.  Still I thought her long term survival was unlikely. There were no ventilators and if she failed to breathe for herself there was no hope. We had endotracheal tubes but with only two nurses and 60-80 patients it would have to be family bagging so we never intubated anyone. But then she began to take breathes and eventually we stopped assisting altogether. A day or two later on rounds, I told the nurse to tell her mother she could move to another section of the ward away from the oxygen concentrators since her daughter no longer required oxygen. I recalled her arrival on the ward and said to the nurse and resident, "You know this was a resurrection. She was dead. No heart beat and no respirations for at least thirty minutes. But, God has something planned for her life. Every one of her days was written in his book before there was even one, and it was not time for her to die that day." The nurse stopped and said we have to give this testimony to her mother and translated my words into Chichewa. "We need to give thanks and praise to God for what He has done."

Luke 7:22 "... the dead are raised and the good news is preached to the poor."

"She was just too little"

I was called to the maternity ward to help assess and manage an infant delivered at 28 weeks by dates after premature rupture of membranes. The mother had had some abdominal pains earlier in the week and had been hospitalized for possible preterm labor. Everything had been done that could be done to prevent delivery and to prepare for it at the same time; antibiotics for possible urinary tract infection even though the urinalysis was normal, steroids to try to mature the babies lungs and drugs to attempt to stop contractions. The parents had been waiting, hoping and praying for a child for eight years and the mother was now 38 years old. Mercy Oduyoye, Bridget Ben-Naimah  and other African women theologians have described reproduction from the traditional African perspective as a woman's religious duty and the most important factor governing marriages. They report African woman are disempowered and shamed by childlessness even in the church community. One of the students from Ohio doing a rotation asked me if people think about children the way we do. It is clear by the names given to children, they are desired and cherished; patients with names in Chichewa meaning Accomplishment, Remembrance, We are thankful, Love, Faith, Gift, and Fruition were all on the ward this month.

I saw the breath go out of this medically educated mother when I told her the baby weighed just 720gms. We spoke of the next 24 hours as the most critical for her baby's survival. Being able to breathe alone would be the telling factor. I tried to instill hope even when I had none. It was less than an hour after birth when the baby began to have episodes of apnea (failing to breathe) and bradycardia (low heart rate) with concomitant drops in oxygenation. Apnea and bradycardia are seen in nearly 100% of babies born under 1000gms.  In Neonatal ICU's  in the US we have surfactant and ventilators to help premature lungs and children survive. We did not have a catheter, an endotracheal tube or even a nasogastric tube small enough to use in this infant. Through a miniscule butterfly IV introduced into a vein barely visible through the translucent skin, we gave antibiotics and dextrose.

When the baby failed to breathe we began giving extra breathes with an ambu bag. The oxygen saturation continued to fall slowly and inexorably. Despite drugs to stimulate the heart, respiratory distress persisted and progressed. In a final effort to try anything that might help I called the lab to come and assess for anemia and then contacted the missionary surgeon with O- blood to give 15ml (3 teaspoons) of blood in the unlikely event that this would improve the course of events. Shortly before her death,her mother began asking questions every mother asks, "Was there anything I did to cause this? Was there anything I could have done to prevent this?" When a child is sick mothers the world over blame themselves wondering if there was anything done or not done that led to their child's illness. I have done it myself. At a deeper often unspoken level in Africa people often wonder if there is a curse or an evil force conjured by someone to cause illness and death. Five hours after her birth this beloved and cherished child died. "I am so sorry. She was just too little."

In the late afternoon, when the relatives had gathered, a group of 30 women proceeded in single file out from the hospital gate carrying a small bundle. The mother and father were not among the group which included women friends, staff, patients and myself. Three different women took turns carrying the baby, wrapped in a pink blanket, in their arms. A cloth which covered their chests was tied at the back hiding their precious bundle. Twice on the journey the group stopped while the baby was taken and placed in another's arms, retying the cloth. Each of the three women bore the burden of their friend's child a relatively short distance on the way to the forest but there was solidarity in the act - a sharing of the loss. It was getting toward dusk, the breeze was picking up and the clouds in the sky were changing to pinks and oranges. There was a good chance of rain and only one of us had an umbrella. We marched on across the field, across the road, through the school yard and into the graveyard. Without a word women broke away from the line and began picking up large rocks from the sides of the path. I moved into the grass and found two sizeable moss covered rocks. Rocks in hand we proceeded on past fresh graves strewn with withered and faded flowers into the quiet of the surrounding forest. We followed a narrow dirt path further into the forest till the group stopped by a large tree. After some discussion one of the women began digging with a khasu, a wooden handled hoe whose blade can be turned and used as an axe or a shovel. Women took turns beating the earth and shoveling it aside. Each worked digging the grave deeper and deeper while others stood in a semicircle watching. When one woman paused another would take the handle and begin again pounding the earth with renewed vigor. The vigorous hammering seemed cathartic. Eventually the depth of the grave reached mid-thigh. Still the beating and shoveling continued until everyone was satisfied it was deep enough so that this tiny infant would not become prey for the wild dogs. Finally a woman on her knees in the soft earth at the edge of the grave shoveled out the last bit of earth and all were satisfied. As we stood in the darkening forest watching the proceedings, the laughter of children playing in a field nearby moved through the trees and we could feel the coming of rain. Nearby saplings were quickly hacked down and leaves stripped off the branches, creating a bed of leaves on which to place the infant. Then the patter of rain drops began as if the Lord himself were weeping and the infant was gently lowered into the grave and covered with white plastic. Sticks were positioned lengthwise over the body followed by a layer of rocks and dirt. The remaining dirt was mounded up a foot high above the level of the ground and rocks arranged on top. A simple prayer was said and we slowly filed back out of the forest past many, many, many other small unmarked mounds.

Psalm 139 "....All the days ordained for me were written in your book before one of them came to be..."