This post begins with our voyage atop Chinongu Mountain Sunday evening. It is really just a large, bouldery hill, but my super graceful climbing skills (ha) made it much more difficult than necessary- I now have minor battle wounds to show for it. Free souvenirs! Hope you enjoy the view we posted :)
So far this rainy week we've had a very busy time at the hospital:
Hearing about the weekend events at the hospital on Monday morning was quite shocking. We learned that on Saturday there had been a double mini-bus accident on the main road when one mini-bus tried to overtake another right by Chinongu (which isn't surprising considering the driving we've witnessed here!). Sadly, 4 people died in the wreck- one a mother of a 3-mos child. Luckily, the child was unharmed in the accident. Someone also saw a man covered in blood running from the scene of the accident, assumingly the driver of the bus. However, the staff of Ekwendeni Hospital on-call and at home came together and worked very well through the trauma, allowing no deaths in any passengers brought here. Also, we learned that a child died in the ward on Friday evening. This was upsetting because we had rounded on her in the morning and, in fact, her case was not very rememberable because she had no issues at the time and no hint of decompensation. Two tragedies.
Seeing new patients this weekend has been very interesting. On Monday we US scanned a woman 20-weeks pregnant, diagnosed with malaria, who had been having vaginal bleeding and contractions for 2 days. Although we found a fetal heart rate, it was slow. There were no fetal movements and no amniotic fluid, indicating that a miscarriage was inevitable. We just had to wait. However, the heart was still beating (with decelerations) on Tuesday and she had actually stopped having contractions, but when we scanned her again today (Wednesday), there was no longer a fetal heartbeat. It was difficult news to deliver (and to receive, I'm sure). Now labor would be induced to avoid any septic complications.
In the children's ward this week have been some more sad cases. One child with cerebral palsy was diagnosed with malaria and malnutrition- he is 4 years old and weight 8 kg! It has been very difficult to assess his feeding ability both orally and through his NG tube. Its funny- at home we worry about levels of functioning in children with cerebral palsy, but the largest issue here is simple nutrition. We also discovered that another child we have been following for the past week was HIV positive (we simply screened him because there were tests available, not for any reason in particular), as well as his mother. I can't imagine what him and his mother have been going through. Just imagine- bringing your child to hospital because he is deathly ill with sepsis, but watching him improve over the course of the week until he is ready to nearly go home, then discovering that both you and him are HIV positive and that your three-year-old son will need to start antiretroviral therapy now, which he will continue for life, and you may need to start medication soon as well. It breaks our hearts. We actually discovered two HIV positive children through routine screening this week.
On Tuesday there was fuel for the mobile clinic! At 9:15am we were told they would be leaving at any minute, so Julie and I rushed over, ready to go. But typical Africa time, we were FINALLY on the (very bumpy) road to Luhomero village by 11am (after stopping once for a live chicken - lunch! - and once for vegetables and rice at the market). The "clinic" was really an empty building with 4 empty rooms, but was crowded with mothers and their babies waiting to be seen. Children were weighed (by hanging them on a hook with fabric pieces), screened, and received various immunizations. Unfortunately, Julie and I were not extremely helpful talking to the young mothers (in the villages hardly anyone knows English, and we only know how to ask a few questions in Chitambuka which are only helpful with yes or no answers). However, we did perform the antenatal exams on the expecting mothers- weight, blood pressure, gestational age, fundal height, and listened for fetal heart tones- with a hollow hourglass contraption, not Doppler! Its definitely a learned skill, but we are just starting the get the hang of it. We also were able to give a couple vaccinations, so we weren't totally un-useful! It was a great experience and we were very glad there was fuel to go that day!
Now this morning was the most interesting day so far. After rounding in the children's ward with Anneke, a man came into the rounding room and sat down in front of Julie and proceeded to hand her a small package with what looked like teeth in it and then began to take off his pants. Something was wrong with him (drunk? mentally ill?) and we quickly rushed him AWAY from the children and to the outpatient department. Then a man was brought in who had been hit by a taxi as he was walking alongside the road. He was clearly bleeding internally, so we did what we could and sent him to the larger surgery-capable hospital in Mzuzu... by taxi! (The ambulance had left, but no worries, Dr. Jack accompanied him to Mzuzu in the taxi and stayed with him until they took him to the OR for a splenic laceration). Then we US scanned the pregnant woman described earlier, then another pregnant woman for gestational age, although she "guessed" (correctly) she was about 9 months, and then another patient who had been diagnosed with pancreatic cancer and had some operation, but was now experiencing abdominal pain again. Julie and I thought we had been becoming more comfortable with ultrasound throughout this year, but due to the operation and cancer, this gentleman's abdomen was a mess. It was very difficult to identify normal structures and landmarks. It was possible that the cancer had metastisized to the liver and that there was a large cyst near the pancreas- anotehr case in which a CT or PET scan would be more than helpful! Lastly, we returned to Children's ward to check on one child who was quite sick and nearly unconscious during rounds, but she had not improved with fluids, so we started antibiotics and I did an LP to rule out (hopefully) meningitis. There are no more glucose strips available to test her blood sugar, but hopefully the dextrose in her IV fluids will help. Another day where the lack of resources are just so pronounced. But I mention only the interesting cases, which are often the sickest cases. Over just the course of two and a half weeks, we've seen hundreds of patients get well again. Mickie is not an exception! While we can constantly comment on Malawi health care, one of the poorest of the resource-poor countries, we can also celebrate the healing that occurs in hospitals like this one. Everyone is just doing their job with what they have- and very well!
Oh, and one last disappointing (albeit humorous) comment to leave you with, Julie and I ONCE AGAIN bought "mangoes" at the market only to discover that, yes, they were, in fact, avocadoes. Fool us twice, shame on us. Maybe we are lacking some mental resources here...
Wednesday, February 29, 2012
Five Things: A World Away
There isn't a real "theme" for this edition... just a random assortment of insights:
1) Sightings from Home
It's amazing how even the smallest glimpse into our lives at home excites us. Stevie has spotted a couple of old Philadelphia Eagles tees/jerseys and jumped into pictures with the person wearing them, and I have been patiently waiting for my moment of Cleveland glory. On Monday, I got my chance when I spotted a retro Cleveland Indians tee on my morning run (and not retro in the brand new, really expensive throwback way... retro in the worn out, this shirt has been worn every day since the 1980's way). Without my camera or Stevie there to verify the sighting, I suppose you could argue that it was just a mirage... but with the way that poor guy looked at me as I was frantically pointing at his shirt and squealing in a foreign language, I'm pretty sure it was real. Oh, and if I see someone in a "retro" Omar Vizquel jersey, I'll probably trade them the shirt off my back.
2) Lunch on the Road
To us in America, this means grabbing a granola bar and a banana... or maybe packing up a PB&J if we're not too rushed on the way out the door. In Malawi, this means loading up a car filled with 11 people and then making two stops on the way to the village clinic: the first to buy a chicken, and the second to buy vegetables and rice at the market. Then we drove 40 minutes to the village clinic and saw patients for 2 hours. Meanwhile, 2 women came with us just to prepare lunch - they built a fire, killed the chicken, and cooked everything over a fire 10 feet from where we were giving children measles and polio vaccines. When we finished seeing patients, we all sat around outside and ate... with our hands. Then we washed dishes, piled back in the car, and drove back to Ekwendeni. The whole process of buying a live animal and transporting it with you to the place where you will kill eat it was a little strange... but on the upside, at least we knew it was fresh!
