Passion Points: Giving Back
“Put it this way,” Doctor Marks says, attempting perspective, “nearly 300,00 people died in the  tsunami, right? Well, that’s the same number as die monthly in Africa. Not many people know that. Did you?”
No, I shake my head, I did not. I can tell by the shocked murmurs of the people I am with that they didn’t either. Mike Marks runs a hand through his sweat-limp hair and continues, “If only Africa had the same outpouring of aid, who knows what we could accomplish.” He stares at us for a moment then tosses out another zinger. “This report,” he says, holding up a small book titled The Commission on Africa, “claims that unless we intervene in a big way, by the year 2010 every third child in Zambia will be an orphan.”
Despite a trace of arrogance, Marks is a man to be admired. The sort of character Graham Greene might have invented in one of his novels. Recently, Marks left his lucrative private practice in Jersey, England to become the sub-Saharan Africa advisor for Direct Relief International, a Santa Barbara, CA based medical aid organization. He spends most days amongst Africa’s poorest and sickest, fighting the war against poverty and disease in the trenches.
Marks speaks like a seasoned orator, punctuating his statements with Shakespearean idioms, making the habit appear perfectly natural even within the backdrop of an impoverished African town. “In Jersey,” he had said when I first asked why he had chosen this work, “I looked after the world’s wealthiest and most spoiled people with deep concerns about things like earwax. I profoundly believe it is my duty as a doctor to confront one of the worst injustices in history. The African continent has been neglected by the wealthy world for too long. In Africa, I am responsible for 50 million people, and I plan to do something about that neglect.”
We had met Marks in Mansa, a town at the very end of the line in northwest Zambia, a part of this savagely poor but beautiful country that never sees tourists. Occasionally an aid worker or a missionary comes through, but there were 22 of us, all from America, and we were the largest group of white people in remembered history.
The purpose of our being in Mansa was to raise money for Direct Relief, a secular non-profit that annually donates and delivers 210 million dollars worth of medicines, supplies and medical equipment into countries suffering from extreme poverty, war or disaster. Every year they bring medical aid to 29 million patients by supporting local hospitals and medical staff starved for the basic supplies with which to do their jobs.
Direct Relief’s belief is that until we address the basic healthcare issues of the world’s most challenged countries, they will never conquer poverty, hunger, AIDS and foreign dependence. An ailing population cannot work; cannot support a family; cannot contribute to economic growth, and cannot send their children to school.
The idea for this trip stemmed from Sherry Villanueva, a friend of mine who lives with her husband and two teenage daughters in a grand house in Montecito, Santa Barbara. Sherry is not only a mother, she has a high-powered job and she is a volunteer member of the Direct Relief board. She is also the sort who is dead set on bettering the planet, and she compels others to do the same. “If we, the most advantaged people in history, don’t wake up, witness what is going on in other parts of the world and take action towards social justice, who else will? It’s our responsibility. And each individual can make a difference.”
Following a growing trend in philanthropic “reality” travel, Sherry proposed an annual trip to raise money and create awareness of Direct Relief’s work. She chose Zambia as the destination for the first trip and asked her friends to bring their families. Her goal was to raise $100,000. The trip filled quickly, and we were a group of eleven adults and eleven children—aged ten to 20.
The plan was to spend the first three days of the trip visiting clinics supported by Direct Relief in remote parts of Zambia’s north. After this, the group would head southeast to Luangwa National Park to decompress and spend ten days on safari, experiencing the more lyrical side of Africa.
Of the 52 nations in which Direct Relief operates, Zambia was selected for several reasons. Despite being one of Africa’s poorest countries, it is a politically stable democracy; it is geographically lovely, and it is not yet overrun by tourism. On the other hand, AIDS, malaria, tuberculosis, and malnutrition have ravaged the population. Life expectancy has dropped to 37, and, on average, there is only one doctor per 15,000 people. In rural areas like the Northern Province, the ratio is one doctor per 46,000 (in America the average ratio is one physician per 415 people). Direct Relief equips many Zambian bush clinics and township hospitals, and still the unmet demand for medicine and equipment is overwhelming.
