Zambia anyone?

When I chose to volunteer with iVO, I thought it would be lovely to go to a remote island off the Australian coast or Cambodia, but I got Africa. Well, no harm done and the continent that is mysterious to all except aid workers, had me falling in love with it. The love affair continued through my 20 months volunteering at HIV hospice in Lusaka, Zambia. I was fortunate to have a placement that had everything going for me – the role itself, accommodation, location, co-workers and other volunteers.

Lusaka, being the capital city was a great place to be – while people may argue against not getting the true local flavour, I can only say I got the urban Zambian flavour that was equally interesting and brought me a flashback of India several years ago. It also possibly made for a happier me to have opportunities that I would not have in other jobs – lead an organisation and have full control to give it a new lease of life, working with government department, the upper echelons of the catholic church and several diplomatic missions with direct access to the ambassadors. Having come from the private sector, this learning was new to me and I wouldn’t trade it for anything else.

From the moment I started my placement, I went on understand the importance of such an ambience to palliative care. The hospice has been in existence for over 10 years and was set up to provide palliative care for patients dying of HIV/AIDS. However, the nature of palliative care evolved as HIV became a treatable and manageable illness. My background in hospitals and healthcare definitely helped prepare me for this experience, but as I found out, hospices (by themselves) and in Africa are very different. In a country, where the life expectancy hovers around 49 years at birth, the incidence of disease and death is very high and it took me a few months to reconcile to the fact the most of the dying were in what in other parts of the world we would call ‘prime of productive life’.

The hospice I went to – Our lady’s Hospice (OLH) was started by the catholic missionaries and they have been instrumental in bringing in the funds and running it until I went. With the global recession, aid from countries such as US, UK and Ireland were declining and typically hospices find it hard to get support from established large aid organisations as they are considered ‘bottomless pits’. The hospice was in the throes of a severe funding crisis with no great source of income for running costs. Also, human resources in leadership positions, in the form of catholic nuns were declining with that vocation going out fashion. There are lesser and lesser Zambian women choosing the austere way of life to replace the English and Irish nuns that abound in the mission health centres.

Phase 1 of my stint here was interesting and memorable in more ways than one. I was the ‘young’ (debatable) Indian girl with gorgeous hair and great skin tone (no and no in the Indian context, but obviously welcome in Zambia!) who has come out to volunteer, which in itself was novelty as I found out. The Indian community here did not comprehend why I quit a corporate job to do this for ‘no money’ and leave a husband behind in India (what was he thinking, letting her go!) while the hospice staff and locals I met thought I was like the Mittals and Tatas with loads of money to offload at the hospice. Having said that, the Zambians are among the warmest and friendliest people one can find and very accepting of outsiders. Their love for football supersedes all else and they draw you into the spirit of the game. The ‘Chipolopolo’ support is high and it’s always ‘football Friday’ at the hospice when everyone sports Chipolopolo jerseys!

It was fun in the initial months trying to get the intonation for ‘phiri’ right, pronouncing names like ‘mwale, mbewe’ and other double consonant names correctly, trying not laugh outright when I heard names like Survive, Obvious, Innocent, Blessing, Gift, Given, Wireless, Reloaded, Suffer and Grief and more importantly learning the names of all 60+ staff that I had to manage at the hospice! The learning curve was steep and challenging where I learnt a lot about pain management, resource allocation in a non private setting, cultural needs and associated working issues and HIV/AIDS amongst other things. And for me to be successful in the professional context of the hospice, it was imperative I understand not just hospice management needs but also the background of the ‘catholic’ community that has helped the hospice become one of the best in Zambia. Just as for most people I ran into before I went to Lusaka who thought Lusaka & Zambia were the same as Africa, Christianity was one large religion for me. The nuances of the denominations, sub groups, the church and the politics of money were big learning and very fascinating. And I insist on being called Reverend Sr. Hari these days!

I was looked down upon in friendly condescension when they figured out I was a vegetarian in a meat eating country and was happy eating beans and greens! Beans are akin to our Indian Rajma and are the lowest form of food here and had only if there is nothing else and I love it. And there is no dearth of green leaves in this country, where spinach is just one of the many greens one has. Bean leaves, pumpkin leaves, rape (it is a green leafy vegetable and fondly referred to as 5 year or giant referring to the 5 year growth ability of the Giant rape!), Chinese cabbage (it does not look like any Chinese cabbage I have seen in India and is often called Chinese) and several other random greens whose names I still haven’t got. As convenient as it is to live in Lusaka, the cost of living as volunteer is high and your opportunities to learn more about local culture customs is low. Which is also is the reason why I didn’t learn to greet anyone in the local language for months after I came – almost everyone speaks English! My biggest challenge on the work front was when I was told that I would be the Administrator running the hospice. My placement request said Assistant Administrator that had evolved into the Administrator’s role – my biggest fear was the lack of a safety net in what was the new world of development for me and my first experience of living in a foreign country for beyond 3 months.

