Zambian stories : Fall 2005

#1: Wailing

There’s a woman wailing outside. Someone has died.

I’ve been staying in this one-bedroom unit for eight days now. The concrete floors make it quite comfortable in the heat, and the mosquito netting makes me feel like I’m spending my nights in some elegant canopy bed. There are paw-paw and lemon trees out my back door, which overlooks a couple of dry hillsides, which I’m told are typical of a Zambian September.

However, the most significant feature of my lodging at this moment is that it is directly across from the front entrance of Mukinge Hospital, where I’m spending these seven weeks. The reason that I’m currently so aware of this feature is that there is a woman wailing about thirty meters from my front door. In the few short days I have been here, I have unfortunately seen enough examples of this to know the basic process. When someone dies, the family exits the front entrance of the hospital, crosses the newly paved road, collapses down on the grass, and wails.

So someone has died. I wonder who it was. I’m praying that it’s not one of the children I’ve been seeing on the pediatrics ward this past week. One particular little girl named Dorothy comes to mind, who has been in the throes of bacterial meningitis for a few days now, but there are several that could have taken a sudden downturn. Maybe it’s one of the adults that I never got a chance to meet.

It’s hard to know whether there is an intentional chant or song in the wailing, since the intrinsic musicality of most Zambians could have infused a melody subconsciously. And I don’t know if there are any actual words, but each line ends by being broken up in sobs. The wailing is loud, and unavoidable for those of us who live nearby, especially since windows and doors stay open most all the time. The unavoidable nature of it is fruitful, I think, because it forces me to pause and realize that someone’s son or daughter has just died, while I live free of disease, with my own stomach full of a lunch of leftover spaghetti. This brings me compassion and humility, which, for all the medical field’s talk of the value of detachment from your patients’ tragedies, are qualities that I know I desperately need more of. It also brings me to prayer, for in the face of such limited medical resources, the illusion that we have control of the situation through our ventilators and broad-spectrum antibiotics is stripped away. And so I pray:

Jesus, you are our wounded healer, who wept at the pain our sicknesses can cause. May the empathy from your own suffering be the comfort that binds up our wounds. Wrap your loving arms around this wailing mother. Let your mercy be a robe for the one who just died. Teach us all to love, to heal, to serve, and to learn. In Jesus’ name, may all this be.

#2: Choir

I love my church. Well, it's not my church, I guess, but rather the church I've chosen to attend during my time here in Zambia. Mukinge church meets in a simple building about a ten-minute walk away from my house. They average a couple hundred people a week, and the service begins around 10:30 Sunday morning and ends sometime in the next 4 hours. I have yet to discover an accurate way to predict how long the service will be.

Generally, the men sit on the right, and the women sit on the left, though there's a little mixing in the middle. Most of the service is translated from Kikaonde into English, so I understand most of it. Each week, one guy is chosen to lead the service. Whoever is chosen starts the congregational songs, gives announcements, and invariably has a huge booming voice. Most Zambians have voluminous voices, but these guys stand out for their lack of need of a microphone.

My favorite part is the choirs, particularly the combined men and women’s choir. There are about 25 of them. Each song starts with everyone doing a little dance step, and only after everyone is in on the chosen step does the first note sounds. I think most Americans have some idea in their minds of how an African choir sounds. If your idea would somewhere contain the phrase "joyous and powerful wall of harmony", then you are likely not far off of the Mukinge joint choir.

There is usually a man on the left side who's a little out of step with everyone else. In fact, he's really doing a totally different little dance, but the joy with which he undertakes it makes you wonder if it's not everyone else who is doing the wrong step. On the opposite end, there's another guy, not too tall and wearing glasses, who is in step with everyone else, but he stands out because his smile is bigger and his dance more vigorous than anyone else's. The women form the front row and the middle of the choir. Most all the choir members are younger, with a few that could be in their late 30's, and one lady in a white head covering whose toothless grin betrays her as notably older than anyone else in the choir. She stands behind the front row, slightly to the left, and though her movements don't have quite the vigor of the others (and nothing near the guy with the glasses), her arms know all the movements, and her mouth shows that she never misses a word.

