This afternoon we participated in the Under 5 Clinic in Chebele Village. The clinic was supposed to happen yesterday, but it was rescheduled due to rain- it rained all morning and afternoon yesterday.
The Under 5 Clinic is a monthly outreach program of the Ministry of Health (MOH). The MOH trains Neighborhood Health Committees (NHCs) and Workers to provide check-ups and immunizations for children under age 5 in rural villages, where coming into a clinic for routine check-ups isn't an option. The Under 5 Clinic is run by the Neighborhood Health Committee (NHC) of Chebele, which is comprised of 3 men and 1 women who live in our village. (It's worth noting that Chebele is comprised of 3 villages: Kote's Village, Kamboo's Village and Chalibana's Village.)
At the Under 5 Clinic, the Neighborhood Health Workers weigh the children and record the child's weight on the child's health & weight card, which the mother brings with her. The children are weighed by sitting in a canvas seat that hangs on a scale, which is hung on a strong mango tree branch. The scale used today was apparently donated by UNICEF, as its logo was prominently displayed on the scale. Children may also receive immunizations at these monthly clinics, but I didn't see any administered today. I was told that any immunizations are administered by clinic staff when the clinic staff come out the village for the Under 5 Clinic (which is not every month).
The child's weight is recorded on a graph on the child's health and weight card. The graph has curves that show ranges of healthy, concerning and dangerous weight and growth. Malnutrition is very prevalent in rural villages here, and Chebele is no different. Many of the cards I saw showed the child's weight this month as either the same as the month before or lower. This is concerning and dangerous, respectively, as healthy children are expected to gain weight month after month.
Before attending today's Under 5 Clinic, I consulted a fellow PCV who regularly attends Under 5 Clinics. Her only advice was to bring earplugs. I'd heard from other PCVs that these events are quite loud- it turns out babies don't enjoy being weighed and whatnot, so you're surrounded by crying, screaming babies. Another PCV once jokingly told me it's been a great form of birth control for her.
This afternoon the women were congregated under the giant mango trees in front of the second headman's house (he is the chairman of the Neighborhood Health Committee). Some had already had their children weighed while others were waiting their turn. Most women had more than one child with them to be weighed; a few had 3 and 4 children with them, all under age 5. (Families in the rural areas of Zambia tend to be quite large. One set of children who visit us often number 7; the oldest among them is 12 and always has a baby sister on her back.)
We'd gotten together with the NHC a few weeks earlier to see how we can enrich the Under 5 Clinics and bring information to the women. The NHC invited us to this month's clinic to speak to the women about HIV/AIDS Prevention and basic principles of nutrition. We started with basic nutrition information, using the Grow-Go-Glow Model. This model breaks food into 3 simple groups based on what it helps us do:
Grow: proteins (like meat, fish, beans, nuts, eggs and milk) help us build a healthy body
Go: carbohydrates (like nshima, bread, rice and potatoes) give us energy
Glow: vitamins and minerals, found in fruits and vegetables, keep our bodies healthy and looking beautiful
In The States, we take basic nutrition knowledge for granted. In rural communities like ours, nutrition, food groups and knowing what basic nutrients each food provides are new ideas. In fact our counterpart, who is a knowledgeable farmer and father of 7, surprised me when he said the idea of food groups was new to him. He hadn't realized that meat, fish, beans, nuts, eggs and milk all are high in protein which helps us, especially children, grow. He also didn't realize that vegetables and fruits are full of different vitamins and minerals that work in different ways to keep us healthy and free from illness. We have had many conversations with our counterpart over the last year about the benefits of eggs and beans (protein, growth), various vegetables and how they help deter common ailments, etc. His reaction surprised me, but again reminded me that: nutrition takes time to understand; nutrition is a very new idea in rural areas; nutrition is a topic that can be reviewed, revisited and reinforced frequently.
At the Under 5 Clinic, we also took time to talk about HIV and AIDS. We focused on how HIV is transmitted and how people can protect themselves from the virus. This is an important topic throughout Zambia, where the HIV infection rate hovers around 14% (11% among women in Luapula and 15% among men in the province). When we asked how HIV is transmitted, the only suggestion offered from the group of mothers was that it was transmitted through sharing razors and needles. While this is true, in Zambia, this accounts for only 1% of HIV transmission. More than three-quarters of HIV transmission in Zambia happens through unprotected sex, followed by over a fifth of cases stemming from mother-to-child transmission. Thus, it is quite concerning for a group of obviously sexually active women (a vulnerable demographic) to only suggest sharing razors and needles as a means of transmission.
Knowing that most Zambians who are HIV+ became so by having unprotected sex with an infected person, the discussion on prevention necessarily focuses on safe sexual practices. Today, we presented 7 ways people can protect themselves against HIV.
Know your HIV status and your partner's HIV status.
Go for Voluntary Counseling and Testing (VCT), preferably with your partner, every 3 months. This service is offered free at the clinics and 1,000Zkw – 3,000Zkw ($0.20 – 0.60 USD) at an NGO called New Start, which does Mobile VCT to reach rural areas.
Practice safe sex methods: abstinence and/or using condoms correctly and consistently.