Although my own children were too young to come—the age requirement was ten and up—this was a trip I could not miss. The majority of American children, in my opinion, are sheltered and isolated, and most don’t see enough of the world during their lives. Only 23 percent of Americans hold passports, and the bulk of those are used for travel to resort destinations. Witnessing poverty, privation and the flimsy stake between survival and extinction is undeniably a life-changing experience. Travel breeds compassion, and widespread compassion rarely leads a nation astray.
Having spent time in Africa, I knew this group had signed up to see a side of the continent most Americans never see: the teetering and merciless Africa, the everyday place of depressing headlines and United Nations statistics. But they would also bear witness to the miraculous Africa, where people who battle starvation go about joyfully, where they gossip in the marketplace, celebrate weddings and births, and argue over politics. They would see the dignified and tenacious Africa that barely beats the odds but dies trying. When a tourist visits only the game parks, they come away having seen a rarified slice of Africa. Most Africans pass their entire lives without stepping foot in a game park. Game parks are for rich people, camp staff, and poachers.
And so we had all arrived in Mansa by charter plane, there being no commercial flights to these parts. Flying in, the ground below looked plundered and drained, as if the land itself had given over to apathy. The sky around the town was sepia-singed with smoke. Zambians burn off their fields, they burn garbage, they burn to cook, they burn to flush out animals, they burn to warm themselves, and they burn by accident. The result is a pervasive pollution that stings the eyes and irritates the lungs.
A town of roughly 200,000 people, Mansa was a shoddily constructed place, crafted from whatever material was to hand, crumbling after a year or two. The streets were cut from dirt and every surface was dust-coated. Despite there being no other foreigners, glimpses of Western culture were everywhere. Lean-to’s served as businesses with names like “Malcolm X Haircutters,” a dingy café was called “Michael Jackson Quick Serve” and a shop selling random household items was ironically designated “God Knows Investments.” Women wore their traditional brightly colored fabric wrap skirts but with T-shirts on top. Men sported well-worn Western shirts and slacks. This was a town like thousands of other African towns, a generic place of making-do and getting-by, with anachronistic imprints left by departed colonizers.
Arriving at the Mansa Hotel, I wondered briefly if bringing these well intentioned, Buzz Off-and-Merrell-clad Americans here had been a mistake. No one spoke as they regarded the motel with its row of poorly painted red doors, cracked linoleum floors, bowed beds and rust-stained sinks. Having slept in some truly hideous places in my life, it was better than I’d expected—scrubbed clean and with hot water, but by Western standards it was barely acceptable. I watched Sherry Villanueva brace for bitter complaint, but not a soul ventured one. They passed the first test. They were a staunch group.
Early on our first morning we split into three groups to head to different parts of the north. Some took jeeps, some flew in an AmRef (African Medical and Research Foundation) plane, and others took a bus arranged by the local Rotary Club. We all traveled hundreds of miles from Mansa.
Three doctors were accompanying us: Doctor Jerome Sulubani, Congolese-born, Italian-trained, and now one of only two pediatricians serving almost 12 million people in the country of Zambia; Doctor Bill Morton-Smith, Chief Medical Officer for Direct Relief, and Doctor Marks, Medical Advisor for Africa.
I was with a group who was to bus north for about 120 miles then fly back late in the day. Leading us was the gracious and distinguished Doctor Sulubani, who lives and works in Mansa at the general hospital “It’s frustrating,” he sighed, rubbing at his forehead. “We have so much to do and little to do it with. At Mansa General we have 403 beds intended to serve the hundreds of thousands of people in the province that might need surgery. In the West I believe you would call that ridiculous.”
Sulubani seemed dispirited; he seemed ready, like so many African doctors, to bail out of Africa and head to Europe where there are plenty of high-paying jobs. Direct Relief, he tells me, is the only reason he stays—for now. Through them, there is hope to get supplies and equipment to help patients actually survive. Without medicine and equipment, Zambian hospitals are merely a lobby for the cemetery.
