I am in America. I brewing beer now. I am trying to brew a pliny the elder clone.

These white globs have me concerned. Any ideas?

Bits and Pieces 1

Handing the underweight two-year old back to her mother, the clinic nurse turned to the battered register and wrote: malaria. When they arrived at Lusuntha clinic on the eastern border of Zambia earlier that morning, the mother explained that the child had spent the past three days suffering from diarrhea. Lethargic and miserable, she looked like she was on the verge of tears but her body, so extremely dehydrated, didn’t have any left. The nurse turned to me and asked me to hand her a regimen of Coartem – the World Health Organization’s “Essential Medicine” used to treat malaria. Throughout my Peace Corps service, I had gotten to know the family personally and saw members washing, playing and drawing water from the same low-lying stream that had become stagnate with the dry season. I knew malaria was a possibility, but so were a hundred others. It seemed to me that the nurse made her diagnosis too quickly, as if she knew what the child had before she even stepped into the room. But to be fair, it wasn’t her fault: even if she wanted to test for malaria, the clinic didn’t have testing kits – they ran out nearly three months earlier. She did the only thing she could: treat yet another suspected case.

In the remote villages of Zambia, malaria does not necessarily refer to the specific mosquito-borne disease. Malaria prevention and treatment have been so strongly integrated into the Zambian society that the word has taken on a catch-all meaning. Children, adults and even community health workers nowadays refer to malaria as anything that involves diarrhea, fever and body aches. Problem is: most diseases in rural Zambia involve diarrhea, fever and body aches. And when clinic staff diagnose (or patients self-diagnose) cases of malaria that aren’t really malaria – the actual infection goes untreated and its potential severity and infectivity increase.

During the wet season, the recorded number of malaria cases rise dramatically. This makes sense: mosquitos carry the disease from person to person and they also breed in shallow pools of water. So: more water means more mosquitos and more mosquitos means more malaria. However, it isn’t the only disease that finds opportunity in a wetter environment. First rains wash human excrement and other disease vectors from higher grounds into unprotected water sources – putting nearby villages at risk for cholera and other water borne diseases. Poorly ventilated homes and buildings become stagnate with mildew and moisture – increasing risk for pneumonia and other respiratory infections. And as the incidence of all communicable diseases rise, so does the chance for misdiagnosis.

Zambia receives significantly more donor support for medications than it does for testing kits, so clinics’ medicinal supplies often outlast diagnostic. As a result, clinicians and nurses frequently have to rely on their own judgment to decide whether or not someone has malaria. In 2009, routine health data from the Ministry of Health demonstrated that roughly only one in three cases were actually tested and confirmed – the rest were diagnosed on a symptomatic basis. Bydon Tembo, the health officer in charge of the Lusuntha clinic, said he’s aware that even he diagnoses many cases of malaria that may not be malaria at all. But, again, there’s little he can do without the testing kits. Prescribing Coartem for a case that isn’t actually malaria might make someone sick, but not giving the drug runs the risk of more advanced forms, such as the often fatal cerebral malaria. Bydon once admitted to me that he and his staff purposely err on the side of diagnosis; their feeling: why take the chance? They usually have plenty of Coartem – if they run out, they can easily buy the heavily subsidized medicine from the small shops surrounding the health center. And if the patient doesn’t get better, they can always make a referral to the district hospital 16 kilometers away in town.

This strategy of treat-first-ask-questions-later may work well for those living close to clinics, but for the majority in rural Zambia – follow-up isn’t so easy. Most clinic catchment areas can range anywhere from 12 to 30 kilometers in radius – epic distances for people who rely on their own feet as a primary means of transportation. To ask the sick and dehydrated to travel to the clinic for testing and drugs means a journey through a rough, hot, sometimes unbearable landscape. And if the drugs aren’t effective, there may not be a second trip.

