Notes from the bush

finale

noreply@blogger.com (Matt) — Fri, 21 Nov 2008 05:08:00 +0000

Hey there to all you faithful readers....
I'm now officially back in the US, and as such, think that it's probably time for the blog to end. I was at the Global Health Missions Conference this past week and actually was stopped in the halls by a couple of people who I had never met except through the blog -- a funny experience, but also one that made me realize that more people than what I had pictured were reading the thing. So thanks to all of you.

They told me in my 'debrief' that most people will have about a 3 minute attention span for my stories about what my experience in Africa is like; that seems a little bit silly to try to condense it all into 3 minutes and I'm guessing that if you've made it through 200+ blogs then you're probably willing to stick out a bit more of my rambling. I've been trying to come up with some pithy insights, but a comment from one of the people at the conference has stuck with me: "the relationships that I have overseas are some of the most complicated relationships I've ever had in my life." I resonate with that comment as the experience has so many different layers to it.

I was reading Henri Nouwen before I left and he said "no one can help anyone without becoming involved, without entering with his whole person into the painful situation, without taking the risk of being hurt, wounded, or even destroyed in the process." Maybe I've been wounded some in my time overseas, but it's a beautiful scar, and one to treasure, not hide. Some scars open you up deeper.

I hope every one of you will pursue your call to be gloriously wounded that way someday. I am looking forward to connecting with each and every one of you.

Until then.

Matt

seed distribution continued

noreply@blogger.com (Matt) — Wed, 08 Oct 2008 18:53:00 +0000

seed distribution continued, originally uploaded by mattcotham.

One of our hospital chaplains, Daisy Munguya, sharing with the crowd
about Joseph and the famine in Egypt.

seed distribution continued

noreply@blogger.com (Matt) — Wed, 08 Oct 2008 18:52:00 +0000

seed distribution continued, originally uploaded by mattcotham.

Some of our ward attendants teaching everyone how to cook porridge with
peanuts mixed in....

more pictures

noreply@blogger.com (Matt) — Wed, 08 Oct 2008 18:51:00 +0000

more pictures, originally uploaded by mattcotham.

seed distribution

noreply@blogger.com (Matt) — Wed, 08 Oct 2008 18:50:00 +0000

seed distribution, originally uploaded by mattcotham.

These past two weeks have seen the distribution of all those seeds I
posted on the blog last week. It's been a great opportunity to spend
time with the communities, get other glimpses into local village life
(entertaining the local headmen, etc), and spread the love of God in the
places that we've been. I'm gonna post a few pictures so you get the
flavor....

The Glostavent

noreply@blogger.com (Matt) — Wed, 01 Oct 2008 17:01:00 +0000

The Glostavent, originally uploaded by mattcotham.

The Glostavent -- perhaps the sequel to The Groundnuts Project -- is the
name for our new anesthesia machine. It arrived about a week ago and we
had a visiting anesthesiologist come out to show us the ropes the first
part of this week. It's been great -- although a little bit expensive
it's perfect for our environment and will be fantastic for what we're
doing here. It should help us to give safer anesthesia and smoother
anesthesia as well, especially for some patients who are more ill and
can't withstand the usual drugs that we give. What a great gift to the
hospital -- thanks to all of you who helped contribute to make this happen!

out with a bang

noreply@blogger.com (Matt) — Wed, 01 Oct 2008 17:00:00 +0000

Haven't been writing all that much for a while -- perhaps it's best to
be winding down a little bit with the blogging and honestly after two
years I'm not sure that I have much more to say. The last few weeks
will be a tough transition for me -- transitions are always tough, I
think -- and I'm going 'flat out' as David likes to say trying to spend
time learning about our new anesthesia machine, get the restaurant
finally open, get all these seeds packed, transported, and distributed,
cover the 4 wards in the hospital that I'm responsible for, get the HIV
study off the ground, and manage to get my stuff distributed, packed and
on it's way. This week and next will be especially busy as the
groundnuts project finally draws close to the end, meaning that I will
just be remaining with a few things left on my list. I wouldn't have it
any other way, however.

The groundnuts project

noreply@blogger.com (Matt) — Wed, 01 Oct 2008 16:56:00 +0000

The groundnuts project, originally uploaded by mattcotham.

