A young man sipping a sachet of tujilijili in Chaisa compound, Lusaka, Zambia. Officially he risks a two-year prison sentence by doing this, as these sachets containing hard liquor have now been banned. Credit: Jorrit Meulenbeek

By Jorrit Meulenbeek and David Mwanza
LUSAKA, Sep 12 2012 (INSP)

About a dozen men aimlessly wander around what seems like a prison courtyard. Most of them appear completely disoriented, a confused gaze in their eyes.

A shivering old man staggers around the area in circles with a friendly but absent-minded smile on his face, continually picking imaginary insects from his body. “Doyo,” (insect) he mumbles, as he helpfully points out a birthmark in the neck of one of the nurses.

A young man sits on the concrete floor in another corner, his body shaking so heavily that he fails to bring the spoon filled with porridge to his mouth. He has to be fed like a baby. “This one is still in the withdrawal phase,” head-nurse Alice Phiri remarks dryly. For her, this is business as usual.

“Many of them come with wounds like these,” she points out the circular scars around the young man’s arms and ankles. “When the family doesn’t know what to do with them anymore, they tie them up using electricity wire to restrain them.”

This is not a prison. It is the mental ward of Chainama Hills hospital just outside Lusaka, the capital of Zambia. About three quarters of the men admitted here are only temporarily ‘mad’, as a result of serious alcohol abuse and withdrawal symptoms.

Hearing the stories of those who have already returned to their senses – after 72 hours of detox – most mention one word when asked what they used to drink to end up here: tujilijili.

Killer sachets

These plastic 60 ml sachets, sporting brand names as ‘Zed’, ‘Officer’, ‘Joy’ and ‘Double punch’, appear innocent with their bright and fruity colours, but contain over 40 percent alcohol. Locally produced by various companies they became a trend over the past five years. Apart from in bars and licensed outlets, they were soon sold by the many informal street traders, going for around 1000 Kwacha (20 U.S. cents) or less.

This made them available to the poor, who often use alcohol as an escape from the harsh realities of everyday life. Reports of school children drinking the sachets in class, security guards sipping them on duty, and several deaths attributed to tujilijili made headlines, earning them the nickname ‘killer sachets’. Earlier attempts to ban the product failed, as the producers were operating within the law and the content of the drink itself complied with all existing regulations.

This is why it came as a surprise to both critics and supporters in April when Professor Nkandu Luo, minister under the newly elected Patriotic Front government, made the bold move to outlaw the production, sale and consumption of alcohol in sachets. She did not ban the drink, but the packaging.

For concerned parents like Peter Mbewe from Lusaka’s Chaisa compound, this decision was long overdue. “You have seen how youths are dying at a tender age because of these things,” he says. “The minister was right to ban the substance. It was destroying our children.”

Business out of booze

In the dusty gravel roads of Chaisa, a poor township with high numbers of youth unemployment, a layer of trampled tujilijili sachets has become part of the ground cover. Now the remaining ‘jilis’ are sold under the counter at double the price. It has become risky business since the council police started patrolling undercover. Anyone found with the sachets risks a two-year prison sentence.

Dibblo Mwanza, who used to sell the sachets from his makeshift shop, was also arrested trying to finish his stock, but got away with a fine.

“The PF government is not fair,” he says. It was mainly unemployed urban youths like him who voted the opposition party into power in September last year: “They promised us more money in our pockets, yet there are no jobs, and the only way to sustain ourselves, keep our family and pay rent was through this lucrative business.”

According to the official statistics, Zambia does not rank as highly as other alcohol-loving countries. Compared to Eastern European countries, Zambians seem quite modest, consuming only 3.9 litres of pure alcohol per year compared to 15.7 litres in Russia. But these numbers do not give the full picture as they are mainly based on registered alcohol sales and fail to take into account the homebrews that many poor Zambians drink instead.

Before tujilijili came onto the scene in recent years, hard liquor came in the form of kachasu, a traditional distilled spirit that people brew and sell from home. Kachasu houses are especially common in rural areas and the compounds of Lusaka, where poverty is rife but while Kachasu is also officially illegal, police are less concerned by its use.

Brewer Harry Kalad, who manages to support his wife and kids, his old mother and two orphan children from this business, admits he prays that the police continue their hunt for tujilijili, as his own kachasu business is now doing better than ever. “All my old customers have come back, my profits have been increasing.”