We arrive first at the Mambilima Hospital, located close to the river that divides Zambia from the troubled Democratic Republic of Congo. A tall, handsome man in a white coat greets us in English, introducing himself as Tentani Mwaba. I call him “Doctor,” and he shakes his head. “I am not a doctor. There are no doctors in this part of the province. I am the administrator. We have only one clinical officer and two registered nurses here.” I ask how many patients they can sleep and he hesitates. “Officially we have 58 beds, but there are typically around 85 patients here at any time.”
I follow him into a room and he begins to tell me the story of a thin, mournful woman who sits in a chipped iron bed wrapped in a faded piece of cloth. Makemba is her name, he says, and she has just lost her third child. Makemba lives on the other side of the Luapulu River, which acts as the border between Zambia and the Democratic Republic of Congo.
Makemba and her husband walked for several miles through the jungle at night while she was in labor. She crossed the river and made it to this clinic in time for the baby to be born. “She did not cry out, she did not make a fuss, that is not the way of these women,” Mwaba tells me proudly, as if he knows it’s not that way where I come from. “You see,” he continues, “Makemba has AIDS and she was told that here in Zambia there was a clinic with free medicine that would allow the baby to come virus free. She had already lost two children to AIDS and her husband had told her this one must live.”
Makemba made it to the clinic but they had no nevirapine, the drug she was seeking. Nevirapine is the medical bandaid many developing countries use to decrease mother-to- child transmission of the virus. The odds for children of HIV positive mothers not on sustained antiretroviral treatment are not good. They have a 20% chance of contracting the virus in utero, a 40% chance during delivery, and another 40% probability if the mother breastfeeds. While nevirapine has it’s own set of problems, it’s the best and cheapest way to ameliorate those odds during birth. If a mother gets a single dose of the drug during labor, and her infant gets a dose within its first 72 hours of life, the child has an 85% chance of being born without HIV.
Boehringer Ingelheim, the German maker of nevirapine, has donated the drug to many African nations since the year 2000. The problem is no longer cost, its distribution. Although Coca-Cola seems to reach the far-flung corners of the globe, medicine does not. As Sherry Villanueva said wryly, “If only we could get the nevirapine on the Coke trucks…” Now there’s a concept.
Makemba’s baby was a boy, but he lived for only eleven hours. Malnutrition, the administrator said, shaking his head. It’s as simple as one good meal a day. It kills far more people than AIDS. If she had made that journey across the river months earlier, he told me, we could have given her the vitamins, told her to eat more protein and the baby might have lived. “This what you do,” he says, as if I am personally responsible for the stockroom full of Direct Relief’s pre-natal vitamins and protein powder, “you save babies.”
“Come with me,” he demands, suddenly anxious to leave the forlorn Makemba. He ushers me into an empty, fluorescent-lit, cinderblock room. “This,” he explains happily, “is our new operating theater. Direct Relief has pledged to equip it.” I pause before I bring up the lack of a surgeon. “We have built this facility in the hope one will come,” he explains. “That’s the way it works around here.”
From Mambilima we drive north to Mbereshi Mission Hospital, 120 miles from Mansa, about as remote as it gets in this country. There are three doctors and 80 beds at Mbereshi, and they see the really bad cases. The walls are peeling, but clean; the floor is cracked, but scrubbed. There is no such thing as décor, only posters advising, “A Friend With AIDS Is Still My Friend,” or cartoon images of a woman asking her husband to use contraception, or, distressingly, of a baby falling into an open cooking fire.
A tall, elderly nurse with bottle-thick glasses greets us outside the maternity ward, as if she had been awaiting our arrival. While we, the rich foreigners, look limp and drab in our safari clothing, she is resplendent in an impossibly crisp white uniform and a war-era nurse’s hat. She speaks no English, but gesturing she indicates that the men are to remain behind and we females are to follow her inside. We enter a closed room and are immediately confronted with the sight of two women in the latter stages of childbirth. Worried, I look to see if the mothers are upset by our intrusion. They appear not to have noticed, clearly used to a lack of privacy. I turn to the three young American girls standing with me. At home, we don’t show teenagers this sort of thing and I can tell by their body language that they are stunned and ready to bolt. For the next thirty minutes I watch as they go from being afraid, to awed, to euphoric. They will talk about this moment for days.