Have only one partner at a time. (Having multiple concurrent partners is very common here in Zambia for numerous cultural reasons.)
Male circumcision (This has been shown to reduce the risk of HIV infection in heterosexual men by about 60%.)
Participate in Prevention of Mother to Child Transmission programs (PMTCT).
Visit your healthcare provider regularly to stay healthy and know if you should start ARVs/ART if you become infected.
Clearly, volumes more can be said about both nutrition and HIV prevention. However, the key to educating rural communities seems to be K.I.S.S. Also, this was just our first meeting with the Under 5 Clinic group, and we plan to contribute th the future monthly clinics, at which time we can bring more in-depth and interactive lessons on basic health, nutrition, and HIV prevention. In fact, the women asked that at our next meeting we do cooking demonstrations, which is an excellent, interactive and tasty way to introduce nutrition and health concepts.
We are also talking to the community about organizing a community garden, where by the community gathers together a small amount of money for seeds, they organize a work schedule, and Shaun and I teach them about the nutritional benefits of the different foods they grow. Since Shaun and I go to the provincial capital (Mansa) monthly we can pick up and bring back a wide variety of vegetable seeds that the community might be interested in trying, and multiplying locally, but to which they lack access otherwise. Few seeds are available in Mwense.
* * *
After presenting to the women at the Under 5 Clinic, we sat off to the side while they finished their meeting with the Neighborhood Health Workers. The Health Workers had conducted the Clinic and were now giving reminders and closing remarks. One of those reminders was an announcement about the community garden.
We noticed other community members, men, other women and children, start slowly gathering in the surrounding area. Women all congregated together under the mango tree, young men gathered together under the shade of the second headman's porch and the older men of the community sat near where we were sitting under another mango tree with our counterpart, an older male in the community. I asked our counterpart why everyone was gathering and he said, “We are just waiting for the headman to arrive.”
But why? No answer.
About 10 minutes later, the headman arrived, accompanied by the village secretary, and we found ourselves suddenly in attendance of a village meeting. We had no idea this was part of our agenda for the day, but it turned out to be, which is pretty typical of our experience in the village. The day just kind of unfurls in front of us as we go along.
The meeting started when the headman, ba K., stood in front of the village and brought it to order with a greeting and assigning someone to say a prayer. The headman is a husband and father, in his late-thirties or early-forties (though he looks older). He is tall and thin, with long, lanky arms and legs, and a shiny bald head. Today he was dressed in one of his usual outfits: an untucked button-down blue-with-thin-white-stripes shirt, unhemmed, slightly tattered black dress trousers and a Chinese knock-off version of Teva sandals. He used to live on the other side of the stream, about a kilometer from our house. Rumor has it that he sold that land to a mine for about 7,000,000 Zkw (about $1,400 USD) after the mine had dug huge pits on it prospecting for copper and cobalt. Then, he moved out of the village and now lives in the township around Mwense boma.
And this begs the question: how can he be headman of the village if he doesn't live there?
The village had gathered this afternoon for a meeting at the second headman's house to talk about 3 agenda items:
some people not doing their part in giving small amounts of food or money to families who experience a death and hold a funeral, as is Zambian custom;
the village's concern about the headman not living in the village of which he is headman;
whether to petition the government to further grade the dirt road that goes trough town or to ask for its help in building a village health clinic.
Before jumping into the day's business, the headman read the minutes from the last village meeting in June of this year. He spoke all in Cibemba and I have to admit I kind of tuned out, as did the rest of the crowd gathered, it appeared.
Finally, the meeting got around to the first point on the day's agenda: the funeral givings. Different community members stood up and said their piece, all in Cibemba. What I gathered is they were each imploring others to give something at funerals, nothing big like a bicycle but rather some maize meal, charcoal or 500Zkw ($0.10 USD). At some point, and I couldn't tell you when, I realized the discussion moved to the idea of having a village record of who gave what to whom for family funerals. Then, when death came to your family's door, you could reasonably expect the families you'd helped would make small contributions to your family for the funeral of your loved one.
I wondered how this system would work in this rural village in Zambia where people are not accustomed to keeping records. For the last year, I've been teaching farmers, women's groups and small-business-owners about the benefits of record-keeping and no one seems to have gotten excited enough about the idea to actually do it.
As the village discussion wore on, I heard thunder in the distance and saw full, gray clouds move slowly over the distant hills and toward the village. I wondered how far into the meeting the village would get before the rain was upon us.
The first discussion subsided and now we were on the second point of the agenda: the village's concern about the headman not living in the village. The concerns brought up were mainly about what happens when a stranger comes to the village and the headman isn't here to regulate them, and then the village is left vulnerable to the mal-intent of outsiders. One of the elder men of the community stood up to say that we don't see the president of Zambia, Mr. Michael C. Sata, presiding over Zambia but living in neighboring DR Congo; thus we shouldn't have a headman presiding over Chebele but living in the neighboring Mwense township.