3) Singing
Everyone sings here. There were at least 5 different choirs in church the first time we went, and probably 3 or 4 this week. Just outside our guesthouse window, there is a building where all of the choir groups practice throughout the week - this makes for lovely background music when we're hanging out in our rooms in the evening! Bible study each week starts with everyone joining together for a few songs, and even the people out jogging are singing as they pass us. When they ask us if we sing, we're honest with them - yes, we sing, but no one likes to listen! They tell us that everyone can sing, and that seems to be true when it comes to Malawians!
4) How to Attract a Crowd
Whether it be doing lunges across an empty soccer field, riding in a minibus, or going for a jog, Stevie and I always seem to have curious followers...usually children. Yesterday we drove past a primary school 100 meters from the outreach clinic we were heading towards, and within 3 minutes of getting out of the car, over 50 children from the school had wandered over to us for a closer look. Last week we were up early doing a workout on an empty netball court, and there were one or two children cutting the grass when we started. (Side note: when I say "cutting the grass", I mean using scythes that cut approximately 10 blades at a time.) By the time we finished our workout, over 20 kids had gathered to help cut the grass... somehow I doubt that they are usually so eager to do chores at 6:30am!
5) Wearing Many Hats
Everyone here seems to have multiple different jobs. The lady who we usually see cleaning the hospital floors was the same woman who came with us to the outreach clinic yesterday and cooked our lunch. People who work in the hospital also hold positions in the church and in village shops. Beyond their usual work, the Malawian people have a real sense of unity and are very willing to take on additional responsibility when others are unable to do so. Both responsibities and rewards are shared among many, which is a refreshing change from our more private Western ways!
1) Sightings from Home
It's amazing how even the smallest glimpse into our lives at home excites us. Stevie has spotted a couple of old Philadelphia Eagles tees/jerseys and jumped into pictures with the person wearing them, and I have been patiently waiting for my moment of Cleveland glory. On Monday, I got my chance when I spotted a retro Cleveland Indians tee on my morning run (and not retro in the brand new, really expensive throwback way... retro in the worn out, this shirt has been worn every day since the 1980's way). Without my camera or Stevie there to verify the sighting, I suppose you could argue that it was just a mirage... but with the way that poor guy looked at me as I was frantically pointing at his shirt and squealing in a foreign language, I'm pretty sure it was real. Oh, and if I see someone in a "retro" Omar Vizquel jersey, I'll probably trade them the shirt off my back.
2) Lunch on the Road
To us in America, this means grabbing a granola bar and a banana... or maybe packing up a PB&J if we're not too rushed on the way out the door. In Malawi, this means loading up a car filled with 11 people and then making two stops on the way to the village clinic: the first to buy a chicken, and the second to buy vegetables and rice at the market. Then we drove 40 minutes to the village clinic and saw patients for 2 hours. Meanwhile, 2 women came with us just to prepare lunch - they built a fire, killed the chicken, and cooked everything over a fire 10 feet from where we were giving children measles and polio vaccines. When we finished seeing patients, we all sat around outside and ate... with our hands. Then we washed dishes, piled back in the car, and drove back to Ekwendeni. The whole process of buying a live animal and transporting it with you to the place where you will kill eat it was a little strange... but on the upside, at least we knew it was fresh!
3) Singing
Everyone sings here. There were at least 5 different choirs in church the first time we went, and probably 3 or 4 this week. Just outside our guesthouse window, there is a building where all of the choir groups practice throughout the week - this makes for lovely background music when we're hanging out in our rooms in the evening! Bible study each week starts with everyone joining together for a few songs, and even the people out jogging are singing as they pass us. When they ask us if we sing, we're honest with them - yes, we sing, but no one likes to listen! They tell us that everyone can sing, and that seems to be true when it comes to Malawians!
4) How to Attract a Crowd
Whether it be doing lunges across an empty soccer field, riding in a minibus, or going for a jog, Stevie and I always seem to have curious followers...usually children. Yesterday we drove past a primary school 100 meters from the outreach clinic we were heading towards, and within 3 minutes of getting out of the car, over 50 children from the school had wandered over to us for a closer look. Last week we were up early doing a workout on an empty netball court, and there were one or two children cutting the grass when we started. (Side note: when I say "cutting the grass", I mean using scythes that cut approximately 10 blades at a time.) By the time we finished our workout, over 20 kids had gathered to help cut the grass... somehow I doubt that they are usually so eager to do chores at 6:30am!
5) Wearing Many Hats
Everyone here seems to have multiple different jobs. The lady who we usually see cleaning the hospital floors was the same woman who came with us to the outreach clinic yesterday and cooked our lunch. People who work in the hospital also hold positions in the church and in village shops. Beyond their usual work, the Malawian people have a real sense of unity and are very willing to take on additional responsibility when others are unable to do so. Both responsibities and rewards are shared among many, which is a refreshing change from our more private Western ways!
Monday, February 27, 2012
Disclaimer
This blog is supposed to document and celebrate our amazing experiences in Malawi. We are sharing our patient stories so that you can follow our incredible hospital encounters in the most accurate light possible, but the real names and details of some of the patients have been changed for their privacy. In addition, no pictures of the hospital wards or patients will be posted without permission from hospital staff or patients.
This being said, every Malawian we have encountered has been thrilled to have their picture taken and their story shared. We hope you've enjoyed reading so far!
We also sincerely apologize for butchering the spelling of the names of many people mentioned in this blog- especially the Dutch!
This being said, every Malawian we have encountered has been thrilled to have their picture taken and their story shared. We hope you've enjoyed reading so far!
We also sincerely apologize for butchering the spelling of the names of many people mentioned in this blog- especially the Dutch!
Dr. Anneke's children - Maria, Thomas, & Ruth
 |
| (I know this pic is a little messed up but I will try to fix it later!) Stevie and I were lucky enough to spend Sunday morning after church at Anneke and Martin's house. We played with their 3 beautiful children and munched away on popcorn, brownies, and cookies. Best of all, Anneke told us the next day that they ask their kids every night at bedtime "what was your favorite part about today?" and their response was..... "when the students came to play with us!" |
Chimongu Mountain
Our little hike turned into climbing Mt. Chimongu with Sweetman (really its a big rocky hill just on the edge of town). But don't worry, I still found a way to skid a couple feet down a rockface and scrape up my wrist, leg, and ankle. But it was totally worth the view from the top! Behind us you can see the town of Ekwendeni and even some surrounding villages and mountains.
Chibambo Guesthouse
Sunday, February 26, 2012
Wedding Crashers
Wednesday and Thursday were quiet at the hospital. We tried for several days to go on one of the Mobile Clinics into the local villages, but there have been fuel issues in Malawi lately and there was none to operate. (Mickie is doing great, by the way! Just breastfeeding away every time we check on her!)
Wednesday night was Bible Study at at a Dutch couple's house, Marika and Djerck (pronounced w/ a "Ch" sound, not "J"!). Focused on some Lent-related passages. We sang and prayed and discussed. It was really
nice!
On Thursday we did see a couple interesting patients. One child was extremely malnourished child with severe Kwashiorker's. She had the bloated belly, swollen hands and feet with weeping blisters and some open wounds from blisters that popped, downy hair, and not to mention scabies all over her body. The mother says they have enough food at home, but there is some social situation that we can't get a handle on. 2 of
4 of the child's siblings have died. It was really sad. Dr. Annika even teared up a little after the patient and mother left the room. Even by Malawian standards, this child was SO not healthy and not clean. Such compassion. We also watched a baby being born! Walked into the room just as its head was almost fully out. The midwife student, Claire, only had time to get on one glove! The interesting thing was that the baby was almost born in the amniotic sac- her membranes didn't rupture until nearly the shoulders were out! Very different from our previous OB experiences. The midwives also speak up if the parent wants to name their newborn something funny- they are simply told "Nope, you can't name him/her that!" This is how one midwife students had a baby named after her- might be one of the only Malawian Jennys!