Late in the day we board the AmRef plane that had landed on dirt strip in the middle of a field to fetch us. As we rose up, I watched a hazy orange sun slide behind a silver lake. For a moment Zambia looked lovely, lush, even benevolent.
The following day Doctor Sulubani escorted us to the children’s ward Mansa General Hospital, his own domain. Small figures lay unmoving in their beds, eyes closed or staring fixedly at nothing. These children, it occurred to me, were simply waiting to get well or to die. They waited in that unique African way, where waiting is an activity in itself. There was not a toy or a book in sight. In a country struggling for adequate medicine, toys are not a high priority.
The children eventually swiveled their heads to watch us, staring with solemn eyes. The embarrassment of voyeurism fell over our little group, and we had no idea what to do next. Then, without encouragement, ten-year-old Clay Davis, our youngest child, walked between the beds to a boy of about his own size. Clay tore a piece of paper from the coloring pad he had brought with him and slowly folded it into a paper airplane. He grinned at the boy, held the airplane aloft and launched it. It flew upward in a perfect arc, landing on the bed. Within seconds the sick children sat up, laughing, their torpor forgotten. That was all it took, a paper airplane.
Our children scattered through the ward carrying offerings of toys and pencils—teaching the Zambian children how to fold, how to color, how to draw. Most of the children had no idea how to color. In school, if they go to school, there is no such thing as coloring pencils. Such a thing can be more precious than food. Hunger is common, but a red pencil means you have something no one else has. It elevates you. It wasn’t impassivity that made these children lie here and wait to die; it was the lack of anything else to do.
The American children had worked hard to raise money for Direct Relief before coming on this trip. The goal had been for each family to raise $15,000 or more before departing. Although their parents could have whipped out their checkbooks and covered for their kids, they didn’t, and instead the children held bake sales, dog washes, flower sales and car washes. This had been another of Sherry Villanueva’s ideas. If the children raised the money by their own grit, they would feel more invested in what they would see in Zambia. Beyond reaching their goal of $100,000, the children had selected and packed bags of toys, the toys they used now to play with these children.
To lift our spirits after each hospital visit we would find a school, a place of healthy children, and donate a couple of soccer balls and a pump. These were occasions of unbridled joy where our arrival would generate a happy riot. Class would be interrupted and the head teacher alerted. The children, hundreds of them, would tumble outside to assemble in front of us, their dazzling white teeth bisecting their beautiful black faces. The soccer balls would be formally presented to the head teacher, who was always proud and statuesque. She would thank us and show us her school—identical to one another: broken windows, pitted blackboards, rough wood desks, and dirt playgrounds.
Later, the American children spoke of disparity. They knew they wore $50 safari shirts with eight-dollar-a-day anti-malaria medicine coursing through their bloodstream. With a solid 2000, mostly-organic calories a day every day they have been alive, they were faced suddenly with how splendid their lives were. Guilt, we kept telling them, is not constructive. The point of seeing all this is not only to keep a solid perspective on your own wildly fortunate circumstances, but also to put a shoulder to the wheel and help those less fortunate.
Alia Aizenstat, a seventeen-year-old who had arrived in Africa mortified at having to wear beige safari clothing, seemed the most changed. One day she quietly passed me her diary. “I am having a hard time reconciling the Zambian’s suffering with their willingness to smile,” it read. “It will be hard to return to my life of thoughtless over-consumption after what I have seen.”
Observing her 12-year-old daughter Katy meet a village girl of the same age who had a one-year-old baby, Villanueva observed, “It rocked her world to meet that child. They connected immediately, as children do, but this other girl lived in a grass hut, owned no shoes, and had already given birth. I could see Katy’s whole worldview shift.”
I hope I know these children in ten years. I would like to observe what homage their spirits pay to what they had witnessed in Zambia. My hope is I find they have not joined the ranks of the uninvolved—those who turn the page thinking, “What a terrible shame, but there’s nothing I can do.” Instead I would like to think this experience has influenced the kind of adults they will become. That it will affect how they travel, the way they vote, how they spend money, the way they raise their own family. For it’s children just like these young, shining, oh-so-fortunate Americans who are the successors of our foreign policy. And of our moral future.
See Zambia Details for information on Direct Relief International trips.
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