The community members were circling around their main desire, rather than saying it directly. The village wants the headman to step aside and ask the chief to appoint a new headman. The second headman's family expressed that the headman should allow the second headman to act as headman. I noticed that each time a community member stood up to make a strong point- or at least a point counter to the headman or status quo, the speaker would seemingly turn it into a joke. The joke clearly had an undercurrent of honesty and genuine opinion, but it was turned into a joke in order to diffuse tension and avoid confrontation. I found this very interesting and quite different from any city council meeting I'd ever seen back home where a major issue, like the mayor's ability to perform her main duties, was at hand. A meeting like this in The States could easily be filled with confrontation and acrimony. But the meeting today was filled with laughter.
I should back up and explain these terms and traditions. The headman of a village is appointed by the chief of an area. The headman is to act on the chief's behalf and settle disputes in the village and generally know who's in the village, what their purpose is and the general happenings of the village. Our village of Chebele is quite large- it is actually 3 villages in one: Chalibana, Kote (where we stay) and Kamboo (near the Chebele Basic School). So, the headman appointed a “second headman” for each of these areas to help him out. It's safe to say the “second headman” is like the assistant headman.
The headman, however, hasn't shown interest in stepping down, and he also hasn't shown interest in moving back to the village. One community member told me that the incumbent wants to retain the headman position likely because the headman receives gifts from anyone who wants to do programs in the village.
Throughout this discussion, sprinkled with tense laughter, those full, gray clouds slowly approached. Gusts of wind would push them closer. As these gusts of wind came, they would also shake the branches of the giant mango trees under which we were seated, causing heavy thuds as large mangoes would fall around us. Again, there would be tense laughter as everyone knew having a mango this size fall on your head would be like a rock falling on your head- quite painful, bordering on serious. But no one moved- the discussion continued. It continued even when large sporadic raindrops began to plop around us. However, when the rain was finally upon us, the group scattered, running into neighboring houses for shelter from the hard downpour.
Ba Godfrey and I ran under the eve of the house across the road from the where we'd been sitting. This was the house of a farmer who has fish ponds, but no source of water other than the rain (the dam on the village stream isn't strong enough to push water all the way down the furrow to his ponds.) Shaun was grabbed by one of the kids and drawn into the second headman’s house.
When the farmer and his wife got to the house, they invited us, and two young mothers- each with an infant child, to come inside and have a seat. This farmer has a nice village house. The sitting room is a good size, the roof is tall and doesn't leak, they have 4 rustic but comfortable chairs, a table, and a TV and radio powered by a solar panel and battery-inverter set up. On the walls of the front sitting room were posters from the September presidential election: one encouraging Zambians to vote, another for an MMD Party member running for a local position, and a third poster for the MMD presidential candidate, former Zambian President Rupiah Banda. Also on the wall hung a drawing the oldest daughter, Eunice, had drawn and colored earlier this week at our house during “ukudrawina”- drawing and coloring time for the kids in our insaka.
The conversation at the house was a continuation of the interrupted village meeting. But this time, the villagers were much more frank, complaining that the headman should go and allow someone else to step up to do the job they felt he was neglecting. I learned later that even where Shaun was, at the second headman's house, the talk there was the same.
After the rain subsided, the community dispersed to their homes and the meeting was over. I still don't know if this last matter was resolved or will get resolved to the community's satisfaction. Nonetheless, we liked getting to be part of the action and know what was going on in the village around us. So often, we feel cut off from the inner workings of the village, understandably as we are merely long-term visitors.
* * *
Today was quite eventful, in contrast to every other day this week, each of which has been quiet and slow. This is how things happen here: feast or famine in every way. We'll go days without anything happening, except additional empty time as programs get canceled. Then all of a sudden, we'll have a day like today that seems a flurry of activity and interaction.
This evening, after returning home from the village meeting, our gang of usual kids came over as did our friend ba F. Ba F. is a good friend of ours, a village confidant. He is also as addicted to playing chess as Shaun is, and they spend hours in the insaka playing each other in chess, trading wins and losses.
A second storm rolled in just as it was getting dark. Shaun and ba F. were deep in a game of chess and concentration, so I doubt they noticed their audience of village children retreating back to their respective homes. Then the downpour and darkness came. Still, Shaun and ba F. were playing chess by the light of two furiously flickering candles. There they sat, each hunched over the board, holding both hands up to their head as they strategized and executed their moves, all the while a storm raged around them. I had to laugh.
The final move was made, the game won and the two men snapped out of their trance to the storm around them. They started cleaning up and ba F. prepared to head home, despite the heavy rain. I was inside finding a rain poncho for him to wear on his bike ride home (he was insistent he head home), when I looked over to the small window in our sitting room and saw a long, thin snake winding its way through a small hole in the screen, around the crossbar of the window and up the wall. It looked like he was headed to hide in the black plastic of our roof, out of the flooding downpour. I can't say I blame the snake for wanting to get shelter, but he was unwelcome nonetheless.
I yelled “SNAKE!” and Shaun and ba F. came running in the house. Shaun grabbed our slasher and ba F. grabbed our rake. The two men swung and whacked at the snake as it tried in vain to scurry up the wall and into the roof for safety. The snake fell to the ground, where Shaun gave it the fatal blow to the head with the slasher.
Ugh and phew.
