from A to Zimbabwe

Day 344

2006-11-23T11:05:00.000-05:00

Today I lost my US sim card for my cell phone. Well actually today I realized that somewhere in the last year I have misplaced my US sim card. For the most part of the year I was really good about putting this tiny little chip in my eyeglass case or in an altoid box or in any random box. Now that I have cleaned my room and packed my clothes I can not find it anywhere. I believe that the last time I saw it I put it in the altoids box which I threw in the trash on Monday. So today at lunch I went home, put on some gloves and dug through the maggot infested trash to no avail. Naomi our housekeeper and Asarimi our guard were laughing at me when I would yell out, ‘this is SO gross!’ It is definitely time to leave when I am now digging through the trash.

So basically I was all excited to call all of you when I get home, but I can not because I do not have any phone numbers. Please if you find the time send me an email with your phone number so I can put it into my new sim card when I get one.
Four days and counting!

Day 351

2006-11-20T13:31:00.000-05:00

Eight days and counting! This week I have started the hand-over with Sharifa (from Wisconsin) and it is going well. I was happy to hear her say she was a bit over-whelmed solely for the reason that it reassured me that when I was overwhelmed last year it was completely normal.

We have opened Nketa clinic a bit over two weeks ago and put 103 patients on treatment so far. It is a fast start to the clinic, and will not continue in that manner but it was nice to end the mission on a high note like that.

This Saturday is a party at the house to say good-bye to myself along with our logistician, Brice who is leaving on the 5th of December. We invited the entire office and a few friends, which will be nice. Last year at this time it was my going to Africa party in DC when I actually started this blog……strange how quickly time goes by.

I have still not heard anything from the Clinton Foundation and maybe I should actually apply for more than just one job. You know, increase the odds of actually getting a job. I never did like that adage ‘don´t put all your eggs in one basket.’ Who would carry more than one basket of eggs anyway?!

I am practicing my Spanish and so far I have learned to ask for the luggage locker (at the airport), ask how much the luggage locker is, tell someone I am really hungry, and say my name is Nancy Dunphy. Extremely useful for next week in my opinion, however, maybe not so useful for trying to communicate in Spanish at any other moment in time.
Missing you all!

Day 341

2006-11-10T16:07:00.000-05:00

So in three weeks I will be back in the states, at home. Hopefully I will be eating some pizza and having a Miller lite. Oh the simple pleasures in life!

These past few weeks have been action packed and heart warming! Last weekend I went back up to Victoria Falls to raft the Zambezi again. It was amazing! At one point our guide told us that the next rapid was the largest commercial drop in the world. When I asked him what that meant he told me that it was the largest drop in a rapid that is rafted for tourism. Yeah, I got the full brunt of that drop when I was holding on to the life line around the boat and felt myself suspended from it than just gave in to the Zambezi and got caught up in the rapid only coming to the surface a few feet from the boat, but it felt like I should have been much farther away, like in the Atlantic . Luckily, or not so lucky I should say, I was the only one in our boat that feel out on that rapid.

On the heart warming side we finally opended the HIV clinic! This week we put 51 patients on ARV treatment. One lady came into the consultation and said, 'I am so happy that you are finally open, and I am not dead yet!' I had to laugh because if I really thought about her comment I might cry. Everyone was so happy to be there, including me! My replacement comes on Sunday and I start my two week hand-over on Monday. Yikes, I do not even know what to say about leaving. I do know that I am thrilled about coming home though.
See you all soon!!!
Nancy

Day 333

2006-11-02T17:12:00.000-05:00

Today was a wonderful day! First of all the city clinic finally opened! I was not there for the first day because I was in Tsholotsho doing a few presentations for their HIV training week, but the doctor I work with was and she said it went pretty smoothly.
So after months of waiting we are finally going to be able to provide more people with the treatment that they so desperately need.
Secondly, I got an email from my brother saying how he forwarded my resume to the Clinton Foundation and by doing that fast-forwarded the application process and I will absolutely get an interview. This has been a good day.
On Wednesday I received the confirmation of my flight back states-side and I will arrive on the 1st of December into Newark. I can not believe that I only have about 25 days left in Zimbabwe. I spend about 3 days in Barcelona doing debriefings and then make the last leg of the trip on the 1st.

It is a good day, now only if I could sleep. The heat (which is over 90, and still hot at night) lately has been making it unbearable. See you all soon!!
Nancy

Day 324

2006-10-24T15:47:00.000-04:00

Today was another schizophrenic day in Zimbabwe. I laughed this morning at a man that was telling me about his toothache and how he thought the tooth would probably need to be pulled…..¨you know sister, I have had other teeth pulled,¨ he said smiling a wide grin full of about 6 intact yellow teeth. ¨Yes, I can see that,¨ I responded.

Then this afternoon I spent hours in a meeting making the final preparations for the new clinic only to be told that 126 patients had been identified with their CD4 counts done. Three on the waiting list had already died, 3 more had CD4 counts of 1 (normal with no HIV is about 800 – 1500) waiting for the Ministry to approve the opening of the clinic. My heart broke imagining the people excited that they finally got on a list for HIV treatment and to wait while beaurocrats (sp?) slowed their only hope at life. While we were in the meeting one patient called to check on whether they could come to the clinic for treatment yet. Augh!
This part of my job is so infuriating.

The patients are wonderful, no teeth and all, but the policy makers are so out of touch with the situation that they do not realize one day means lives that could have been saved.

The sky on the other hand was like the Simpsons episodes, full of big clouds and clear blue as far as the eye could see. It is beautiful. See you all in 6 weeks.

Day 314

2006-10-14T10:36:00.000-04:00

In the middle of the week I was working in the office when I heard some people outside yelling and looking up at the sky. The sun had almost a reverse eclipse look and there was a ring around the sun so large it looked like it took up the whole sky. One of my friends told me he heard that this either meant really good rains or war. Brigitte, one the doctors in the project had seen this years ago in Rwanda, and I asked her if it was before the war, and she thought back and figured it was about 6 months before the genocide happened. I am hoping for the rain, although I do not see an end to the >1000% inflation and mismanagement of govern without some type of civil unrest.

The rest of the week again found me carrying box A from place A to place B. Managing the pharmacy is not something that I am ever going to miss. On Friday I was so filthy after moving boxes that I had dirt streaks on my face and my hands looked like I was more of a native African than a pale pasty Irish-Polish mix from the US.
I am in the hunt for gifts for family and friends and feeling the pressure of our horrible per diem change last month. We used to get the per diem in US dollars and changed it on the unofficial market so we really did not feel the inflation so much. Now our per diems are frozen because the are over double what the lowest salary gets paid. We are getting Zim dollars (46 thousand per week) which are exchanged by the company at a rate of 600 Zim for 1 US. The unofficial market is now changing for 1300 for 1 US. That makes the shopping a bit harder and I have found myself changing the personal money I brought with me from the states. Inflation of this caliber is something I hope not to have to live through again. Our house is no longer buying cheese because it is too expensive and we are all on an unplanned and unwelcome diet. I do exaggerate a bit though, instead of being able to eat out whenever I want to and not worrying about money I am now counting my thousands to make sure I have enough to get through the week.

Day 310

2006-10-10T15:12:00.000-04:00

I have gotten used to living MSF style, working long hours, stressing out over drug shipments, having my favorite white bra turned purple in the wash, and all sorts of fun things about sharing a house with 7 other adults that may or may not act like adults. However, my time here is coming to an end soon, a replacement has been found for me. This nurse should arrive in Zim around the 15th of November and I should begin my travel back via Harare – Nairobi – Amsterdam – Barcelona (debriefing) – London – and finally, Philadelphia the last week in November. That puts me in the states well before my birthday!

Of course I am sad to say goodbye to all the friends I have made here, but I feel like I am ready for home.Across the past few weeks I have been doing mostly administrative work, the HIV training week, organizing the pharmacy order, and reviewing the annual plan for 2007 so I have not been close to the patients lately which is probably the one thing that I will miss the most once I leave, actually I am still here and I already miss it.

Day 307

2006-10-07T01:24:00.000-04:00

- The HIV training course that MSF holds is coming to a close on Friday. I am so relieved! I know it is only 5 days, but it is exhausting for me to organize the speakers, invite the participants, track down the participants, track down the speakers, organize the teas (which is really not tea – Zimbabweans put half a glass of sugar and powdered milk into a mug and than the other half is tea…what comes out is more like white hot water, but everyone calls it tea) make sure the lady providing the lunch is on time, make sure the projector does not foul up, and finally sit and listen to presentations doodling on my pad so as not to fall asleep. In the end it is nice to teach people about HIV. I am so engrossed in HIV everyday that I find it surprising when health care workers that live in a 20% prevalence area do not know about it.On a funny note, I saw the Philadelphia eagles! Not in person of course, but on TV. It was the 4th quarter with 31 seconds to go on the Monday night game against GreenBay. The Eagles were winning! I was so excited and Juan looked at me and asked, ‘Ahh, you understand this game?’ Come on who does not understand…well apparently a few Spanish people. Oh yes, all this happened on a Tuesday night at 6pm….better late than never to watch Monday Night Football.

Day 301

2006-10-01T02:17:00.000-04:00

I have lived for the past 301 days in the sun of Zimbabwe, the sorrow of Zimbabwe, the hyper-inflation of Zimbabwe. What have I learned? That is one of the hardest questions that I ask myself. I guess on the base level I have learned to appreciate the security of my existence, the love of my family and friends. When I look professionally, I have learned to love those who suffer from HIV and realize I would like to do more in way of assisting them. Personally, I have learned that I can actually live with 7 different people from varied backgrounds. Not always in harmony, of course, but living it to the fullest.

This weekend the presents my family sent were given out as gifts and the children loved them! They all wanted the sunglasses and the high-heeled shaped pencil sharpeners. The tennis balls were used as a game to assist with disclosure and fight discrimination.

Earlier in the week I was so mad I could have spit fire. I was working with a counselor at a neighborhood support group when one of the women, holding her 1 year old son, told me she had stopped her ARVs because she could not pay and was told that she could not receive them. We had a meeting with the city health department and they assured us that it would not happen again and that although the fee of $800 still is in place they will look into getting rid of it. I guess that is learning diplomacy on some level.

64 days to go!!! Missing you all!!!!

Day 297

2006-09-25T15:35:00.000-04:00

I finally white water rafted down the Zambezi!! It was an amazing experience, but I realized that I am a chicken. Our guide would tell us to ¨Get Down,¨ which meant we needed to sit in the bottom of the raft and hold on for dear life. Basically I was in the ¨get down¨ position for most of the trip. Then our raft went over a class 5 rapid and flipped! We were all in the water and holding our breath. It was only about 3 seconds, but it felt like much more.
After the flipping incident I was much less afraid of the whole trip and was actually an active participant in the paddling. The climb (700 feet) out of the gorge gave my quad´s the stair-climbing experience from hell, but I made it to the top alive and in one piece. The trip home was also an experience. The car we took was overheating and we had to stop five times along the road in the middle of the bush and let the car breathe. The bush fires were around us and there was no cell phone reception, but at 7pm at night we arrived back in Bulawayo.

We arrived back in Bulawayo to see cars lined up in the fuel que around 6 blocks. Welcome back to life in Zimbabwe, lines for gas that last all night and all. To let you know the economic situation, the US dollar is now changing for $1,000 Zimbabwe dollars. The internet cost went up 2,700% because the suppliers had not paid the South African companies, so basically I will not be writing on my blog or typing emails that much anymore, and that is only if I am actually able to connect to the internet.
A few more great experiences and I will be out of Zim, back in time for Christmas and my 30th birthday in the states!!

Day 291

2006-09-19T16:14:00.000-04:00

I have been trying to get on-line for the past few days but it is exceedingly difficult for some reason. This week we have a visit from our big boss in Barcelona and I really like her! She is pushing us to not get caught in the day to day but to realize or rather remember why we are here. To allow patients access to drugs...access to life. I hope that after her visit the momentum continues..

