The Home Visits

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I slipped off my dirty sandals and stepped onto the cool tile floor of the clinic. I chose my clothing to try to stand out as little as possible: a dark, solid colored shirt and a long blue skirt that falls, unfamiliarly, to my ankles. But when I met the Zambian health workers, my blonde hair and fair skin made this seem a laughably futile attempt.

“You will come with me today,” said one of the oldest women. Annie had a loud laugh, two missing front teeth, and perfect posture. She was wearing a black blazer with her dark purple shitangi, a 2-meter length cloth that functions as a skirt, baby sling, padding on the top of the head when carrying a bucket of water, and I’m sure multiple other uses that I have not yet seen.

“This morning we will visit 4 homes,” Annie told me as we leave the clinic and make our way down the dirt road. “The families are all part of the feeding program.”

I nodded. I observed the feeding program yesterday, a group of 19 children brought by their mothers, aunties, or grandmothers who gathered to be weighed, to hear a short bible lesson and basic education on malnutrition and healthy eating, and to receive their weekly allotment of eggs, peanuts, fortified rice, and milk powder. The image of the two year old who barely reached the 7 kilogram mark on the scale was still fresh in my mind.

Annie turned sharply off the main road and up a steep bank of sand. I hurried to keep up, legs churning. When I arrived in Zambia I had expected the country to be lush and green, but this was the dry season and all around me was bare sand punctuated by sparse dry grass and the occasional tree. I was entering my second week in Mongu, and had not seen a single cloud.

I noticed I had fallen a few steps behind Annie as we reached the top of the sand bank, and I quickened my pace. Annie smiled. “Maybe it is too much walking?” she asked. I shook my head no. Remembering that Annie was a kuku, a grandmother, I let my breath out slowly, trying not to pant as I replied, “Oh no, it is fine.”

Annie stopped in front of a small house. The walls and roof were bunches of reeds tied together. In the bus on our way to Mongu a little over a week ago we had passed many of these reed houses and I had been convinced they were only temporary shelters, maybe rest areas for the herders who traveled around with clusters of small, long-horned cattle. I now knew they were the permanent homes of the poorest Zambian families, the ones who could not afford concrete block or even mud and reed construction.

Annie called out a greeting in Lozi and three children emerged. Annie spoke to the oldest girl while the two younger boys stared at me. I smiled and waved and after a moment they grinned back at me. The youngest boy was carrying a brand new toothbrush, with bright white plastic that was jarring against the muted colors of the reed house, the sand, and the dusty black of the children’s bare feet.

Annie turned to me. “The kuku has gone to get water. So we will not be able to see her today.” We waved at the chilren and continued on our way, soon reaching the paved road that connected Mongu to the rest of the country. Relieved to be out of the sand, I matched Annie’s stride more easily now. It was still early, maybe a little after 8, and the sun had not yet been up for two hours. We passed women carrying loads of water or charcoal on their heads and babies in colorful shitangis on their backs. Men pedaled by on bicycles, and minibuses and trucks, both equally overloaded with passengers and freight, churned past us.

A few vendors dotted the roadside, small tables with a dozen or two tomatoes, little charcoal grates roasting cassava roots, and bowls full of fritters, glistening with oil. Many women recognized Annie and she stopped to greet them and chat briefly. The women gave me wide smiles when Annie introduced me and quickly exhausted their English vocabularies: “How are you?”, “I am fine,” and the occasional “You are welcome here.” English is Zambia’s national language but in the rural communities on the outskirts of Mongu the level of proficiency is markedly lower than in the cities. It seemed unfair, somehow, that as a foreigner I was more fluent in the Zambian national language than many of its own people.

I could see a crowd gathered on the side of the road ahead of us, and as we approached we saw a minibus sprawled on its side, windows smashed and a gaping hole in the roof. I wondered what kind of a driver could have an accident on this flat, straight road with no intersections. Annie lingered for a few minutes, asking questions of a few women who were on the fringe of people staring at the damaged vehicle as if it was a fallen elephant. She didn’t stay long, and once we were headed away from the crowd I asked her what had happened.

“There were two thieves who stole cows from a farmer,” she said. “They cut off the heads of the cows and put the cows on the minibus and were going into town.”

“How did the minibus crash?” I asked.

Annie paused. “The farmer, he put some… medicine… on the cows.”

I thought of the small museum we had visited near the palace of the Lozi king, who was the traditional leader of Mongu and the rest of the Western province. In a glass case were twisted, dark objects made of bone and hair and wood. Defensive objects meant to protect, and offensive objects meant to hurt. I thought of the small knife with the neatly typed placard next to it: “made from the arm bone of a child.” An ugly wooden cane with the carved faces of three women was used: “to cause miscarriage.” Even the memory of that cane made me shiver and touch my abdomen, slightly rounded in my 10th week of pregnancy, as if something from that object, simultaneously both preposterous and powerful, could seep out from behind the glass and attack.

I connected the dots of what Annie hadn’t quite told me. “So because those men stole the cows, something bad happened to them?”

Annie gave a short laugh. “You know how we are in Africa.”

I didn’t know, not really, but I nodded.

