FEATURES

ADVANCING KNOWLEDGE THROUGH COLLABORATION

Found in translation

Five American women from Kentucky travel to Zambia and find that they share common ground—concern for good health—with their African counterparts.

by Lynn Whitledge

Using translational equivalence, a translator (left) conveys to the audience important health information taught by the author.

It was with sleepy eyes and chattering excitement that we left Hotel Preston in Nashville, Tenn., at 4:30 a.m. on May 31, 2005. Three airports, three airplanes and 40 hours later, our excitement returned as we walked across the airport tarmac in Lusaka, Zambia, toward the terminal and the smiling, arm-waving people who had come to meet us. Rev. and Mrs. Abernathy, our host family in Zambia, wrapped us in hugs, collected our luggage and guided us to their Land Rover. We had come to participate in the Lusaka WISH (Women in Spirit and Health) conference, a gathering that had come together following two years of e-mail exchanges and two brief, face-to-face meetings.

Zambia, formerly Northern Rhodesia, is a landlocked African country of more than 11 million people. Located in the south central region of the continent and slightly larger than Texas, Zambia has a tropical climate. The rainy season starts in October and ends in April.

Lusaka, the capital city, has an official population of 1.9 million and an unofficial population of 3 to 4 million when you include homeless people and abandoned children. The life expectancy of 39.7 years is directly attributable to the 1-in-4 rate of HIV/AIDS incidence. Zambia’s second major disease is malaria, and the government recently hosted a kick-off celebration in Lusaka for the World Health Organization’s Roll-Back Malaria Coalition, a group that promotes malaria education, preventive measures, diagnosis and treatment.

The WISH conference was held in a church building that was surrounded by 15-foot-high concrete walls topped with jagged, broken glass to provide security. The entrance to the compound, a solid metal gate, swung open only upon request from the Land Rover’s horn. The church was constructed of concrete block, its large window and door openings positioned to catch any breeze.

Visible over the wall behind the church was the minaret of a mosque. According to the U.S. State Department, about 85 percent of Zambia’s population is Christian. Approximately 5 percent of the population is Muslim, many of them Asians who settled along the railroad line from Lusaka to Livingstone (U.S. Department of State, 2003).

Inside the church, a newly completed concrete floor thick with dust was being treated with water from a small washtub as the ladies prepared for the day. Two rows of white, plastic chairs were positioned near the front of the church, behind which were rows of benches constructed of narrow wooden planks. As more and more ladies began arriving for the conference, the benches quickly filled and additional seating appeared nonexistent. Nevertheless, seating for new arrivals was secured by crowding one more person onto each bench.

The attendees were excited about meeting old friends and making new ones, and their thirst for knowledge was amazing. Combining education for body and spirit is a powerful and appropriate method for meeting the needs of women. Some had walked three days to attend the conference and others had used public transportation, riding a bus for 24 hours. Many mothers came to the conference with their babies secured to their backs with chachenza, a colorful fabric about 2 meters in length. The women also carried a grass mat to sleep on, a pot to cook in and a small washtub for bathing.

As a conference educator who is a teacher by profession, I was introduced each time as “a teacher of nurses.” That sounded strange to me, until I realized that education and educators are held in highest regard in Zambia. The other nurses who taught at the conference, but who were not professional educators, were introduced as nurses according to their degree of education. I asked one of the translators, an RN with additional training and degrees in public health and midwifery, why she was not one of the teachers. I learned she is not viewed as an authority because she is a native. This lovely lady told me that her education began in Lusaka at the University of Zambia and, for her additional education, she had to relocate to Ghana and finally to the United Kingdom.

Teaching with a translator was a unique experience. We quickly learned that information was not always translated word for word, but often by concepts or general equivalency. To communicate information about fever and rash, the English word “red” was translated to “fire” for Zambian understanding. Translating thoughts and concepts accurately was a concern for us. Although most of the ladies had some understanding of English, women who had traveled the greatest distances spoke only their native tongue.