We planned a half day for Friday in order to head to Nkhata Bay, so of course it was the busiest day at the hospital. We spent all morning helping Carol round in the Children's Ward. It seemed like every time we finished one admission, there was ANOTHER child with severe malaria who needed a blood transfusion! Another patient presented to the female ward, which Dr. Summers definitively diagnosed as a stroke based on physical exam and history alone! That's what you have to do with limited resources. No imaging. Could only put her on oxygen, monitor her blood glucose & blood pressure, and maybe slip her some aspirin if she becomes conscious enough to swallow. That's all.
We finally got on the road to Mzuzu, stopped at the bank and post office and our new Mzuzu buddy, Donald the Duck, set us up us a taxi ride to Nkhata Bay. Just otuside Mzuzu a Malawian woman passenger made the taxi stop so she could stop at a small stand where we picked up a couple other passengers, of the poultry variety. Yes, we had an hour car ride with live chickens in a plastic bag squawking away. At one point they did calm down- either they were sleeping or suffocating... Malawian drive-thru dinner! But it was still a really pleasant trip, driving through the mountains, listening to reggae and a Zambian song about Facebook.
Got to Mayoka Village in Nkhata Bay just in time for a quick swim before dark. Feasted at the DELICIOUS BBQ buffet- salad, avacados, Morrocan carrot salad, potato chips, breaded eggplant, veggie
sausages, beef kabob, spinach cooked in peanut flour, potato sald, honey BBQ chicken, and, Julie's favorite, the chilli bites. Spent most of the evening chatting with Nick and Zuflaa, a couple from Sydney who
are on a 4 YEAR trek through Africa which they started at the World Cup in South Africa. They've already backpacked South America and Southeast Asia some years ago. They plan to finish their trip in
Greece in 2014 to get married at Nick's grandfather's castle! Crazy, right? They stay in one place for several months to earn money as they go- Zuflaa works as a bartender and Nick is a chiropracter/
acupuncturist who does free-lance work, even getting room and board in exchange for treatments! We also met Clyde and Anthia, a couple from Derbyshire, England who are here for a wedding. One of the Malawian Mayoka staffers, Benji is marrying an English girl, Eimei (pronounced "Eema"), on Saturday AT Mayoka Village! They actually met 10 years ago when Eimei was volunteering as a secondary school English teacher during her gap year and visited Nkhata Bay one weekend! Things just tend to work out in Africa like they're supposed to. Now she lives here permanently- they actually just built a house just a little
down the bay from Mayoka Village.
Saturday morning was pretty lazy. It had thunderstormed all night and was still raining in the morning, so we didn't get the sunshine we were hoping for. Julie and I were planning on leaving in the afteroon to get back to Ekwendeni Saturday night for church on Sunday, but how could we pass up partaking in a Malawian wedding?! Once again, the decision was easy to stay an extra night.
We read on our lakefront porch then headed to the deck for breakfast where they were already setting up for the wedding. Clyde, Anthia, and Suzie (the bride's mother) recruited us to move tables and twist
fabric for decorations while we waited for our food- suddenly we were practically part of the wedding party! Which paid off later because we had prime seats for the reception). Then the actual wedding party left on a boat, with an army of brightly colored umbrellas, for the ceremony on a private beach. Julie and I took the time to swim across the entire bay and back. It was a great swim and we made it back in time for the reception...which included Benji's entire village, including the chief, crowdingon the Mayoka deck. Thats about 150 people on a deck meant for, hmm, 50, max?
But it was FANTASTIC. Great food, great festivities. The reception started out with speech's by the brides parents and the groom's father (done in both English and Tambuka with the help of the translating
priest). A close friend of Benji (who looked straight of out of Jackson 5 with his fro and plaid get-up) serenaded them with the guitar and another Mayoka regular, Wonder, read them a poem he wrote
(we've heard several of Wonder's poems during our Nkhata Bay visits-he's really good actually. And in case you're wondering, yes I took a picture with him- of Stevie & Wonder).
Then, it traditional Malawi fashion, the crowd threw money at the bride and groom. This consisted of music playing (the Facebook song- twice!) and people dancing their way to the front of the room and tossing
money in a big bowl in front of the newlyweds. It was HILARIOUS. Especially when people asked for change out of the bowl. We were cracking up.
The reception ended around 6 and most of Benji's village headed home- that's when the party really got started. Lot's of music and dancing. Everyone had a great time! We met Benji's great uncle who was the
village elder at the ripe old age of 81. He had a little photbook he carried with him of pictures that had been sent to him from previous traveler's. It was really cool. He also had a picture of his father,
one of the first men in Malawi to practice medicine! Thie highlights of the night include one local, Charles nicknamed MJ for his dance moves, going crazy whenever an American song popped up on the ipod,
another Malawian who danced the night away balancing a beer bottle on his head, and, best of all, a private reggae concert. This guy was real good. The crowd favorite was a song about Lake Malawi itself:
How big is the Lake?
I said the Lake is SO big.
How big is the Lake?
Its SO big! SO big!
How big is Malawi, yeahhh?
We got really into it. One of the verses consisted of him giving the true dimensions of the lake. I tossed in a line about over 600 endemic species, which he, while in song, corrected me to 740 endemic species. I don't usually like being wrong, but it was well done.
All in all, we made the right choice to stay for the wedding festivities. WHAT a day, despite the rain. And we even hitched a taxi early this morning back to Ekwendeni and made it back in time for the English Church service! Then we were invited for coffee at Annika and Martin's house where we got to play with their 3 frickin' adorable children- Thomas (6), Mariah (4), and Ruth (1). The best part? Annika served us brownies, popcorn and... cheese! Its a little rainy and muddy here today, but we are gonna try to go on a hike later this afternoon.
Everyone we've met has said 1 month is too short of a visit Malawi. Now we get it. So much more to do, to see- its hard to accept we are over halfway through this journey. SO big! SO big!
Wednesday night was Bible Study at at a Dutch couple's house, Marika and Djerck (pronounced w/ a "Ch" sound, not "J"!). Focused on some Lent-related passages. We sang and prayed and discussed. It was really
nice!
On Thursday we did see a couple interesting patients. One child was extremely malnourished child with severe Kwashiorker's. She had the bloated belly, swollen hands and feet with weeping blisters and some open wounds from blisters that popped, downy hair, and not to mention scabies all over her body. The mother says they have enough food at home, but there is some social situation that we can't get a handle on. 2 of
4 of the child's siblings have died. It was really sad. Dr. Annika even teared up a little after the patient and mother left the room. Even by Malawian standards, this child was SO not healthy and not clean. Such compassion. We also watched a baby being born! Walked into the room just as its head was almost fully out. The midwife student, Claire, only had time to get on one glove! The interesting thing was that the baby was almost born in the amniotic sac- her membranes didn't rupture until nearly the shoulders were out! Very different from our previous OB experiences. The midwives also speak up if the parent wants to name their newborn something funny- they are simply told "Nope, you can't name him/her that!" This is how one midwife students had a baby named after her- might be one of the only Malawian Jennys!
We planned a half day for Friday in order to head to Nkhata Bay, so of course it was the busiest day at the hospital. We spent all morning helping Carol round in the Children's Ward. It seemed like every time we finished one admission, there was ANOTHER child with severe malaria who needed a blood transfusion! Another patient presented to the female ward, which Dr. Summers definitively diagnosed as a stroke based on physical exam and history alone! That's what you have to do with limited resources. No imaging. Could only put her on oxygen, monitor her blood glucose & blood pressure, and maybe slip her some aspirin if she becomes conscious enough to swallow. That's all.