I've heard Zambia's HIV infection prevalence quoted at 20-25% of the population, which is the 5th highest of any nation. I think about this as I watch the choir, as they revel in the power of their own beautiful music. It rarely strikes me to consider this fact when I'm meeting one individual Zambian (that is, unless in a medical context), but sometimes in the midst of a group, I look out across the bunch of them and think "certainly, 20% of the people I see don't have a lethal virus running through their veins." I notice that it's not just the choir which is quite young. I was told last week that the average life expectancy of a Zambian is in their early thirties. It would seem that there is an obvious reason why there is only one lady in the choir who has lived long enough to loose her teeth.

I have spent 3 weeks here on the Pediatrics wards, and almost 2 on the adult wards. I've seen HIV in both of these places. With the kids, it's usually a child who looks half as old as they are, who has never really known a period of wellness in their entire life. And even with all the resources of the hospital behind them, they probably won't ever know a period of wellness, either. With the adults, the patients waste away more and more, with chronic diarrhea from cryptosporidium and bloody coughing from tuberculosis, holding a desperate hope that they might get included in one of the nation's fledging AIDS medication programs. The diagnosis is more common than high blood pressure in the US, but carries with it a most terrible prognosis and a temptation towards despair for treatment, because you know they will never get anywhere near healthy again.

And so watching my church choir is a source of sorrow and of joy. Sorrow in thinking that so many of these people are going to be so very sick. Joy because I get to see how their lives can be full of life, light, and music.

#3: Epilogue

Five weeks ago today I came back to the states, and now I'm looking out the second story window of my Michigan apartment, starting at the snow. I don't know that any of the Zambians I met at Mukinge Hospital have ever seen snow. I wonder how many have ever looked out a second-story window.

Certainly it's worlds apart. I've been back in the University Hospital here, and I've watched a whole section of the cafeteria fill with young surgeons at lunchtime and thought of all the times in Zambia we needed a surgeon so desperately, but couldn't find one. Here, meds come in by the truckload and pharmaceutical companies market to the patients on TV. There, cancer pain patients at times had nothing more that Tylenol to soothe the agony of their excruciating tumors, and I remember riding the cramped public bus back from the provincial capital eight hours away, carrying four precious vials of insulin, because the hospital was about to run out. I've started to notice just how many electrical cords are required to run a Sunday morning worship service here. A Zambian bible college student told me that his church used to have a guitar for worship, but a string broke, and they can't get a replacement. But then, their rich harmonies hardly need accompaniment to make beautiful worship.

For all the ways in which it really is worlds apart, there were some surprising similarities, too. The reaction of the American inpatient psychiatry patients to the Halloween party the nursing students gave them bore a curiously strong resemblance to the afternoon when a missionary came and blew up balloon animals for the Zambian pediatrics ward. And though it exists on different levels, a trip to the hospital for an average Zambian or American is still a jump into a mysterious system, where the patient knows that what is happening is vital to him or her, but is still struggling to really comprehend it. Thus, there is always some trepidation in the process and some comfort to be found in friends and family to talk it over with.

And of course, I'm not quite the same. The biggest joy and struggle from this trip is to try and integrate the experience into life here. The swift pace of the holiday rush would gladly have me just step back into life like nothing's changed, but there are treasures from my time in Zambia that would be lost if I let it. So I guess writing this little reflection piece is worthwhile for me. At the end of the day, I like to drive home through Ann Arbor in the quiet and imagine some of my Zambian friends looking out the window next to me. I think they would compliment a lot of little things I would take for granted. I think they would marvel at the paved roads and the neon signs. And the snow, of course. And I suspect that all these observations would lead to some interesting conversations about money, happiness, justice, and the love of God. Before I went Zambia, I probably would have been just listening to the radio.