The Groundnuts Project -- sounds like a 60's band. I spent last Friday
traveling with the hospital truck to a nearby district to pick up around
4,000kg of seeds for peanuts and soybeans to bring back for seed
distribution this week. It's been kind of a madhouse with staying up
late to pack up seeds, leaving early in the morning the next day to
travel out to the villages and do the distribution ceremony, and cover
my inpatient duties at the hospital. We ended up moving around a total
of around 8,000kg of seeds, which has been developing my back and
stomach muscles -- Zambians have such good core strength, I think it
comes from hoeing and hauling around 50kg sacks of maize! You could
continue to pray that people feel the love of God through the work at
the hospital and through these gifts of seeds, and that there will be a
good harvest for the families that plant them.

fire on the mountain

noreply@blogger.com (Matt) — Sun, 21 Sep 2008 13:06:00 +0000

fire on the mountain, originally uploaded by mattcotham.

When I was a kid we accidentally burned down the neighbors yard by
putting some not-quite-extinguished coals in a bag of grass clippings.
I think I'm getting a little payback this week. It's a little late for
the burning season here -- it's usually in June-July -- but the last few
days we've had a couple of fires creep pretty close to the hospital.
This is the hill next to the hospital, and then the next day the field
behind my house was set on fire and burned to about 50 yards of my back
door. It makes me a little bit nervous when you realize there's no fire
department for about a 4 hour drive. But everything did fine, and
actually now I'm pretty safe since there's nothing left to burn....

jewish zambia

noreply@blogger.com (Matt) — Mon, 15 Sep 2008 18:33:00 +0000

We are cranking out the circumcisions these days at the hospital. Who
would have thought that adult circumcision would be such a popular
thing, especially since we aren't doing childrens' circumcisions very
much. There's a big push in the country because circumcision is thought
to decrease the HIV and sexually transmitted infection rates, so there's
funding to get these done. I honestly don't really understand the
popularity amongst the local populace, but we get lines of 10-15 young
men every Saturday outside of the OR to get the snipping done. Many of
our hospital staff has signed up at one point or another. Fortunately
I'm involved very peripherally -- only to give a few words of comfort as
they gingerly make their way around the hospital on Monday morning.
I won't put any pictures with this post. :)

Leaving home

noreply@blogger.com (Matt) — Sun, 07 Sep 2008 07:15:00 +0000

Hello again from Mukinge!

Time in Zambia is rapidly drawing short for me -- my departure date has officially been set for November 10th, which is just 10 weeks away from today as I write this. I had my end-of-term review this week with the director of the mission, which seemed maybe a little premature -- what if I set the hospital on fire next week? -- but has given me a chance to do some reflecting and thinking about what I've been learning over the last two years:

- community: except in a family, there's not many communities like a mission community, where you work, socialize, exercise, eat with, go to church, and in general never escape a small group of people from widely different backgrounds (Ireland, NZ, China, England, America, Canada, Zambia) and ages (2 weeks to >70 years old). Psalm 133 -- 'How wonderful, how beautiful, when brothers and sisters get along! -- expresses the idea that a vibrant community is one where every day brings a sense of expectancy to see what is being done in each others' lives and in your own. I've been growing in learning about forgiveness and refusing to 'close the door' on a relationship because of past issues or hurts; God's mercy is new every morning and I cannot deny the possibility that each day brings a transformation in each of our lives. (Read C.S. Lewis' "The Weight of Glory" for a more erudite exposition of that theme.) It's been a good journey to learn to live with that sense of possibility.

- transformative development: entire books, thesis, and international organizations have been dedicated to figuring out how to best help people in Africa. It seems to me that Africa itself has had more difficulties showing progress than other nations in the developing world, especially in the areas of poverty and disease. I've been struggling with these concepts as we've been working with the nutrition project, to try to bring some small amount of transformation in the farming practices in a way that doesn't foster dependence, shows the love of God for the people, and will make a change in the area. I've been learning from lots of different sources and experiences. One conclusion that I have come to, however, is the one that our western ideals of independence and self-sufficiency are neither biblical or practical for the region. We should be aiming for interdependence, where all of our gifts on both sides of the coin are freely offered and control is relinquished to achieve the greater purposes for the area. Of course, for true interdependence, each gift has to be honored, even the gifts that don't seem so important from a western perspective.

