As I indicated in an earlier post, difficulties with my temporary employment permit put me in a position of choosing between a planful exit a month earlier than I had anticipated or spending several days and about $1000 of the university's money to renew my tourist visa and to continue to assume that I would not be hassled for teaching with it. I was so close to finishing in the time frame of my first tourist visa that I opted to have one extra class period per class the week of April 9 and to leave Zimbabwe April 14th, the day before my tourist visa was set to expire.
People have asked me about the experience overall and whether I would do something like this again. My answer is that I learned a great deal, got to work with some very interesting (and interested) students, met some people whom I will count as friends for the rest of my life, and overall had a good experience. I told the vice chancellor and the dean that I would be happy to return to Africa University again, perhaps even next year, if (1) the temporary employment permit situation can be sorted out and (2) if the political situation permits. I don't want to spend money and 4 days out of every 30 to maintain a status that is not meant for teaching, even volunteer teaching, and which might lead to difficulties with the government. I have a crystal ball that is notoriously cloudy, and I don't know what the political situation holds for Zimbabwe. I can imagine some scenarios in which it would be possible to return next year, and some in which that would not be prudent. I'll just have to wait to see.
For now, I have nothing more that I want to write for this blog. If you're reading this post, it's a fair bet that it's the last. . . until the next time. Thanks for reading! Maggie
Saturday, May 5, 2012
Teaching (and learning) about Trauma in Zimbabwe
I was privileged to be able to co-teach a graduate course in
trauma in a program in Child and Family Psychology, which is designed to train
mental health professionals at the masters’ level. My mentor for this w
The other instructor argued strongly that Post Traumatic
Stress Disorder (PTSD) is a conceptualization originating in Western culture
and not particularly applicable to sub-Saharan Africa. He had us read numerous critiques of PTSD,
which partly focused on important things like the inherent but unrecognized
culture biases in the diagnostic criteria.
(I think that argument could be made for most of the current diagnostic
categories, and he acknowledged that sub-Saharan Africa has contributed little
to date to the research literature and the discussion and formulation of
diagnoses, so has to share responsibility for the lack of representation of
that region’s experiences and conceptualizations in the diagnostic manual.
We talked a lot about mass traumas in Africa. The best known to Westerners is the genocide
in Rwanda in 1994, in which 800,000 Tutsis were massacred by the majority Hutus. However, Zimbabwe has had its share of
traumas. The Second Chimurenga (from the
Shona word meaning “fight” or “struggle”), lasted from 1966-1979, and involved displacement
and restriction to certain guarded areas and extremely meager circumstances for
many natives. Independence in 1980
turned out not to be the end of oppression, however:
In addition to these major traumas, there are many
individual ones. I heard about maybe a
dozen, and will share just two here:
There is a real struggle to try to
depict the Zimbabwean experience. One of
the graduate students in the trauma course talked about a community outreach
event she participated in, in which people started out talking about a cycle of
violence and ended up renaming it “cycle of disappointment”. Grief over loss and disappointment over the
government seemed to be major themes. Most
of what they discussed would not meet the diagnostic criteria for PTSD, and
shouldn’t necessarily be pathologized if people are functioning
adequately. The student reported that in
one group where this issue was discussed, participants began talking about
“emotional suffering” as a persistent pattern for many Zimbabweans.
The trauma, or suffering, or
whatever we choose to call it, is compounded for Zimbabweans, in my opinion, by
restrictions in the range of affect they have been allowed to express. In talking with a community leader about a
proposed seminar to help Early Childhood Development (ECD) educators help children
deal with their emotions, I mentioned that I think of three basic emotions
(sad, mad, and happy) from which all others are derived. She thought about it and said that Shona are
allowed two emotions, happy and mad.
Then she thought some more and said that they’re allowed “mad” only
under some restricted circumstances.
I’ve heard the stereotype of the happy Africans for decades, but had
never realized that it might have developed out of the restrictions on
expression of other emotions. These
restrictions are rooted in culture, which makes them difficult.
For example, Shona people don’t express
grief when loved ones die. Within hours,
they’ve put on their happy faces and gone on with life. I discovered that the basis for this is a
traditional belief in the nzuzu, the water spirits. These spirits not only control rainfall, but
I was told that the traditional Shona explanation of death is that the nzuzu
abduct people and take them to an alternative world with crops and trees, sky
and rain. The nzuzu also come back and
listen at the doors or windows of loved ones of the person they’ve
abducted. If they hear crying, they kill
the abducted person. What a powerful
belief to squelch expressions of grief!
If a person expresses grief outwardly, they may be responsible for the
death of their loved one. In Zimbabwe,
25% of people say they are Christian, 24% adhere to traditional indigenous
beliefs, and 50% identify themselves as “syncretic”, meaning that their beliefs
are a mixture of Christian and traditional elements.