17 – Sept- 2006

It is so strange to travel just a few tours away and feel like you are living in a completely different world. Having just got back from holiday in the middle east I knew that life in Africa was different, but I did not expect to have the same feeling traveling to Botswana. The shops were full of products that were not available in Zim and the products that were the same were at a drastically different price. The lack of financial management and the over 1200% inflation is killing this country.
One of the doctors that I was speaking with had just moved to Botswana and when I asked her why she left Zim she told me that she could not even afford the school fees for her two children anymore. One of the doctors I traveled down with told me he was happy at times to see the inflation rise because it was the only real thing that the president could not justify. An inflation like this means lack of governmental management. The funny part of this conversation came when he told me he hoped Mugabe did not have the same genes as his mother since she lived until she was 104. (he is presently 84 and I can not imagine what could happen if his rein is for another 20 years)

As a whole the conference was great. It is so interesting to see and hear what advances are happening with regards to HIV management but I felt like some of the guest speakers did not really have a clear picture of the day to day workings in TRUE resource limited settings. Although it was nice to hear that we should pressure Western countries to increase assistance and pharma companies for cheaper ARVs the reality is that what is that there is a chasm between the ideal treatment for the patients and what we are able to provide.

Day 281

2006-09-09T19:20:00.000-04:00

I continue to repeat how the children of this program amaze me, but it is just me speaking from my heart. There was a youth art show today in which children both HIV+ and negative showed their works. The resident artists of the Bulawayo Art Gallery acted as coaches to the children. At first glance the paintings were just simply childrens drawings and paintings, but then you heard the children describe what they had painted.
On boy told me he was painting HIV in jail, it had been arrested so that it could not affect children anymore. Another was showing HIV being sent in a rocket to another planet where it would not kill anyone. Still there were more, one in particular that had children playing and stated, ‘I have HIV, but you can still play with me.’
At the end of the day all the children were given notebooks and bags from one of the local clothing stores, and a few were chosen and awarded prizes. This is where I need to thank my sister, mother, father and friend Steph. The prizes were the toys that they sent to me in care packages. The children loved them!

I read an article in one of the US News and World Reports, that my parents sent me, and it was about Zimbabwe and how the country is suffering from over 1000% inflation and the once highly profitable farming industry has been destroyed due to a governmental policy redistributing the land to local war veterans that either had no interest in farming or were not equipped to do so. This country is a mess, and not just because of the 20% HIV rate, or the average life span of 34 years for women. It almost seems like the leaders are so far removed from the suffering that the people I encounter have to overcome in order to obtain the basics…food and shelter. Selfishly, I am looking forward to leaving in 3 months, but at times my heart feels like even the simplest effort made by a few is in some small way putting smiles on people´s faces. The ARVs that MSF is supplying is making it possible for people to push off death for a few more years. The international policy of sanctions may hurt the govern but it is neglecting those that need assistance.

Tonight I will go and have a beer with my house mates and do the things that put smiles of my face in order to continue working tomorrow.

Day 278

2006-09-07T14:44:00.000-04:00

Botswana or Bust......There is an HIV conference in Gaborone, Botswana next week and my head of mission approved my participation which I am so excited about! There is only one hitch which would be the way in which I arrive there. One of the Ministry of Health doctors is driving and it would be so convenient to go with him but I am not sure if that would be allowed with MSF security guidelines. I hope that they do. I will keep you posted.

On another happy note, Konstantina found a dead rat caught in the trap this morning. Now normally this would not be something that most people are thrilled about, but considering our on-going battle (that we are usually not winning) with the rats this is a real victory!! So far we have caught one rat with some strange ¨rat glue,¨ the lazy old dog caught one, and this is the third. Three points humans.... Mind you the rats have eaten, multiple avocado´s, dog food bags, cheese, apples, pears, one back pack and the handle to the car door (not sure how the rat got in the car) so maybe I should not be adding up points and just focus on the small victory.

Day 273

2006-09-02T18:41:00.000-04:00

I think I am too old to have a blog since I am not up to date with all the blog dialect, but I think I was tagged by Sarah so here goes.....

I am thinking about: how Zimbabweans do not fight against the wrongs done to them.
I said: Why would a grown man run after a giraffee?
I want to: Have a wine with my sisters
I wish: Everyone who needs ARVs could have them...for free.
I hear: My family is happy.
I wonder: How my neices and nephews look now.
I reget: Not too much right now.
I am: always a nurse.
I dance: at the movie rental place (today)
I sing: hardly ever...my voice is best left in my head.
I cry: Gosh, I can not remember the last time I cried....probably my going away party.
I´m not always: as organized as a I appear.
I make with my hands: baby blankets for my neices and nephews.
I write: in my blog to stay in touch with family and friends.
I confuse: the way home (yesterday took a wrong turn and 30 min later arrived at home)
I need: hmmmm...maybe a great love story...or is that too cheesy...how about a Carmen Ghia.

Hope you enjoyed.
Nancy

Day 272

2006-09-01T16:31:00.000-04:00

Today was beyond depressing. The clinic opened the booking of new patients, and it was so sad. What I mean when I say opened the booking, is allowing more patients to register for ARVs in teh clinic. We can only accomodate 6 to 7 new patients a day and with the high demand have needed to close the registration many times. Today we booked through March 2007. Many of these patients will die before their registration day comes up and to hear the stories about how people got there at 4 in the morning to wait outside for 5 hours before anyone even saw them was so depressing. The AIDS crisis is overwhelming and there are not enough clinics providing care in the country and people are desperately trying to stay alive. The man in this photo wanted me to take his photo when I explained I wanted to share it with my headquarters so they could push to open more clinics faster.
So basically tonight I drank 3 glasses of wine and thanked God that I am alive and healthy.

Day 271

2006-08-31T14:54:00.000-04:00

Today I visited one of our counselors in the private hospital. This is the nicest hospital in Bulawayo and having recently visited the hospitals in Oman where a private room not only has a view but waiting areas, and room for an entire Zim family this hospital with 8 patients per room was not that impressive. Although, given that the other two major hospitals in the area often use matressess on the floors if they do not find the bedframes it is ¨the nicest.¨ Anyhow our counselor has been admitted for about 5 days with fever of unknown origin, initially suspecting pneumonia, but now with pleural effusion it sounds more like TB. Considering 80% of TB patients are HIV+, I am thinking our counselor may need to use his own skills to assist himself.
I can only hope that he is negative, but the statistics are leading my common sense in the other direction.

I miss you all and love you more - Nancy

Day 267

2006-08-27T16:42:00.000-04:00

There was a train accident this morning on the route from Victoria Falls to Bulawayo around 9am, so at 10am when I woke up the house was in overdrive with the Tsholotsho team getting ready to go assist and I found myself going to the office in my pyjamas to get medical supplies to help out the team that was going. It is a good thing my pyjamas are scrubs and a sweatshirt so that I actually just looked like a scruff to the guard and not the truly lazy person that sleeps in until 10am.
We later found out most of the injuries were bone fractures and burns since part of the train caught fire. Fortunately there was a Zimbabwe medical conference in Victoria Falls that ended today so there were plenty of doctors around the area, and we mostly needed to support the logistics of the problem. I’ll let you know what happens later since we are still in typical ¨MSF stand-by¨ mode; always ready to run at the word ‘emergency’ be it a true one or one in which we stretch the definition.
Yesterday the youths took their monthly outing at Hillside damns, which is a beautiful place just a few miles from the clinic. At one point I was playing volleyball (or rather something like hot-potatoes since we were just throwing the ball in the air or at each other) with three children and Richard the MSF-Holland logistician, and then quickly the game grew to 10 children and then 30 children and then about 50 children turned volleyball into rugby by running after whoever had the ball and tackling them. Richard found himself on the bottom of a pile of about 20 kids and I played referee picking the kids off one at a time. This was by no means organized chaos, just fun. The rest of the afternoon I helped cook sausages, chased stray dogs away from the sausages, and danced with the kids. I know I have mentioned this so many times, but these kids are really an inspiration. I doubt any of them will make it to the age of 20 and yet they have so much vitality. A poem I once read said, ¨participate joyfully in the sorrows of the world.¨ I think that is what I did. I hope that is what the kids do as well. On of the girls in my family (from the youth weekend), Marylynn asked me for 19 million dollars (which is now re-valued as of August 20th at 19 thousand) to help her by glasses. She had apparently gone to the social welfare department and another organization that turned her down, and she said that her eyes had been bad for quite a long time. Now, 19 mil is really only something around $40 US, but in Zimbabwe that is a lot of money.

Day 266

2006-08-26T12:54:00.000-04:00

Living in Zimbabwe is having some added bonuses that I never calculated upon deciding to work here. My parents take care of everything! I had a hard time booking the flight to see Fifi – I called my Dad and he fixed it. I got a strange fee on my credit card that I have not taken out of my wallet since last year – I emailed my Mom and she fixed it. This is great!
My time these last few days at work have been spent primarily in pharmacy management, drugs come and I move them from point A to point B and then sometimes to a random point C if needed. Luckily I have the strong arms of the guards at the office to assist in the moving since my bicep muscles are not exactly something to write home about. Today I was dropping off some drugs at the clinic when a patient needed to be transported across the street to the hospital so we used the MSF car to do so. The women could not walk and bless her waited until her appointment date for her two family members to carry her into the clinic. Getting her into the tiny car was a chore and when we arrived at the hospital of course there were no wheelchairs in sight so her brother and I carried her through the hall to the casualty area (again, the lack of muscles is a big negative at times like this, I really need to do some push-ups or something). While we were putting her on the bed I managed to get myself directly under her so we were basically both lying in the bed. I looked at her and said, ¨I guess this morning you did not think you would be sharing your bed with me?¨ This at least got a smile out of her emaciated frame. The people here have an amazingly resilient spirit, unfortunately their bodies do not have the same resilience.

Day 260.

2006-08-20T11:45:00.000-04:00

So I guess this means that I have 105 days left to go.....yikes, it sounds better saying that I have 3 months and even better to say that I have one tube of toothpaste left. I think I will stick with the toothpaste time line.

I arrived back to Bulawayo after another 18 hours in transit to a balmy 26 degrees C, which was a blessing have just left the 45 C stiffling hot as balls heat of Oman. I am not sure how I am feeling about jumping back into work. At this point I am just ready to go back and see my family. I know the way to cure this is to put all of my effort into work and just remember the people I am here to help.....my friend Morgan who has gained 20kgs since starting ARVs in April; Itai the teenager that is now skin and bones and hopefully still alive. Yup that was enough of a pep talk for myself....here I come work! As always missing you all so much that at times it is physically painful. Love, Nancy

Day 259

2006-08-19T13:51:00.000-04:00

My visit with Fifi is coming to an end and I must admit I am more than a bit sad! It is really interesting when you meet a friend that you get along with in such a way that at times you feel like she knows you better than you know yourself. I am blessed for some reason, thankfully.

The rest of the week, I found myself in a car for 5 hours on the road to UAE, eating under a big gold buddha, getting my pale pasty skin tanned at "Wild Wadi" water park, and dancing the night away at a triple-decker club called 'Trilogy'. I had a great time and will miss Fif and her family, who I have started to know more over the years.

I do have an all new respect for Fifi and in fact for all breast feeding mothers. The fact that your body produces such large quantities of milk is strange enough, but then add to that you are constantly thinking when can my baby feed, or when do I have to pump makes me respect all mothers in this state. I have seen Fifi pump in the house, pump in the car, pump when she wakes up, pump before she sleeps, and feed in between. God bless her! I will miss you Fifi.

Day 256

2006-08-16T05:59:00.000-04:00

If anyone noticed, in my last title I think I was living in the past.....Anyhow, here is my tourist push for Oman. The beaches reach out for miles, the ocean water is as warm as your bathtub, and the people are very open and hospitable. As for transportation the highways are clean and wide allowing easy travel for destination spot to destination spot. I would beware of the round-abouts since Americans do not encounter many of these, except for maybe in New Jersey. Travel advisory: May not be the best place to visit during the summer months (i.e. NOW) with temp well over 100.
I have had such a wonderful time visiting with Fifi and her family. Fifi and her husband are wonderful and so welcoming when I arrived I felt like I was coming home from my holiday in Zimbabwe and not going on holiday.
We have seen some amazing sights here, and I hope to post them so you too can see them.