- hope: for many people, hope is at best a vague longing, a feeling in the pit of your stomach that things could be better, a dissatisfaction with the state of the world. Here I've been in touch with a more concrete definition of hope, however, that not only recognizes the dissatisfaction but also knows that a remedy is coming. Every day has the potential to be a depressing day in the hospital -- small kids with cancer, HIV and its consequences on individuals and families, neglect and malnutrition, inadequate health care being offered by referring institutions and by the hospital itself, witchcraft and shamanism, and death and disability in all of the patients at the hospital. Learning to have hope in a setting like this one has been difficult, but life-changing.

There's still a number of things going on in my last few months -- organizing 16,000kg of seeds to distribute to the surrounding communities, getting anesthesia machines and soft-serve ice cream installed at the restaurant that we built this year, working on a survey research project for children taking HIV medications, organizing a training for community malaria health-care workers, and of course just being a doctor in the hospital with all its usual challenges and joys. I have been so appreciative and blessed by your support and prayers over the past two years. I've mentioned it in previous emails but you have been so generous with money and time for the work here in Zambia. I think it's been a real picture of interdependence in my life to be here.

Thanks so much for all of you. I will be back in Fort Worth after Nov 19th and through the holidays, and then likely back to Denver sometime at the beginning of 2009 to start up work again (this is still in the air, so if you've got some job tips, I'm all ears!). I hope to have a chance to share with each of you what these last few years have been like and where I'm heading next.

All the best,
Matt

Captain and crew

noreply@blogger.com (Matt) — Fri, 22 Aug 2008 16:38:00 +0000

Captain and crew, originally uploaded by mattcotham.

Captain (the kid on the right) was in the hospital for about 3 months
last year; he came back today after not feeling very well for a while at
home. The man on the left is his brother, who's two years older than
him. Captain's 18 years old. He hasn't gained any weight since he was
7 years old -- he was 16 kg when he was admitted then, and he's still 16
kg today. We actually spent a lot of time with his family when he was
here in 2007, organized a meeting with everyone, sat them down, and so
forth, but they have basically said that he's on his own, despite his
chronic diseases. It's very sad to me.
For some strange reason on the bus today we got a mysterious package
from someone I don't know -- full of Twix bars. So I decided that they
must be (at least in part) Captain's Twix bars. Not that Twix is
exactly the nutritional answer for a kid that's malnourished, but part
of Captain's problem is the loss of hope and love in his life, too.
Maybe a gift of chocolate can help him remember that love.

a birth and a death

noreply@blogger.com (Matt) — Wed, 20 Aug 2008 11:39:00 +0000

The Tompkins welcomed Emelyn, their third child, into the world
yesterday morning at 9am. After a somewhat stressful week, she arrived
one week late and without any complications. I've blogged about this
before, but it's a little bit weird being expected to make the medical
decisions for your friends and people that you live with closely; it's
difficult to maintain a good perspective on things and still be
respectful to what other people want to do. Fortunately, my role was
basically as a remote observer, as two of our nurses did all of the work.

The president of Zambia, Mr. Mwanawasa, died yesterday after being in a
coma in France for over a month. Zambia has traditionally been a very
stable country, with orderly elections and a good democratic process.
Like during any crisis, at home or abroad, this democratic process will
be tested as new elections take place over the next few weeks.
Sometimes it's difficult to remember what it's like for a country to be
only 40 years old or so; the pull of inertia to keep the status quo may
not be as strong as a place like America.

I'm pretty optimistic that it will go pretty smoothly, however, in
contrast to the debacle in Zimbabwe just to the south of us.

chicken coops and generosity

noreply@blogger.com (Matt) — Mon, 18 Aug 2008 20:26:00 +0000

My neighbors, Pam and Menda, want to start an orphanage. In fact, they
are already supporting several orphans, but are currently working to
build an actual dormitory and house so they can have a stable place for
them to live. To do that, they raise and sell chickens in their
backyard. They are not the only ones. In fact, we have so many people
raising and selling chickens for various charitable causes around the
mission station that at one point it became quite tricky for me to
navigate the social circle of the 'chiken corner' when I was deciding
from which of my neighbors I would buy my next chicken.