Because of the difficulty with
outward expression of grief and, to a lesser extent, anger, Zimbabweans
experience many more somatic symptoms (e.g. headaches, stomachaches, fatigue)
associated with distress than I’ve ever experienced with other groups of
people. This is true of children as well
as adults.
There are special challenges in
helping people who have experienced trauma (or persistent grief, or emotional
suffering) in Zimbabwe. Their situation
is not safe, and cannot readily be made safe.
Threats of death and actual deaths of individuals suspected of
opposition activity continue. Much of
Mutare was locked down when Robert Mugabe arrived to celebrate his 85th
birthday, as members of the Desert Southwest Conference delegation in the city
during that time can attest. I’m told
that schools at all levels, from ECD through university level, will close for
several weeks before the next election, and foreign NGO’s will have employees
leave the country. This is because prior
to past elections, ZANU-PF enforcers have threatened and beaten teachers and
others suspected of being sympathetic to the opposition (and anyone with
education or social services jobs is suspect).
It is safer to abandon the schedule, close services, and resume them again
after the election.
On a day-to-day basis, the
attention paid by everyone in Zimbabwe to surroundings and people present is difficult
for an American to imagine. To get the
10 km from Mutare to Africa University meant having the potential to be stopped
at three different check points. Police
have the right to search cars at any time.
They often charge “spot fines” for minor infractions, which may not
correspond with law. Once some police
tried to charge a fine to a passenger in the back seat of a car in which I was
riding because she didn’t have a seat belt on, but I’m told there’s no seat
belt law in Zimbabwe. Another person was
hauled out of his car and sat by the side of the road for about an hour before
paying a $100 spot fine because of a car registration that had expired, but was
within a 3-day renewal grace period which is officially sanctioned. It is
widely known that spot fines, of which no official records are kept, are simply
graft on the part of police officers. Additionally,
everyone is constantly aware of their setting and who is within earshot, and
factors that into what they say. I was
told that every class has at least one member who is CIO (sorry, I don’t know
what that stands for—it’s a ZANU-PF informant).
If I wanted to talk politics with someone, I waited until we were alone
in a car, or maybe in their home, though some people are even careful about
what they say at home because house help or another family member might be
CIO.
This has been a bit rambling
because the current context in Zimbabwe and the experiences of Zimbabweans
since independence have been complex.
There are many interlocking pieces which contribute to people’s
experiences of trauma, violence, disappointment and suffering. Americans have had a few—9/11 and the bombing
of the Murrah Building in Oklahoma City in 1995 come to mind. But with the exception of the first few weeks
after 9/11, I don’t believe I’ve lived with the kind of uncertainty and sense
of threat that is present for many people in Zimbabwe all the time. Thank God we don’t have to, and pray to God
for relief from this kind of pressure in the lives of Zimbabweans.
as an anthropologist who is a full-time faculty member at Africa University, and whose work over the past decade has been focused on two issues: mass trauma and the experiences of children who have HIV/AIDS. I clearly learned much more than I taught in this class.
We talked a lot about mass traumas in Africa. The best known to Westerners is the genocide
in Rwanda in 1994, in which 800,000 Tutsis were massacred by the majority Hutus. However, Zimbabwe has had its share of
traumas. The Second Chimurenga (from the
Shona word meaning “fight” or “struggle”), lasted from 1966-1979, and involved displacement
and restriction to certain guarded areas and extremely meager circumstances for
many natives. Independence in 1980
turned out not to be the end of oppression, however:
In addition to these major traumas, there are many
individual ones. I heard about maybe a
dozen, and will share just two here:
There is a real struggle to try to
depict the Zimbabwean experience. One of
the graduate students in the trauma course talked about a community outreach
event she participated in, in which people started out talking about a cycle of
violence and ended up renaming it “cycle of disappointment”. Grief over loss and disappointment over the
government seemed to be major themes. Most
of what they discussed would not meet the diagnostic criteria for PTSD, and
shouldn’t necessarily be pathologized if people are functioning
adequately. The student reported that in
one group where this issue was discussed, participants began talking about
“emotional suffering” as a persistent pattern for many Zimbabweans.
The trauma, or suffering, or
whatever we choose to call it, is compounded for Zimbabweans, in my opinion, by
restrictions in the range of affect they have been allowed to express. In talking with a community leader about a
proposed seminar to help Early Childhood Development (ECD) educators help
children deal with their emotions, I mentioned that I think of three basic
emotions (sad, mad, and happy) from which all others are derived. She thought about it and said that Shona are
allowed two emotions, happy and mad.
Then she thought some more and said that they’re allowed “mad” only
under some restricted circumstances. I’ve
heard the stereotype of the happy Africans for decades, but had never realized
that it might have developed out of the restrictions on expression of other
emotions. These restrictions are rooted
in culture, which makes them difficult.