Seeing the effects

While those who really want to drink still have other options now tujilijili is gone, the ban does seem to have had an effect, as the number of people admitted to Chainama Hills hospital with alcohol intoxication seems to have dropped already.

“In the first days after it was banned we saw more people suffering from withdrawal symptoms because they could no longer get the sachets,” says Nurse Alice Phiri. But now she sees the number has dropped.

“Of course Kachasu is still there, but that is sold in bigger, more expensive bottles and is not so easy to carry,” she explains. “I have worked here for more than 20 years. Before tujilijili, when we only had kachasu, such patients were rare.”

“My own son, who also used to work here, was fired because of abusing alcohol. I salute the government for banning these things,” she adds.

But the manufacturers and traders of the sachets have not given up and are still fighting the decision to ban tujilijili in court.

*Published courtesy of www.street-papers.org /INSP

“I had no power, I could not even walk. I just had to be lifted by someone. When bathing, when going to the toilet, when going anywhere,” Geoffrey Mwila says in a soft voice.

AIDS patient Geoffrey Mwila, with palliative care nurse Mercy Ng’andwe by his bedside at the Mother of Mercy hospice in Chilanga, Zambia. Credit: Jorrit Meulenbeek

“Things were very bad with him,” recalls sister Mercy Ng’andwe, the palliative care nurse who currently takes care of him at the Mother of Mercy hospice in Chilanga, just outside Zambia’s capital Lusaka. “When he first came in, we did not even know if he would still be there tomorrow.”

After receiving proper antiretroviral and pain medication, as well as exercises and massage therapy for his weakened legs, Mwila is now able to walk again. “I can’t go very far, but at least I can go alone.”

Expanding access to palliative care

Hospices like Mother of Mercy have been on the forefront of providing palliative care in Zambia ever since the HIV epidemic rose in the early 1990s. By then, anti-retroviral medicines were not yet widely available and the public health sector struggled to cope with the large number of patients, so hospices founded by the churches had to fill the gap.

The Palliative Care Association of Zambia (PCAZ), formed in 2005, is now working to make good quality palliative care more widely available. This is not only for people who are very close to death, as people often assume.

“Palliative care starts from the moment you are told: this disease cannot be cured,” says Njekwa Lumbwe, national coordinator of the association. “With ARV’s you can prolong life, but it should also be a quality life.”

In addition to the emotional pain that often follows being tested positive, both the virus itself and the treatment using ARV’s are known to cause so-called neuropathic pain in patients.

In a 2008 survey on the state of palliative care in Zambia, the association found that pain was the main complaint for 87 percent of patients in Zambia, while 98 percent of health workers lacked the skills to assess and deal with pain properly.

In Zambia, drugs for pain relief such as morphine have been used on a very small scale so far, but the association, with support from the UK-based True Colours Trust Charity, has been implementing a two-year morphine pilot project to supply and familiarise health workers with the drug. It is hoping to continue this programme, which has so far been successful, if further funding can be found.

Training and sensitising public health workers, caregivers, community workers and pharmacists is the association’s main way of expanding palliative care.

Learning to deal with pain

“It has changed my perspective,” says Vera Kafuenku, a young nurse who has just attended a three-day workshop on pain management organised by the Palliative Care Association.

“If a patient is in pain, we just give them paracetamol. That is the routine,” she portrays the current situation at the hospital in Choma where she works.

“In our mind, morphine was a killer drug, we feared to use it,” says Kafuenku.

“It has always been highly controlled,” her fellow participant Zangi Mululu adds.

In his own ward at University Teaching Hospital, Lusaka’s largest general hospital, Mululu feels confident to just increase the dose of morphine whenever a patient needs it, but he knows in many other wards nurses would not dare do so without prior approval of a senior doctor. “Some would end up having to leave a patient in pain for the whole night.”

The training does not deal with physical pain alone. “We work under pressure and have to see a lot of patients, so we do not always have time to think of a patient’s other needs apart from the physical,” admits workshop participant Mululu. “But I learnt palliative care is done by a team, and we can also refer them to a counsellor or a priest for their emotional or spiritual needs.”

