Guilty of Options

Last week we were pleased to welcome visitors from the charity three:eighteen to Kapumpe and Arise. Alex and Richard are trustees of three:eighteen, a UK based Christian charity that seeks to provide lasting hope to the vulnerable through microfinance, education and discipleship. They came to see the people and projects in action at Kaniki.

Richard’s wife Clare also visited. She embraced the opportunity to teach music and singing to each of the classes at Kapumpe.

I asked Richard, as one of the trustees of three:eighteen, to share his thoughts and experiences about visiting Zambia and their ongoing work here. Here's what he shared...

Alex and Richard with some of the pupils at Kapumpe

Clare teaching Grade 2 music

A staggering 60 per cent of Zambians live below the poverty line – with 42 per cent of those considered extremely poor.  How can a white European who lives in a world of endless choices possibly hope to understand the condition of hopelessness which exists among the impoverished communities of sub-Saharan Africa? For a matter of fact, do we find the solution in throwing money and handouts at such people?  

I spent a year in Zambia in 2005-06 on a Christian programme aiming to impact communities - whether that be through building work, visiting and preaching at remote hilltop churches, or feeding street children.

Richard and his team in Zambia in 2005/6

I am currently back in Zambia for the third time since I left in 2006 as part of a voluntary role I hold with a small-scale microloans charity.

Non-governmental organisation three:eighteen was formed in 2010 with the aim of bringing empowerment and lasting hope to vulnerable individuals. It directs this through a range of measures including microfinance, education and discipleship. With ambitious aims of reaching 10,000 people in total by 2021, it holds a conviction that the best way to help people is through empowerment, and namely that this is done through building relationships with partners on the ground. The most common conduit for such work sees three:eighteen standing alongside churches – the very organisations which offer the best means of utilizing local knowledge and pinpointing needy groups and individuals.

A microloan training session

Thinking back to my previous sojourns to this special and distinctive landlocked nation, I often felt struck by a sense of guilt; guilt at the electronic devices I use or the money I have but most of all a palpable concern that I often didn't acquiesce to requests for Kwacha notes to be dealt out to the impoverished hands of those begging. No doubt my own inhibitions spoke much about this, alongside selfishness and a 'concern' about where the money would end up. It is within this difficult context that I have come to fully appreciate the valuable nature of microloans.

In the words of the Bangladeshi entrepreneur and Nobel Peace Prize winner Muhammad Yunus: “Poor people are the world’s greatest entrepreneurs. Every day, they must innovate in order to survive. They remain poor because they do not have the opportunities to turn their creativity into sustainable income.” (Yunus won the Nobel Peace Prize in 2006 for his microfinance theory).

three:eighteen microfinance trainers

On this trip, I’ve already experienced seeing some of the happiest pupils around attending daily at Kapumpe Christian Primary School. Like microloans, this is to see another transformative activity which sees people looking within themselves to see how they can best help those outside. Working alongside Arise – an orphan sponsorship project – schoolchildren who would have found themselves with little education now have the potential to lift themselves up.

Richard with Kapumpe pupils

More and more it strikes me that so much of this wonderful work comes back to the idea of fully grasping the wonderful options and choices we have in Western Europe and seeking to extend this same gift of opportunity to those who fall the wrong side of chance when it comes to where they are born.

One particular story I’ve heard out here in Zambia brings to light the sheer paucity of concepts such as choice and options, and indeed life chances. A much appreciated young boy called Lawrence is one of many pupils at Kapumpe School. Having not been able to use his legs properly since an early age, it was only relatively recently that he was discovered to have cerebral palsy. A pair of crutches has given him a sense of new life if not full physical freedom, while his teachers are quick to comment that he was one of the most excited participants at a recent sports day.

Lawrence was all smiles on Sports Day

In cases of this neurological condition in the UK, we can believe that earlier intervention would undoubtedly have given children like Lawrence the ability to walk freely again. A chance for many and no chance for others; Zambia is tragically a world away from the often lamented but rarely appreciated NHS health system of the UK.

Last time I was here a group of ladies from Chinsali in Muchinga Province were just about to take a trigger a second loan having faithfully repaid their first. This time I’ve seen successful repayments of loans from both a blankets business and a fish selling enterprise in Chinsali. Undoubtedly there are negative aspects to microfinance too; some groups take the money and do not pay back. The question of the godly but fair response to this is one of many of our discussions out here.