For example, Shona don’t express
grief when loved ones die. Within hours,
they’ve put on their happy faces and gone on with life. I discovered that the basis for this is a
traditional belief in the nzuzu, the water spirits. These spirits not only control rainfall, but I
was told that the traditional Shona explanation of death is that the nzuzu
abduct people and take them to an alternative world with crops and trees, sky
and rain. The nzuzu also come back and
listen at the doors or windows of loved ones of the person they’ve
abducted. If they hear crying, they kill
the abducted person. What a powerful
belief to squelch expressions of grief!
If a person expresses grief outwardly, they may be responsible for the
death of their loved one. In Zimbabwe,
25% of people say they are Christian, 24% adhere to traditional indigenous
beliefs, and 50% identify themselves as “syncretic”, meaning that their beliefs
are a mixture of Christian and traditional elements.
Because of the difficulty with
outward expression of grief and, to a lesser extent, anger, Zimbabweans
experience many more somatic symptoms (e.g. headaches, stomachaches, fatigue) associated
with distress than I’ve ever experienced with other groups of people. This is true of children as well as
adults.
On a day-to-day basis, the attention paid by everyone in Zimbabwe to surroundings and people present is difficult for an American to imagine. To get the 10 km from Mutare to Africa University meant having the potential to be stopped at three different check points. Police have the right to search cars at any time. They often charge “spot fines” for minor infractions, which may not correspond with law. Once some police tried to charge a fine to a passenger in the back seat of a car in which I was riding because she didn’t have a seat belt on, but I’m told there’s no seat belt law in Zimbabwe. Another person was hauled out of his car and sat by the side of the road for about an hour before paying a $100 spot fine because of a car registration that had expired, but was within a 3-day renewal grace period which is officially sanctioned. It is widely known that spot fines, of which no official records are kept, are simply graft on the part of police officers. Additionally, everyone is constantly aware of their setting and who is within earshot, and factors that into what they say. I was told that every class has at least one member who is CIO (sorry, I don’t know what that stands for—it’s a ZANU-PF informant). If I wanted to talk politics with someone, I waited until we were alone in a car, or maybe in their home, though some people are even careful about what they say at home because house help or another family member might be CIO. There's a reason I didn't post this while I was in Zimbabwe.
I was privileged to be able to co-teach a graduate course in
trauma in a program in Child and Family Psychology, which is designed to train
mental health professionals at the masters’ level. My mentor for this was an anthropologist who
is a full-time faculty member at Africa University, and whose work over the
past decade has been focused on two issues: mass trauma and the experiences of
children who have HIV/AIDS. I clearly
learned much more than I taught in this class.
·
In 1987, there was an action by Robert Mugabe’s
government to slaughter about 20,000 civilians, mostly minority Ndebele, in
Matabeleland. This was called the
gukurahundi (in Shona “the early rain which washes away the chaff”). I’d never heard of this, and suspect I’m in
good company in that respect. The
remaining Ndebele, who comprise 14% of Zimbabwe’s population (compared to the
Shona’s 85%), remain chronically hypervigilant about their status, because they
tend to be viewed by the leaders of ZANU-PF, the dominant political party, as
opposition.
·
In 2000, Zimbabwe land reform went from a
gradual process that depended upon having willing buyers and willing sellers to
a “fast track” system, in which white settlers (and their farm workers of local
descent) were often forced off their land, which was then given to war veterans
and ZANU-PF supporters. There was a lot
of intimidation, threats of deaths, and enough deaths to keep the tension high
associated with this. The process has
continued intermittently for the past twelve years, with the effect that no
white farmers feel safe, and most debate every time they think about making an
improvement or planning a crop what the likelihood is that they’ll still own
the land for long enough to recover the expense.
·
A man I met while touring told me that in 2000,
his parents were killed by ZANU-PF because they were believed to have been
recruiting votes for the opposition part.
ZANU-PF soldiers encircled their home with wire so they couldn’t get
out, poured petrol on it, and lit it.
The man I talked to was in his mid-20’s at the time and was also sought,
so he fled the country and stayed away for almost two years before
returning. He had five younger siblings
who were all still children, and therefore not targets. They remained in Zimbabwe and were cared for
by relatives. He’s still trying to pick
up the pieces of his life and reconnect with his remaining family.
·
A student told me about being taken from her
work by ZANU-PF interrogators because of her association with a woman friend of
hers during the time when that woman’s husband was dying. He apparently had been engaged in opposition
activities. My student was held, but was
allowed to use the restroom at one point and managed to get a message out so
that help arrived for her. She continued
to be fearful at work, however, and eventually quit her job because of her
anxiety about being singled out for interrogation.
as an anthropologist who is a full-time faculty member at Africa University, and whose work over the past decade has been focused on two issues: mass trauma and the experiences of children who have HIV/AIDS. I clearly learned much more than I taught in this class.