In the past, many NGO’s have trained lay community health workers (CHWs) to provide simple home-based medical attention to those unable to access institutionalized health care. And while Zambia has established policy inclusive of the rural community health worker – rarely does the Ministry of Health provide the resources necessary to properly diagnosis and treat. Joseph Ngwila, a rural CHW that I worked closely with, said that even when he had Coartem to distribute, it never lasted long. Plenty of people came to him complaining of malaria, but beyond assessing for the basic symptoms there was no way to differentiate cases. And so, just like clinic staff, he typically gave it to anyone who looked the part.

During my service, Bydon Tembo and I collaborated with CHWs to conduct surveys on the prevalence of malaria-like symptoms. While the assessments themselves were informal, the findings were staggering: every family interviewed said that at least one child experienced malaria-like symptoms in the span of one month. Now integrated into their routine reporting process, CHWs keep tallies on the number of people that present malaria-like symptoms, submitting them quarterly to the clinic so an overall number can be determined. But until they are armed with testing-kits, it’s an inexact process. While training clinic staff and CHWs on the methods of proper diagnosis and surveillance may help, funding must be increased for diagnostic methods so that the medication, and the response, can be better utilized.

As someone who has actually had malaria, I can attest to the miracle of Coartem. It worked perfectly; then again it worked perfectly because I had malaria, testing myself twice just to be sure. For the child at the clinic, the standard artemisinin treatment might have saved her life, but then again it might have made her sicker if the illness was, say, cholera or giardia. In the end the second guessing did not matter: we still didn’t have the test. So, doing as I was told, I handed the nurse the medication, she recorded the visit and the mother and child began their long walk home.

Civilization

When I moved to Lusaka, I heard a lot of people asking me if I was excited moving back to "civilization". At first I felt a little indignant over the question. What made the people in Lusaka any more civilized than people in the village? Murder rates are actually higher in the capital - doesn't that point more to barbarism than to civilization? Before attempting any satisfying answer, I realized I really didn't know the meaning of civilization. If I was going to become all emotional over the issue, I realized that I should probably look it up.

The Merriam-Webster Dictionary defines civilization as "a relatively high level of cultural and technological development"; it goes as far as to cite barbarism as its antonym . The Oxford dictionary defines it as "the stage of human social development and organization which is considered the most advanced"; it goes on to simply include "society, culture, and way of life".

Obviously, this did not make things any clearer. Was I to consider the people in my village uncivil because they didn't reach the most advanced stage of social organization? Or was I to focus on the technological development - look more at the state of infrastructure and communications? Obviously the larger macro developments were not there, but were they able to organize and mobilize themselves on a smaller scale? Well, yes and no. While they were able to come together on traditional issues, many internationally funded and supported projects died due to major problems with community management - but did this qualify them as uncivilized?

Merriam Webster cities cultural development as a component of a civilized society. Previously, I never considered whether a culture could actually be "developed" - the whole idea seemed extraneous, even ethnocentric. I always considered culture a definite and definable phenomenon. Either there's a group with constituent and regularly interacting members - or there isn't. That was my thought at least. Based on Merriam Webster's definition, there's a scale as to how advanced a culture can be. Whether that refers to moral or ethical development isn't explained. Nonetheless, what I remembered most about my experience in the village was not the lack of electricity or running water, but rather the cultural events that dotted the (figurative) community calendar. From the larger events, such as funerals and weddings, to the more routine, lunch and dinner, daily life was abound with cultural tradition - tradition that took hundreds and hundreds of years to develop. Tradition that adapted and absorbed western culture and Christianity (for better or for worse). Tradition so complex that two years can only allow an outsider to understand how intricate the entire culture is - not the intricacies themselves.

In short, yeah, I like my water heater and I like my microwave oven. I even enjoy zoning out to my satellite tv. But I wouldn't call it a return to civilization. Every morning when I wake up, I am no longer greeted by my neighbor's two year old son, but rather by the sound of morning traffic and the smell of yesterday's burning trash. Every evening when I eat dinner, I am no longer accompanied by my 82 year old host father and his long, rolling stories of post-colonial Zambia, but rather by Sam Waterston and the fast-paced stories of Law and Order.

Life is different here. I wouldn't call it worse, I wouldn't even call it uncultured. It's just different.