We reached our second house and once again Annie called out a greeting. This time the mother was home, and we ducked under the grass roof and stepped inside. The small house had a dirt floor and was divided by a sheet that hung as a partition. Annie and I sat on wooden chairs around a low wooden table. The mother sat with us, as did another woman who Annie told me later was the woman’s sister. The mother spoke quietly, looking down at her feet. Her toddler sat on the dirt floor behind her, playing with a sleeve of small blue pills. Annie snatched the pills from the toddler with an exasperated expression. She asked the mother a question, and the woman slowly got up, stepped behind the partition, and emerged with a plastic bag full of her allotted food from the program earlier this week. None of the containers had been opened. I knew part of Annie’s job was to ensure the food was being given to the children in the program, and I glanced at Annie to try to judge her reaction. Annie simply nodded, face unreadable, and made some comments to the auntie sitting across from her. A quiet settled over the house. I looked to the doorway to see three young roosters bobbing their heads inside to take a look, and eventually marching into the house to survey the dirt floor for crumbs.

Annie touched my arm and nodded that it was time to go. I said goodbye to the two women, the toddler staring up at me solemnly. After we had made our way back across the sand onto the road, Annie told me that the mother had been sick and had spent two nights in the hospital, returning home yesterday.

“Why was she sick?” I asked.

“She had a fever and her heart was beating fast. I don’t know what is wrong. They sent her home with some medicine. I told the auntie she needs to take care of feeding the little one while the mother is still sick.”

We reached our third house, which was a longer walk off the main road. As we approached, we saw a grass mat on the sand outside the house. A baby was laying on the mat, half covered by a blanket. No one else was in sight. I had a brief, horrible confused thought that maybe the baby was dead, but when we walked closer I could tell that she was sleeping. Annie called a greeting into the house, but no one answered. She called out in the direction of another house a few feet away, and several children tumbled out. Annie spoke with them briefly, then gestured to me to sit down on a fallen tree nearby. “Their mother has also gone for water. We will wait for her to come back.”

The children surrounded their sister on the mat, then, moving in unison like a small swarm of bees, surrounded us on the log. There were laughing, jumping off the tree, inching closer and closer to where I sat and sneaking glances at me. I smiled at them and they grew bolder. A little girl in a stained quilted parka sat right next to me with her back towards me, looking over her shoulder at me and then laughing and looking away when I looked back at her. None of them looked older than 7. I wondered how long their mother would be away, and what would happen if the baby woke up crying. In the US these children would without question be considered too young to be left home alone even for brief periods of time, but in Zambia they were not only left alone, but left in charge of their baby sister.

After maybe 10 more minutes had passed, Annie stood up. “We should keep moving,” she said to me, and turned and spoke to the children, who all nodded and chattered in response, their high pitched voices drowning each other out. They were still jumping off the log as we walked away.

We started heading back towards the clinic, since our fourth and final house was near where we had started. Annie flagged down a crowded minibus, and we climbed in, squeezing onto the narrow seat next to several other passengers. The rows behind us looked so full I wondered how anyone could breathe back there. At my feet was a large basket of dried fish. Flies swarmed over the basket, a host of free-loading passengers.

Everyone was speaking loudly and directing comments at the driver, including Annie. Not for the first time, I thought how easy it is to assume everyone is angry when they are using raised voices in a language you don’t understand. But before we got off at our stop, Annie was laughing and the woman next to us was smiling.

At the last house, a young, heavy woman was holding her toddler while an elementary aged girl held her youngest child, a baby maybe 6 months old. When the woman smiled at me, her eyes were warm, bright, almost teasing. I wondered what it would take to keep your heart light in this dry place where your children didn’t have enough to eat. Annie proudly pointed to the toddler. “Soon he will finish our program. When he started several months ago, he was kwashiorkor.” She puffed up her cheeks. I remembered the pictures on the wall of the clinic of children with faces, limbs, and abdomen swollen due to water retention caused by lack of protein in their diets.

Annie turned to the mother to confirm what she had said. The woman smiled and nodded. Annie began quizzing her on the information discussed about malnutrition in the most recent feeding program class. The woman listed off a few of the recommended foods and then faltered, covering her mouth and blushing as she looked at me and laughed, like a college girl caught by her professor reading a novel during lecture. I wondered if we were the same age. After Annie had reviewed more of the information with the mother, she turned to me. “Is there anything you want to ask her?” she said.

I hesitated, thinking of my daily routine in our little brick townhouse in Pennsylvania, with water running from the tap, indoor toilets, and a stove to boil water for tea and bake apple crisp or lasagna or carmelized brussel sprouts whenever I wanted. I thought of my almost one year old son and this just-barely forming new baby and how they would probably never sit on a dirt floor surrounded by chickens. But then I thought of how I felt in the months before and after Henry was born, how all the resources in the world couldn’t make me feel ready to be responsible for the life of a new, helpless person. How I worried when Henry had that ugly cough last winter. How I wasn’t sure if I’d be able to take care of both Henry and the new baby the way I wanted. And I wondered if this mother felt some of those same things.

“How…far apart are these two,” I asked as she held both the baby and the toddler in her lap. Annie translated. They were 13 months apart. “Mine will be 18 months apart,” I said. The mother laughed and nodded. I asked her if she saw a change in her son since he had started the feeding program. She nodded emphatically, saying that he hadn’t been able to walk just a few months ago, but that now he was growing strong. We exchanged a few more comments, our words passing through Annie, a portal between two alien worlds.

We said our goodbyes and walked the short distance that remained back to the clinic. At the bottom of the hill that led up to the clinic, I thanked Annie for letting me tag along, and she smiled and nodded before walking towards the small building. She would visit more mothers and more children later in the afternoon. I watched her before turning down the path that led to the house where I was staying with other expatriate workers. Over the past few hours, I felt as if I had stepped behind a partition like the ones in the reed houses on the home visits, and that now I was stepping back again. I wondered if someday that partition would ever fall down.

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