Home Based Care Days

"If you reject the food, ignore the customs, fear the religion and avoid the people, you might better stay home." - James Michener



Brave and homecare workers, Airport Clinic



Now let me tell you about the Home Based Care program. I went out on a number of the ‘walk-abouts’ and it was more to my liking and much more what I had expected, but a bit slow, or should I say, lacking in patients. Brave told us that many, although they would know we were coming that day and were in need of being seen, would not be able to wait for us to show up, needing to get to jobs, the market, or go and collect water or other such daily neccesities that they deemed more important to life then their health at that particular time; how sad.

I should tell you that Livingstone is made up of many different areas, rather like our municipalities; there’s Nakatindi, Maramba, Linda, Libuyu, Mawandi, Natebe, Dambwa, etc.

On my last Friday, we started out in Mawandi, from the Airport Clinic. It’s located in the hills, and so we took the downhill trail from the clinic, walking for perhaps ½ an hour.

Brave stopped us at an area under a tree, where a make shift bench had been placed and several folks were already waiting. We each carried a backpack with some first aid supplies, stethoscope, vitamins and aspirins, along with the log book for the area. As with the clinics, each person seen, was recorded, so it was necessary to look up their name in the front of the book, then try and find their personal page within, no small feat, on this day as the wind had picked up and the book was full to the point of falling apart, so pages kept flying everywhere, with each gust of wind.

I’ve come to the realization that if I ever do this sort of thing again, I will need to carry a pillow with me! Constantly sitting on 2 X 4 type wooden benches, wooden stools, gas cans, water buckets, rocks or the ground, is not something my derrière, and the rest of me is accustomed to, and there were many aches and pains at the end of the day......or, maybe a little extra weight in that department would help, eh?

 

sitting on buckets etc.

So, while I was busy trying to keep papers together, or chasing them around the area, Tobias and Inge, along with Benny translating, would ask the folks what their problems were, then we would huddle together and try and figure out what we could offer to help, usually just a few aspirins, perhaps some vitamins and usually a recommendation to attend the clinic, which I understand most would not be able to do, due to lack of transport, or other problems. While we were attending to these folks, Brave had taken a young girl over to an area, under another tree, where he was lancing her swollen and infected right foot. She had arrived shortly after us, with her foot hugely swollen to at least twice its size. When he was finished he called us over to take a look and explained that she had acquired the infection from something she had stepped on and been suffering for a couple of weeks. It was hardly believable, that someone would be able to bear the agony she must have been experiencing, without the benefit of being able to see a doctor. The amount of infection that Brave removed was stunning, the skin of her foot was like dried paper after it was all removed. The question remained, would she be able to go to the clinic if the infection got worse and/or would she be able to keep it clean and bandaged till it healed....we didn't know. We left her with bandages to try and keep it protected, but without clean water to cleanse it or any antibiotics, it’s hard to say what has become of the poor girls foot.

Brave just finished with the girls foot



Another young woman also waited to talk with Brave and he took her off to one side to speak to her. As we left he quietly explained that she had bilharzias, a parasitic disease, acquired from washing/swimming or drinking contaminated water. I was surprised at the way this was imparted to us, in such a hush, hush, secretive way. To me it seemed nothing to be ashamed about...the fact that you have no clean water is not something that needed such secrecy.

During another HBC (home based care) day in the Natebe area we meet up with a man who Brave felt had TB, he had been after him for several weeks to get to a clinic and be tested, but as yet the man had not gone. This was another instance that was told to us in a secretive fashion. People in Zambia seem open to discussing their HIV status, and other complaints, but bilharzias and TB seem to be the new shameful diseases, for some reason. They are only discussed in whispered conversations, out of earshot of friends, neighbours and family.





"the park is over that side"



This fellow lived right up along the railway tracks, which is the only boundary between the Mosi-O-Tunya Game Park and the Natebe village, nothing to to keep out or stop marauding elephants and other wild animals from coming into the area and eating the small crops the people depend on for food. As Brave led us along the tracks for a short distance he told us to be on the look out for snakes, frequent visitors to the tracks! Luckily I didn’t spot any!!!

On the way to Nakatindi.
This cement block fence was built to keep out elephants from the park, but is not working so well!

We also visited with a gentleman (HIV positive) who had an large open wound on his ankle, caused back in November, which had not healed. Brave used good old Hydrogen Peroxide to pour over the wound to cleanse it. The poor man felt faint with the pain, so I sat behind him and held him, and bathed his face with water, while Brave did the cleaning. Tobias and Inge had never heard of using HP for cleaning wounds, so I guess there are some things I learned growing up that are still useful. Brave was telling me how expensive HP was to acquire in Livingstone, and was quite happy to hear that I had brought a huge bottle with me in my personal first aid kit and would be happy to donate all but a small bit to keep with me for emergencies. We again left clean bandages; along with a few aspirins and another entreat to get to the clinic.

As we were walking along this lady came to her gate and asked us to come back and take her picture. When we arrived back later, she was all dressed up for the occassion. The children decided they too needed to be in the picture.

On another day we walked some of the Nakatindi area, where we only found one fellow to visit. He was in his little mud-brick home, lying on a piece of cardboard, under a well worn blanket. He was full of many complaints, slowly dying of AIDS and there was not much we could do for him, except to hand out the obligatory aspirins and visit for a bit, which seems to be enough for most, just the fact of knowing that someone, somewhere cares and has taken the time to sit a chat for awhile.



Brave and I outside Nakatindi School...you can just make out the spray from Victoria Fallsin the background.

 We had 1 other day out in the field, this was a full day, with a larger group; half walked most of the way, about 5 miles (yes, up-hill, but in the heat not snow, and with shoes, not barefoot ;) while my group walked only about ½ of that and got to drive the rest of the way…thank goodness they took pity on the elderly of the group! There were not many people to be seen that day, but it must be remembered that the homes are few and very far between. We ended up beside a small homestead where a few people arrived out of the bush, to be seen,  we waited for the rest of the group to arrive. It was sometime in mid afternoon and we had the chance to relax and cool down while eating our packed lunch, and chewing on fresh sugar cane that Brave had collected from one of the farms we passed.

Brave with some sugar cane



Yuyi is trying to get some cell phone reception while we 'picnic'.



These HBC experiences were much more what I had anticipated and I really enjoyed having the chance to spend a little time and interact with the people. Each visit we made I would say “mulibutti’ which is hello in Tonga (the language used in the Kalomo area) but not the language they use in Livingstone, irregardless everyone got a real kick out of the fact that I was saying it and they all had a good laugh, but at the same time were very appreciative.