The two most prevalent Zambian languages are Chinyanja and Chibemba, commonly known as Nyanja and Bemba. Nyanja is spoken in Lusaka, the capital city, and also in the Eastern and Central provinces, and Bemba is spoken in the Copperbelt, Northern, Central and Luapula provinces.

Our health education efforts and mini-exams of attendees brought us face to face with traditions passed from generations long gone and the influences of “dark healers.” In teaching nutrition, discussion of the life-threatening danger of dehydration in infants paved the way for discussion of a rehydration drink and how to identify dehydration— specifically, depression of the baby’s anterior fontanel.

Presentation of this information prompted a question regarding the age at which the anterior fontanel should close. Zambian tradition holds that if a baby’s fontanel is open beyond the first few months of life, it indicates a curse for which the mother should seek consultation from a “natural healer.” Informing these ladies that the fontanel is normally open until 12 to 18 months of age caused a disturbing hum of discussion.

An older lady, posing a question in scenario fashion, stated that her husband sleeps and gets up to “pee,” sleeps and gets up to pee, sleeps and gets up to pee—all through the night. “What does this mean?” she asked. The answer—that frequent urination can indicate an enlarged prostate, a condition that comes to most men with age—brought another hum of discussion, then applause and then dancing in the aisle. The interpreter explained that the witch doctor had advised the women that it was due to a curse. They were overjoyed to learn it was not. Even though the corrective surgery would most likely never occur, the ladies’ excitement continued.

The subject of AIDS transmission brought questions about the increased transmission rate from men to women. It was a topic the ladies previously had not felt comfortable discussing. In that male-dominated society, women are subservient and regarded as little more than property. Wives and mothers are at the mercy of their husbands when it comes to fidelity and intimacy. A man’s prosperity is judged in the community by the size of his wife. If she is large, the husband is believed to be prosperous.

Every effective educator wants to know if information he or she has presented has been understood and assimilated. For one conference teacher, this confirmation was received on the very day that information on hygiene was presented. She had to make a visit to the toilet. The women’s toilet consisted of a 1-foot-square hole in the ground shielded by a three-sided concrete block wall. There was nothing to sit on. (The men’s facility was similar, but with a slightly larger hole.) Upon exiting the toilet area, the teacher was met by two conference attendees. Carrying a small washtub, filled with dirty water, the women urged her to wash her hands and sing “Happy Birthday.” They almost had it right. Earlier that day, they had been instructed to wash their hands using clean water, soap and lots of friction for as long as it took to sing the happy little tune.

Following the conference’s daily workshops, the teachers became clinicians, providing blood pressure checks for the ladies and focused exams for the babies. To encourage the women to utilize health care that is provided by the government for children under 5, problems were referred to the local clinic.

More than 200 babies were seen. Most were very afraid of our pale faces. Later, we learned that moms on the other side of the world use the same types of behavior control methods that many in America use— that is, threatening the child’s security with a dire warning. Zambian moms warn, “If you don’t do (whatever), the white people will come and take you.”

In Zambia, babies are breast-fed and carried by mothers until weaned, usually between 18 and 24 months. Although various health problems were observed, many children presented with no problems. The mothers merely wanted their babies to be seen and to be told that their children were healthy and beautiful. A couple of the babies were very sick and appeared to be AIDS victims, as were a few of the ladies. Considering the country’s 1-in-4 incidence rate, there could have been, statistically speaking, 300 to 400 attendees who were HIV-positive.

The conference, titled “Women Touching Heaven,” came about as the result of a simple lunch conversation between Mrs. Abernathy and me in 2003. She asked, “Do you know anyone who could do a ladies conference, focusing on health issues?” That was the open door that brought five ladies from Kentucky, in the United States, together with 1,187 ladies from various parts of Zambia. I know my heart, perspectives and appreciation for life have been changed by those women, their sacrifices and their desire for knowledge. RNL

Reference

U.S. Department of State. (2003). International religious freedom report 2003. Retrieved May 24, 2006.

Lynn Whitledge, RN, MSN, is assistant professor, Nursing Division, at Madisonville Community College in Madisonville, Ky.

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