On a funny note, last night we had games night at Fifi's cousin's house and we played "Cluedo." Apparently that is a new form of "Clue," but I am not sure what the "do" adds to the game. I miss you all and love you...

Day 148

2006-08-08T16:43:00.000-04:00

I am leaving for holiday tomorrow to visit my friend Fifi in Oman and I am so excited! The holiday will be wonderful and when I get back we will hopefully be able to move into the new clinic and start working. I think I am due for a holiday since my daily functioning is not working so well. Today, for example I was carrying three bottles of medication to a clinic and when I got out of the car I dropped one, bent down to pick it up and dropped the second one, bent down to pick that one up and tripped over my skirt. Life has a funny way of telling you to take a rest.
This afternoon I was then in another training session for peer educators informing them about the process of HIV and how it invades the body and one teenager asked me, 'Are you married? I mean are you single?' This seems to be an important question in these sessions and I asked him, 'Are you asking me if I have a small house?' Everyone laughed at that. In Zimbabwe a small house can be anything from your boyfriend to your second husband, to the person you are having an affair with. It somes from prior times when men had wives but could afford to also have second women on the side in the smaller house. I neglected to mention that for the time being I do not even have a tent let alone an actual small house.

Things at work have been a bit slow lately with doing planning and not actually implementing anything, but I realize that it is just how Zimbabwe moves. The snails pace at times and you have to adjust to it.
A big change here has been with the currency. Last week a new bearer check was implemented which cut off the last three zeros in all the currency. So, a 100,000 note is now 1,000. It is strange to see so many changes in currency and to realize the economic instability of a country. The new currency ranges from a 1 cent check to 100,000. It just does not seem possible, but it is happening and people are coping. The resilience of the people of Zimbabwe consistently amazes me.

I love you all and miss you! I will write when I get back on the 20th.

Day ..... I forget

2006-07-31T15:41:00.000-04:00

30 – July – 2006

I am almost done my third tube of toothpaste, and having measured my time in Zimbabwe by these tubes, I can say that I am almost ¾ of the way through my year here.

We are still in the planning stages of the scaling up process and right now I am writing guidelines for how nurses should start patients on ARVs, whether the patients are appropriate and how to manage infections and side effects. Concurrently I have been assisting in the training of peer educators for HIV-AIDS. Last week while training a group of 20 men about HIV one of the men was asking about the ability to have children if the couple is HIV positive. He asked me, ¨say we are married and we want to have children. Will they be HIV positive?¨ My response to that was, ¨wow, aren´t I a lucky woman to be married to you!¨ The rest of the class enjoyed that.

This weekend was the youth camp again, and as always it was really nice. Two girls were in the hospital across the street and only one was well enough to come so we collected her in the morning and returned her at the end of the day. The stories are enough to make you cry. Her father abandoned her after her mother died and now she lives in a poorly run orphanage. The sadest part is that she either got HIV from her mother through birth or by molestation from her uncle when she was young. The child services here are like all government organizations, overwhelmed and understaffed with a pittance for a budget. Today I went back to the hospital and brought her a few fruits and muffins. I felt like I was trying to make myself feel better rather than her, but hopefully she enjoyed the short visit and the food.

Day 232

2006-07-23T16:07:00.000-04:00

The Fly Part 2......Sitting in the clinic this week I noticed a few small things flying around my head. At first I thought they were flees, but as the afternoon heat swelled I realized they were the beginning of the flys coming back to Zimbabwe. It started with just two and then by 1 in the afternoon there were about 7. I managed to kill two by slamming my hand down on the table but quickly stopped doing that since it usually scared the patients who seemed to tolerate the mangy things much more than I did. I am consistently impressed with the resiliance of the people I work for, they fight HIV, economic hardship, family tragedy and do not even complain about the flys. I can only hope that their skill of strength rubs off on me in some way.
On a more professional note, a representative from Barcelona is coming on Monday night to discuss with the local authorities the plan to scale up treatment to 20,000 patients. Fortunately, for us there is need for this type of increase but the logistics of it all is a bit scary. As I have said before we are only treating about 2,000 people right now and the increase will be felt most strongly on the already stressed city clinics. Most of the clinics are working with less staff than required, sometimes by as much as 50%. The situation in Zimbabwe continues to deteriorate with regards to the health care infrastructure. This week the junior doctors were on strike, asking for a 700% salary increase (if you recall the >1000% inflation this is really not an outlandish request) which meant that there were practically no doctors in the hospital at all. The situation with the nurses is similar the salary can not compete with inflation and the pastures from surrounding countries just seems to look greener. On a few occasions student nurses have asked my why I left the US to come here to work as a nurse? When your salary does not cover basic food, altruism does not seem as appealing and I try to make up some answer that seems appropriate.
Again, there is a new member in the team. An anthropologist/nurse/guitar player has joined the Tsholotsho team. He has what I would call a mullet with a dread lock in the middle of it, but I think that is fashionable in Europe, and his name is Feran. He seems quite nice, but his level of English makes conversations a bit challenging. I miss you all and love you!!!!!!!Nancy

Day 215

2006-07-05T15:58:00.000-04:00

So, posting the photos last time did not really work. I will try again today.
I was at the office early this morning and received a strange phone call. This man was asking me who we were and what type of organization MSF was. I found all this odd, but have received calls like this before, just not usually at 7.45 in the morning. Then he goes on to tell me that his wife dreamt of the number and he decided to call. He wanted to meet the staff.....I told him we usually do not accept visitors. Then the clencher hit. He is a member of some church on 5th and Mugabe road and if I was interested he would love to meet me and I should feel free to bring the other members of my staff.
I guess this is a new recruitment tool for churchs.

The rest of my day I was giving a lesson to peer educators about HIV, its transmission, signs and symptoms of HIV and ARVs. About half-way through the lecture I realized I kept saying that I was the virus and this is how I am attacking your army (immune system). It was at this point that I realized, maybe I should not be calling the only blonde(ish) white girl in the room the virus.
Hope everyone had a wonderful Independance Day!

Day 213

2006-07-02T15:52:00.000-04:00

This is the 4th of July weekend in the US. Independence day. For Zimbabwe, it is just another winter weekend. I look at the photos my family sends me and everyone is in shorts and tank tops while I am currently wearing a tank top, a long sleeve shirt, a sweater and a scarf. I can not wait for Sept and Oct when the summer will be here.

As is usual with MSF a lot of changes are on the horizon. Our Head of Mission (big boss) is leaving in a few weeks and his replacement should be coming on Friday. The pediatrician on the team is leaving on the 19th of July and a new doctor will be coming in the next few weeks to replace her. Then in August three additional people should be coming to the project to replace Vasilis, our current project coordinator (not as big, except in girth, boss) and Nuria, our financial coordinator. I guess with ngo´s this high turnover is normal, but it still takes some getting used to since the people you work with also become part of your Zimbabwe extended family.
This week in the clinic to celebrate the pediatricians’ birthday/leaving we had a party in the clinic. I attached some photos of the party. Needless to say, looking at some of the nurses I work with you would be surprised there are food shortages in the country.

Day 207

2006-06-26T15:30:00.000-04:00

25 June, 2006

Yesterday a new baby was born in the suburbs of Philadelphia! Welcome to the world Katlyn Murray! (not sure how Jenn and Brian are going to spell that so I gave it my best)

My sister sounds great and I am so happy for her and her family. I asked my mom if having 3 granddaughters and 4 grandsons means she is now old? ‘Of Course Not,’ she exclaimed over the phone. I think I asked her the same question just six months ago at the birth of my other neice. I really am a pain in the ass sometimes.

I wish I could be there to see all of these babies being brought into the world, but in a few short months I will be able to hug them and tell them stories of how I almost hit four cows crossing the road on the weekend they were born. On second thought, I may have to make up a more exciting story since that exact event could happen right at home in Pennsylvania. This weekend I did have a close encounter with a few cows that were trying to commit suicide. It was dusk and I could not see them well until it was almost too late. Just imagine the scene, tires screeching, cows mooing, knuckles white on the car wheel. Luckily we all came out alive.

The economy continues to tank here. I am getting seriously worried about the people in this country. The inflation is out of control. At present on the parallel market the US dollar is now changing for $450,000 Zim dollars and next week it is supposed to go up to $600,000. I was talking to one of the ladies that clean the house we live in and she explained to me that almost all of her salary goes to food now. There is no thought of putting money away for savings, or education every dollar is put towards ensuring that food is on the table and there is a roof over their head.

Having said all that, I do have a special request for anyone interested. The childrens clinic has no toys. At one point there were a few, but they are old and not exactly what you would think of as cheerful. I know many people have asked what I need, but if you are still considering sending something to Zim (it may be costly through the mail) I would love for you to send some toys for the kids. Stuffed animals, childrens books, pretty much anything would be greatly appreciated!!!!! You can send it directly to me at 5 Vincent Ave,
Khumalo, Bulawayo,
ZimbabweThanks in advance, but no pressure, only really cute kids with HIV…I mean come on! Seriously just kidding, it is expensive to ship things out here.

Day 200

2006-06-18T11:58:00.000-04:00

17 – June- 2006

I have been receiving some comments about not writing on my blog as much as I used to....there are a few reasons for this.
1 – I am tired when I get home from work and the internet connection is slow, but since the speed of the internet connection has always been slow, and anyone who knows me well, knows I am always tired this excuse is basically just an excuse.
2 – I have been so busy I have not had the time to write…. unfortunately or fortunately however you look at it, I have not been that busy these past few weeks and have actually at times sat around attempting to find something to do after 3pm (in comes the endless supply of MSF meetings that last until about 7pm so that usually saves me)
3 – The new and exciting has become the normal and usual…..bingo!

Although, I am still impressed at the mechanics of the country, and how it is not in a major engine breakdown, my job has become normal for me. The huge growths on ons eye, the work in the clinic, the dinners at home with six nationalities, yup, all of it seems like everyday.

Now having said this, I am taking a new look at my work here and in the next six months going to try to break away from this feeling and learn all the new things I can about the country and working with HIV-AIDS in a third world setting.

18-June-2006
Today Esther and I went to Khami Ruins. Stating the obvious this is a bunch of ruins of old civilization. The interesting part was that inhabitants lived in these stone buildings from the 15th thru the 19th century. It amazes me how Africa could stay so primal (for lack of a better word) while the Western world was busy sailing ships into new harbors, conquering new lands, and well attempting to live the civilized lifestyle by living in proper houses with all the many new things that comes with what we now know the term civilized meant in the early 1900´s. It was an interesting day and upon leaving again ran into some of the largest Baboons I have seen in my 29 years.

Day 193

2006-06-11T15:22:00.000-04:00

Success and failure all in about 30 minutes….A couple came into the clinic and told me how much they appreciated my working with them and how helpful I was in explaining the process of HIV and the reasons for the ARVs. This praise made me feel so nice I thought, I am really helping people today. Directly following them, a well dressed and well spoken man came in to tell me after eight months on ARV treatment he decided that he was going to stop taking the drugs. Now this is not only foolish in my opinion, but basically a death sentence. If he stops drugs there is a chance of him becoming resistant to the first (of only two) lines of treatment available to him in Zimbabwe. Although he is physically feeling much better his immune system was still severely injured and he would be at risk to fall sick quickly. The reason he gave me for why he was going to stop treatment was that he was a preacher and how could he continue to preach the healing power of God while taking these medications. I sat with him for some time and gave him the medical reasons why not to stop and when I realized this was not working tried to appeal to his religious side and convince him that he could be doing a great service to all people with HIV by living and stopping the stigma about HIV. He could be a witness to others by living this healthy lifestyle. After about 30 minutes of me listening to my own failing attempts at changing his mind I told him if he gets sick in the future he should come back sooner rather than waiting until he is really ill.
It was so discouraging to see someone improve so much and fail at convincing them to continue the improvement. It also struck me as slightly ironic that these two patients came back to back. The very obvious message that not everything works out as you plan it was blatantly clear.