Vera Kafuenku feels it is their responsibility as nurses to at least diagnose those needs, “Because we are the ones who spend most time with the patients and see them every day.” At the hospital where she works she will now be involved in setting up a palliative care team. “It is now up to us to take this further.”

Giving people hope

“Yes, we will all die, but we want to give people hope,” says PCAZ coordinator Lumbwe. “And that is not false hope, because people are not dead until they have died. I was touched by Steve Jobs, who never gave up and still continued to change the world of technology even though he was sick.”

Geoffrey Mwila, still spending most of his day in bed at Mother of Mercy hospice, is now also hopeful again. Before he fell sick, he was running a shop in farming supplies, which he was forced to abandon. But now he has managed to recover this far, he dreams of getting back to his business one day soon.

“It will be difficult,” sister Ng’andwe says, when asked about Mwila’s future after he will be discharged. “I think he has no family to care for him at home.”

But luckily for him, palliative care does not end at the door of the hospice. “We will keep checking on him and visiting him, to make sure he is doing fine.”

*Published under an agreement with Street News Service.

Excerpt:

Peggy Kapanda has bad memories of the time she spent living with her uncle when she was young. She was treated as a second-rank child. But this only motivated her to do a better job herself. At her small home in John Laing compound, in Zambia’s capital Lusaka, she and her husband take care of two other children in addition to their own three young boys.

Peggy Kapanda with her extended family: her own three sons and two young cousins she has also taken into her home. Credit: Jorrit Meulenbeek/SNS

“They are my aunts’ children,” says Kapanda. Dorothy, now in the last year of high school, was unable to go to school in the village where she stayed. The nearest school was far away, and after her father died her family had no financial means to send her there.

For Kapanda, a teacher by profession, taking the girl in was a natural thing to do. “Staying there in the village, without going to school, she would have been married now, with I don’t know how many children. I feel pity for these children who have no school, no future.”

While her aunt is grateful, Kapanda finds a lot of people in town do not understand her action. “They see it as wasting money. Why do I educate these children when they won’t even stay around to take care of me later? But that is not why I do it.”

Taking care of distant family members beyond your own small family unit used to be common in Zambia, like in most African cultures. No matter how poor one may be, people are still expected to take responsibility for others in their extended family.

In Zambia, a proverb in the Bemba language captures it well: “Clothes can be too small, but food can never be too little to share”. But in recent years this culture has slowly been changing, as people start to see the disadvantages of this system.

Changing circumstances, changing attitudes

Jack Kampole, a communications consultant and video producer who runs his own company in the capital Lusaka, recognises the tensions and pressure that come with family expectations. Through hard work, he has managed to build his own house in Makeni compound for his wife and his two kids.

“Before I was married I was already working. I told my brothers: this is the time I can help you pay school fees and everything. But now I am married I have my own family to take care of. I have to make my own plans.”

He currently has one of his younger brothers staying with him, but some family members feel he would be able to do more, and that his big house has plenty of space for more of his brothers.

Collins Phiri, who came to Lusaka from the Copperbelt province looking for business opportunities, experienced the same thing.

He is now setting up his own taxi business, and feels that if you want to make a career for yourself, it is best to move out of the town where you have your family, because once you start making money, the demands and requests for assistance you get from family members will hold you back, leaving you with little money to save and invest in your own business.

Social welfare organizations and churches have been calling for a return to the extended family system, especially as a way to take care of the country’s enormous number of orphans.

As a result of the AIDS pandemic there are between 750,000 and 1.2 million orphans in Zambia, according to the HIV/AIDS National Strategic Framework 2006-2010. A survey done in Kitwe, Zambia’s second largest town, revealed that almost 20 percent of children under 14 did not live with their parents.

“In our family tracing surveys for orphans and street children we have had many cases where we ended up finding the relatives”, says Teddy Masuwa. He works for Macnet Zambia, an organisation providing counseling and activities for street children, but also trying to reconnect them to their families.

“But in many cases the relatives refused to take the child,” Masuwa says.

“People think: you are an NGO, you must be getting a lot of money from donors, why don’t you take care of them?”

Masuwa sees this attitude especially in towns. “In rural areas the extended family system still works, because there families require a lot of manpower. If there is an orphan boy, an uncle will just say: come here, so he can help in cultivating the land. But in town, people don’t see a benefit. They will only see their salary getting smaller.”