That's pretty typical of my experience of African generosity. My host
family where I learned Kikaonde for 2 weeks not only farmed three entire
fields for their family, but also cultivated an additional 2 fields for
the support of orphans in the community. At our church, we all go and
hoe the hospital field so we will have maize to sell or give to hungry
people who come to the service. The Nurses Christian Fellowship
sponsors work days to buy clothes for their trips to the local prison.

I don't know many people at home who are volunteering to work an extra
job and donate the entire proceeds of that job to their local charity.
If they are out there, I'm certainly not one of them. I'm humbled by
how pale and flabby my giving is in comparison to that kind of 'sweat'
giving that so many people do here. Let me tell you, it's not easy to
hoe one extra field, much less two for the support of people around
you. That kind of exercise of love builds a strong Christian body.

I have benefited so much from being able to learn from people like the
Mendas and my neighbors. It also makes me want to help in whatever ways
that I can -- contribute some clothes to a yard sale, buy an extra
chicken here or there (at one point I was up to seven in my freezer --
not an easy fit in my rattling old fridge). Hopefully my love has
gotten stronger as well for the chance to work alongside people like them.

which is dirtier, the bath or me?

noreply@blogger.com (Matt) — Thu, 14 Aug 2008 13:15:00 +0000

which is dirtier, the bath or me?, originally uploaded by mattcotham.

I won't say that sometimes I don't become frustrated with the
difficulties of the basics of life (at least the basics for an American)
-- electricity outages (I had several pieces of equipment get fried this
weekend with various power surges, including my computer cable --
fortunately I have a backup) and water. This week the water has been
intermittent; this was my long-awaited bath today after two days with no
water in the morning. Perhaps I should have held out for one more day....

which is dirtier, the bath or me?

noreply@blogger.com (Matt) — Thu, 14 Aug 2008 13:12:00 +0000

which is dirtier, the bath or me?, originally uploaded by mattcotham.

kind of pretty, in a gross kind of way....

handovers

noreply@blogger.com (Matt) — Mon, 11 Aug 2008 15:56:00 +0000

This week marks the official handover of my job as the director of
clinical services at the hospital to one of the other docs who's
planning to stay longer than me. I've been nominally in charge for
about 18 months now (at times it seems like no one's in charge, but I do
my best) but since I'm planning to head back to the US in November we
wanted to try to do the transition a few months early to help work out
the bugs and make sure things go smoothly. So far, it has been less
than smooth, but we've got three more months to work it out.
How to hand things over well must be a recurring issue for missionaries
and aid workers all over the world. I haven't figured it out yet. So
many of us want developing countries to be 'self-sufficient'; this is a
more complicated issue than it seems on the face of it. So much more is
needed to keep a project running here than at home, and it's almost
impossible for the community to support these projects with the limited
resources that they have, even if the community has embraced the idea
and wants to make it work. I see projects that would have died for the
lack of the funds to buy 20 gallons of fuel (currently priced at around
$14/gallon in the town where I live). I see equipment in the hospital
which doesn't work because of lack of batteries, or the simple matter of
a UK-style plug (about $2, plus a 5 hour one-way bus ride to get to the
store that sells them).
But these small expenses, at least to me, loom larger for a community
that is chronically strapped for cash, living on the wages of
subsistence farming (on average $800-1000/family), or who has extended
themselves financially to buy into the 'American' dream of possessions,
comfort, and entertainment. Add to that the need to support large,
extended families -- the money order post at the post office must be the
busiest place in town -- and most of the time even small expenses can be
difficult to meet, and unfair for an institution to expect to be filled
from the pockets of the workers.
So I've been learning to let go, but it's difficult because I know the
road has been made much smoother for me by the gifts and resources that
I have at my disposal as a rich American with good support from home.
The road is more rocky for someone similar trying to do my job without
those resources. True 'self-sufficiency' is still a long way off. In an
ironic way, I'm beginning to see that a good handover actually means
that I continue to be involved, present, and available to help meet
needs even as I'm not the one in charge. Or to put it another way, to
not only hand over responsibility, but also to hand over my resources
and the control of those resources so that the job can continue to move
forward without me.