A microloan group who run a carpentry business

Three:eighteen affirms everyone has something to offer. It cherishes individuals using their skills and rewards their hard work. In fact as the American entrepreneuer as well as founder and CEO of Acumen (a non-profit global venture capital fund which uses entrepreneurial approaches to address global poverty) Jacqueline Novogratz said: “Poverty is not only about income levels, but for lack of freedom that comes from physical insecurity”. Microfinance indeed does more than kickstart enterprise, it removes the burden which prevents God-given talent from flourishing. It is indeed a firecracker of an idea. And it works.

To find out more about the work of three:eighteen, please visit: three:eighteen website

Different Worlds

At the moment I feel a bit like I have two lives, one British and one Zambian. There are so many things that I love about both of them, but it can be difficult going from one life to the other. When heading back home to the UK or returning to Zambia, the prospect of catching up with lots of people who I'll see is exciting but at the same time means leaving others behind and missing out on things that are happening in their lives. 

At Heathrow with my sisters, preparing to leave for Zambia

Living in a culture so different from my own has challenged my thinking, and I hope it has also changed my perspective on some things. It has made me realise how my world view is heavily influenced by the British culture, environment and way of thinking, as well as my own experiences of growing up there. In fact, my world view is very different to that of people living in different countries such as Zambia.

Children growing up with a different world view to mine

In the UK we highly value honesty and integrity, even if not everyone lives it out. We believe in democracy and freedom of speech. People are expected to be tolerant and accepting. These are positive things and since being away I have certainly developed a greater appreciation for being British (although I still don't drink tea!). My British friends and I love any excuse to gather and celebrate events here, such as the Queen's birthday, Wimbledon, the Olympics, St George's Day. In fact we probably celebrate some of them more than we would if we had been at home!

Celebrating the Queen's birthday

People here seem very proud to be Zambian. I have learned to sing the Zambian national anthem with them! There is a strong sense of community among people, which is something we seem to have lost a bit in the UK. People here make time for others and respect is highly valued. However, on the other hand there is a huge amount of bribery and corruption. In many situations that occur it's hard to know what the real truth is because information is not readily communicated. There is also a lot of fear here. And many things here still surprise me because they seem unfair or wrong according to the way I think. Ideas, customs and social behaviours in my British and Zambian lives are very different, and that's mainly because our thinking is so different.

On Zambian Independence Day last year

One of the things I've seen to be very different here compared to the UK is peoples' belief about God. It is widely accepted in Zambia that people believe in the God of the Bible. I think the belief that there is a God who is greater than we can imagine comes partly from the humility that people here have about themselves and their view of humanity. They understand that we are small, which in the grand scheme of life, we are. Perhaps it is the high mortality rate and shorter life expectancy that accentuate this. People seem to accept that our minds cannot understand all there is about life and death.

Visiting one of the bush churches

In the UK we are a small nation who are used to having a fairly large amount of influence in relation to our size. We are very fortunate to have excellent healthcare, education and on average, a very good standard of living. It can be very easy to look down on people who have less than us and think that we know better. But none of us have got it altogether, even if we try and present things as if we have. I think we can learn a lot from trying to see things from someone else's perspective, whether that be someone in the UK or in another country far, far away. 

World Teachers’ Day

The 5^th October is World Teacher’s Day. It is observed in many countries across the globe by UNESCO (United Nations Educational, Scientific and Cultural Organisation). The theme for this year's World Teachers' Day was ‘Valuing Teachers, Improving their Status’.

Me with one of the Kapumpe pupils

Although I have been teaching since 2005, this is the first year I have celebrated World Teachers' Day. Even teaching in Zambia last year, I didn’t realise the significance and assumed that Teachers’ Day must be just another public holiday. Here there are so many public holidays such as Farmer’s Day and Heroes’ Day, this was just another day that the school was closed. Last year there was just one Zambian teacher at Kapumpe Christian Primary School. We now have several Zambian teaching staff and so this year they made sure that we discussed Teachers' Day in advance and made plans to celebrate.

One of the Kapumpe teachers

Teacher’s Day is celebrated in Zambia to recognise and appreciate the contribution that teachers make to the lives of children. As wages are not very high here, people feel it is important to acknowledge and thank staff for the work they do beyond what is expected. Pupils may bring in a gift for their teacher, for example one of the children at Kapumpe brought in a 2kg bag of sugar. Our staff kindly informed me that as Head Teacher I would be required to give awards to some of the teachers! After asking several different people about the local traditions and expectations, I found out that the gifts are usually a household item (e.g. wall clock or a fridge, depending on the budget) or money.

