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ISSUE 121 VOL 12 PUBLISHED 2/29/2008

Making a difference in Africa

By David Henke
Variety Editor

Friday, February 29, 2008

According to the World Health Organization, roughly 33.2 million people worldwide are living with HIV/AIDS. It's a staggering statistic, especially when you stop to consider that an estimated 22.5 million of those cases are concentrated in sub-Saharan Africa.

When faced with such overwhelming numbers, it's tough not to feel a little daunted. But Bethany Birkelo '08 and Rachel Bean '08 didn't let that stop them. Over Interim, while hundreds of St. Olaf students ventured off the Hill for studies abroad, internships and research projects in other states or countries, Birkelo and Bean volunteered in health care centers in Livingstone, a city in the southern Zambia.

Livingstone, home to roughly 100,000 people, is the adventure capital of Zambia. It's so close to Victoria Falls that you can see the mist from the city streets. As a result, it's a tourist hotspot. However, the natural beauty of the area is underscored by the fact that Livingstone has been hit hard by the AIDS epidemic.

"Livingstone has the highest rate of known HIV [cases] in all of Africa," Bean said in an e-mail interview, "so this disease absolutely affects this town and this community." The epidemic is so severe that roughly 32 percent of all adults in city have tested positive for HIV or AIDS.

Birkelo first became interested in volunteering in Africa after she traveled to Ghana as part of a St. Olaf study abroad program in 2006. She began communicating via email with African Impact, an aid organization, in February of the following year. She and Bean, who spent a semester in Tanzania on a St. Olaf program, sent in their applications and booked flights last summer.

"I wanted to go back to Africa, but I wanted to go somewhere where I could learn more about HIV," Birkelo said. "Zambia met the criteria."

Because Bean and Birkelo were working with an independent volunteer organization rather than participating in a St. Olaf program, they were both concerned about the legitimacy of the program before they left. "We were definitely nervous about it," Birkelo said. "It's kind of a big leap of faith." Even so, they were both excited to be heading back to Africa.

When they arrived in Livingstone, Bean and Birkelo spent a several days acclimating, and then they moved into a volunteer house. "We were mixed in with all the other volunteers: some from the United States, some from England, a few Europeans -- German and Dutch, and a couple Australians," Bean said. "It was also a really great way to make connections around the world and meet new people from totally different lives than your own. The house was a nice way to settle in and be able to process your day with people who ultimately felt like a family."

In Livingstone, the pair did a variety of volunteer work; they participated in an adult literacy program, provided family support for Zambians by assisting with a child care program, worked on a farm and helped out on a local construction project. At the heart of their volunteer experience, however, was their work at the clinics and hospital in Livingstone.

Bean and Birkelo both began their work in four Livingstone clinics -- Dambwa, Libuyu, Maramba and Linda. In addition to their work at the clinics, both Bean and Birkelo went along on "home care" visits, where a team of nurses and volunteers would visit patients in the outlying neighborhood of Livingstone and conduct check-ups. Birkelo also spent a large portion of her time shadowing a doctor in the pediatric ward of Batoka Hospital, the largest health care center in the city. Every morning at the clinics, Bean and Birkelo took patients' vitals and assisted with some of the clinics' registry paperwork. Because of the lack of trained doctors in Zambia, Bean and Birkelo often worked with "clinical officers" -- individuals who have received three years of medical training and serve many of the same functions as a doctor in the clinical environment.

As well as being understaffed, the clinics were often critically short on supplies. "I had to bring my own thermometer, my own blood pressure cuff, my own alcohol swabs for cleaning the thermometer and, usually my own pen," Bean said.

Maintaining basic sanitary standards was also difficult in the clinics -- often the bedsheets and blankets would go unwashed between patients, and Birkelo noted that even the hospital did not always have running water.

"We were pretty underequipped in terms of sanitary supplies, especially alcohol swabs," Birkelo said.

To complicate matters, the clinics are often the first stop for many Zambians suffering from illnesses or injuries. "I saw a lot of malnutrition, anemia -- due to malaria -- and some tuberculosis," Birkelo said. Also, many of the patients being treated at the clinics were HIV-positive, which made treatment more difficult because of the social stigma surrounding the disease.

"I quickly learned that the bulk of the patients we were seeing were positive," Bean said. "I didn't grasp this initially because our home-care guides -- Zambians in the community who provide basic care and support -- referred to every patient that was [HIV] positive as having tuberculosis, not HIV. So we didn't know, at first, that all these people were positive, we just thought they all had TB. But 'TB' is also what they say about people who are HIV positive because it's less stigmatizing. I only met two people on home care in the whole month that openly told me they were positive."

Birkelo explained that a lot of people refuse to get tested for HIV because they are terrified of the results. In one situation, a patient that Birkelo was in contact with had three HIV tests that had come back positive, but the mother of the young girl refused to believe that her daughter had contracted the disease. "There's only so much you can do," Birkelo said. "If they don't want to accept it, they're not going to."

According to Bean and Birkelo, the widespread poverty of the area often compounded the problem. "One of the nurses explained to me that there are people who, when they find out they're HIV-positive, work for a month just to pay for a coffin," Birkelo said.

"There were a lot of emotional highs and a lot of emotional lows, but it was a really good experience," Birkelo said. "I really liked working with the doctors and nurses -- they were so welcoming, and I learned a lot about medicine and health care structures."

Both Bean and Birkelo loved working on home care assignments, when they got to walk out as part of a small group of volunteers and visit patients in one of the three major residential areas of the city. In Livingstone, the home-care network is not affiliated with any single health institution. The program is carried by volunteers who fundraise for medical supplies by selling fruit and vegetables grown on a local farm.

When they went out on homecare assignments, Bean and Birkelo often carried all the medical supplies they could in backpacks. "We were mainly serving those with chronic conditions, HIV, TB and malaria, but we carried gauze, bandages, antibacterial ointment, ibuprofen, oral rehydration salts and kalomine lotion."

Usually the home-based care groups consisted of two African Impact volunteers, and as many as five local volunteers, which gave Bean and Birkelo a first-hand opportunity to learn about Zambian culture.

"HBC was the best opportunity to talk to locals about life, and it was the best opportunity to see genuine Zambian life considering the fact that I was an outsider/guest/white person/tourist," Bean said. "The people on home-based care--the Zambian groups that we went around with--are very willing to talk about the pertinent issues they face."

Just because Bean and Birkelo arrived back at St. Olaf at the end of January doesn't mean they've stopped volunteering--the pair is determined to follow up their experience in Zambia by doing some fundraising on the St. Olaf campus on behalf of Batoka Hospital, which is building a new pediatric ward. Any donations would go towards the purchase of additional medical supplies and equipment for the new ward, which would help reduce the mortality rate in the hospital and increase sanitation.

Bean and Birkelo have set up a website,, with a Paypal account for donations. Anyone interested in hearing more about volunteering in Zambia is also welcome to attend their presentation, "Health Care Systems in Zambia," Thursday, Feb. 28th in SC278 at 7 p.m.

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