The other instructor argued strongly that Post Traumatic
Stress Disorder (PTSD) is a conceptualization originating in Western culture
and not particularly applicable to sub-Saharan Africa. He had us read numerous critiques of PTSD,
which partly focused on important things like the inherent but unrecognized culture
biases in the diagnostic criteria. (I
think that argument could be made for most of the current diagnostic
categories, and he acknowledged that sub-Saharan Africa has contributed little
to date to the research literature and the discussion and formulation of
diagnoses, so has to share responsibility for the lack of representation of
that region’s experiences and conceptualizations in the diagnostic manual.
·
In 1987, there was an action by Robert Mugabe’s
government to slaughter about 20,000 civilians, mostly minority Ndebele, in
Matabeleland. This was called the
gukurahundi (in Shona “the early rain which washes away the chaff”). I’d never heard of this, and suspect I’m in
good company in that respect. The
remaining Ndebele, who comprise 14% of Zimbabwe’s population (compared to the
Shona’s 85%), remain chronically hypervigilant about their status, because they
tend to be viewed by the leaders of ZANU-PF, the dominant political party, as
opposition.
· In 2000, Zimbabwe land reform went from a
gradual process that depended upon having willing buyers and willing sellers to
a “fast track” system, in which white settlers (and their farm workers of local
descent) were often forced off their land, which was then given to war veterans
and ZANU-PF supporters. There was a lot
of intimidation, threats of deaths, and enough deaths to keep the tension high associated
with this. The process has continued
intermittently for the past twelve years, with the effect that no white farmers
feel safe, and most debate every time they think about making an improvement or
planning a crop what the likelihood is that they’ll still own the land for long
enough to recover the expense.
·
A man I met while touring told me that in 2000,
his parents were killed by ZANU-PF because they were believed to have been
recruiting votes for the opposition part.
ZANU-PF soldiers encircled their home with wire so they couldn’t get
out, poured petrol on it, and lit it. The
man I talked to was in his mid-20’s at the time and was also sought, so he fled
the country and stayed away for almost two years before returning. He had five younger siblings who were all
still children, and therefore not targets.
They remained in Zimbabwe and were cared for by relatives. He’s still trying to pick up the pieces of
his life and reconnect with his remaining family.
·
A student told me about being taken from her
work by ZANU-PF interrogators because of her association with a woman friend of
hers during the time when that woman’s husband was dying. He apparently had been engaged in opposition
activities. My student was held, but was
allowed to use the restroom at one point and managed to get a message out so
that help arrived for her. She continued
to be fearful at work, however, and eventually quit her job because of her
anxiety about being singled out for interrogation.
There are special challenges in
helping people who have experienced trauma (or persistent grief, or emotional
suffering) in Zimbabwe. Their situation
is not safe, and cannot readily be made safe.
Threats of death and actual deaths of individuals suspected of
opposition activity continue. Much of
Mutare was locked down when Robert Mugabe arrived to celebrate his 85th
birthday, as members of the Desert Southwest Conference delegation in the city
during that time can attest. I’m told
that schools at all levels, from ECD through university level, will close for
several weeks before the next election, and foreign NGO’s will have employees
leave the country. This is because prior
to past elections, ZANU-PF enforcers have threatened and beaten teachers and
others suspected of being sympathetic to the opposition (and anyone with
education or social services jobs is suspect).
It is safer to abandon the schedule, close services, and resume them
again after the election.
On a day-to-day basis, the attention paid by everyone in Zimbabwe to surroundings and people present is difficult for an American to imagine. To get the 10 km from Mutare to Africa University meant having the potential to be stopped at three different check points. Police have the right to search cars at any time. They often charge “spot fines” for minor infractions, which may not correspond with law. Once some police tried to charge a fine to a passenger in the back seat of a car in which I was riding because she didn’t have a seat belt on, but I’m told there’s no seat belt law in Zimbabwe. Another person was hauled out of his car and sat by the side of the road for about an hour before paying a $100 spot fine because of a car registration that had expired, but was within a 3-day renewal grace period which is officially sanctioned. It is widely known that spot fines, of which no official records are kept, are simply graft on the part of police officers. Additionally, everyone is constantly aware of their setting and who is within earshot, and factors that into what they say. I was told that every class has at least one member who is CIO (sorry, I don’t know what that stands for—it’s a ZANU-PF informant). If I wanted to talk politics with someone, I waited until we were alone in a car, or maybe in their home, though some people are even careful about what they say at home because house help or another family member might be CIO. There's a reason I didn't post this while I was in Zimbabwe.
This has been a bit rambling
because the current context in Zimbabwe and the experiences of Zimbabweans
since independence have been complex.