Cards that I received from some of the children

In Ndola and other similar sized cities, a spokesperson for the Ministry of Education gives a speech and some teachers go on a march to celebrate the day. Some schools are closed for the day and other schools close early. After discussing our options with the teachers, we opted to celebrate the day by hosting a special school assembly before the children went home early.

I organised an assembly with the help of some of the children from our Grade 3 class. Our ‘special guests’ that we welcomed at the start of our assembly were pupils dressed up as our teachers. They greeted everyone in role and the rest of the children had to guess which teacher they were. Unsurprisingly, the children enjoyed performing and ad libbing. It was very amusing to see them portray various habits and quirks of our staff! The 'actors' then joined with our real teachers to complete several challenges to test their mental maths, Bemba spelling and teamwork in front of all the other pupils.

Teachers and our 'special guests' in assembly

I was a little unsure if my plan for the assembly was culturally appropriate as this was my first Teachers' Day, however the teachers and children wholeheartedly embraced it. There was lots of fun and laughter. Everyone who took part proved what good sports they are, and it was clear to me that our teachers at Kapumpe do their best to make learning fun. This must be one of the reasons why the children love coming to school here. Many of them didn't actually want to go home early!

Children sharing their messages

During the assembly some of the children joined me in sharing words of thanks and appreciation for each of our teachers. We gave them each a gift (no fridges though), sang several songs together and prayed for the staff. Afterwards, the teachers joined in play time with the children before we sent them home early. .As teachers we continued our celebration by watching a movie and eating dinner together.

Play time for children and teachers

I am really grateful for the teachers we have at Kapumpe – both Zambian and British. They each bring their own unique skills. At home in the UK, this sort of celebration might seem a bit unnecessary or over the top, but it was lovely to have an opportunity to show staff that they are valued. I am sure Teachers’ Day boosted staff morale but also benefited the children – it encouraged them to be grateful and they also had a lot of fun in celebrating their teachers.

Meal with Kapumpe teachers

Our Scholarship Fund

The aim of the Arise project is to give children in Kaniki and the surrounding areas opportunities that they wouldn’t otherwise have. For the majority of children and young people supported by Arise, this means paying their school fees and ensuring that they have the practical and spiritual support which they and their guardians need. The main focus of Arise so far has been on supporting the children to reach Grade 12 (the final year of secondary school), with only a few of them having the opportunity for further study. However, we now have a growing number of young people who have successfully completed Grade 12 and who are really keen to attend college. They have aspirations to become nurses, teachers or mechanics. High aspirations are not common among school children here, so we really want to encourage and support these individuals. We have noticed that without college, many girls return to help out in their family home when they have completed Grade 12, and many boys are faced with a future of finding piece work (occasional manual labour) in order to survive.

Arise students with high aspirations

We have seen a few examples where Arise has been able to support individuals to attend college over the past few years. Unfortunately, the cost of college fees is significantly higher here than school fees and therefore it has not been possible for the project to support many students in the past. Sadly, the cost of college fees is far too high for the people we support to be able to pay the funds themselves, despite working hard to get the grades required for college. To put this in context, on average it costs the equivalent of £1000 per year for a two or three year course here in Zambia. The most common type of employment for our Arise guardians is piece work, which is typically paid about £1.50 per day. College fees are a struggle for most people living in Kaniki and the surrounding areas, and a virtual impossibility for our Arise guardians who are among the most vulnerable.

Me with one of the college students that Arise currently supports

We hope that increasing the number of opportunities we provide for our young people to attend college will mean that they have greater potential in securing skilled employment, and therefore providing for their own families and future. This fits with our focus on empowerment which is at the heart of the vision for Arise. I thought I would share the stories of two students who we would like to be able to support to attend college.

Albert* lives in Kaniki Extension and has been supported by Arise throughout school. His guardian works selling tomatoes by the roadside and his younger brother attends Kapumpe School. Albert has proved that he can study hard and speaks a good standard of English, even though many children of his age in the community do not. He completed Grade 12 at the end of 2015 and since then has started a small business making and selling bricks to help provide for his family and to try and save some money for college. It has been a pleasure for us to see his entrepreneurship and commitment to his future. He would love to one day train to be a secondary school teacher.