After the initial months or Phase 1 of settling in and transitioning into the role of the ‘Administrator’ at the hospice, I moved into Phase 2 of my life lessons here – Playing God. In a country where the incidence of disease is high and resources are scant (the story of every aid workers life!), one needs to start making the tough decisions and prioritising. The hospice relies entirely on donor funding, a model that was inadvertently doomed from the start, was bleeding financially and in the last legs of full operations and my timing to start volunteering here was impeccable – I had to take stock, close what was not funded and re-evaluate the operational and business strategy for the hospice!

I am not a clinician but a quack of sorts having dabbled in the healthcare industry for a fairly long time and I understand treatment modalities, intervention needs and patient needs as well. However, in the country, that has what I think is a ‘humanism’ legacy from possibly the Kaunda regime, everyone expects everything to be free, which meant no one wanted to pay for any service at the hospice. The hospice having started off as an inpatient palliative care centre evolved to include an outpatient ART clinic as part of the national ART programme and HIV/AIDS response. In the beginning I was constantly bogged down by stories of how my patients did not have money for the next meal and hence could not pay for a liver function test, how I should give some money for a patient to go back home as he did not have transport money, how I should contribute to the funeral of a staff member’s fourth removed cousin’s husband etc.

It was unsettling and I was very uncomfortable because saying ‘no’ and continuing to maintain a relationship with a person is not my comfort zone. But neither could I give hospice money or my own meagre allowance for all these needs. It was hard to have an ordinary conversation such as ‘It is a cold day isn’t it’ for that would be an opening line to ‘why don’t you get me a jacket as you come from a rich family’. The fact that I am volunteering makes for the perception that I can afford to spend on these things and it has been uphill task persevering to have a normal conversation without being begged to.

While I dealt with these day to day people issues, working with donors was a whole different ball game. In my tenure here, I think I have mastered the fine art of financial management, juggling funds and maintaining a fairly reasonable buffer to ensure all eventualities. Donor funding as I learnt is a one sided game where the donor is always right and I tried to come to terms with it by mentally equating the ‘service provider-client’ relationship in the private sector where the client is always right! The key difference in this scenario is that ‘client’ in this case is a down trodden NGO trying to work within limited resources! Having come from the private sector, where shoddy performance is just not an acceptable option, coping with mediocrity in getting simple requests executed can be a frustrating experience. And as always a modal bias exists amongst the aid workers – if you are working with the large aid organisation, your own compensation is important. But if you are lowly ‘allowanced’ volunteer, you wonder why that money can’t be channelled to a grassroot organisation! It was not all frustrating, we had some memorable new starts in terms of HIV programmes – as the hospice team, we started a teenage support group for teenagers with HIV/AIDS and partnered with a theatre group to focus on younger children and their parents/ caregivers. We promoted some of the potential income generating ventures at the hospice and tasted some success there too.

I had to make the decision to partially close some services at the hospice in the light of the financial circumstances. This obviously resulted in a lot of heart burn and tragedy with staff losing jobs and patients having nowhere to go for palliative care. We were the last hospice in Zambia to close and this did not help the public reaction to it and I woke every morning to thinking I was going to get lynched that day for the terrible decisions I made. I survived that difficult phase to make the hospice a well supported institution for a set of limited services while I worked on building a business plan to re-open closed services in a self sustaining model. The foundation for the plan is underway and as I came to the end of my placement, I can look back to see the ups and downs of my role and hope that the successful implementation of the business plan by the incoming management will breathe new life into a fantastic organisation.The experience was priceless and some my most memorable and fun moments before I end the post –

• Making friends among other volunteers and colleagues
• Every time a big funding source said ‘yes’ to supporting the hospice
• The ability to use my private sector experience in creating a plan for a sustainable future
• Assuring people that a loaded ‘CC’ line in an email will not slow the email itself!
• The fabulous green vegetables and avocados directly from the tree
• How it is permissable to drive holding a beer can in your hand!
• The ‘live for the day’ attitude to life