There are many interlocking pieces which contribute to people’s
experiences of trauma, violence, disappointment and suffering. Americans have had a few—9/11 and the bombing
of the Murrah Building in Oklahoma City in 1995 come to mind. But with the exception of the first few weeks
after 9/11, I don’t believe I’ve lived with the kind of uncertainty and sense
of threat that is present for many people in Zimbabwe all the time. Thank God we don’t have to, and pray to God
for relief from this kind of pressure in the lives of Zimbabweans.
Thursday, May 3, 2012
Reproductive Health in Zimbabwe
I haven't written about the content I taught while in Zimbabwe. I guess I needed to get past teaching my courses in reproductive health (for masters' level MPH students) and family health (for undergraduates in a program training them to be administrators in small health clinics so that I could give some thought to the material I taught.
It's been a rocky road for Zimbabwe in terms of its health care in general. Before Zimbabwe became an independent country in 1980, the quality of people's health care depended largely upon race, and also upon whether a person lived in a city. Whites and urban dwellers got pretty decent health care, and most other people did not. Then there was a period of about ten years in which Robert Mugabe and his government tried to rectify that situation by putting more money into rural health care and providing universal free maternity and child health care. The result was a decline in infant mortality (often taken as a good indicator of the overall health of a country) from 70.4/1000 in 1978 to a low of 50.2/1000 in 1988. (For comparison, the US, which has been criticized for its high infant mortality in the context of developed countries, was 6.1/1000 in 2005, and has been relatively steady for decades.) At that point policies reversed, and women began having to pay fees for prenatal care, delivery with a skilled birth attendant present, and neonatal and infant care. As a result, earlier progress was eroded. Throughout its history since independence, maternal mortality has been high in Zimbabwe. In 2006 it was 555/100,000, compared to the US's 12.7/100,000. A more graphic way of presenting this information is the lifetime risk of maternal mortality for women. In 2008 is was 1:42 for Zimbabwean women and 1:2100 for US women.
During the period since Zimbabwe's independence, its birth rate has steadily declined from 47/1000 women of childbearing age to 29/1000 (compared to 14/1000 in the US). Over 21% of Zimbabwean women are mothers or currently pregnant at least once as teenagers, which is very high. In the 1980's, the HIV/AIDS epidemic hit Zimbabwe, and by 1995, more than 25% of the adult population was infected. This put a tremendous strain on health care systems, which has continued to the present day. Largely as a result of the HIV/AIDS epidemic, there are many orphans in Zimbabwe (980,000 estimated in 2003, out of a population of about 12,000,000), and many children being cared for by grandparents or other relatives even if not orphaned because of parental incapacity due to HIV/AIDS. Only 52% of the population is in the age range (15-64) that usually is responsible for the financial support of everyone, compared to 67% of the population in that age range in the US. Malnutrition in childhood is an issue: in 2006, 36% of children under 5 years of age were malnourished (height for age), compared to 3.9% in the US, and more than 7% were wasting, compared to .6% in the US.
It is challenging for a sub-Saharan African country with such devastating health statistics and such a precarious economy to make progress on health issues. As you've seen in some photos in earlier blog posts, equipment is rudimentary at best in rural health clinics. People often don't seek medical services. Although there are a small proportion of Zimbabweans who won't use medical services due to religious convictions, lack of money is a far greater factor in people's decisions to postpone or avoid medical treatment. Zimbabwe is a country with a per capita income estimated at $500, compared to $21,587 in the US. In 2009, the per capita health expenditure in Zimbabwe was $6, compared to $7410 in the US.
Teaching reproductive health in the Zimbabwean context was a challenge. The class and I had to focus on inexpensive interventions, and to think about how to make those interventions acceptable in the cultural contexts of the countries of my students. I learned about sexually transmitted infections I'd never learned about in graduate school because they just aren't found in developed countries. I had to scale back my expectations about routine health care when I learned that very few women ever get Pap smears, much less mammograms. I learned about current thinking about how to minimize parent-to-infant transmission of HIV/AIDS, again in the context of Zimbabwe (where most mothers don't even know their HIV status). It was a challenge, but one from which I learned a great deal. My thinking is much more flexible now than it was before, and I respect the barriers in sub-Saharan Africa to providing the kind of health care that I believe all people deserve.
I have no comprehensive answers to the challenges faced in Zimbabwe and the rest of sub-Saharan Africa when it comes to reproductive health. I'd worry about me if I thought I had the answers. What I have is a great deal more information about the nature of the challenges, and a huge amount of respect for the health professionals who work every day to try to overcome them. I feel blessed to have been a part of the development of a few of these professionals, and wish them well in their efforts to develop programs and health clinics that make good use of the few dollars available to them to do the most good for the most people they can. That's all anyone can do.