Lunch Break

As I sit at my desk in the CDC Zambia offices, trying to flesh out a much needed blog update, I realize how much has changed in the past year and how much time it'll take it get it all on the blog. I guess that's my fault though - I more or less stopped posting on purpose. Didn't see how I could accurately share what happens here with my friends and family back home. That, I realize now, is unfair. Everyone back home has been extremely supportive of me through out my service and you all deserve an update.

Its been a while, but the LEAD project was successfully developed and still stands today next to the Lusuntha Rural Health Center. 145 egg-laying chickens were transported from Chipata to Lundazi on September 1, 2010. The structure, while extremely delayed, was also finished recently and still houses about 140 chickens. I left the village on September 4, 2010 to start my new third year extension position here in Lusaka, so I am unfortunately unable to be apart of management. Currently, the new volunteer is working very hard to standardize a managerial system that will hopefully take the project into its integration phase where the funds will be finally used to help support widows and less-fortunate families to take care of orphans and vulnerable children. I would like to thank everyone for all their help and support from home - through the commitment of the current volunteer, this project promises to be a enormous benefit to the people and community of Lusuntha, Zambia. I promise to give a more in depth timeline to everyone when I come home to visit in December and January.

As I mentioned, I extended my service for a third year in a Peace Corps extension position. I was successfully placed with the Centers for Disease Control and Prevention Zambia Office in the Global AIDS Program. I work with the Surveillance, Epidemiology, Evaluation and Monitoring Branch and support many HIV-related programs that range from rural behavioral assessments to trainings on basic epidemiology. I will also be working with Jhpiego (a John Hopkins associated organization) to help coordinate data collection and management for an assessment of their Male Circumcision Counseling Package which is given to all men that undergo the male circumcision surgery. I really like my new job and look forward to the coming year.

And the best part: I am coming home to the US in December! Since I stayed on with the Peace Corps for a third year, they are flying me home for five weeks for a home visit! I fly out on December 18, 2010 and fly back to Zambia on January 23, 2010. I am so excited to see all my friends and family - its been much too long and too far. I am planning to stay in Ventura till after the holidays so I can get some well-deserved R&R and time with my family. After that I am planning to head up to the Bay Area and Davis to see friends, TKE brothers and even my old academic advisor (need to figure out what I'll be doing after this). Then on January 14 or so, I will be flying to Atlanta to attend the wedding of two very close Peace Corps Volunteer friends. It'll be a packed trip - but I can already tell it's going to go by in a flash.

Our Project

The Lusuntha Economic and Agricultural Development Project (LEAD)

LEAD Project
PO Box 530376
Lundazi, Zambia

Phone: +260 979 121 697
Website: https://www.peacecorps.gov/index.cfm?shell=resources.donors.contribute.projDetail&projdesc=611-051

A Village in Need
The village of Lusuntha lies on the border between Malawi and Zambia. To the ten thousand people who call this place home, little is known of the opportunites that exist outside the village. They accept that the earth is barren and incapable of providing the nutrition they need. They accept that half their children will die before their fifth birthday, mainly from malnutrition and related diseases.
Unaware of modern farming techniques that can revitalise the soil, the people of Lusuntha cannot provide enough food and nutrition to feed their families and raise their children. This is not their fault. Infertile soils lead to poor crop yields; poor crop yields mean low incomes; and low incomes mean hunger, poverty and an inability to gain the knowledge and resources necessary to better agricultural techniques. Sinking further into the dark spiral of poverty, the parents of Lusuntha are forced to watch their children grow up malnourished and starved – literally dying of hunger.
The fact that such a cycle exists in the 21st Century, the fact that children cannot live to see their fifth birthday, is a tragedy that can and must be stopped.