Matthew* lives in Kamalasha which is near Kaniki. I first met him early last year when I went to visit some families in the local community. Sadly his family were gathering for a funeral because his brother had died of TB. His brother was just 21 years old and was Matthew’s only sibling. Matthew has been supported by Arise throughout school and also completed Grade 12 at the end of 2015. His ambition is to become a clinical officer (a licensed practitioner of medicine in Africa) so that he can help people who are sick like his brother was.

Arise secondary school students studying for exams with one of our Zambian volunteers

The need here is huge and as an Arise team we are confronted on a daily basis with situations that we would like to support but don’t always have the resources and capacity to be able to. In response to the situations that Albert and Matthew are in, and many other young people like them, we are setting up a Scholarship Fund to enable more young people supported by Arise to attend college. We have put together a process so that once students have completed Grade 12, they will be eligible to apply for an Arise Scholarship. They will be expected to complete an application form with details of what and where they wish to study, attend an Arise panel interview to discuss their suitability and commitment, and contribute a portion of the fees which is determined by their personal circumstances.

Meeting with Arise secondary school students

All money donated to the fund will go towards paying tuition fees, accommodation, food, transport and books or equipment for the young people we sponsor through college. We know that the benefits of a college education extend not only to the young person but also to their family, friends and wider community. To find out more, please read the poster below:

Click here to open the Scholarship Fund poster in a separate window

We would be extremely grateful to anyone who is able to make a donation towards the Scholarship Fund, or who can pray for our team and potential students as we start up this scheme. Thank you for your interest and support! 

*Names have been changed for privacy.

The Waste2Toys Workshop

In Zambia there is a lot of waste produced, and limited opportunities for recycling. At Kaniki Bible University College where I live, we have recently started a basic recycling scheme separating food waste and collecting plastic bottles. Since people here have to pay to have rubbish collected, many people burn it which is certainly not healthy judging by how many plastic bags (or 'plastics' as they are known here) are used. Last week I came across some great ideas as to how we could re-use our rubbish in a much more useful way.

Re-using paint tins

I had the privilege of attending a ‘Waste2Toys’ workshop led by two ladies from a South African charity called Singakwenza (meaning ‘We can do it!’ in Zulu), which was hosted by our friends at Beyond Ourselves Zambia. Our Pre-School teacher from Kapumpe attended with me and we had a great day with teachers and head teachers from other schools. We were presented with lots of simple but inspiring ideas about how to recycle waste and use it to make school resources.

The Singakwenza team with recycled display resources

Teachers from a variety of schools in Ndola

I am hoping that we are going to embrace these ideas at Kapumpe, which could bring multiple benefits for the school. Perhaps most obviously it will help to save us money. It could also help us to encourage parental engagement, as children who are sponsored through Arise don’t pay to attend our school but it is still good for their families to contribute in some way. Everyone can collect plastic bags, cardboard boxes and bottles at home to bring in for recycling. Furthermore, if the children see that they can make their own toys with recycled materials then it might provoke them to also do this at home, leading to more opportunities for play and learning. If resources get broken, it will mean they can more easily be replaced so it will also help towards making the school more sustainable.

Very importantly the workshop also taught theory behind early childhood development and clearly explained the reasons for learning through play. It was suggested that teaching a child is a bit like building a house – in the early years the parents and educators build the foundations, primary school teachers build the walls of the house and secondary school teachers put on the roof. If the foundations aren’t good, then it will fall down!

Building the foundation for a good education

Those of us who are passionate about primary education understand the importance of the early years and believe that play is a foundation for learning. Fred Rogers, who was a pioneer in television for early years education, said:

Play is often talked about as if it were a relief from serious learning. 
But for children, play is serious learning.

Play is really the work of childhood.

Play = serious learning

Children learn to communicate through play, developing their vocabulary and language skills. It encourages them to work in groups which involves sharing, negotiating and resolving conflicts. Play gives children opportunities to solve problems and to learn about numbers and symbols which develops early mathematical and scientific concepts. It also allows children to be active and even to deal with fears whilst acting out situations in role play. In summary, it is during play that children really learn how to learn.

Developing language through play

The workshop that we attended presented us with some practical ideas for making resources that could facilitate play like this. It also taught us about specific skill development. For example, we started off using plastic bags to make balls. These could be used for throwing and catching to develop a whole host of skills. Gross motor skills (control of large muscles) hand/eye co-ordination, 1 to 1 number correspondence (counting the actual number of objects/events), proprioception (knowing where to move your body to/the space it takes up) and laterality (using both sides of the body), for starters.

