There are quite a few ways in which Zambian culture is very different from UK culture. We have already mentioned a few but I thought I would summarise some more ways here.
The first that we've covered is clothing. Women shouldn't show their knees or stomachs - this prevented me from showing Abraham how much darker my arms are than my tummy! Although it seems that richer Zambians (probably those from towns / cities) are more relaxed as there are a few women around the hospital that wear skirts on the knee and in Chipata the swimming ladies had short shorts on. But in general it's very conservative.
Men are the leaders of the family and it's rare for there to be a woman in authority. There are no female Zambians in any role in Theatres and only 1 female Zambian doctor. Any woman wanting a sterilisation must first have her husband's permission (and before you get too irate about that, it's worth pointing out that this was the case in the UK when I was born).
Music plays a very important role but it's not the type of music popularised by Paul Simon. It tends to be either gospel music or country music! They seemed surprised when I said neither was particularly popular back home, particularly not with people in their 20s. 'You mean you don't have any Dolly Parton? or Kenny Rogers?' [I have one song from each, I can hear my friend Dan Caines groaning at this as he has spent a lot of time trying to educate me about proper songs :) and he's doing an amazing job] I just laughed at them. 'Why don't you like country music?' Err, because it's depressing and it's always about some guy who wants to marry his dog! There is a Zambian pop star - I don't know his name but everywhere I've seen music videos there's always been this one guy on there - he is slightly plump and has many silly hats. Not keen on his music. Anyway, exactly like at home, people wander around playing music out of their phones. There's one key difference - the EU rules about hearing loss and maximum volumes don't apply here - trust me, this EU rule is really a blessing. You could happily join in a phone call here from 10 meters away and be able to hear both sides of the conversation perfectly!
The gospel music hints at my next comment - Church. Religion and going to church are very important. There are many churches to choose from - in Katete there's a road dedicated to churches and some mad race to see who can build the largest - the bigger your church, the bigger your congregation... Sunday best is still worn to go to Church. The community is still conservative in many ways beyond dress, homosexuality is illegal, for example, which can make some hospital consultations difficult, also it's very frowned upon to have sex outside marriage - Dr Amy treated a lady who was bleeding very badly (I'll explain in a second) who nearly died because she was too ashamed to admit what had happened to her. It was only in theatre that Amy discovered the source of the blood and could save her life.
There's an interesting interplay between abuse against women, HIV/AIDS and marriage. There was a BBC News article from India this week that was similar to what I'm going to say now but without the HIV/AIDS. Each week the hospital sees women (and a distressingly high number of young girls) who have been attacked (sometimes sexually, sometimes not) by 'known' or unknown persons. There are public awareness posters in Chipata urging the community to stamp out this behaviour. Near the administrative centre in Katete Boma there's a painted sign that says 'Rape is not only a violent act, it spreads HIV/AIDS.' I'm not sure whether they think the blokes care more about giving the woman AIDS than mental scarring or whether they are suggesting the women have AIDS and will harm the rapist. Whichever way round, it is clear that rape is a significant issue locally.
For some time I was interested to understand why HIV spread so quickly through Africa. It's easy to point to a lack of education (true), lack of availability of condoms in remote areas (true) and the fact that it went unnoticed for many years before being detected. All of these are correct. But, in normal (as defined by Western practices) consensual sex the chance of passing on HIV is relatively low (falling to 1/900 if the infected person is on ARVs). However, if there is significant tearing on either side and blood to blood contact then it's much higher. It seems to be the preference of men here for that sort of thing to happen (remember the lady earlier) so the chance of spreading the virus is much higher.
It is pushed higher still by the richer men from the towns that come out to the villages with presents to try and procure sex. And some traditional healers still tell people that sex with a virgin will cure them of the virus. Not desperately helpful. There are lots of health posters around the hospital urging women to wait and not to accept presents, to think about their future and career aspirations.
And because unmarried women often feel ashamed of what has happened to them (whether they consented or not) there can be a significant delay in seeking treatment which can, unfortunately, have serious consequences on their health.
But it's not all unlike at home. The other week Nat was approached by a mum who said that her 15 year old daughter had been 'defiled' and she wanted a medical opinion on her police report. Sometimes it can be tricky to be certain of what has happened, particularly if there is a late presentation. In this case the girl was mute in the presence of her mother. Nat despatched the mother to the end of the ward and suddenly it all came out. She hadn't been raped, it had been consensual (if illegal), she was in love with a married man of 22 and she was going to have his baby... Nat had a little feel of her tummy and, yes, more than 20 weeks gone, she was indeed having a baby. Well, that made the police report easier to fill in at least!
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