The Circle of Life
As hopeless as the situation may seem, it can be stopped. The soil can be improved and the cycle can be broken. Sustainable agricultural techniques (commonly referred to as organic farming) allow farmers to produce crops indefinitely while replenishing soil nutrients. By recycling crop and livestock waste, employing nitrogen fixing plants, and increasing seed diversity, the stewards of Lusuntha can bring everlasting fertility to the earth and soil. Thus the cycle breaks: fertile soils result in higher crop yields; higher crop yields lead to increased incomes; and increased incomes mean improved health, more education and better farming techniques. The Zambian countryside contains all the sun and water required for organic farming, all that is needed is the spark of knowledge. By equipping the community with the knowledge and seed necessary for sustainable farming practices, we can provide a brighter future for the families and children of Lusuntha for years to come. But if we do not act now, the lives of Lusuntha are doomed to wither away alongside their crops.

How will it work?
The Lusuntha Economic & Agricultural Development (LEAD) Project, in partnership with the Zambian Association for Sustainable Projects (ZASP), will provide training in agricultural techniques that empower local farmers – endowing them with the knowledge and skills necessary to farm sustainably. LEAD also plans to supply comprehensive education in business, nutrition and HIV/AIDS prevention and care. Beginning in 2010, LEAD will provide a wide range of seed for soil-friendly and highly nutritional crops, such as beans, soy, and peanuts. In order to maintain sustainability all participants will return an equal amount of seed after harvest, further extending the number of beneficiaries reached by the LEAD project.

Who will benefit?
Within the first two years, LEAD will help under-privileged Zambian families (those either currently headed by widows or are orphan caretakers) to develop their own lucrative and sustainable agricultural projects. By 2013, a projected 120 families will have been trained in conservation farming techniques and provided with a wide variety of seed. Expansion will occur after 2012 and with oversight by ZASP, the Swedish funded NGO founded in 1991, residing 12 kilometers from Lusuntha village.

The Chicken and The Egg
The LEAD project can end the crippling malnutrition and starvation plaguing Lusuntha today, bettering the lives and condition of its citizens for many years to come. However, we can not do this without your support.
In order to maintain sustainability and ensure the project continues to help people for many years to come, LEAD plans to set up a non-profit chicken and egg business that will generate the funds needed to pay for seeds and training. In order to do this, LEAD needs $4000 to pay for the materials, chicken, and feed necessary to start the egg business. We need your help to raise this money and to start providing the endless gift of knowledge.
Your donation to LEAD is crucial to the development and implementation of the project and without it the citizens of Lusuntha will never rise above destructive poverty. Every dollar donated to the LEAD project helps!

What is Microfinance?
Microfinance provides small loans to community members who cannot access traditional bank loans. The community decides which group member will receive a loan, and the repayment is made directly back to the community so new loans can be provided. If the money is not repaid then it is the debtors’ family, friends and neighbours who will suffer. Because of these social pressures, repayment rates for microfinance schemes around the world average 98%.

A Brighter Future – with your support!
By August 2012, LEAD aims to have helped over 100 families deemed most at risk become self-sustainable in the practice and business of sustainable agriculture. Once the projected number is reached, LEAD plans to expand its loaning program to include other environmentally and culturally sustainable businesses, on a microfinance basis.
Our project uses the principals of microfinance to increase the community’s ability to better their income, nutrition and lifestyle. It focuses on providing community members with very small loans – generally no larger than $100 – in concert with specialized training. The power of microfinance comes from its ability to provide financial support to those people completely unfamiliar with our western financial traditions. It does this by specifically tailoring those services to fit the traditions of a certain culture or society. So instead of lower credit scores, fines, bankruptcy, etcetera being the driving force for loan repayment, motivation comes from social forces already existing and familiar within that community. With repayment rates averaging 98% throughout the world, this system of development insures the betterment of lives for many, many years to come!

To donate please visit our website at https://www.peacecorps.gov/index.cfm?shell=resources.donors.contribute.projDetail&projdesc=611-051.

THANK YOU SO MUCH!!!

A salad.