We finally got on the road to Mzuzu, stopped at the bank and post office and our new Mzuzu buddy, Donald the Duck, set us up us a taxi ride to Nkhata Bay. Just otuside Mzuzu a Malawian woman passenger made the taxi stop so she could stop at a small stand where we picked up a couple other passengers, of the poultry variety. Yes, we had an hour car ride with live chickens in a plastic bag squawking away. At one point they did calm down- either they were sleeping or suffocating... Malawian drive-thru dinner! But it was still a really pleasant trip, driving through the mountains, listening to reggae and a Zambian song about Facebook.
Got to Mayoka Village in Nkhata Bay just in time for a quick swim before dark. Feasted at the DELICIOUS BBQ buffet- salad, avacados, Morrocan carrot salad, potato chips, breaded eggplant, veggie
sausages, beef kabob, spinach cooked in peanut flour, potato sald, honey BBQ chicken, and, Julie's favorite, the chilli bites. Spent most of the evening chatting with Nick and Zuflaa, a couple from Sydney who
are on a 4 YEAR trek through Africa which they started at the World Cup in South Africa. They've already backpacked South America and Southeast Asia some years ago. They plan to finish their trip in
Greece in 2014 to get married at Nick's grandfather's castle! Crazy, right? They stay in one place for several months to earn money as they go- Zuflaa works as a bartender and Nick is a chiropracter/
acupuncturist who does free-lance work, even getting room and board in exchange for treatments! We also met Clyde and Anthia, a couple from Derbyshire, England who are here for a wedding. One of the Malawian Mayoka staffers, Benji is marrying an English girl, Eimei (pronounced "Eema"), on Saturday AT Mayoka Village! They actually met 10 years ago when Eimei was volunteering as a secondary school English teacher during her gap year and visited Nkhata Bay one weekend! Things just tend to work out in Africa like they're supposed to. Now she lives here permanently- they actually just built a house just a little
down the bay from Mayoka Village.
Saturday morning was pretty lazy. It had thunderstormed all night and was still raining in the morning, so we didn't get the sunshine we were hoping for. Julie and I were planning on leaving in the afteroon to get back to Ekwendeni Saturday night for church on Sunday, but how could we pass up partaking in a Malawian wedding?! Once again, the decision was easy to stay an extra night.
We read on our lakefront porch then headed to the deck for breakfast where they were already setting up for the wedding. Clyde, Anthia, and Suzie (the bride's mother) recruited us to move tables and twist
fabric for decorations while we waited for our food- suddenly we were practically part of the wedding party! Which paid off later because we had prime seats for the reception). Then the actual wedding party left on a boat, with an army of brightly colored umbrellas, for the ceremony on a private beach. Julie and I took the time to swim across the entire bay and back. It was a great swim and we made it back in time for the reception...which included Benji's entire village, including the chief, crowdingon the Mayoka deck. Thats about 150 people on a deck meant for, hmm, 50, max?
But it was FANTASTIC. Great food, great festivities. The reception started out with speech's by the brides parents and the groom's father (done in both English and Tambuka with the help of the translating
priest). A close friend of Benji (who looked straight of out of Jackson 5 with his fro and plaid get-up) serenaded them with the guitar and another Mayoka regular, Wonder, read them a poem he wrote
(we've heard several of Wonder's poems during our Nkhata Bay visits-he's really good actually. And in case you're wondering, yes I took a picture with him- of Stevie & Wonder).
Then, it traditional Malawi fashion, the crowd threw money at the bride and groom. This consisted of music playing (the Facebook song- twice!) and people dancing their way to the front of the room and tossing
money in a big bowl in front of the newlyweds. It was HILARIOUS. Especially when people asked for change out of the bowl. We were cracking up.
The reception ended around 6 and most of Benji's village headed home- that's when the party really got started. Lot's of music and dancing. Everyone had a great time! We met Benji's great uncle who was the
village elder at the ripe old age of 81. He had a little photbook he carried with him of pictures that had been sent to him from previous traveler's. It was really cool. He also had a picture of his father,
one of the first men in Malawi to practice medicine! Thie highlights of the night include one local, Charles nicknamed MJ for his dance moves, going crazy whenever an American song popped up on the ipod,
another Malawian who danced the night away balancing a beer bottle on his head, and, best of all, a private reggae concert. This guy was real good. The crowd favorite was a song about Lake Malawi itself:
How big is the Lake?
I said the Lake is SO big.
How big is the Lake?
Its SO big! SO big!
How big is Malawi, yeahhh?
We got really into it. One of the verses consisted of him giving the true dimensions of the lake. I tossed in a line about over 600 endemic species, which he, while in song, corrected me to 740 endemic species. I don't usually like being wrong, but it was well done.
All in all, we made the right choice to stay for the wedding festivities. WHAT a day, despite the rain. And we even hitched a taxi early this morning back to Ekwendeni and made it back in time for the English Church service! Then we were invited for coffee at Annika and Martin's house where we got to play with their 3 frickin' adorable children- Thomas (6), Mariah (4), and Ruth (1). The best part? Annika served us brownies, popcorn and... cheese! Its a little rainy and muddy here today, but we are gonna try to go on a hike later this afternoon.
Everyone we've met has said 1 month is too short of a visit Malawi. Now we get it. So much more to do, to see- its hard to accept we are over halfway through this journey. SO big! SO big!
Five (Dumbest) Things We've Done in Africa
To mark the halfway point of our trip, Stevie and I decided that we would like to share with you all the 5 silliest things we've done so far in Africa. Laugh away :)
1) Tipping
For me, figuring out how much to tip people other than waiters/waitresses is always a bit confusing. Do I really need to give the bellhop who carried my bag five feet $3? Do I tip the valet guy when I drop the car off AND pick it up or just when I pick it up? If it's stressful in America, imagine getting off the plane in Lilongwe, exchanging American dollars for Malawi kwacha, and then 10 seconds later having twenty cab drivers swarm you and offer you a ride into town. Another man who was basically an airport bellhop (although he was not actually employed by the airport, just trying to carry bags for some money) took our big bags, walked 20 yards and loaded them in the trunk, then turns to us and says "now you tip me." Scrambling to do conversions in my head, I hand him 40 kwacha. He flat out says "this is too small." Now I'm really caught off guard, so I do some quick math and realize that 40 kwacha is about a quarter. Embarrassed, I take out the only other type of bill I have, which is 500 kwacha. Doing the math in my head, I realize that it was about $3, and didn't think much of it until about a week later when someone told us that 500 kwacha is an average day's wages in Malawi...should have stuck with the 40 kwacha tip! On the flip side, one night Stevie and I were eating a a restaurant where our meals came to 400 kwacha each... we left 80 kwacha each on the table as a tip, figuring that was 20%. As we're walking down the street a couple minutes later, we see the waitress running towards us with the tip money waving in her hands. She gave us the money back and then left. Needless to say, we still have no idea whether we're supposed to tip in this country.
2) How to use a mercury thermometer
This seems self-explanatory to all you adults, but for us children of the digital generation, it's not so obvious. Stevie and I were helping collect vital signs in the pediatric ward one afternoon, and all of the digital thermometers were broken. The nurse handed us 2 mercury thermometers without any further instructions and we proceeded to go child to child checking temps. After about 4 children, I had noticed a strange pattern... all 4 of the kids had temperatures of 39.4 degrees Celsius. I turned to Stevie and asked her if she was having the same problem, and she said "yes, mine are all 38.5." Not sure if the thermometers were broken or if we were doing something wrong, we asked the nurse, who looked at us with an expression somewhere between shock and pity. She then informed us that you have to shake the mercury back down between uses....who would have known?! In retrospect, I have vague memories of my mom flicking her wrist with the thermometer when I was little, and I always just assumed she was waving it dry after cleaning it. What's even funnier is that even now, I always shake my DIGITAL thermometer dry instead of wiping it because that's how my mom always did it... little did I know that the wrist-flicking technique only applies to MERCURY thermometers.