It's been a rocky road for Zimbabwe in terms of its health care in general. Before Zimbabwe became an independent country in 1980, the quality of people's health care depended largely upon race, and also upon whether a person lived in a city. Whites and urban dwellers got pretty decent health care, and most other people did not. Then there was a period of about ten years in which Robert Mugabe and his government tried to rectify that situation by putting more money into rural health care and providing universal free maternity and child health care. The result was a decline in infant mortality (often taken as a good indicator of the overall health of a country) from 70.4/1000 in 1978 to a low of 50.2/1000 in 1988. (For comparison, the US, which has been criticized for its high infant mortality in the context of developed countries, was 6.1/1000 in 2005, and has been relatively steady for decades.) At that point policies reversed, and women began having to pay fees for prenatal care, delivery with a skilled birth attendant present, and neonatal and infant care. As a result, earlier progress was eroded. Throughout its history since independence, maternal mortality has been high in Zimbabwe. In 2006 it was 555/100,000, compared to the US's 12.7/100,000. A more graphic way of presenting this information is the lifetime risk of maternal mortality for women. In 2008 is was 1:42 for Zimbabwean women and 1:2100 for US women.
During the period since Zimbabwe's independence, its birth rate has steadily declined from 47/1000 women of childbearing age to 29/1000 (compared to 14/1000 in the US). Over 21% of Zimbabwean women are mothers or currently pregnant at least once as teenagers, which is very high. In the 1980's, the HIV/AIDS epidemic hit Zimbabwe, and by 1995, more than 25% of the adult population was infected. This put a tremendous strain on health care systems, which has continued to the present day. Largely as a result of the HIV/AIDS epidemic, there are many orphans in Zimbabwe (980,000 estimated in 2003, out of a population of about 12,000,000), and many children being cared for by grandparents or other relatives even if not orphaned because of parental incapacity due to HIV/AIDS. Only 52% of the population is in the age range (15-64) that usually is responsible for the financial support of everyone, compared to 67% of the population in that age range in the US. Malnutrition in childhood is an issue: in 2006, 36% of children under 5 years of age were malnourished (height for age), compared to 3.9% in the US, and more than 7% were wasting, compared to .6% in the US.
It is challenging for a sub-Saharan African country with such devastating health statistics and such a precarious economy to make progress on health issues. As you've seen in some photos in earlier blog posts, equipment is rudimentary at best in rural health clinics. People often don't seek medical services. Although there are a small proportion of Zimbabweans who won't use medical services due to religious convictions, lack of money is a far greater factor in people's decisions to postpone or avoid medical treatment. Zimbabwe is a country with a per capita income estimated at $500, compared to $21,587 in the US. In 2009, the per capita health expenditure in Zimbabwe was $6, compared to $7410 in the US.
Teaching reproductive health in the Zimbabwean context was a challenge. The class and I had to focus on inexpensive interventions, and to think about how to make those interventions acceptable in the cultural contexts of the countries of my students. I learned about sexually transmitted infections I'd never learned about in graduate school because they just aren't found in developed countries. I had to scale back my expectations about routine health care when I learned that very few women ever get Pap smears, much less mammograms. I learned about current thinking about how to minimize parent-to-infant transmission of HIV/AIDS, again in the context of Zimbabwe (where most mothers don't even know their HIV status). It was a challenge, but one from which I learned a great deal. My thinking is much more flexible now than it was before, and I respect the barriers in sub-Saharan Africa to providing the kind of health care that I believe all people deserve.
I have no comprehensive answers to the challenges faced in Zimbabwe and the rest of sub-Saharan Africa when it comes to reproductive health. I'd worry about me if I thought I had the answers. What I have is a great deal more information about the nature of the challenges, and a huge amount of respect for the health professionals who work every day to try to overcome them. I feel blessed to have been a part of the development of a few of these professionals, and wish them well in their efforts to develop programs and health clinics that make good use of the few dollars available to them to do the most good for the most people they can. That's all anyone can do.
Saturday, April 7, 2012
Chris, the stone carver, and his work
Today I finally got to go to Tszingwe to see how Chris, the stone carver, does his work. Tszingwe is a small village about 6 km. from Africa University. He met me at the farm store, and we walked, mostly on a rough path between fields and through fallow land, to get there. Chris lives with his wife and three daughters, and has been in this community his whole adult life. His oldest daughter, Faith, is a boarding school student who had just come home for semester break. The other two girls, Agnes and Ellen, live at home and go to schools nearby.
When the economy was better, Chris was able to buy a small plot of land for a house, and a concrete pad has been poured for the home. However, then the economy went bad. Chris and his family live in a small temporary house made of vertical tree branch poles, rough wood siding, and a corrugated material for the roof. The inside has one main room with couches and chairs and a small table. There is a partial wall and a drape over a door opening at one end into a very small (I’d guess about 8’ x 4’) bedroom for the parents. There is electricity hand strung across the ceiling in the home, which runs one overhead light in the main room, a two-burner cooker (without an oven) and a small radio. There is no running water. Water comes to this village through pipes from the nearby mountains, and women go to collect it within the village. There is an outhouse and a very small workshop for Chris’s carving activities.