Day 188

2006-06-06T15:52:00.000-04:00

Given that the world cup is about to start I thought I would entertain you with our own private Zimbabwe soccer that has occured in our house. Well, to preface this.. there has been a battle between the rats that are living outside the house and trying to take up occupancy inside and the human inhabitants trying to keep the rats out.....so the soccer story begins.
The other day Miriam and I were chasing a rat out of the food closet with a broom. Amongst much screaming Esther came in and tried to help. She opened the side door and Vasilis stood at guard by the door where Miriam and I were pushing the rat towards him. At this point Vasilis took up the forward position while the rat was running towards him and kicked the rat out the door in full World Cup style......one battle won for the humans, but I fear the war may be lost to the rats. Missing you all!

Day 185

2006-06-03T04:32:00.000-04:00

June 3rd...Picture this surreal scenario. At the going away party of our boss we ended the evening dancing at a bar called the Brass Monkey. Between being flipped over my bosses hip where I thought I may not land on my feet like cats do (fortunately I did) and the song CaliforNIA the DJ put on Bruce Springstein´s Born in the USA. All the expats came to the dance floor and yelled NANCY. So, I danced in the middle of a circle of people ranging from France, Austria, Eqador, Argentina, Belgium, Spain, and Zimbabwe…of course in the middle of a dance floor in Zimbabwe.
It was very amusing!
I am going to try to put up a photo of a little girl that I saw at the clinic she was adorable.

Day 182

2006-06-03T04:12:00.000-04:00

Its funny how some weeks you can not find enough minutes in the hour and other weeks you check your watch to make sure that it is still working and to verify that time has actually not stopped. At present I am in the ‘time has stopped’ week. It actually leaves me a bit confused about how I could be so busy sometimes and not others. I know this is natural, but since I have arrived I always feel like I am needing to do something be it count drugs, or store drugs, or supply drugs, or plan trainings, or perform trainings…Yup, for some reason this week I did not feel overwhelmed by the counting and the supplying and the performing. What I have been overwhelmed with is the planning of going away parties. Our field coordinator is leaving the project next week, which makes me nervous in many respects. He has come to be the person I ask most of my questions to, and the one I rely on to answer all of them. Now, I do not mean to sound dramatic, the project will continue and people will get treatment, but the planning is going to be different. Being human, change always comes with a bit of anxiety.

I find it hard to believe that I have been here a full six months. With all of the changes occurring I am assuming that the next six will go by in the blink of an eye. I can only hope that the work that I have been at times stressing about is actually making a difference in some way. I guess that is the eternal question of life, what is the meaning of my presence here? I am sure that I will be no closer to answering that in the coming months than I am right now, but I hope to have a hell of a lot of fun searching for the answer.

Day 172

2006-05-21T15:10:00.000-04:00

These past three weeks I loved, I cried, I laughed, and I yelled. The first two weeks of May I spent in Cape Town with my parents and it was amazing! When I saw my mom I hugged her for longer than I have hugged in her in so many years. Although I strongly believe (at times) in the work I am doing the distance is just too damn far! We drove around the South of South Africa for two weeks and did everything from wine tasting to feeding elephants. I was the navigator and my Dad was the driver…lets just say there were a few sentences such as, ¨Dad, you were supposed to take that turn we just past!¨…..¨Shut up, Nancy.¨ And the funny part is that I loved every minute of those conversations. I attached some photos of our visit.

When I got back to work…(ugh, work!) we were in the process of reviewing our annual planning. This is where the yelling part comes in. The pseudo-management team (I say pseudo because at times I do not think the definition of management translates from English to Spanish in the same manner that I am accustomed to) discussed, among others, my changing role in the team, and I was not involved in this discussion, which annoyed me to no end. How people can discuss what you do and how it will change without your input is fascinating to me. Anyhow, the yelling took place (in my polite yelling way). The very next day I was in the last consultation of the afternoon when I was discussing with a patient his progress and how although he was not doing wonderfully he was not getting sicker as well which is to be appreciated. I asked him at the end of our conversation if he had any questions, and he told me, ¨well, none about my medications, but I have a personal question to ask you.¨ This is where I thought, great, he is going to ask me for money or a date or something…..he looked up at me and asked, ‘Is there hope?’
At that moment my stomach dropped and I realized again why I came here and that even though I may not agree with the internal political games that happen, it is for this man and the other individuals that we can help. This coming week I have to deal with some pharmacy ruptures and other time consuming and completely not exciting issues, but I am sure I will meet some more people that make me understand why I am a year away from family and friends

Day 147...back on track.

2006-04-27T16:31:00.000-04:00

Who is this Murphy character anyway? On Wednesday of this week everything that could have gone wrong did. (yes I am slightly stretching that statement) I was at the local clinic and tried to move a desk a few inches away from the spot it was in and the whole thing collapsed and fell to the floor! The computer that was on it slid off the desk and hit the floor as well. As I stood there in shock the patients came in to help me. Thankfully the computer is fine, but the desk is in about 5 pieces. Then on the way back from the second clinic of the day our packed car (about 11 people in it) got pulled over by the radio police. Apparently you need a license to have a radio in your car (yup ours does not even work) and when the radio police man was speaking in Ndebele for too long I got out of the car and started to discuss with him....¨Sister, are you Zimbabwean? You may not know our laws.¨ Of course I am clearly NOT Zimbabwean with my blonde hair and my American accent MR. radio police.....needless to say I paid the $550,000 fine (all of about 3 US dollars) after arguing for 20 minutes with no luck. Then we get back to the office and we are in a slightly higher security mode since some men (who may or may not be potential thieves) came to the office asking for ARVs and counselling from none other than myself and one of the counsellors I work with! It is really not a big deal, but my goodness I was happy when Wednesday ended!
I am off tomorrow for two weeks to Cape Town to visit with my parents so I will tell you all about it when I get back!!

Lost track of the days.....

2006-04-22T02:00:00.000-04:00

So, it is getting a bit harder to keep track of how long I have been here, but as of today I have 8 days left till I fly to Cape Town and visit with Mom and Dad! I am very excited about that. 6 months is a long time to be away from those you love.
I attached some photos of the Easter Weekend trip up to Northern Zim.

Work this week was, as expected very busy, and I have caught some upper respiratory cold again this year. I had the same thing last year which starts out as seasonal allergies and then spreads into my chest until I have to cough all day long….you would think that going across the world you would have different allergens but apparently not! I guess I could say I now have Africa Allergies. I love you all and will write more later!

Day 134

2006-04-14T02:48:00.000-04:00

So apparently all of these years I have been thinking that my friend Dewey was helping me measure, but thanks to my good friends in the navy I now realize that he was only assisting librarians in their efforts to catalogue endless books. Wow, you learn new things (or realize you must have been day-dreaming this day in primary school) everyday.

This week was an interesting and busy one with the Easter holiday coming up we are cramming 10 days worth of patients into 7. One gentleman came to my consultation with a lace scarf wrapped around his right eye and under his chin. When I asked him what was wrong with his eye he told me he had a tumor. Yes, I immediately thought of Arnold in ‘twins’ saying ‘its NOT a too-mor!’ Anyhow, I mistakenly asked him to see it. Oh….my…..gosh!!! This thing growing on his eye was enormous and bleeding. It was by far the most disgusting sight I have seen while I have been here. He is being followed up with the maxo-facial surgeons, but the poor man had to have a biopsy done twice since his first biopsy results never came back. As with all of Zimbabwe right now getting results is not easy since most places do not have the money for the reagents of the tests or the staff to perform the tests. I had no positive words for him. Then to top that I had a man come in who was loosing his eye sight due to CMV retinitis. I had to sit there and explain to him that there was really no treatment that would help and the medications that he was buying for over a million Zim may delay the blindness, but it was inevitable. Sometimes my job sucks. As a whole I love coming in and seeing patients because there are so many positive stories as well. For the Easter weekend I am headed up north to Lake Kariba with some of the other expats. I hope that you all have a nice Easter weekend!! Missing you, Nancy

Day 130

2006-04-09T13:54:00.000-04:00

So this weekend I was so excited for white-water rafting at Victoria Falls, but it did not turn out as planned. We got on the night train and after 12 hours arrived at Vic Falls to hear that due to high water the rafting was cancelled for the next few months. So as an alternate plan we went canoeing on the Zambezi. Initially you would think canoeing was a calm and tranquil jaunt down river….not exactly. The river was wide and the current pretty strong, plus add a few aggressive hippo´s in the middle and you got a pretty good work-out. No need to worry though, we were able to out paddle the hippo´s, but needless to say I am a bit sore at the present moment. The river was as beautiful as the falls were amazing! Towards the end of the canoe trip we ran into five elephants taking a swim. For huge animals they are pretty agile creatures. They got out of the river with more skill then I got out of the canoe.
Now the falls…what a sight to see. They are 2km wide and about 80 meters down. While walking along the falls you see the spray rising hundreds of feet above your head (yes I know I am mixing the dewy decimal system with the metric one but it is a bit hard for me to live in the metric world yet forget my roots of good ole´dewy) Anyhow the spray goes up and if the wind is right you get absolutely drenched while walking along. At many points you can not even see the river below because of the huge cloud of mist rising up. The rainbows were comparable to the ones I saw in Hawaii as well. Hawaii will always hold a special place for me though so I can not say these were actually better per say. As for work, it was so nice to end the training that I was so excited to go back to helping patients and nurses, but this month will make it hard to concentrate with all the holidays. Last week I ended up giving a lecture to 12 nursing students and this coming week I am giving a lecture on post-exposure prophylaxis to a victims of sexual abuse committee. The idea is that in such a high HIV prevelance area to offer ARV´s for one month to people that are raped or molested who initially test negative for HIV. The sad thing is that most of these people do not come forward in the first 72 hours and that is when the PEP would really be helpful. It should be interesting to help inform people of the policies and procedures to try and help them implement the program though.
Again…I love you and miss you all! I will post some of the photos later, but I gave my camera to a friend to help in downloading the photos.

Day 123

2006-04-02T03:52:00.000-04:00

I remember in college always wanting to go on an African safari. I talked to my mom about taking a trip for a few years, but it never was planned. Yesterday I guess you could say I went on a walking safari. I went to a natural reserve about 15 minutes out of the city and walked about two hours. About 20 minutes into the walk I ran into a family of 7 giraffes. They are such interesting animals. They were not to keen on having four human visitors so they kept their distance but we were able to get pretty close to them, which was amazing. Later in the walk I realized that I was spending the majority of the time looking down to make sure of my footing and not taking in the world around, so I decided to chance the occasional animal hole and look around at all the wild chickens and birds. No zebras were seen, and we were told that the big five (elephant, rhino, tiger, buffalo, and leopard) were not found in these areas. Still, I listened out for some roars, but did not really know what I would have done had I encountered any. My shoes were the only real weapons that I had and with my apparent interest in the rocks and holes at my feet I imagine I would have been hard pressed to part with them as well. It was a nice break after a week long training session that found me at the office at earliest at 7 am and latest at home from work at 9:30pm. The session went well though. We had about 40 participants and I think they enjoyed it and hopefully left with more knowledge than they arrived. It will be up to them to put this information into practice though. I did stop at the clinic this week for about a few hours and encountered a few of the teenagers in my family who warmly greeted me, Hi Mom! It made me feel special, maybe more so because I am not a mom and did not actually have to birth any of them. This weekend is the much anticipated Victoria Falls trip. Since I have been talking about it for what seems like an extremely long time I will be happy to be there and enjoy the wonders. Missing you all! Nancy

Day 117

2006-03-26T12:41:00.000-05:00

So, it looks like I have gotten into the habit of writing only on Sundays…sorry, sorry. The month of March (although it is almost over) has been full of activities and a bit stressful to be honest. Tomorrow we are starting our weeklong HIV training and I have been planning that and trying to make sure that no big problems occur. A new medical coordinator arrived to the team and while she seems to have a lot of experience her approach to me seems abrasive, so basically I am very happy that she will not be in the same city as me. My role here is changing into one of more advisor and less involved with hands on patient contact which is interesting, but I miss the more personal contact with the patients. I still manage to say hello to everyone that lines up in the clinic hallways and many seem to know my name by now…..Yebo Nancy….Which makes me feel very special although I am still not sure who they all are. At the clinic this week I did run into a few of the kids in my family (Bectemba and Marylynn) which was so great. They were there for their follow-up and to get supplies of drugs. The strength that those kids have is beyond admirable to me.
Today I went to the office to make a few extra copies for the training tomorrow and for the second time in four months I accidentally set of the alarm in the office. I thought that the security company would call and when they did not I was happy thinking that maybe I turned off the alarm within a certain amount of lee-way time….no such luck. About 10 minutes later two police officers arrived and asked me who I was? …..it was not really a problem though. About an hour later I was getting some stationary out of the locked closet (again for the training) and very efficiently locked the key in the cabinet. It was at this point that I decided I should not be in the office today and came home! I guess on a happy note it is nice to see that my somewhat clumsy side is fully intact here in Zimbabwe. Missing you all….and I will write to tell you how the training goes..