3) Tomato, To-mah-to....Mango, Avocado?
Before we left America, we were told that mangoes would be in season in Malawi during our trip. By the time we arrived, we were craving mangoes, and went to the outdoor market in Ekwendeni to get some for dessert on one of our first nights. We didn't really see anything that looked exactly like the mangoes we buy from Giant Eagle, but we found something that was about the right size and shape and when we said "mango?" and pointed at it, the seller shook his head yes so we bought them. After dinner that night, we were about to cut into them when the night watchman came up to us and asked if we wanted a spoon. Confused, we asked how you eat a mango with a spoon, to which he replied "Those aren't mangoes. They're avocadoes." Turns out he knows his fruit, because those were two of the biggest avocadoes we've ever seen. A few days later, we tried again. We perused the market for awhile until we found someone who spoke English, and they pointed us in the direction of bowls fruit the size and shape of limes, which are actually mangoes. Stevie and I attempt to buy 2 mangoes for 50 kwacha each (30 cents-ish), thinking we're getting a pretty good deal.... and then the lady proceeded to dump two entire BOWLS of mangoes into our bag. Turns out we had gotten a pretty GREAT deal.... and also more mangoes than we knew what to do with.
4) Timing is everything
If tipping is confusing, trying to figure out which events you can be late for and which ones you actually need to show up on time for is a complete mystery. Stevie and I were invited to a Valentine's Day fundraising dinner for HIV/AIDS programs that started at 6 pm. We showed up fashionably late - 6:15 - and were literally the very first 2 people there. Our other mzungu colleagues from the hospital showed up around 6:30, and then the 6 of us stood there for over an hour until any Malawian people arrived. Literally no one came until 7:30. Figuring this was just the way things roll in Malawi, we decided not to show up at Bible Study the next night right at 7:30. We arrived around 8 (after getting lost in the dark and showing up at 2 wrong doors) and were the very last people there... they had already done 2 rounds of passage reading and discussion, and because of us the study leader had to read the entire Bible passage aloud again to get us caught up. Apparently we chose the wrong event to stroll in late.
5) To Pee or Not To Pee?
Stevie told you all in her blog about our visit to Lake Malawi last weekend, and how we decided to swim despite the 99% risk of getting "bilharzia" (aka shistosomiasis aka a gross parasite). We figured there is one easy pill you take 6 weeks after swimming and you're good to go. So after our first leisurely swim, our midwife friend Jenny starts talking about how she saw this show on TV where the parasites swim up your urethra while you're peeing in the lake. Stevie and I get really quiet all of a sudden, prompting Jenny to say "wait, you guys didn't pee in the Lake, right?" HOW DID NO ONE MENTION THIS TO US BEFORE WE WENT SWIMMING?!?! We were in there for like 4 hours! How did this not come up?! Anyway, we were pretty grossed out after that, but it kind of sounded like an old wives tale. As soon as I could get my hands on a textbook, I discovered that the parasites actually penetrate through skin, so no worries... at least Jenny has bilharzia now too ;)
1) Tipping
For me, figuring out how much to tip people other than waiters/waitresses is always a bit confusing. Do I really need to give the bellhop who carried my bag five feet $3? Do I tip the valet guy when I drop the car off AND pick it up or just when I pick it up? If it's stressful in America, imagine getting off the plane in Lilongwe, exchanging American dollars for Malawi kwacha, and then 10 seconds later having twenty cab drivers swarm you and offer you a ride into town. Another man who was basically an airport bellhop (although he was not actually employed by the airport, just trying to carry bags for some money) took our big bags, walked 20 yards and loaded them in the trunk, then turns to us and says "now you tip me." Scrambling to do conversions in my head, I hand him 40 kwacha. He flat out says "this is too small." Now I'm really caught off guard, so I do some quick math and realize that 40 kwacha is about a quarter. Embarrassed, I take out the only other type of bill I have, which is 500 kwacha. Doing the math in my head, I realize that it was about $3, and didn't think much of it until about a week later when someone told us that 500 kwacha is an average day's wages in Malawi...should have stuck with the 40 kwacha tip! On the flip side, one night Stevie and I were eating a a restaurant where our meals came to 400 kwacha each... we left 80 kwacha each on the table as a tip, figuring that was 20%. As we're walking down the street a couple minutes later, we see the waitress running towards us with the tip money waving in her hands. She gave us the money back and then left. Needless to say, we still have no idea whether we're supposed to tip in this country.
2) How to use a mercury thermometer
This seems self-explanatory to all you adults, but for us children of the digital generation, it's not so obvious. Stevie and I were helping collect vital signs in the pediatric ward one afternoon, and all of the digital thermometers were broken. The nurse handed us 2 mercury thermometers without any further instructions and we proceeded to go child to child checking temps. After about 4 children, I had noticed a strange pattern... all 4 of the kids had temperatures of 39.4 degrees Celsius. I turned to Stevie and asked her if she was having the same problem, and she said "yes, mine are all 38.5." Not sure if the thermometers were broken or if we were doing something wrong, we asked the nurse, who looked at us with an expression somewhere between shock and pity. She then informed us that you have to shake the mercury back down between uses....who would have known?! In retrospect, I have vague memories of my mom flicking her wrist with the thermometer when I was little, and I always just assumed she was waving it dry after cleaning it. What's even funnier is that even now, I always shake my DIGITAL thermometer dry instead of wiping it because that's how my mom always did it... little did I know that the wrist-flicking technique only applies to MERCURY thermometers.
3) Tomato, To-mah-to....Mango, Avocado?
Before we left America, we were told that mangoes would be in season in Malawi during our trip. By the time we arrived, we were craving mangoes, and went to the outdoor market in Ekwendeni to get some for dessert on one of our first nights. We didn't really see anything that looked exactly like the mangoes we buy from Giant Eagle, but we found something that was about the right size and shape and when we said "mango?" and pointed at it, the seller shook his head yes so we bought them. After dinner that night, we were about to cut into them when the night watchman came up to us and asked if we wanted a spoon. Confused, we asked how you eat a mango with a spoon, to which he replied "Those aren't mangoes. They're avocadoes." Turns out he knows his fruit, because those were two of the biggest avocadoes we've ever seen. A few days later, we tried again. We perused the market for awhile until we found someone who spoke English, and they pointed us in the direction of bowls fruit the size and shape of limes, which are actually mangoes. Stevie and I attempt to buy 2 mangoes for 50 kwacha each (30 cents-ish), thinking we're getting a pretty good deal.... and then the lady proceeded to dump two entire BOWLS of mangoes into our bag. Turns out we had gotten a pretty GREAT deal.... and also more mangoes than we knew what to do with.
4) Timing is everything
If tipping is confusing, trying to figure out which events you can be late for and which ones you actually need to show up on time for is a complete mystery. Stevie and I were invited to a Valentine's Day fundraising dinner for HIV/AIDS programs that started at 6 pm. We showed up fashionably late - 6:15 - and were literally the very first 2 people there. Our other mzungu colleagues from the hospital showed up around 6:30, and then the 6 of us stood there for over an hour until any Malawian people arrived. Literally no one came until 7:30. Figuring this was just the way things roll in Malawi, we decided not to show up at Bible Study the next night right at 7:30. We arrived around 8 (after getting lost in the dark and showing up at 2 wrong doors) and were the very last people there... they had already done 2 rounds of passage reading and discussion, and because of us the study leader had to read the entire Bible passage aloud again to get us caught up. Apparently we chose the wrong event to stroll in late.
5) To Pee or Not To Pee?