Chris walks about ½ hour to a nearby mountain where he can find soapstone and serpentine, the two kinds of stone he carves. He roughs out the stone on the mountain, using small saw blades. This is so that he has less stone to carry back home by hand for finishing. On a good day, he can rough out five or six pieces, depending upon their size and design.
Chris showed me the process he uses from that point on. He uses a file and small saw blades to finish shaping the sculptures.
Then he uses three different grades of sandpaper and water to smooth the sculptures.
At that point, he boils each sculpture in water. The heat makes the substances he puts on the sculpture in the next step stick better.
Once the rock is very hot, he applies a coat of black or dark brown shoe polish to the sculpture. He lets that dry and the rock cool before he adds a second coat. If he wants to bring out the natural color of the stone, he may brush it with melted candle wax first, and then add just a little shoe polish, which gives the rock a shine without coloring it deeply.
Chris’s grandfather was known as a very good stone carver and taught Chris this trade when Chris was a young man. He used to make a reasonable living at it when there were more tourists in this part of Zimbabwe, but now he is branching out into buying and reselling food items and hiring out his truck to carry people’s maize crops from the field because he cannot sell enough sculptures in this economy to support his family.
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| Chris and his family |
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| This is taken from Tszingwe. The rounded peak just to the right of the road is where Chris goes to get his stone. |
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| Chris with a rough cut elephant sculpture |
Then he uses three different grades of sandpaper and water to smooth the sculptures.
At that point, he boils each sculpture in water. The heat makes the substances he puts on the sculpture in the next step stick better.
Once the rock is very hot, he applies a coat of black or dark brown shoe polish to the sculpture. He lets that dry and the rock cool before he adds a second coat. If he wants to bring out the natural color of the stone, he may brush it with melted candle wax first, and then add just a little shoe polish, which gives the rock a shine without coloring it deeply.
Chris’s grandfather was known as a very good stone carver and taught Chris this trade when Chris was a young man. He used to make a reasonable living at it when there were more tourists in this part of Zimbabwe, but now he is branching out into buying and reselling food items and hiring out his truck to carry people’s maize crops from the field because he cannot sell enough sculptures in this economy to support his family.
Friday, March 30, 2012
trip to Chibuwe
Yesterday I went with two friends from church, Francine and Hlupe, to a rural area about 2 ½ hours from Mutare. Francine and her husband, Steve, are involved in a farming ministry here, and Francine does other bits of community organizing.
We visited three different Early Childhood Development programs. Chibuwe is a bit hotter and drier than Mutare, so it was still quite warm. Unless it is rainy or cold, the programs meet outside. One had a playground, with a couple of swings and seesaws made out of tires and tree branches . The head counts I got ranged from 39-50 for these sites. Each had one teacher. The children have no materials to speak of, but we saw them do songs and were told about nature lessons in which they pick up leaves and little insects to examine. We were at one site when they had snack time. The children washed hands under cups of water poured from a bucket. Some had bread or peanuts, but many children came with a small bag of chips and a bottle of water flavored with Mazoe, a fruit-flavored syrup sold in stores by the liter. Some children didn't have a snack, and just sat there and watched the others eat.
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| First ECD classroom, with seesaws make of sticks and tires |
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| Hlupe and Francine helping children wash hands before snack time |
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| Better of the classrooms |
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| Some of the ECD children |
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| Snack time |
We also stopped by the local clinic. Two women had delivered babies during the morning. One woman had two older sons, I’d guess about 10 and 12 years, who had brought her to the clinic in a donkey cart and were waiting to take her and the baby home. The other woman was a young mother, still a teenager, who is the granddaughter of someone my friend works with in Chibuwe. She and her mother were preparing to walk 9 km. to their home, so we ended up taking them by car. It probably would’ve taken them most of the afternoon to walk, because the mother was still in pain and could not have walked far without stopping to rest.
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| Delivery Table |
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Delivery Room Equipment |
Monday, March 26, 2012
Rock Paintings near Mutare
Yesterday another faculty member took two of us who are visiting faculty to St. Augustine’s Mission. I had visited that place at the end of January, and did a blog post at that time about the orphanage there. This time we went because there are some ancient rock paintings near there that I wanted to see. Almost by chance, we found someone in the mission church who had been there once, 14 years ago, and who agreed to guide us to the place. We took eight boys with us, and had a great time.