Day 110

2006-03-20T16:30:00.000-05:00

This past weekend was the youth camp in the bush. It was such a great time! Most of the children have never been on a vacation and they all really enjoyed it. Towards the end of the weekend they all mentioned that we should have gone for longer. I am not sure if I would have had the energy for a longer trip. Most of the children take their meds at 6am or 7am and waking up before 6a to make sure they were awake made me feel all 29 years that I have achieved. The children were put into families with two adults acting as the ¨mom and dad.¨ My family was made up of 9 children..Cinderella, Priscilla, Becktemba, Tendai, Melissa, Nobody (a boy and his real name), Funguy, Tenashe, and MaryLynn. I sent a picture of the family and me! There were many games and we went in the lake on canoes, a treasure hunt and walking around in the bush looking for fire-wood. A few of the children read poems they had written and one in particular really struck me with the maturity of it. A 16 year old girl was writing about the emotions she lives with such as fear and happiness. I can not imagine the acceptance that these kids have to deal with regarding thier illness. None of them will live to see the 29 years that I have and they will be lucky to turn 20. Having said that, I was thrilled that they were able to enjoy the weekend and really leave the reality of day to day life even if just for a weekend. As always, missing you all like crazy!!!

Day 103

2006-03-12T17:09:00.000-05:00

Wow, so I have finally made it past 100 days! I can not believe it. The time has seemed to pass quickly in one respect and in other respects the minutes drag on.
I got an email from my wonderful friend, Gabby, and she asked for more photos of where I live. So, I thought I would send some of the most essential places....the bathroom and the kitchen! (sorry could not make the photos right side up) The part I hate about the bathroom is that the shower head is only about shoulder level, so to wash my hair I have to contort my body. I guess I should appreciate the fact that I have running water though. The house is actually a great structure but the up-keep is a bit lacking. The electricity in the `family room´ does not work so if we are in there during the night it is all candle light and no electric sockets work. Apparently our logistician is working on that, but having difficulties with the owner of the house wanting to pay for it.

At work this week I was again introduced to the gross and gory. One woman came in limping and when I asked her what happened she told me that she stepped on a thorn. When she took off her sock I gasped and said. `Interesting, we need to take care of that!´ What I really wanted to say was, `how in God´s name did you let this happen!´ Her whole foot was infected and the open wound was about the size of a Big Mac (yes I am missing American fast food). Needless to say she is on some antibiotics now that I doubt will have the needed effect but may allow her to avoid going to the hospital. In the states she would have definitly been admitted for a few days for IV Antibiotics, but we are in Zimbabwe! The second more disgusting case was a man that told me he had a sore on his butt. When I examined him he had a huge sore that was tunneling into the tissue. I think it originated as some type of abcess but who knows. I recommended he go to the surgeon and get it packed. So basically this week I have not really been treating people living with HIV but more the gross ailments that just happen concurrent to the HIV disease.
As always, I miss you all more than I can find words for!

Day 95

2006-03-05T13:00:00.000-05:00

The weather outside is frightful! But the fire is so delightful! The last part about letting it snow is just going a bit too far for Zimbabwe. However the weather is very cold and we are all wearing jackets and scarves or kikoi´s which are kenyian wraps that can second as skirts/tablecloths/scarves. This is not supposed to be the winter season yet, but it does feel like it. There is a small fireplace in my room and last night I lit it with much help, but I still felt like I earned a brownie badge. Tonight I was not so lucky and the fire would not start. Since it was raining the wood was wet and the fallen tree that I drug home from my dog walk apparently was still too green. Maybe next weekend, because I am sure that during the week I will not want to put the effort in to making a fire.

Work is going along nicely if still stressfully. The nurses that take over the training for me when I am at the other clinic are not that organized and I am finding more problems when I get back to the main clinic. But, all of this is easy enough to solve with some creative thinking and encouragement….i hope. I love you all and miss you! I have attached a photo of my fire and two of the girls making soup.

Day 90

2006-02-28T16:25:00.000-05:00

So I am now approaching my 100th day in Zimbabwe. It has been a very busy couple of weeks so I will try to update you on what has happened. After the wedding there was a big brie (bbq) here at 5 Vincent. There were musicians from the local school for the handicapped where Doris (the bride) works as an occupational therapist and many of the staff came from the office. I have put up a few photos of the party. It was such a great time but at the end of the party one of my housemates realized that her camera was stolen and a big NYPD blue type investigation followed. Some of the guards (now party guests) saw another guard with the camera. I thought the first lesson of thieves was not to be seen with the stolen goods, but apparently when you add alcohol to the mix that lesson goes out the window. Afterwards some of the guards and Brice (the groom/logistican) at work contacted the suspect and questioned him. Originally he denied the theft but then another person came forward stating that they saw him with the camera. About two days later he actually confessed to the crime by way of saying, ¨I know who has the camera and give me a few hours and I can get it back.¨ This was sad because we had to fire that guard.
After the camera was returned I was at work until really late last week planning many trainings and being a bit homesick. There is nothing like throwing yourself into work to cure homesickness. I would get home exhausted and wake up about the same way. Now for those of you who know me well you realize that I sleep more than the average person, so my being exhausted means I did not get the required 10 hours of sleep but more like a normal persons 6. No pity needed there.
At the end of the week I travelled the 5 hours to the capital, Harare to attend the mini La Mancha conference between the three sections of MSF in Zimbabwe. There is MSF-Spain, for which I work, as well as MSF-Belgium and MSF-Holland. There were many interesting questions about what is going to be MSF´s policies with HIV projects since they normally only do emergency relief and while HIV is an emergency it requires life-long treatment. On Sunday four of us drove back to Bulawayo the entire 5 hours. I drove the last few hours and it was quite difficult. When you have no lights on the road your headlights are the only things you can rely on. Now the difficult part comes in. There are always people on the side of the road trying to get a ride. Since the side of the road is not really a side of the road they are actually in the road. At one point I turned to Elena and asked, ¨Everyone on the side of the road knows this is a Masunga (white person) car. They should know that this Masunga car is not used to driving with no lights and they should have some type of survival instinct and get the hell out of the road.¨ Luckily there were no casualties on the road.
That leaves me at this week. I am still working part-time in two clinics. This leaves me with the feeling of not doing a proper job in either clinic. Things just move slow here so maybe my feeling of not doing a proper job is actually at the pace that things normally move. I love you all and miss you!

Day 84

2006-02-25T09:22:00.000-05:00

I have officially been in Zimbabwe long enough to go through an entire tube of toothpaste. Now, in all honesty, the house I am living in is nicknamed ‘Hotel California’ and given that I leave the toothpaste in the bathroom I am sure that I had some help in the usage. Still, measuring time by toothpaste consumption makes it seem like I really am not going to be here a year, just about 4 tubes worth of time.
Work is still pretty much the same, REALLY sick people that my heart reaches out to and the constant fight to motivate people.
This weekend I am going to the capital, Harare, to participate in a meeting being held between all the MSF sections in Zimbabwe (which is really only two but it makes it sound more impressive to use the word ALL). I am not really sure what the discussions are to be about. I have been reading the required pre-meeting documents, and it seems to be about the MSF policy of providing healthcare to people in need while at the same time trying not to get too involved in the political situation. Having said that, providing testimonial regarding the health problems populations face in direct relation to the policy of governments, is seen by MSF as one of its primary mandates so you can see how avoiding getting involved in the political situation can be a bit tricky.This week, as every week seems to go, I am missing you all very much and for some unknown reason also missing Craft Mac-n-Cheese. The instant cheese that looks an unnatural shade of yellow is still one of my favorite meals, especially if I add hotdogs. I will have to wait until I get home for that.

Day 81

2006-02-18T18:16:00.000-05:00

Living in a team is proving to be challenging and yet at the same time really nice. It is nice to live with people that are going through the same experiences that you are, but at times you want and need the seperation from work. I was making a cup of tea a few days ago for myself and two of the other expats and I realized that I know how these people take their tea. I have known my parents since birth and yet I do not know if they take one sugar or two with their tea. This forced intimacy is strange at times.
Work this week was completely exhausting, which is why I have not written in some time. We are planning a week long training at the end of March on HIV and ARV treatment. Elena and I were at work until 10:30pm on Wed planning for it and today I went into work and spent a few hours on the manual we are creating for the training session. I am so happy that there are people in the team that are willing to put in all of this time for work but in the same vein frustrated that not all of the team feels this level of commitment.
Needless to say, Friday a few of us had some much needed beers.

I heard from my mom that there was a huge snow storm on the east coast and it made me think of snow days off from school and wearing down jackets and hats and gloves. All of this reminiscing I did while scratching the many mosquito bites that have made a nice design across my ankles. The bugs are still here flys, mosquitos and geckos, Oh My!

Day 73

2006-02-11T00:39:00.000-05:00

There are so many funny things to talk about this week. First of all, as I think I mentioned I got kicked out of the clinic I was supposed to be working at on Monday. Then in the middle of the week our Administrator, Nuria (who also is the finance coordinator), called and told me that while applying for my nursing registration with the nursing council she was told that I need to have extra paperwork so I need to call the US nursing boards in an effort to get that, AND I need to take an English proficiency test. I am the only native English speaker in the entire project, was born in the US, and do not even speak another language, but I need to take a proficiency test. Oh, how I love bureaucracy! Then yesterday our logistician, Brice officially got married to his wife Doris at the courthouse in Bulawayo. Two witnesses are required for the marriage, and they were our ¨big¨ boss Alex, and me. They had actually been married over two years ago in a church ceremony in France, but needed to make it legal so it would be easier for Doris to get her visa. We were told to arrive at the courthouse at 8am. So, just imagine that there were 8 couples waiting to get married (not all of whom really looked happy) standing in the middle of the street waiting, and waiting, and waiting FOR 3 hours! They finally let us in to the area to get the marriage vows over with around 11. The judge explained the different types of marriages. Apparently a 507 allows for multiple wives as long as you can financially provide for them. Now, as mentioned above Doris and Brice are not native English speakers and the judge spoke softly and had a thick accent, so with the exchange of vows she told them to repeat after her….which proved more difficult then it should have been. The judge looked at Doris told her to place the ring on Brice´s hand and say, ´I do thee wed.` Doris, took the ring and said, ‘I do the right.` Brice then did the same gesture saying, ‘I doo dis right.` I am sticking to the fact that it is still illegal since they did not say the right words.

Day 69

2006-02-06T19:42:00.000-05:00

...