the power of prayer

noreply@blogger.com (Matt) — Tue, 05 Aug 2008 19:31:00 +0000

My friend Hilary has been out to visit me the past month (she's the one that has been guest blogging on the site) and she's been challenging me to improve my prayer life with the patients at the hospital. One of the beauties I've found about practicing medicine here in Africa is that I feel less self-conscious when I'm spending time with my patients (maybe because I feel so much more self-conscious everywhere else....) and often feel free to share the gospel or pray with them and their families. However, even though I pray for patients on my own, or in prayer meetings, or with the chaplains, I rarely do it with the patients themselves. Part of me gets nervous for my patients when I pray with them -- what if they don't get better? What will that do to their faith? And part of me just plain gets nervous for myself -- what does it mean to take a public step of faith, in the middle of a whole ward, with other patients looking on; God's reputation, so to speak, at stake? Can my faith survive another 'unanswered prayer'? It's a test of the strength of my relationship with God to see if it can withstand months and months of heartfelt prayers that often seem to end up being answered with deformity, or disability, or even death in my patients. Maybe it would be better just to ask for safe things -- God to 'bless them', or 'give them comfort', instead having the boldness to ask for what I really want to see happen -- my 7 year old patient Edward to wake up from his cerebral malaria coma and drink some water; my 16 year old patient Tom to get up from his mysterious paralysis and walk again, my 60 year old patient Vincent to fight off his drug resistant TB and go home after 120 days in the hospital.
Most of us have been faced with situations like that in our own lives -- the parent who died from cancer, the young person who died in a traffic accident, the young baby that died from SIDS -- and these things often test our faith. It can be difficult to work in a hospital where those crises of faith happen every day, several times a day, as you watch the hope fade away from some of your patients and their families until they become resigned. But Hilary reminded me that God's reputation is God's business, and it's not my job to pray the prayers and answer them too (a conundrum which sounds easy, but quickly becomes complicated when you're the doc caring for the patient that you're praying for). This has been freeing for me to keep praying for patients on the wards, in the hallways, sitting on the fence outside -- wherever I find them, and let God take the circumstances and use them for himself as he sees fit.

Back to usual

noreply@blogger.com (Matt) — Tue, 05 Aug 2008 19:02:00 +0000

I wanted to say thanks to Hilary for being willing to contribute to the
blog for the past few weeks. She's winging her way back to the US
today. I hope you've enjoyed it a little bit. Now you're back to just
boring old me....

Mukinge Hill Academy teaching staff

noreply@blogger.com (Matt) — Mon, 04 Aug 2008 20:22:00 +0000

Mukinge Hill Academy teaching staff, originally uploaded by mattcotham.

The fabulous teaching staff at Mukinge Hill Academy: from left to right
- me (Auntie Hilary Burg), Auntie Patricia Fungaloko, Auntie Grace,
Auntie Mabel Pollock, Auntie Brasselo, Uncle Humphrey, Mr. Fungaloko
(teaches at Mukinge Basic School). Normally everyone has beautiful
smiles - maybe we waited a little bit too long to take this picture :-)

last day of school

noreply@blogger.com (Matt) — Mon, 04 Aug 2008 17:03:00 +0000

last day of school, originally uploaded by mattcotham.

report card - end of term

noreply@blogger.com (Matt) — Mon, 04 Aug 2008 17:01:00 +0000

From Hilary: Hi, everyone! I'll be headed back toward the United States of America a little later this week…. I hope my guest blogging has provided a wider perspective on life here in Kasempa, Zambia. It's been a little hard to describe the differences between education in the United States and education in this part of Zambia in just a few entries. I think the general prevailing attitude is one of doing the best we can with the resources available. We haven't had running water in the school the entire time I've been here (there is a faucet in the classroom but nothing has ever come out of it), which makes science and art projects a bit challenging. There's no photocopy machine for the school, and there's only one math book for each grade level, so the kids take turns copying the problems out of the book then passing it on to the next student. As you can imagine, it takes several hours/days for all the kids in a particular grade level to complete the homework for the current math lesson. I've been amazed at the lack of wastefulness when it comes to paper. The kids typically have a small exercise book for each academic subject in which they write all the answers during their independent curriculum work. The kids are very careful to write on both sides of the paper, all the way across each line on the page. If a child leaves the school, his or her exercise books are=0 Acollected, and the remaining blank pages are torn out one by one to be used for taking tests, etc. It's quite a bit different from our throwaway society.