Stevie told you all in her blog about our visit to Lake Malawi last weekend, and how we decided to swim despite the 99% risk of getting "bilharzia" (aka shistosomiasis aka a gross parasite). We figured there is one easy pill you take 6 weeks after swimming and you're good to go. So after our first leisurely swim, our midwife friend Jenny starts talking about how she saw this show on TV where the parasites swim up your urethra while you're peeing in the lake. Stevie and I get really quiet all of a sudden, prompting Jenny to say "wait, you guys didn't pee in the Lake, right?" HOW DID NO ONE MENTION THIS TO US BEFORE WE WENT SWIMMING?!?! We were in there for like 4 hours! How did this not come up?! Anyway, we were pretty grossed out after that, but it kind of sounded like an old wives tale. As soon as I could get my hands on a textbook, I discovered that the parasites actually penetrate through skin, so no worries... at least Jenny has bilharzia now too ;)
Thursday, February 23, 2012
Mayoka Village, our weekend paradise in Nkhata Bay
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| Picture steep/irregular staircases connecting quaint chalets nestled into the hill. Also featuring beautiful featuring stone showers... and a compost toilet. |
Wednesday, February 22, 2012
Five Things: A Sparkle Of Hope
1) Road transportation
Getting around in Malawi is not always easy. There are lots of minibuses and so-called taxis, but as it said in the guidebook, they are "overcrowded, unreliable, and dangerous." Our trip to Nkhata Bay last weekend, which would take only an hour if you had your own car, took over two hours. The first leg of the trip (to Mzuzu) was in a minibus containing up to 12 people at times. We paid less than $1 for this ride, but since we were the first ones in the van, we had to wait around until it filled up. The second part of the journey (from Mzuzu to Nkhata Bay) was in a station wagon type taxi with 4 friends we've met here and 1 other Malawian man. This trip cost about $5 each. The crazy part about it was that we were pulled over at police checkpoints 3 times during the 1 hour trip and fined several dollars each time for random, minute reasons. Additionally, fuel here is extremely expensive... it comes out to almost $8.50 per gallon!!! Between the stiff fines and cost of
gas, it's actually amazing that any of the local people can afford to drive at all.
2) Simple Solutions
Before we left for Africa, two people gave us cheap international cell phones to use while we're here. However, one of them didn't have a charger, so I assumed that it would be worthless and left it at home. Similarly, we were asked to carry a package from a Malawian man living in Indianapolis to his father here in Ekwendeni. The package weighed about 8 pounds (which is a lot considering a suitcase must be less than 50 pounds!) and was sketchily taped shut, so we decided we had better open so it we would at least know what was in it in case someone from airport security asked. Inside were about 25 cell phones without chargers - we didn't see the point but brought them anyway. Now that we're here, we understand... there are cell phone charging shops called TNM set up all over the place. Because of this system, even people without electricity have cell phones. It's really an ingenious solution, and a good reason to donate old cell phones (even if you've lost the charging cord)!
3) Pancake Day
Yesterday we were invited to Dr. Carol Jack's house for "Pancake Day." At first, we thought she just really liked pancakes (and who doesn't?!), but then she explained that Pancake Day is a tradition in the UK on the Tuesday before Ash Wednesday. The idea is that people use up all the excess eggs/flour/etc that they will not need during Lent. There was also some talk about people doing races where they run and flip the pancakes in the pan... but only one person tried that! We told everyone at the dinner about Fat Tuesday and Mardi Gras in the US (leaving out a few choice details about how beaded necklaces are acquired), and then we each tried the pancakes. Actually, they were more like crepes, and toppings consisted of jams, mangoes, and honey. Although they can't hold a candle to Javorek family pancakes, they were still pretty delish :)
4) Clean water
Residents of Malawian villages spend a good deal of their time obtaining water. There are pumping stations along the side of the road, and women go there in the mornings to fetch water and carry buckets back on top of their heads. Water is often boiled for purification, but yet we've still seen patients in the hospital admitted with dysentery because their water source is a dirty stream. Stevie and I brought chlorine drops and a portable water filter to make sure we'd have clean drinking water, and even that task has become tedious after only 10 days. We jump at the chance to drink a Coke or a Fanta because it means we don't have to filter more water, and have really come to appreciate how easy it is to turn on a faucet back home.
5) How to hold onto the Sparkle
Much of this week, we have been in the pediatric ward focused on a very sick child named Mike. He had a complicated case of cerebral malaria, and had been seizing for over 24 hours when he came in on Monday. Throughout that day, his condition remained grim, and by the end of the day there was little hope that he'd make it through the night. However, Dr. Anneke told us that she still had what she called "a sparkle of hope." We thought about that patient a lot overnight, and were amazed and ecstatic to see that he was alive and improving the next day. Thinking about what Anneke had said the day before, we realized how resilient children can be. Was Anneke's hope stemming from the wisdom of a pediatrician who has seen similarly sick children survive, or is that "sparkle of hope" something that everyone can strive for?
Getting around in Malawi is not always easy. There are lots of minibuses and so-called taxis, but as it said in the guidebook, they are "overcrowded, unreliable, and dangerous." Our trip to Nkhata Bay last weekend, which would take only an hour if you had your own car, took over two hours. The first leg of the trip (to Mzuzu) was in a minibus containing up to 12 people at times. We paid less than $1 for this ride, but since we were the first ones in the van, we had to wait around until it filled up. The second part of the journey (from Mzuzu to Nkhata Bay) was in a station wagon type taxi with 4 friends we've met here and 1 other Malawian man. This trip cost about $5 each. The crazy part about it was that we were pulled over at police checkpoints 3 times during the 1 hour trip and fined several dollars each time for random, minute reasons. Additionally, fuel here is extremely expensive... it comes out to almost $8.50 per gallon!!! Between the stiff fines and cost of
gas, it's actually amazing that any of the local people can afford to drive at all.
2) Simple Solutions
Before we left for Africa, two people gave us cheap international cell phones to use while we're here. However, one of them didn't have a charger, so I assumed that it would be worthless and left it at home. Similarly, we were asked to carry a package from a Malawian man living in Indianapolis to his father here in Ekwendeni. The package weighed about 8 pounds (which is a lot considering a suitcase must be less than 50 pounds!) and was sketchily taped shut, so we decided we had better open so it we would at least know what was in it in case someone from airport security asked. Inside were about 25 cell phones without chargers - we didn't see the point but brought them anyway. Now that we're here, we understand... there are cell phone charging shops called TNM set up all over the place. Because of this system, even people without electricity have cell phones. It's really an ingenious solution, and a good reason to donate old cell phones (even if you've lost the charging cord)!
3) Pancake Day
Yesterday we were invited to Dr. Carol Jack's house for "Pancake Day." At first, we thought she just really liked pancakes (and who doesn't?!), but then she explained that Pancake Day is a tradition in the UK on the Tuesday before Ash Wednesday. The idea is that people use up all the excess eggs/flour/etc that they will not need during Lent. There was also some talk about people doing races where they run and flip the pancakes in the pan... but only one person tried that! We told everyone at the dinner about Fat Tuesday and Mardi Gras in the US (leaving out a few choice details about how beaded necklaces are acquired), and then we each tried the pancakes. Actually, they were more like crepes, and toppings consisted of jams, mangoes, and honey. Although they can't hold a candle to Javorek family pancakes, they were still pretty delish :)
4) Clean water
Residents of Malawian villages spend a good deal of their time obtaining water. There are pumping stations along the side of the road, and women go there in the mornings to fetch water and carry buckets back on top of their heads. Water is often boiled for purification, but yet we've still seen patients in the hospital admitted with dysentery because their water source is a dirty stream. Stevie and I brought chlorine drops and a portable water filter to make sure we'd have clean drinking water, and even that task has become tedious after only 10 days. We jump at the chance to drink a Coke or a Fanta because it means we don't have to filter more water, and have really come to appreciate how easy it is to turn on a faucet back home.