Number skittle bowling

We tried out some activities which would enable children to develop the fine motor skills (movement of small muscles) that they need to strengthen, before holding a pencil with the correct grip. Bottle tops and rolled up paper balls created little games of flick football. We used polystyrene trays and matches to develop a pincer grip to pick up small items. We used straws and onion bags for threading activities. All of these activities enable children to develop bilateral co-ordination (using both sides of the body at the same time).

Playing 'Flick Football'

Polystyrene trays and matches

The most challenging piece of equipment to make was a skipping rope – this was made from 72 plastic bags! It involved folding and cutting, tying the bags and plaiting them.

Making skipping ropes

My attempt at a skipping rope!

It is interesting that the Zambian curriculum encourages learning through play but it is still extremely rare to see it in Zambian schools. I don’t think this is because teachers are reluctant or unwilling, but rather they have not received appropriate training so are unaware, or they have huge class sizes, minimal space and little or no equipment/resources to make it happen. It seems a shame that teachers and schools here are not empowered to practice what the government preach.

Despite this, one of the key messages from the course was that it is the teacher interaction with the children that is important, rather than the resources themselves.

Our Pre-School teacher with her class

Since the course I have seen our Pre-School teacher trying out some of the activities. She is also going to lead some staff meetings on it to share her knowledge with the other teachers at Kapumpe. I have been delighted to see how keen our Zambian staff are to learn. I expected that people might be more stuck in their ways, but that is not the case. They simply need to be given the opportunity to hear information explained. I hope that the education our team are providing at Kapumpe will empower the children here to keep on learning throughout their lives and empower others along the way. It’s funny how even rubbish can be used to help in this!

Paint pot drums (which we might soon regret!)

Rhi's Zambian Healthcare Adventure

As well as working with one of our pupils, Lawrence, during her time in Zambia, my sister Rhi used her healthcare skills in many different ways. Here she tells us about some of her experiences...

Rhi with Lawrence at Kapumpe

During the time I spent in Zambia I had the privilege of seeing a number of different local healthcare facilities. As a healthcare professional (Occupational Therapist, or OT) from the UK I have been interested to see both the similarities and differences between healthcare offered in Zambia compared to what our National Health Service provides back at home. I also had the incredible opportunity to offer support to a few adults and children with different health challenges of their own.

One of the biggest difficulties faced by so many people living in Ndola is the lack of available health information and education. Coming from a culture with the opposite problem where patients diagnose themselves (often incorrectly) using Google, I loved being able to teach a handful of people from the local community how to look after their own health. In Zambia, many myths are passed down through generations about different causes and treatments of illnesses that we would probably find bizarre, so it has been great to spend some time teaching the physiological explanations and helping the local people understand things a bit better. I expected some resistance to the information that I was sharing, but in reality I ended up being really impressed and encouraged by their enthusiasm to learn.

A very useful book we were able to buy for the Arise Project

My main opportunity for teaching was with the Arise guardians. The guardians have a weekly meeting of singing, prayer and encouragements from the Bible and during some of these meetings I was asked to conduct some teaching sessions on managing common health difficulties. It was a lot of fun teaching the guardians different exercises they could do to help ease pain and strengthen their muscles, and also having to put everything into picture format as many of them are unable to read. I also ran two sessions about food hygiene, looking at what food is good for us and the healthiest ways to cook. These sessions ended with the guardians putting what they learned into practice by cooking lunch for us all to enjoy together (see previous blog post entitled ‘Masterchef – Zambian style’).  We subsequently realised how much this knowledge is needed when I was asked by a local organisation called Beyond Ourselves Zambia (BOZ) to teach the cooks at their four local schools. You can read more on the BOZ blog here.

Teaching guardians how to look after their knees

Running cooking lessons with Beyond Ourselves Zambia school cooks

In June I was grateful to be taken on a tour of Ndola Central Hospital, the main hospital in the city of Ndola. It was interesting to note the differences between this hospital and the ones I have worked in in the UK, particularly in the equipment and furniture that is used until it is beyond repair, rather than being disposed of at the first sign of wear. Perhaps the most reassuring thing was how familiar everything felt with similar hospital departments and layout.