This weeks proves to be a bit of a challenging one. Sunday, actually, started out great. Five of us went to an area called Lumeme Falls. As you can probably imagine it was a waterfall. We parked our car in the middle of nowhere (bush type country) and walked through a river then up a bit of a mountain to arrive at this waterfall and the pool just below it. It reminded me so much of a similar walk I did years ago in Hawaii up to Sacred Falls. It was beautiful and on the walk back to have some lunch by the car we ran into a family of Baboons. They were huge so we moved the car a bit away from them in an effort to not invite them to our picnic. Luckily, they had previous reservations under another tree.
Monday was the challenging part. I started work at the city clinic. I arrived with one of our counsellors and we immediately realized that much could be done to make the work more efficient. After being there for about 8 hours the head nurse came up to me and informed me that the paperwork (some type of indemnity form) was not approved by the City Council yet and without having that approved we would not be allowed to work in the clinic. I was actually told what if I feel down the stairs (which I did on the first day, however, I neglected to inform her of that) or the building caught fire. To the fire comment, I mentioned that my parents taught me to run away from fire. My attempt at humor was not appreciated. Anyhow, it looks like for this week at least the work is on hold. Towards the end of our meeting she was quite nice, but the politics of trying to help people is tricky here to say the least.
I miss you all and wish I could be there with you at minimum everyday, but I am also enjoying myself here in Zimbabwe as well.
Oh yeah, I forgot to mention we have a new team member. Constantine is from Greece and will be the new Education Officer here. Primarily her job is to do more of an activism role in the city. She seems nice, but having been her first day I really could not make an accurate impression given she was a bit tired. I was trying to remember how I was on my first day (that really long two months ago) but had a hard time recapturing my own initial feelings. .

Day 66

2006-02-04T00:30:00.000-05:00

Yesterday I received a package from my sister, Vicki. It was great to get packages from loved ones. In the parcel were girl magazines and two Oprah suggested books. I love my sister and it was so funny to see her personality coming through in the gift. The other expats and I were reading our horoscopes and for Feb if I am looking for love I am supposed to ¨buy that red dress and those sassy boots you’ve been craving.¨ Doris looked up and said ¨where are you going to get that in Zimbabwe?¨ If I find it I will let you know. Today I apparently have another package waiting for me, but this one has a tax of $4 million on it. I am not sure how they determine to tax one package and not another so I will have to go and try to sort it out this morning.

The other picture I am sending is of the children of the clinic writing memory books in the clinic. I have not asked whether it is a memory of their parents or for their parents. It just seems nicer to imagine the kids enjoying arts and crafts.I miss you all and love you. I can not believe that it is February already and I arrived in early December. Ten more months.

Day 64.

2006-02-01T17:53:00.000-05:00

So, I realize that I have been posting some depressing ideas since everyone is writing me with ´hang in there´tones. It really is not all bad, just at times hard to see.
On a more amusing note... Yesterday the electricity was out in the back room so I decided to open the fuse box and pretend that I was an electrican. (yes I know I am exagerating a bit, but stay with me) Anyhow, one of the fuses was off so I tried to switch it on, and it sparked and turned off again. Now, the more prudent person would probably have thought something was not right here and stopped. Nope, not me, I persisted and made that switch turn on yet in the process blew out all the lights in the house. Our logistician, Brice, was not so amused. For the entire night we did not have lights, but oddly enough the sockets worked so we could have toast if need be. Then this morning the shower was all bone-chilling cold water and when we were ready to leave for work realized that one of the expats had locked the keys in the car. What next you ask? I will tell you. Tonight coming home from work the rain had knocked out all the power in the area and one of the ladies I work with called and asked why I had not just stopped at blowing the lights in my own house but moved on to the entire neighborhood... It was really a funny day. I can not wait to see what happens tomorrow. Missing you all, Nancy

Day 59.

2006-01-28T15:44:00.000-05:00

Today was the second ‘youth day’ that I have been to here in Bulawayo. The youth day is for children on ARV treatment that are HIV positive. I got there late since I slept in a bit from a long week and even longer Friday night with my girlfriends, but it was still amazing to see the children dancing to the bands and really enjoying themselves. At the end of the afternoon one young boy got sick, I think that the spelling of his name is something like, Twanda. He felt dizzy and faint. Elena and Esther were attending to him and I sat next to him and was talking to him for a bit when he started to cry and say things such as ‘I hate being sick, I just want to kill myself.’ At that point my eyes started to well up. For children that have no choice but to be brought into this world sick they need to be so strong and it just seems unfair. I have lived a privileged life by the grace of God and been given a wonderful family to help support me when I am sad and need a hand to help me. Why is it that Twanda has to not only struggle for his health but also for a life in a country that has a horrible economic crisis and no clear outlook for a better situation? One of the more liberal papers today headlined an article about the fear of possible riots if the food prices continued to increase while salaries and the value of money plummeted. As I have seen it, the Zimbabwe people are very peaceful and I can not imagine a riot taking place, but desperate times can not always be predicted. There also seems to be a palpable fear of the military, so that a riot would also not take place due to personal security. Personally, I am glad that I am here and hope that the small bit of work that I am doing is in someway helpful...

Day 54

2006-01-23T16:20:00.000-05:00

Today I have a new neice! Her name is Nicolette Dale. I am so excited for my sister and her family. Not being able to be there with her is a bit frustrating, but I am there in thoughts and prayers. I spoke to my parents today and they seemed so happy to have another grandchild. It is amazing to see how quickly your immediate family can grow. I remember when it was just my parents and the four kids running through the airport to catch the plane for holiday. We would inevitably leave too late and Dad would get stressed so he would run in front of us with only his briefcase to make sure the plane did not leave while the rest of us carried all the bags and ran behind. This was obviously before heightened security made getting through the airport quickly impossible. I am happy for my sister to begin, well actually continue to make her own family memories.
My own family consists of the seven expats and a dog named Teddy. For the past few days I have taken on the task of walking the dog around the neighborhood. I am not really sure why I do this, but it gets me out of the house after work and it is a nice way to relax, especially since the dog is old and walks slower than any dog I have ever had. These photos are of the dog, and me writing at the computer.

Day 52

2006-01-19T14:03:00.000-05:00

This week has been a slow week for me. I woke up on Monday with that Monday morning feeling,…..dread. The beginning of the week can get pretty tiring since I am not used to working 5 days in a week let alone right in a row. Yes, I realize this idea of 9-5 is not a novel concept to most people, but to me it has been an awakening these past two months. Luckily, today is Thursday! Only one day before the weekend. Even though I am really enjoying the job that I am doing and every day have tangible evidence that this work is making a difference it is still work and I still have to wake up everyday at 6:45 to get to work.
I am getting into the mode of trainer, which is pretty nice at times. It allows me to learn a lot of information that I did not already know. Tomorrow is the meeting with the Ministry of Health doctor to figure out MSF´s role in the one city clinic that is supposed to take up most of my time in the coming months. Honestly, I am so excited to start a new project and be a bit more focused.
Yesterday, during ¨tea¨, which is actually a break to drink a coke, there where these two children playing outside with a wheelbarrow. It was so great to watch them play. They had no shoes, cloths that were falling apart and parents that were clearly not interested in their whereabouts and yet they were laughing and loving their afternoon. Even in poverty children play!

Day 48.

2006-01-15T16:30:00.000-05:00

This past weekend a group of us went to visit the rural MSF project. This project is about an hour away from the one I am currently working in and is truly in the Bush. The town center consisted of about 30 little tables with various fruits and vegetables along with a few shops that sold clothing and some hardware needs. The entire town can be walked around in about 20 minutes and this afternoon we spent some time doing that. Needless to say I now have very nice pink shoulders since I forgot to put on sun screen. This was the typical Africa as I have grown to know it. Children running around with no shoes and often no shirts, women carrying huge bags on their heads, chickens and donkeys roaming free and a feeling of poverty everywhere you turn. The expats that work in this area live in a compound that used to be used for making and selling coffins. Ironic that we are trying to prevent death and in the process rented out a building thats livelihood was death.
There is trouble getting registration for the MSF doctors here in Zimbabwe and the ones that come have to do rotations in the pediatrics unit at the local hospital. Esther, was on call on Friday night and when she came home she told us that four babies had died over night. The situation in the hospitals is horrible. The staff does not really seem to care, but it may just be that they are used to the chronic death. I visited the hospital on Thursday with one of the nurses from the clinic and there were people laying on the floor on mattresses naked in their own feces while the nurses handed out lunch to those that were actually awake. It was very surreal. One young woman was dying of AIDS and she was trying to talk to me, but her lymph nodes at her neck had swollen so large that it was blocking her airway and on top of that she had karposi sarcoma on her tongue which also made her tongue swollen. In the US she would have been given radiation to shrink the tumor and when I asked the local doctor what the long term plan was for her, he just looked at me and said, ¨there is no long term for her, she came too late.¨ Death is something I am still not comfortable with and I hope that I do not ever become ok with it. For my own sanity, I hope to try to keep preventing it.

Day 42

2006-01-11T15:43:00.000-05:00

Well, I have mostly recovered from my first case of African illness. For the first three days of this week I was sick with a fever and diarrhea! Pleasant, yes I know. I did not eat for almost two days in fear that I would have to use the bathroom and the horrible paper that Zimbabweans try to pass off as legitimate toilet paper. I mean honestly, I never thought I would miss Charmin.
I did a test for malaria, but thankfully that was negative. I went home early from work on Monday and felt just horrible about it since I was seeing patients that are dealing with much worse illnesses and I could not muster the strength to stay past 1 in the afternoon. Tuesday was not much better. I was visiting a clinic to do an initial assessment on how MSF could assist them in bringing up to speed there HIV care and tripped down about 6 stairs. I have a wonderful bruise to show for it on my arm. When something bad happens Zimbabweans say ¨Shame.¨ Let me tell you how annoying that is! The last thing I wanted to hear in my embarrasment was a bunch of sick patients saying ¨shame.¨ In looking back it was funny though.
Today I was at the clinic again and working with one of the local junior doctors. It was a nice feeling to know that with regards to HIV, I am about on even knowledge level. Tomorrow I have to give two presentations to the local nurses on HIV pathogenisis and WHO staging of HIV. Yeah, I was not really sure what either of them were until about four hours ago, but by tomorrow I should be an expert. If all else fails I will just start to speak really fast since no one understands a word I say when I am speaking fast.
Here is a photo of the junior doctor and one of the patients I saw today. Take care and I love you all!

Day 40

2006-01-07T13:47:00.000-05:00

There are now three living breathing things that reside in my room, a large black spider, a green gecko and myself. I am still at war with the flies and mosquitos so I have decided to entertain the spider and gecko because I heard that they eat mosquitos and flies. I am so thankful that I have the net over my bed at this point because although I am tolerating the spider and gecko I do not want them sleeping on the pillow next to me. This morning was exhausting! Basically, I spent hours shopping for food. First it was this store that contains huge bags of onions, potatoes and oranges (nothing else in the store) and then to the Indian owned vegetable store that is so crowded you have to smash in next to people to get your vegetables, and then to the supermarket for the rest of the food. It took about 3 hours and I am not looking forward to next Saturday. The process was made worse given that over the holidays we really had not properly done any shopping. I now sympathize with my mother more than ever shopping and feeding a house of 7 is very tiring!

Day 37

2006-01-05T23:05:00.000-05:00

No new gross stories to tell today, just a bit of the American girl in me coming out. I miss shopping! Yes, I know that is ridiculous and that I should be focused on helping the people that I came across the world to help. But, I am tired of the 6 tee-shirts, four pants and two skirts that I have worn continuously for 37 days now.
As my family can attest, I do love having new things so this may prove to be one of the more difficult desires to repress.

Anyway, other than wanting new things there is said to be a cholera outbreak about two hours from here and our field director thinks he has malaria. I would love to go and help out with the outbreak, but the ministry of health has not asked for help yet. If the time comes I will keep you all posted. As for my director, I pray that he does not have malaria, but I will find out more today.
This photo is of two of the doctors that I work with, Esther and Elena, at our office.

me

2006-01-02T13:44:00.000-05:00

Here is a photo of me reading in the living room tonight that my roommate took. Yes, who could not love the animal print on the couch.

Day 33.