This mountain and its paintings are considered holy to indigenous people of the area. Our guide showed us a place, sheltered from sun and rain and with two natural sitting places, where people come to pray when they have fasted. At one point, he stopped us all, had us squat, and asked the ancestors to protect us from snakes, animals and accidents while on the mountain. Then he took us on to the area where the rock paintings were located.
I have no idea how old these are. Others in Zimbabwe are usually in the broad period 1000 B.C.E. to 1000 C.E. These are wonderful representations of animals and people. Some of them are quite elaborate. I don’t pretend to know what the complex panels depict, though I can certainly pick out individual animals and human figures.
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| The hillside where the rock paintings are located |
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| Walking up the hill to the rock paintings |
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| The approach to the rock paintings |
I feel honored to have seen these. It will always be one of the highlights of this trip.
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| View from the hill with the rock paintings |
Saturday, March 24, 2012
Passport Woes
There are five Americans who came to AU for the semester. All five applied for temporary employment permits (TEP’s) early last fall. Three of us got them, with expiration dates ranging February 18- March 18. Mine expired March 17. The other two who got them are a couple, and their applications and responses were in the same envelopes, but one expired Feb. 18 and one March 18.
The other two people came in on tourist visas, having been told that AU would get their TEP’s once they got here. So far, that hasn’t happened. Those people have now each left the country twice in order to return with a new 30-day tourist visa. One of them has been granted a 7-day extension this last time and is required to produce police reports from his home community in the US to verify that he’s an upstanding citizen. (He’s a retired family physician, fortunately well known to some members of the police department that have nothing to do with him committing crimes.) Immigration is requiring original documents, not faxes or scans. It’s uncertain whether his letter will arrive on time. When I exchanged express mail with AU last fall, it took 17 days for documents to get to me and 21 days for them to be returned. In the meantime, he and his class are in limbo about whether he’ll be able to finish his course.
I have really mixed feelings about leaving at this time. I will have completed my courses, which was my primary goal in coming. I’m just beginning to understand a bit about the culture, and won’t progress as far as I would wish with respect to that. I also had planned to do more sightseeing at the end of this trip, when I wouldn’t have classes every day to tie me down. I won’t get to do that. Also, I feel the positive pull of home, family and friends. This has been an awesome experience, and there have been many people I have missed while I’ve been here. This way I’ll get to see everyone sooner, including that first grandson, who will probably still be born before I get home, but whom I’ll be able to see on Skype from Las Vegas. The picture part of Skype is a luxury I seldom have here in Zimbabwe because the connections, both at the university and on my dongle, are too slow to support it.
So I’ll see many of you sooner than we expected. I’ll look forward to that!
The other two people came in on tourist visas, having been told that AU would get their TEP’s once they got here. So far, that hasn’t happened. Those people have now each left the country twice in order to return with a new 30-day tourist visa. One of them has been granted a 7-day extension this last time and is required to produce police reports from his home community in the US to verify that he’s an upstanding citizen. (He’s a retired family physician, fortunately well known to some members of the police department that have nothing to do with him committing crimes.) Immigration is requiring original documents, not faxes or scans. It’s uncertain whether his letter will arrive on time. When I exchanged express mail with AU last fall, it took 17 days for documents to get to me and 21 days for them to be returned. In the meantime, he and his class are in limbo about whether he’ll be able to finish his course.
In the meantime, the university was unable to get TEP extensions for the other three of us. I had no difficulty getting a tourist visa coming back from Botswana after my day trip to Chobe. The other person went over the border to Mozambique, which is just a half –hour drive from Mutare. There, he was required to stay out of the country for two nights, and then the immigration official gave him a 3-day visa and wrote in his passport that he was not to do any teaching on a tourist visa and was to pack and leave immediately. AU intervened on his behalf and he is now allowed to stay until her TEP expires April 18, but with the stipulations that he is not to teach in the meantime, and that neither of them can get extensions beyond April 18.
This leaves me in a hard place. No one has directly told me that I can’t teach while in the country on a tourist visa, but it’s clear that the government considers volunteer work forbidden. I think it is unlikely that I could go to Mozambique and return with more than a 3-day pack-and-leave visa. I’m not sure if I’d be successful if I went out to Zambia or Botswana, but I’m not willing to ride buses for 18-20 hours each way to find out. The only alternative I see is to finish my courses and leave within the 30 days of my current tourist visa. Fortunately, I’d always planned to end my courses a bit early, just because I understand that make-up scheduling and overcrowding at the library make the last two weeks of the semester difficult for students at AU, and I’d wanted to avoid that. So I’ve scheduled two extra class periods for each of my Health Sciences classes over the next three weeks, and plan to complete them both by April 13. The primary instructor for the Humanities course in trauma will complete that course. I’ll leave for the US on either the 14th or the 15th. Papers for the trauma course will be emailed to me, and final exams for the Health Sciences courses will be express mailed for me to mark and email grades back to AU.
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