Population

Zambia is not a very densely populated country. Indeed, the whole population (roughly 11 million) is smaller that that of the city of Lahore in Pakistan (almost 15 million). There is not the hustle-bustle here of urban or rural life. In the rural areas, although I have not yet visited them, the towns are said to be miles away from each other, and each one sparsely populated with only 20-100 people living within the town walls.

Not only does this make for a non-hectic (almost suburban) experience when walking around the streets of Lusaka (indeed: after a week here I can count the number of times someone has asked me for money on one hand: 2), but it poses interesting challenges when developing health care interventions for the rural areas.  

On Friday I sat in on a professional meeting for people working on pediatric health in Zambia. New research was presented and discussions were had regarding how to decrease the extremely high neonatal mortality rate.  One pediatrician shared her research regarding the intervention of barefoot neonatologists - that is, lay people trained in basic neonatal health and newborn resuscitation to accompany traditional birth attendants or to visit new moms shortly after birth.  This intervention has been rolled out in India, and in some areas, has reduced neonatal mortality by 30-40%.  However, an interesting concern was brought up: with such a small population, and such sparsely populated rural areas, would a trained lay-person have too little to do to maintain upkeep of their skills? If they only had three or four babies per year in a small town of 20 - would that be enough?  Until you are REALLY comfortable - clinical skills certainly fall under the category of 'use it or lose it' - and they are afraid it is a 'lose it' scenario.  But, with such a small population - it is not worth putting one of the rare doctors in these towns. So that is the challenge of Zambia (ok, one of the many). One solution is to have a system set up where doctors literally fly into rural towns when there is an emergency - but this, too, poses challenges.

The sparse population has affected me as well. The entire time I've been here - I have kept waiting to feel like I am in "Africa." This has begged lots of reflection on my part around the questions of my biases, my expectations, my sterotypes of "Africa." What was I looking for? What was I expecting? Why, when Zambia is almost smack-dab in the middle of this continent, can it not feel like Africa? And I think it comes down to that feeling of being overwhelmed that I am used to - or that I experienced in Mali and Kenya long ago.  I am not really overwhelmed at all. Perhaps this is due to my cush-living situation in ex-pat ville, and perhaps it is due to Zambian culture. It is not a pushy culture. People so far that I have meet have been nothing but lovely, and rarely pushy at all. Even at the markets. Perhaps it is because English is used widely here - so I have been able to communicate rather freely. Perhaps it is in part simply due to my incorrect expectations and assumptions about what this country would feel like on the outside.

Saturday,  in a quest for hustle-bustle, my new friend and I ventured into the down-town area on Cairo-road. I had been warned to 'not get excited' - that it is little more than a row of Banks.

It was more than banks, and my friend and I found a big (ish) Zambian market with local food (ensheema - sp?) which is corn paste - similar to ugali - and fried fish, chicken, and dark greens.  We found pirated DVDs, lots of car parts, sink parts, and the nuts and bolts (literally) of life. Hair salons teeming with women getting new-do's, extensions, un-extensions, braids... and some tailors with black singer sewing machines and foot-pedals.  

I brought my camera - but was too nervous to take lots of photos for some reason.  A few people said 'NO' with their hands when I lifted it out of my bag, and one woman asked for money.

The photos aren't great - and I tried over and over to upload them - but the connection must not like it.... I'll try again later. 

Today I'm going to visit a midwifery class to get a 'feel' for education here.  It will be my second observation, the first of which led to many insights indeed.