Ndola Central Hospital entrance

Ndola Central Hospital building

During my tour of the hospital I also visited the Physiotherapy department. The physiotherapists there explained that they did not know of any Occupational Therapists working in the whole of Zambia and asked if I would come back to see some patients for them. I returned to visit the department on two further occasions and met a few of their lovely patients. I visited one of their patients at his home as he had been in a car accident 12 years earlier and a spinal injury had left him paralysed from the waist downwards. His biggest wish was to be able to feed and drink independently so that his family did not have to be present 24/7. I was faced with the challenge of finding equipment for him that wasn’t available in Zambia. I tasked the carpentry and maintenance team at Kaniki Bible College to make me a bed rail, giving them the specifications that would be used in the UK, and Charles the carpenter did me proud! I was also able to get hold of a few smaller aids from the UK which enabled the patient to achieve his dream of feeding and drinking independently. Just the smile on his face made my whole five month stay in Zambia thoroughly worthwhile.

Charles and the new bed rail

The patient now able to drink independently

Coming from a culture where you need a DBS (Disclosure and Barring Service) check before you can work in healthcare, I was surprised how often I was informally asked to get involved with treating people and providing advice. At a local school supported by BOZ, there is a lovely girl in Grade 5 who has had hemiplegia (weakness down her left side) since she suffered a brain injury when she was a year old. Her mother has struggled to find the right support for her, especially since her father died who was the breadwinner of the family. I was able to teach the girl and her mother some exercises to help her muscles, but it was still frustrating for me to see how much her life and education are limited by her disability, as if she were in the UK she would have had a much wider range of support.

Teaching mother and daughter

Another person I loved visiting was a 10 year old boy who lives next door to Kapumpe School. He was born with a spinal condition which has left him with clubbed feet and no sensation in his feet or legs. The impact of this disability has meant that instead of being in Grade 4 at the local primary school, he is still in Grade 1. Because his family cannot afford the aids that he needs, he has had to miss a lot of school. He is a bright, friendly and determined boy who finds very inventive ways to manage even though he is unable to walk. Unfortunately he has developed large sores on his feet, so following the advice of a friend experienced in healthcare in Zambia, I visited him regularly to provide and change dressings. As specialist products are not available here, I have challenged our mechanic (who is also a tailor in his spare time!) to create a special pair of shoes for this boy who has never had a pair of his own. Visiting this boy and his family reiterated to me the lack of education given to patients and their families, as I discovered that nobody had explained to them that his condition would never improve and that he would face these challenges for the rest of his life.

Boy from next door (in wheelchair on right) and his cousins, showing off his wheelchair and hand bike

Being taught about wounds and dressings

During my time in Zambia I also had the opportunity to visit a rural mission hospital and our local children’s hospital, as well as being able to talk to local healthcare staff. I found it interesting to hear about challenges similar to those faced in the UK, although to a far more extreme degree. Lack of staff, resources and funding mean that staff in Zambia are expected to lift, move and treat patients in ways that would be deemed unacceptable back home. The lack of the litigation and blame culture that we face in the UK means that healthcare staff in Zambia do not have the same fear of being sued and are not faced with the same red tape and hoops to jump through that staff working for the NHS so often are. However, this also seems to result in less responsibility being taken for decisions and mistakes that are made.

Mpongwe Mission Hospital

Equipment at Arthur Davidson Children's Hospital

As with the NHS, healthcare in Zambia is generally free to patients. However, patients are expected to pay for more specialist or expedited services. There are so many things we often take for granted as part of the NHS’ healthcare provision that are very different here. In Zambia there is approximately one nurse per ward. When patients are admitted to hospital they must have a friend or family member with them throughout their stay and attend to their hygiene and care needs. These bedside carers are not given their own beds so must either sleep in a chair next to their loved one, or share their hospital bed! As some patients are kept in hospital for many months, this is a big commitment for their friends and family members, who are also often expected to provide food for the patient. Things that we would expect to be a part of free healthcare treatment in the UK, such as anaesthetic for an operation, are sometimes billed to the patient.

The healthcare staff I have seen whilst I was in Zambia impressed me with their ability to do so much with so little. Nonetheless, I also found that the Zambian culture of not sharing knowledge can also apply to the healthcare setting, which was frustrating to watch as I believe that teaching self-care enables people to look after their own health and reduces their reliance on healthcare services. Perhaps the most important thing I learned from my experiences of Zambian healthcare is how easy it is to come to a developing country and think you know so much more than people who live there, but after spending time with them you realise they have far more to teach you than you could ever imagine!

No running water means hospitals have to be inventive!