5) How to hold onto the Sparkle
Much of this week, we have been in the pediatric ward focused on a very sick child named Mike. He had a complicated case of cerebral malaria, and had been seizing for over 24 hours when he came in on Monday. Throughout that day, his condition remained grim, and by the end of the day there was little hope that he'd make it through the night. However, Dr. Anneke told us that she still had what she called "a sparkle of hope." We thought about that patient a lot overnight, and were amazed and ecstatic to see that he was alive and improving the next day. Thinking about what Anneke had said the day before, we realized how resilient children can be. Was Anneke's hope stemming from the wisdom of a pediatrician who has seen similarly sick children survive, or is that "sparkle of hope" something that everyone can strive for?
High Highs and Low Lows
Still coming off our buzz of such a great weekend, Monday was one of our toughest days in medicine to date. We basically spent the entire day watching helplessly as a 10-month old little girl struggled not to die.
Mickie came in Monday mornign seizing. Her mother and grandmother reported she had been convulsing since the day before... She was afrebile, but the most likely culprit was cerebral malaria. We've since this before- LP to r/o meningitis, IV Quinine, and you see that patient stop convulsing and start to improve. But Mickie didn't stop convusling. Not after several doses of anti-seizure medication. She was in status epilepticus and we couldn't stop it. |Then she started breathing less and less. There were no other new admissions in the hospital, so we spent the afternoon watching Mickie gasp for each breath (respiratory rate got down to 10), in between episodes of small fasciculations and larger tonic clonic convulsions, all the while contemplating the amoutn of brain damage this girl is going to have, even if she lives. Other than nasal cannula oxygen, there are is no airway support at Ekwendeni Hospital, and Mickie was too unstable to transfer. Back home she would have been intubated long ago. But we literally did EVERYTHING we could for her- Nasal O2, IV fluids, dextrose, anti-malaria drugs, antibiotics, anti-seizure medications (which we had to stop because of her depressed respirations...). Then we just watched her, hopelessly. She remained about the same- episodes of convulsions, respiratory rate of 10 for the rest of the day. There was a sparkle of hope, but both staff and family doubted this little girl would make it through the night. We went home for the usual workout on the footy field with a bunch of the little boys following us, email, dinner of pork & rice, shower, and bed- but Mickie was on our minds entirely.
Call it a miracle, God, or modern medicine, Mickie was alive Tuesday morning. We couldn't say that she had improved, but she was alive. Her respiration rate was up to 16. Her sugar was a little better controlled, as well as her convulsions, but she still remained unconcscious for the most part. She definitely looked strange and hyper-agitated. Its hard to explain, but if an old medicine man confessed to me that there was a child in the hospital filled with evil spirits- I'd pick Mickie out right away. She facial expression and movements were weird and jerky. She's alive, but something doesn't seem exactly right about this child...
But Tuesday brought us more patients- another young boy with seizures that didn't respond right away to anti-seizure medications (but ultimately improved with anti-malarials), an HIV patient in the male ward with possible cryptococcal meningitis. Julie and I joined a medical officer in the operating theater for 2 tubal ligations- done under LOCAL ANESTHESIA. That's right, women who are reading this blog, with just a little lidocaine, the surgeon sliced through the skin and abdomen, dug around until he found the fallopian tubes, tied them off, cut them off, tucked everything nicely back in the small but deep hole he'd created, and sutured the belly back up- all with the same piece of suture. These women must've REALLY wanted the surgery. One woman did end up getting general anesthesia because some adhesions on her uterus complicated the surgery, but the other patient got through the whole shebang with a little lidocaine- while crushing my hand in the process she was squeezing it so hard. But Mickie made it through Tuesday too.
Tuesday evening was very pleasant. I spent quite a while playing games with handful of local girls, about ages 8 through 10. We were playing hand games and they were teaching me some of their clapping songs. This brought me back to my days at Erlton Swim Club, me and Jeannie passing by the miserable minutes of adult swim with "Double Doube This This Double Double That That". If a young African girl comes up to you asking to play Double Double- I'm taking credit for teaching them! We'll see if it catches on... We also joined the Ekwendeni Team Mzungu (bascially all the whites in town plus the Malawian medical students) for Pancake Night at Carol's house- the ever-so-innocent UK holiday similar to Mardi Gras, marking the Tuesday before Lent. They make pancakes in order to use up the flour and sugar and whatnot around the house before Lent. They were tasty pancakes-- much more Ekwendeni-style than earning mardi gras beads in New Orleans (although we've seen our share here, as Julie mentioned about indecent exposure).
This morning, Mickie was still alive- AND NOT CONVULSING! She actually appears to be getting better. Who knows if she will ever be a normal child, but at least she's alive today. Other than that, today was very slow and (dare we say it?) quiet around the hospital. Nice to relax and read on the porch. We'll see tomorrow what Malawi throws our way.
Mickie came in Monday mornign seizing. Her mother and grandmother reported she had been convulsing since the day before... She was afrebile, but the most likely culprit was cerebral malaria. We've since this before- LP to r/o meningitis, IV Quinine, and you see that patient stop convulsing and start to improve. But Mickie didn't stop convusling. Not after several doses of anti-seizure medication. She was in status epilepticus and we couldn't stop it. |Then she started breathing less and less. There were no other new admissions in the hospital, so we spent the afternoon watching Mickie gasp for each breath (respiratory rate got down to 10), in between episodes of small fasciculations and larger tonic clonic convulsions, all the while contemplating the amoutn of brain damage this girl is going to have, even if she lives. Other than nasal cannula oxygen, there are is no airway support at Ekwendeni Hospital, and Mickie was too unstable to transfer. Back home she would have been intubated long ago. But we literally did EVERYTHING we could for her- Nasal O2, IV fluids, dextrose, anti-malaria drugs, antibiotics, anti-seizure medications (which we had to stop because of her depressed respirations...). Then we just watched her, hopelessly. She remained about the same- episodes of convulsions, respiratory rate of 10 for the rest of the day. There was a sparkle of hope, but both staff and family doubted this little girl would make it through the night. We went home for the usual workout on the footy field with a bunch of the little boys following us, email, dinner of pork & rice, shower, and bed- but Mickie was on our minds entirely.
Call it a miracle, God, or modern medicine, Mickie was alive Tuesday morning. We couldn't say that she had improved, but she was alive. Her respiration rate was up to 16. Her sugar was a little better controlled, as well as her convulsions, but she still remained unconcscious for the most part. She definitely looked strange and hyper-agitated. Its hard to explain, but if an old medicine man confessed to me that there was a child in the hospital filled with evil spirits- I'd pick Mickie out right away. She facial expression and movements were weird and jerky. She's alive, but something doesn't seem exactly right about this child...
But Tuesday brought us more patients- another young boy with seizures that didn't respond right away to anti-seizure medications (but ultimately improved with anti-malarials), an HIV patient in the male ward with possible cryptococcal meningitis. Julie and I joined a medical officer in the operating theater for 2 tubal ligations- done under LOCAL ANESTHESIA. That's right, women who are reading this blog, with just a little lidocaine, the surgeon sliced through the skin and abdomen, dug around until he found the fallopian tubes, tied them off, cut them off, tucked everything nicely back in the small but deep hole he'd created, and sutured the belly back up- all with the same piece of suture. These women must've REALLY wanted the surgery. One woman did end up getting general anesthesia because some adhesions on her uterus complicated the surgery, but the other patient got through the whole shebang with a little lidocaine- while crushing my hand in the process she was squeezing it so hard. But Mickie made it through Tuesday too.