Things have been a little bit different instructionally as well. As I mentioned in a previous blog, the students spend most of their days working independently on the main academic subjects (social studies, science, mathematics, English, word building) with some whole/large group instruction for Zambian social studies, Kikaonde, art, and physical education. We had the students stop doing the independent curriculum work one week before the end of the term in order to allow enough time for grading and doing report cards, which meant that we were able to provide a little more creative instruction during the last week of school. Apparently the kids don't spend a lot of time writing in school; during this last week I gave a mini-lesson on writing a five sentence paragraph about their field trip to Mukinge Hospital (introductory sentence, three sentences with supporting details, concluding sentence), collected their first drafts and made corrections, then handed the corrected drafts back with instructions to write a final draft. The first drafts needed a lot of work, to say the least; the kids also told me that they had never done a final draft of their work before, so explaining the idea of fixing mistakes and turning in a second copy of their writing took a little bit of=2 0effort. Our second writing assignment was also a bit challenging but highly entertaining; I had the kids write a short script then create their characters with popsicle sticks, pipe cleaners, colored markers, and stickers. (One of my favorite scripts called Cat and Mouse went something like this: CAT – Look, I see a fat mouse that I can eat. MOUSE – I think I will go for a little walk. CAT – I think my dinner is in front of me. MOUSE – I think I can smell danger. I will run home. CAT – My dinner has disappeared.… pretty good for a first attempt!) Once again, the kids' creativity came to the forefront as they started making capes, hats, and all kinds of other decorations for their characters.

So all in all, being and teaching in Zambia has been a great experience. If anyone has the opportunity to teach or work in Africa or another foreign land, I highly recommend pursuing the adventure. And if you come to Mukinge Hill Academy in Zambia, bring lots of rubbers (erasers), high quality pencils, and paper – we would certainly appreciate the contributions! Please feel free to email me at hilaryburg@aol.com if you would like any further information or have any questions… and thanks for bearing with the sideways pictures, weird text appearance, and other blogging mishaps! Lots of love to all, H ilary (Twasanta, mwane – that means thank you in Kikaonde!)

It's time to go back to school! Get the latest trends and gadgets that make the grade on AOL Shopping.

still learning the languages

noreply@blogger.com (Matt) — Mon, 04 Aug 2008 16:58:00 +0000

From Hilary: Hi, everyone! Mabel and I celebrated the last day of school for the term this past Friday with the kids. The language lessons are still continuing…. from Mabel I've learned that "yunks and yunks" means years and years (for example, "I've lived in this house for yunks and yunks"), and that "She's a real gaig" means that someone is very funny. I've gotten used to the kids telling me that their stomachs hurt by saying, "My stomach's paining me," but it took me a while to figure out that my reminders to put a period at the end of each sentence weren't very effective because the kids refer to a period as a "full stop" (in addition, capital letters are officially known as big letters). Learning the form of English spoken by people from the United Kingdom like Mabel has been helpful for me; Zambia was a British colony (Northern Rhodesia) for some period of time, so I think Mabel's version of English is perhaps a little more familiar to the children. I didn't realize "quite" had so many variations of meaning until I saw the phrase "quite good" on the children's report cards and asked Mabel about it. I was trying to figure out the difference between good, quite good, very good, and excellent; I was mostly puzzled by the two phrases "quite good" and "very good" since to me these meant pretty=2 0much the same thing. Mabel explained that "quite good" means "almost good" or "less than good." Oops - I think I had tried to pay a few of the children a compliment earlier in the week by telling them that their work was quite good…. I hope my words didn't demoralize them but maybe inspired them to work a little harder.

It's time to go back to school! Get the latest trends and gadgets that make the grade on AOL Shopping.

village friends

noreply@blogger.com (Matt) — Sun, 03 Aug 2008 19:40:00 +0000

village friends, originally uploaded by mattcotham.

nutrition class

noreply@blogger.com (Matt) — Fri, 01 Aug 2008 21:25:00 +0000

nutrition class, originally uploaded by hilary.