2006-01-02T13:36:00.000-05:00

First and foremost Happy New year to all my friends and family! I can not tell you how much I appreciate your comments and email!
Month two for me has started out with maggots, a Greek new year and more long hours in the car along the spine of Zimbabwe.
Let me clarify a bit. On Friday I was at work when a patient complained to me that her arm was very sore in one area. Upon inspection I noticed a small lump that seemed to be solid under the skin. Being a nurse and someone that likes to pick at things I started to push at her arm. At this point I thought to myself, I should get gloves you never know what could come out. After a few painful exclamations from the woman and much prodding a maggot was forced out of her arm. Yeah, the gross things seem to be commonplace now. After talking with a few of the doctors I learned that this is fairly common and it is due to the fact that large flies (the damn flies again) lay eggs in the linens and when people sleep on them they get into their skin. It can be quite painful as was evident to me. The poor woman found it as disgusting as I did and kept exclaiming, ‘It is alive.’ ‘I see it moving.’ I lied and said, ‘No surely it is dead.’ I counseled her to iron her sheets and congratulated myself on the decision to get gloves on.
Friday afternoon three of us headed up the long road to Harare from Bulawayo, which cuts almost a center line through Zimbabwe. The trip was about 6 hours due to some needed shopping at the OK market for food which ended up taking about an hour. Zimbabwe has not adopted the idea of fast checkout or lines for customers with less than 10 objects. Not only are the lines long, but when the bill for a few small items comes to over a million the cashier is left with the task of counting all that money. I think I explained before that the largest bill is $20,000ZD so you can understand that $1,000,000ZD is 50 bills. Patience is a virtue I am learning tenfold. After arriving in Harare Nuria, Berta, Vasillis and I spent some time relaxing and then off to a new years party at some Greek friends of Vasillis. It was very interesting to be part of the white culture of Zimbabwe. Everyone was very nice but it was evident that most whites do not mix with the majority of the population and they are consumed by private schools and private parties. It was nice to spend new years with other people and enjoy their company. Interestingly a Spanish tradition I learned was that at midnight on new years you are supposed to eat 12 grapes in order to ensure good luck in the coming year. One grape each time the church bell rings at midnight, but since there was not a bell in earshot some improvising was required. Good thing I like grapes because basically you are inhaling them.
On the 2nd of Jan we went to park called Doboshava. I will try to put up some of the photos of the walk. It was quite beautiful!

Day 28 and 29

2005-12-29T15:35:00.000-05:00

Having been here for a few weeks now, I thought it might be nice to give you a picture of what my normal day looks like, so here goes.
A day in my life begins fairly common with the sound of the alarm on my phone going off at fifteen-minute intervals to ensure that I actually get out of bed. I then fight my way out of the mosquito net that covers my bed, and on a rare occasion have unfortunately managed to trip my way out of bed when my foot got caught on one end of the net. A quick shower with the shower head that only reaches chest height, a cup of instant coffee and some toast take up about the next 15 to 20 minutes depending on how many of my house mates are crowded around the industrial strength hotpot, the likes of which I have not seen since college. I am usually leaving for work by 7:45am to open the office and then grab some drugs or some paper that is needed at the clinic. The staff aims to leave the office at 8am for the clinic, but that rarely happens so around 8:15 seven of us are packed in the land cruiser for the 10 minute drive to the O.I clinic, which stands for opportunistic infection. At this point I walk into the halls of the clinic that is packed with patients in all states of wellness, and take a deep breath. I see patients in a consultation room until around 11am when I take a few minutes to go across the dirt road to this type of pool hall that smells like stale beer and usually has about five or six men shooting pool on the one pool table. There is a room to the side that sells coke and fanta, so I buy a coke for $25,000 Zim dollars and take it outside to enjoy the fresh air for a bit. Elena and Esther usually join me on this ¨tea¨ break. Then it is back to the clinic to see more patients until about 1pm. If there are not that many patients to see then I try to take stock of the pharmacy or help out with the new patients that the doctors are seeing. In fact what I am supposed to be doing is writing down all the patients that have not come to see me on their scheduled day, but that is tedious and I usually leave that until Friday.
So the car and driver come to pick me and the rest of the msf staff that works in the clinic up and we find some type of lunch. Lunch may consist of a sandwich at the one coffee shop in Bulawayo or meat and rice at the office if we ordered it from the wonderful housekeeper at the office in the morning. After lunch it is about 2 or 2:30 so this leaves a few hours left in the day that are filled with a number of different tasks that range from training for the counselors, visiting the outside clinics, entering data, figuring out the pharmacy stock and I am sure many other tasks that I have failed to learn yet. I usually get back home around 6 or 6:30pm and have some tea with my housemates and stand around in the kitchen talking about the day. Dinner is usually around 8pm which is really late for the American in me but seems normal to all of my Spanish roommates. After dinner on a few occasions we watch a movie on the computer or I find myself reading a book. Unfortunately, there is a limited supply of both movies and books so I do find myself daydreaming and of course writing this blog. I guess that raps up my typical day. I hope you enjoyed! Day 29 – The patients – They are so wonderful to work with. Everyday I realize how fortunate I am to have been blessed with good health and a wonderful family. Today there was a woman that came to the clinic in tears because the family friends she was staying with found out she was hiv positive and want her to move out. The family apparently was buying new plates. The lack of understanding of the disease can lead to so much heartache. I pray that things work out for her and she finds a new place to stay. It really is a shame. On a lighter note, some of the names of the patients that I encounter make me laugh all day, names such as ´Bigboy, Lovemore, Lookout, Never, Shorty, and Marvelous´ are becoming common to me.

christmas photos.

2005-12-27T17:06:00.000-05:00

Day 27

2005-12-27T16:46:00.000-05:00

What do you get when you bring together a Frenchmen, an Austrian, an American, a Greek, 3 Spaniards, and about 200 flies? A Christmas dinner MSF-Zimbabwe style. The evening was very nice. On Christmas Eve there were Spanish Christmas carols and a nativity scene made of wine bottles as Mary and Joseph, a jam jar as baby Jesus, all with lemons as heads and three beer bottles with candles as their crowns. Even though the dinner was nice and the company better, it was not the usual Dunphy Christmas. I missed my family over the holiday season and speaking with them was wonderful. I received some photos from my family via email and it made me homesick for family and friends. I cannot believe that I have only been here just shy of one month. A year does not seem that long but I can feel the length of time the most when I look at photos of my niece and nephews and see how much they have changed even in the time span of a month. I guess it is fortunate that we do not continue to age so rapidly as time passes, since we would all be gray and wrinkled by the time we were in our 30´s.
At times it feels like I have been here months and other times it feels like just yesterday my parents and brother put me on the train headed out of the US. I hope that all my family and friends had a wonderful Christmas holiday and are looking forward to great new year.
For the holiday weekend myself and the other expats went to Hwange National Park.
The park itself was beautiful and we saw many giraffes and an old elephant. At one point a male giraffe walked in front of the road and stared us down. They are such funny creatures to see running. The tall neck and head do not move and the body looks like a horse running. It is like a strange slow motion film. We took an MSF range rover and although there was plenty of room in the car at times it seemed quite close. After about 9 hours in the car I was happy to be home last night and spend some time by myself.

Day 22.

2005-12-24T01:07:00.000-05:00

Given, Thursday was a holiday Esther and I decided to take advantage of the free day and get out of Bulawayo. We headed to Matopos, the ¨view of the world.¨ I must admit it was very impressive. The area that held Cecil Rhodes grave is at one of the highest elevations which is surrounded by miles of plains. In ´backpackers guide´ it is said to be one of the most beautiful places in Africa. After the view was taken in and we enjoyed some oranges we headed to the wildlife reserve in search of rhinos. Upon entering the reserve we encountered a sign that said, ¨Do not get out of your car! You may be mistaken for poachers. Poachers will be shot on sight!¨ Hmm, I decided to stay in the car. Honestly speaking, I can not imagine anyone mistaking two whites girls in tank tops as poachers, but I was not taking any chances. After driving through rough terrain, small streams, over huge rocks (did I mention I was driving on the opposite side of the car with a stick shift!) we ran into a mother and baby rhino. It was very peaceful to see them grazing, but again we decided not to leave the car.

Esther was a bit more adventurous than I and walked around a bit more. As she did this I readied the get away car. Or so I told my chicken self.

I do want to wish all of my friends and family that read this site a very happy holiday season and please know that I am thinking of you all!

Another Day Another Rain Storm...

2005-12-20T16:30:00.000-05:00

Holy Crap! When they say it is the rainy season they are not kidding. The storms these past few days have created pools in the roads and soaked me on a daily basis.
Regardless of the rain, this week has started out as an interesting one. It was my first week working alone and I felt better than I had expected. There were obviously some things that I did not know, but as a whole the people I am working with are very helpful and always open to questions. The patients in the clinic laugh at me when I run up and down the hallway looking for tests results that are placed in this basket in the main office. The system is not that great and most of the results are handwritten on paper and never in the file when you need them.
Yesterday when we were leaving the clinic we ran into an accident in which a pedestrian was struck by a car. One older gentleman was in the road and he had obviously hit his head because there was a lot of blood on the road, but he was still conscious and speaking to us. I felt like I was back in the ER of George Washington calling a trauma white. However there was no CT scan and the team of 15 or so that usually converged in the ER now consisted of Elena and Esther the two Spanish doctors and myself with no supplies. Usually in the MSF cars we have a medical kit, but as Murphy´s law would have it today it was not in the car because the day before it was in the back of the truck and had gotten wet. In actuality there was not much that we could have done. The ambulance came in about 5-10 minutes and the men did not even get out the stretcher and were about to lift the man with their hands, until we suggested they use the spine board and collar that they had in the ambulance.
I moved into the room that will be mine for the coming year last night since the nurse I replaced left on Monday. It was the first day that I felt homesick. I looked at some of the photos of my family and felt my chest grow tight with missing them. I think now that I am settling into the house I am realizing that I am here for one year. Still, I am really excited about the upcoming year, but missing the states a bit. I miss watching CNN and knowing what is going on the world. My world here has been overcome by Zimbabwean politics and HIV. I do not have a tv and the internet is so slow that I usually do not get the chance to read washingtonpost.com, but I am going to need to change that in the coming weeks. I miss you all and love getting your comments from the blog and your emails so keep them coming!!!!

Youth Day....

2005-12-18T05:42:00.000-05:00

Yesterday was the monthly youth day for the kids that are on treatment for hiv. It was such a great day. There were about 70 kids and the day consisted of some counselling sessions and performances by the kids and then there were three reggae bands that played for free for the kids. They loved the music and everyone was dancing in the courtyard. It is so amazing to me that these kids are so strong. They were all born with this disease and need to be on treatment for their entire life. I can not imagine how hard it is too struggle with that daily, but they do not let it show. Some of the kids were really sick and did not look healthy, but it was just so nice to provide a fun afternoon for them! I will try to paste some photos of the kids.

After the youth day me house had a going away party for the nurse that I am replacing, Kate which was also a lot of fun but in a different way. There was an African jazz band playing and we had about 50 or so people turn out. The after party clean up reminded me why I do not like to have parties, but at the moment it was a lot of fun.

Long day...

2005-12-15T15:41:00.000-05:00

Sorry for the delay in posting the internet connection is so slow it makes it a bit tedious to write, but I will try to be better this coming week. My birthday was nice. I went out with some of the expats for a cocktail in the evening and had a nice time. It was not the same as celebrating in the states, but very nice none the less. I have attached a photo of the hallway at the clinic with people waiting to be seen.