Masuwa blames it on the culture of capitalism, replacing the spirit of “African humanism” that former president Kenneth Kaunda promoted for 27 years after independence. “We were used to staying together. We never knew aunties or cousins. Everybody was your mother or your brother,” he recalls.

“Nowadays most people think they will do better when they just focus on their own business, but I don’t think that’s true. We need each other for development.”

* Published under an agreement with Street News Service.

Staying in Chawama, a compound outside Zambia’s capital Lusaka, I spent many an evening chatting to the local women as they sat outside and cooked on their charcoal braziers. It intrigued me how a lot of the gossip would come back to one topic: the importance of ‘chinamwali’, the traditional initiation training most Zambian women go through before they get married.

Drumming at a chinamwali session. Credit: Jorrit Meulenbeek/INSP

From the way things sounded, this is the key to a successful marriage, but during our chats the women never quite revealed what is actually taught during these mysterious ceremonies. Of course I grew more and more curious, and when I finally got the opportunity to attend one, I did not have to think twice.

After paying the entrance fee of 2,000 Zambian kwacha, less than half a dollar, I walked into the small, dark living room. It had just one window and the furniture had been shifted to the side. It was cramped with women of different ages, from old senior teachers to recently married matrons, and of course a handful of fellow students.

In the corner two ladies were seated, holding large drums. The door was closed behind me, and while I was still trying to gauge the atmosphere, the ladies started undressing, some just pulling up their shirts to reveal their bellies, while others remained with only their underwear and a ‘chitenge’ cloth wrapped around their waist.

Without any further introduction, the drums started beating and the women burst out in song. The drum beats were so intense and loud that I could physically feel them, as the ladies all started shaking to the rhythm in sync, instructing us to copy them.

As I watched the more experienced ladies dance, tilting their waists independently of the rest of their bodies, I really did not think my body was capable of doing such. But as I struggled to imitate, the old ladies would come to stand behind me, holding my thighs to make sure only my waist would be free to move.

“No, no, you’re doing a Shakira,” they said when I would still be shaking too many other parts. When I finally managed to get it right, they clapped and cheered with excitement.

Bridget Banda, who went through this training before she got married three years ago, looks back on it as a very positive experience. “I have grown because of it. I see more maturity in myself. Now, when I see women who did not go through it, I think I am much better off.”

She feels most Zambian men want a woman who is initiated. “Did you not go through training?” is a commonly heard remark from men scolding their wife. In some cases disappointed husbands even end up sending their wives back to be taught more, one of the worst possible embarrassments for the family.

“Most men know what to expect of a woman before they get married,” Banda explains. “So when their wife does not live up to that, they end up having affairs.”

That is one of the main risks of not going through initiation, says Florence Mutambo, one of the experienced ‘banacimbusa’ who are teaching me. “If you do not know how to please you husband in bed, he might just end up going to a prostitute,” she puts it plainly. “Those people are professionals at these things, so he will be much better off there.”

The first minutes of this quite explicit training were pretty awkward. Some of my fellow students and teachers would really get into it, almost as if they were actually in the act. But when I looked around, everybody else seemed quite comfortable. Shy and reserved as Zambian ladies may be about these issues in public, inside this room the atmosphere was amazingly free and open.

“I am going to try this with my husband tonight,” one lady said. “My husband never likes it when I do this,” complained another, after which one of the old ladies would give some more tips and tricks on how to do it better.

The next day I learned even more moves and skills, like how to shave my husband ‘down there’.

After making sure the door was shut, there was nobody peeking through the window, and stressing “this is only for the bedroom, this is only for your husband,” one of the matrons started giving a detailed demonstration of how all the moves we had learned are used in context. Holding her imaginary husband in every imaginable position, she went on for more than fifteen minutes, while the other women clapped and threw money at her in appreciation.

The way lovemaking was turned into a series of dance moves made it more abstract and fascinating to watch. It was nothing like a porn movie, but more like being in a theatre and watching a fine art performance. I could only admire these women, who have almost perfected this skill.

Before I came here, I would not have believed it was possible for women of different generations to freely share such intimate knowledge on this level. It really functions as a social and educational platform, and the way we bonded made it into a great experience. Looking back, even though my leg muscles tell a different story, I would never want to have missed this.

* This article first appeared on the Street News Service