Ok. Lets start with something simple. A salad. These ingredients are
in no way easily available in Zambia, so this probably isn't the best
representation of make-due-with-what-you-have Zambian cooking. As time
goes on I'll bring harder to make, more elaborate recipies, but lets
begin with food easily found in western supermarkets. Most of these
ingredients were found in a Lusaka supermarket, and yet with no
iceburg lettuce or fancy dressing, concessions were made. What follows
is the recipie written as cooked. Feel free to subsistute the blander
parts with fresher, tastier components.

What you need:
200g haloumi cheese
1 pkg bacon
2 large avocados
1/4 cup unshelled sunflower seeds
1 med head cabbage
3 lg carrots
1 cup mushrooms
3 lg tomatoes
1/3 cup black olives
green beans
olive oil
salt and pepper to taste

Fry bacon and set aside on a paper towel. Slice the cheese roughly one
quarter of an inch thick and pan fry on a dry pan until brown. Cut
veggies, cheese and bacon, cube avocadoes and combine. Top with olive
oil and sunflower seeds. Add salt and pepper to taste. Thats it. Easy.
Simple. Edible.

Sans-Fluff

OK. I gotta be honest with you: I don’t like this blog. I don’t like writing it and I sure as hell wouldn’t like reading it if I was on the other end. Now, I’m sure this sounds negative and pouty, but there’s good reason behind my blog-aversion. My everyday life in Zambia has become just that – everyday life. And while it might sound interesting to you, it’s not all that fantastic to me. I love living here, don’t get me wrong, but how many times can I write about mud walls, wells and pit latrines? You try writing a blog about your kitchen sink and toilet and see how far you get. What about work? I certainly could write loads about that, right? Yeah, I could – but I’m not going to. Peace Corps work – and I’ve made peace with this – Peace Corps work is a difficult endeavor mired in cancellations and corruption. Again, don’t get me wrong, I have had successes; I do have a good ending or two, but its frustrating getting there. And while I still believe in development work, I’ve turned somewhat cynical – and nobody wants to read about that. So I’m leaving work out too.

Then what? Why have a blog if I’m not gonna write anything? It’s just gonna take up cyberspace and the time you invest in checking it. I previously intended to simply delete this fluff blog and forgo the frustration of trying to think up another inane post. Long story short, I was talked out of it. I’ll be keeping the blog, but instead of the usual dribble I’ll be writing about a new founded passion: cooking.

As I’m sure most of you know, I love dining out and did it quite often back in the states. Unfortunately this hobby has completely lost its appeal since all the restaurants in Zambia serve exactly the same thing – nshima with chicken or nshima with beef. I was soon confronted with the question, who will make my pizzas? My tacos? My charbroiled avocado double cheeseburgers with garlic fries? These became deeply troubling issues. And while I was physically sated eating the same vegetable stir-fry night after night, dreams of fettuccine Alfredo and my mom’s chicken casserole became more intense as time went on.

Enter John Crockett, a Welshmen with an enthusiasm for cooking. Volunteering for VSO, he and his Spanish girlfriend, Betty Alie, work in the nearby township of Lundazi. The international couple has continually shown us an incredible degree of hospitality, frequently opening house and stocked kitchen to me and my fellow Peace Corps comrades. Over the past eight months John has taken me under his culinary wing, instructing me on recipes such as curry, risotto, and quiche. But, as all things in Zambia, cooking isn’t a straight forward practice. Being 150 miles from the nearest supermarket, we are forced to be inventive, making simple ingredients entirely from scratch. The total and complete lack of ricotta cheese, egg noodles, and jam frequently leads us to find ourselves curdling milk, rolling dough, and preserving fruits. And while these practices are frequently time consuming and somewhat bothersome, the situation only gets worse in the village. With no refrigerator, no oven, and no stove, the methods of preserving and cooking food become even more extravagant and creative. Making bread, pies, and burritos on a charcoal brazier isn’t impossible, just requires time, patience, and the ability to stomach failure.

So that’s it. Over the next two years, I’ll be bringing you tried and tested recipes from the African bush. It’ll be fun. Well, more fun than the pit latrine stories.

Oh and if you want to read blogs about development check out John’s blog, http://www.devex.com/blogs/208 . He’s much better at it than I am.