Today was another day in the clinic and I am exhausted. It is such an experience to face people everyday who are fighting to have a normal life. They are battling so hard not only to stay healthy but also to provide food for their family. One woman I was speaking with today was three months pregnant with her third child. Her husband committed suicide last month due to a number of factors and now she is left trying to make a living by selling fruits on the side of the road in an effort to make a life for herself and her children, which are both under age 7. I try to not have a fatalistic attitude, but she is not responding well to treatment and I fear that her children will become orphans in the coming year or so. At least I know I am doing all that I can to help her. I just wish there was more that could be done within the country to make life a bit easier for her.
As a whole it is really not that depressing, but I imagine that in the coming year I will feel this way many times. This Sat is the youth party at the clinic for children with HIV. It should be a really nice event. There is going to be counselling sessions as well as games and a band that will be playing.
On a more personal level I have decided that I hate flies! Why they were put on this earth is beyond me. I find no value that they add and an almost constant irritation to daily life. I remember watching those commercials asking for donations to Africa and thinking, how can people not care about the flies that are walking on them? I for one care a lot. I find myself swatting at them consistently and on a few occasions accidentally hit the person next to me in my effort to shoo the damn fly away. I also think that I have a number of flee bites on my hands and face which leads me to believe that the bed I am sleeping on has flees. Yeah, gross. Luckily I am only staying in that bed for another 4 days. Tonight I will change the sheets and wash all my clothes.

some photos..

2005-12-11T11:35:00.000-05:00

here is a photo of the clinic I am working in and some of the expats I work with at the Christmas party.

Day 5

2005-12-11T06:28:00.000-05:00

Wow, this has been a busy day. I think if I put it into categories it will be easier to tell you all about.
Work - I am starting to get the flow of patients and the entire drug regiment. The hardest thing for me is writing the prescriptions. Since we are a clinic with both MSF and MoH patients we need to write actual prescriptions to dispense medications. By we I mean myself and the doctor that are seeing patients. HIV meds are not the easiest for me to figure out. Changing drug regiments is a bit tricky, but the best part is that are pharmacy has limited resources so there are not that many decisions to choose from. The patients are great also. They are so aware of their medications and follow exactly what you tell them. Today I saw a woman that thought she was about three months pregnant. She had used a condom, but it broke. The horrible part of her story was that her husband died about a month ago and now she will be the only one to raise this child (if she is pregnant) and she has hiv. So many patients are losing weight not just because of loss of appetite, but because they do not have the money to buy food. Another lady came in with a horrible rash which Elana and I decided looked like the worst case of ring worm we have ever seen. The patients come in at 8am and wait all afternoon until they are seen. By the time we arrive at 8 there are probably about 100 patients waiting to see us. They are lined up in one long hallway and outside as well.
Christmas party - Today was our MSF Christmas party. The entire staff of about 50 people sat around ate food and exchanged gifts in a secret santa type setting. I bought a necklace for this woman Dorothy and when she hugged be to thank me she made me dance to this African ¨Thank you very much¨ song. There was a lot of swaying of hips and people clapping. It was a wonderful and yet embarrassing experience. The entire evening it poured rain so that the front yard of the office looked like a swimming pool.
Bar Hopping - Tonight a group of four expats went out in town to see one of the expats ¨small houses.¨ A ¨small house¨ is someone you are dating either overtly or covertly presently. I think the term came from years past in Zimbabwe when the men had wives that lived in the big house and mistresses that lived in the small house. Anyhow, we went to a Zimbabwean jazz club. At one point I looked around and noticed that we were the only white people in the entire bar. It was not uncomfortable at all though. It was like a regular jazz club in DC. I spoke to a friend of Kate´s small house and he was telling me how he visited DC, but was so scared to go there because he had heard about all of the crime and violence. Ironic, that I was feeling the same thing about coming to Zimbabwe. Although everyone was having a good time I still noticed the economic problems as evidenced by my experience in the bathroom. The ladies bathroom had no toilet tissue. I originally figured that they had just not replaced it, but one woman offered me some that she had brought along and I commented that she was prepared when she told me it is not uncommon for places to not have soap or toilet paper because they can not afford to stock it. Lesson learned. Bring toilet tissue everywhere you go.
I am feeling much better about living and working here. It was an interesting week and I can not wait for some more.
I am sending along a photo of the clinic I am working in and some of the Christmas party.

Day 4

2005-12-06T15:57:00.000-05:00

- Arrived yesterday at Bulawayo and spent the past two days figuring out what in the hell I am going to do for the next year. Apparently this position takes on more of a physician role than a nursing role which sort of freaks me out given that I did not go through medical school. The clinic that I will be working at is for HIV patients and I will be dealing with all of the follow-up as well as opportunistic infections. The nurse decides what meds to put the pt on as well as what tests they need to have and follows up with their treatment and improvement. (yeah, yikes). There is always someone to consult with for questions but there is so much work to do that basically I need to work very independently. I am also in some way excited for the opportunity to learn, but mostly just nervous right now. In being completely honest I am impressed with the staff with regards to their medical knowledge, but they are lacking in management techniques and basically just complain about the national, Zimbabwean, staff being lazy and not doing their proper jobs. Today there was a huge argument with regards to the gentleman, Muabe, who is supposed to be cataloguing and keeping updated the pharmacy. A delivery of combivir arrived on Thursday and no one was aware because he just left the unopened boxes in the main pharmacy and on Monday on of the docs, Elana, was calling all around trying to get these meds since many pts were going to run out within the week. Lo and behold the drugs turned up after someone opened the boxes. Elana felt like she did not need to hold Muabe´s hand through his job, but they really have not implemented any plan of action for him to correct his behavior. I think they have a meeting with him tomorrow to discuss this. Hopefully in the next month or so I can try to make some small positive changes, but I am also learning so much right now that I am still on the steep upward climb of the learning curve.
The house that I am living in has seven msf staff at the moment, but that is changing in the next few weeks given that four of the staff are leaving by the end of December and two new staff are coming in the next few weeks. It is difficult, to say the least, to work and live with the only people you know in a country, but for the moment it is nice to have a bit of a large ¨family¨ so to speak.

On a lighter note I am completely amused by the way African women walk around with HUGE bags on their heads. It is almost likes a hands-free Zimbabwe. Even if they have no other bags to carry and nothing in their hands they put bags on their heads and walk with more ease than I can muster walking through the large puddles that are gathering from the rain. Maybe I too will learn, but that is doubtful.
Anyhow, until later.

Day 2

2005-12-04T13:10:00.000-05:00

Today I got a full appreciation for the rainy season. There were thunderstorms and lightning everywhere. Puddles were all over the road as well. Apparently, this is a welcome change from the dry season that has just finished. Personally I am still not a fan of running from the rain. This afternoon Nuria, Vasilli, and I went to an open air market (when it was not raining) and this area was where most of the white people living in Harare would congregate and shop. The white people that live in Zimbabwe are called ´Rhodies,´ after John Rhodes the Englishman that settled the area prior to its independence in 1980. As we walked through the market I saw a blonde woman and thought ¨wow, she does not fit in.¨ After a moment I laughed at myself because somehow I felt that I fit in more than her.Tomorrow I am driving (actually the driver is driving I have not used my international drivers license yet) to Bulawayo and finally get to officially unpack my luggage. Every time I open the luggage it seems like the insides have thrown up on the floor. It will be nice to be able to unpack for an extended period of time. I am also anxious to get started working. All of the feelings you get with a new job are upon me. Will I do a good job? Am I going to get along with my co-workers/roommates? Do I know enough to actually do the job well? All of these questions will have answers soon enough. Until Bulawayo…

Arrived in Harre

2005-12-03T15:33:00.000-05:00

After about 14 hours in the plane (from Barcelona - Amsterdam-Narobi-Harre) I finally arrived in the capital. It is so exciting to actually be in Africa, an area that I have never been before.
Today I met the financial admin, Nuria as well as the logistical coord., Basila. Both have been here for many months and took me around to the super market, which was surprisingly Western and to dinner. The hyperinflation is the most surprising thing I have noticed. One coke costs about 75,000 Zim dollars. Our meal for 3 cost 1.6million Zim dollars. The check out clerks really have their work cut out for them with counting all that money. I was given a monthly stipend and changed $50 US dollars to zim dollars, so I have almost $3million Zim dollars in my purse. I feel like I am in some mafia movie with that stacks of cash.
Seeing the capital and reading about Zimbabwe are two different things. If I did not know about the almost 80% unemployment and the sanctions I would not have any idea about them today. The capital is a bustling (western type) city with a few skyscrapers and many cars on the road. The supermarket was packed and people were dressed nicely. It was only upon asking questions that I learned due to the sanctions oil is very hard to obtain and the Zimbabwean Air actually grounded all of its domestic flights due to oil shortage. There is also roaming electric shortages. Tonight at dinner the lights went out for a few minutes and the waiter exclaimed, ¨oh, my zimbabwe.¨
I should leave Harre on Monday after a stop at the embassy and the MSF office in town. I do miss all my friends and family, but know you are in my thoughts and prayers..

waiting in london.

2005-11-30T04:40:00.000-05:00

It was very sad to leave yesterday, but I am SO excited to get started. Thanks to all my family for seeing me off in particular my parents and brother who walked me on to the train up to NY. It was like a clip out of a movie, Dad and David carried my luggage on and as the train started to pull away I waved with tears in my eyes back at them. (that is a bit dramatic, but it really was a nice moment)
I am sitting in the Heathrow airport at the moment waiting for my connection since I missed the last one due to a delay in take-off. Anyhow, I will write more later when I do not have to pay 1euro for 5min online.

more goodbye photos..

2005-11-25T12:17:00.000-05:00

here are a few more photos from my party.

Farewell dinner.

2005-11-24T11:55:00.000-05:00

Thanks for everyone who came out to my 'goodbye dinner.' It was such a cold night but filled with warm hearts. I am running around town today packing up my room in Dc to move to philly to move to Zimbabwe. I am not sure what I am feeling more nervous or excited. It is a strange combination of both. I hope to be able to send out my new mailing address and email soon, but seeing as I do not have them this proves to be a bit of a challenge.

Yesterday, my last day of work was a bit sad, oddly enough. I have grown to really love the people that I work with and hope that my new co-workers are equally as enjoyable. I can honestly say that I will not miss the inordinate amount of drunk people that come into the hospital thinking that they are checking into the Hotel Washington not the George Washington ER.

what the future holds.

2005-11-17T21:57:00.000-05:00

So basically I have been running around getting together all the proper documents and the proper shoes for the rainy season, and then today I thought what am I doing all this for?

Is the trip with MSF solely for the experience? Do I have some altruistic side that needs to help? Am I hoping to shift my career path? All of these are good questions that I do not have the answers for. All I have is a gut feeling that is telling me that this is the right move for right now. Oddly enough that IS enough for right now. It will be a wonderful experience both good and bad, and I do enjoy giving back to the world that has given me so much. Plus a year in Africa on an HIV prevention program can not look bad on the old CV. I will think more on these issues, but not at 10pm.

On a less philosophical note today fortune looked upon me. I had been driving around 14th and G streets for about 20 minutes looking for a parking spot so that I could stop at the Board of Nursing to get my letter of good standing and obtain my international drivers license from the AAA on 15th street. Finally on 12th street I find a parking spot, reverse into it and have to make some corrections since the park job was really not that good. Then I turned the radio off, (to save the battery that keeps dying) put the car in park and get out, locking the doors. As I was putting money in the meter I noticed the car looked like it was still running......oh yeah.....I had locked the car with the keys in the ignition and the motor running. GREAT! The fortune part comes when I went to the back hatch/window and realized I never do lock that back window! So I climbed in, unlocked the doors and turned the car off not forgetting the keys this time! Thanks Babci!

2005-11-11T13:21:00.000-05:00

Me before leaving for Africa at the Black Cat in DC.

Getting Ready....

2005-11-11T12:32:00.000-05:00

I have mixed feelings about this whole 'blogging' idea. Basically, I am writing a diary for all to see. That aspect makes me think it is a bit to personal to put on the www. However, it is a great way to get information out without sending impersonal and at times annoying group emails.

So I have caved and created a blog.

I am presently getting ready to leave for 365 days to Zimbabwe to work with an ngo on hiv/aids prevention initiatives. My emotions range from paranoia to absolute excitement and they change from one end of that spectrum to the other in a matter of moments. It is a bit mind numbing to try to keep a handle on said emotions so I have decided to just let them run and if they get too overwhelming I call a friend for a sure fire cure of which is usually a good glass of red wine or a mango margarita. Both are panaceas in my mind.

Anyhow, that is about enough of the diary entry for the moment. I have a list of things to do and it is looking pretty intimidating...