Tuesday evening was very pleasant. I spent quite a while playing games with handful of local girls, about ages 8 through 10. We were playing hand games and they were teaching me some of their clapping songs. This brought me back to my days at Erlton Swim Club, me and Jeannie passing by the miserable minutes of adult swim with "Double Doube This This Double Double That That". If a young African girl comes up to you asking to play Double Double- I'm taking credit for teaching them! We'll see if it catches on... We also joined the Ekwendeni Team Mzungu (bascially all the whites in town plus the Malawian medical students) for Pancake Night at Carol's house- the ever-so-innocent UK holiday similar to Mardi Gras, marking the Tuesday before Lent. They make pancakes in order to use up the flour and sugar and whatnot around the house before Lent. They were tasty pancakes-- much more Ekwendeni-style than earning mardi gras beads in New Orleans (although we've seen our share here, as Julie mentioned about indecent exposure).
This morning, Mickie was still alive- AND NOT CONVULSING! She actually appears to be getting better. Who knows if she will ever be a normal child, but at least she's alive today. Other than that, today was very slow and (dare we say it?) quiet around the hospital. Nice to relax and read on the porch. We'll see tomorrow what Malawi throws our way.
Tuesday, February 21, 2012
Standard Operating Theatre Attire
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| Scrub dress, welly boots, reusable cap and mask, and a rubber apron: Very stylish. |
Monday, February 20, 2012
In this moment, everything is perfect.
Lake Malawi. Now we get it. What a wonderful place. We were there for approximately 7 minutes before we decided that...
1. We are jumping in the lake immediately.
2. We are coming back next weekend.
We stayed at Mayoka Bay, a backpacker's paradise about 10 minutes outside the main town. For $10 a night, we had a brilliant lake view, ate delicious food, and met some amazing people. If it weren't for the lack of plumbing facilities (1 actual toilet and 1 compost toilet for the whole place), I'd call it a resort.
It took about 2.5 hours to get there- I was proposed to by an old Malawian man on our minibus ride to Mzuzu, then our taxi to Nhkata Bay was stopped at all 3 police checkpoints and fined for some minor detail (no fire extinguisher, 8 people in the car instead of 7, having tanks of gasoline in the trunk...) Malawian police have to make their own wages, so they often stop and fine taxi drivers, or elicit bribes. But we finally got into town, then hiked about 20 minutes uphill to the lodge. As soon as we got our rooms (Rhianna, Jenny, and Carol right on the lake) and Julie and I a little higher up the cliff, we changed into our suits and jumped into the lake, swimming out to a little floating dock anchored off shore. The water is clear green/blue, deep, and the absolute perfect temperature. Totally worth the shisto, which we will definitely have by the end of the trip. Oh well, there's meds for that.
After a short swim before dark, we changed (who needs to shower when there's a lake?), and headed down to the main porch/dining/bar area for a BBQ party (SALAD! guacamole, beans, carrot slaw, veggie sausages, eggplant, chili bites) and some "beverages" of the Carlsberg category. We were all staying in little cabins with porches, but there were also many backpackers there camping out in tents. Backpackers are some of the most interesting people. Chris a scuba instructor from South Africa, Vionne a flower harvester for perfumes from South Africa, and Scott a tree climber from Seattle (and younger brother of Cross Country skier Olympian Holly Brooks) had previously met each other on other backpacking adventures, but all decided to meet up again, quit their jobs, and take a year to travel from Capetown to Cairo. Dave and Karen were a young couple from east coast Canada who also quit their jobs to travel through Egypt, Tanzania, Malawi, and Mozambique for 10 weeks and we looking to extend their trip a month longer. Brendan was a young structural engineer from Ireland who had spent 5 weeks in Mzuzu setting up water pipes before starting a new job this spring in Cairnes, Australia. Nicole and Amanda are 2 Dutch sisters working at a hospital in Nhkoma, just outside of Lilongwe for a year. We chatted with everyone and shared amazing stories. It was a really fun evening, which ended to eloquently as Julie and I sat on our porch watching it lightening mystically over the Lake. Words fall short, really.
It thunderstormed pretty severely overnight, but we managed to sleep in/ Julie and I grabbed some brunch (the Breakfast Combo- the most delicious toast with homemade lime marmalade, a bowl of tropical fruit (papaya, mango, apples, bananas, guava), french press coffee that is impossible not to spill, and muesli, a cereal-like mixture of oats/grains/craisins). The food alone is enough of a reason to return. Then we hiked a little down the hill to a small row of craft shops to haggle for some souvenirs and postcards, then returned to the lodge just in time for the Lake Boat tour! This was the excursion of the day.
In a small wooden fishing boat sat Jenny, Claire (who arrive earlier this AM), Carol, Rhianna, and the Dutch sisters Amanda and Nicole, Julie, myself, and our captain named Gift, and a couple other Malawians along for the ride. Captain Gift led us out of the bay and along the coast of the lake where we fed eagles! There are two eagles named Tony Blair and Condoleezza Rice. Gift stuck a small fish with a stick, whistled loudly, and tossed the fish into the air where it landed about 20 ft from our boat (after he had jokingly put the dead fish in his own mouth for a minute or so- EW). Tony left his perch on a tree, fly right over us and dove down to swipe the fish out of the water and flew back to the tree to enjoy his snack. We repeated this a couple more times, I got to throw a fish but purposefully tossed it close to the boat, which didn't please Tony. I had to retrieve the fish and toss it a little further out for his liking. Still got some amazing pictures though. We also saw lizards and monkeys scurrying along the coast. Next we found a nice big rock to go "cliff jumping" (which was really only about 5 meters high). Climbing up the rock face itself was a bit of a challenge (my climbing skills would've made Josh proud!) and being the show-off that I am, I started off with a nice front flip of the rock, but (serves me right) over-rotated and hit the water just perfectly to lose my bikini top over my head. Did I mention how clear the water was? Luckily, I was able to pull my top back over my head before surfacing, but it was still a good laugh for everyone. Gift, Carol, Julie, Amanda, and Nicole (with A LOT of persuasion) made the jump. It was actually so deep right off the rock that I was even able to do a few nice swan dives!
After we had our fill of jumping, we swam over to a collection of rocks perfect for snorkling. We saw so many schools of small fish- some neon blue, some black, some dalmation. It was really something. There were also a few small cave tunnels that Julie and I had fun swimming through. Then we swam to shore and met the rest of the boat on the beach where we had a long jump competition with some of the local children. Julie represented Team Mzungu very well- a smashing third place victory earned her the nickname "Serious" dubbed by Captain Gift. As the daylight started to fade, we boated back to Mayoka Bay, fed Tony and Condoleeza a couple more times, then docked for the evening. Julie and I relaxed with some hot coffee (was getting kind of chilly without the bright sunshine) and the most delicious fresh Bruschetta on homemade baquette. We showered then returned to the porch bar to play some pool with Dave & Karen (we won, obviously), partake in the Curry Night buffet (not quite as good as the BBQ, but still yummy), and sat around the table sharing more stories wtih more backpackers. Jasmine, a Dutch girl who just graduated from law school but decided she didn't want to be a lawyer was traveling alone for 9 months with the ambition to visit 3 continents- South America, Africa, and India, had just arrived in Malawi, starting month 5 of her trek. Exhausted from the day's activites and the blazing sun, we hit the sack pretty early Saturday night, but still took soem porch time to enjoy the lightening over the Lake.
Another full night of thunderstorms, but Julie and I awoke early on Sunday and enjoyed another Breakfast Combo each, plus one giant banana pancake. Then we decided to hop in one of the dugout canoes and paddle around the bay ourselves. For those of you who didn't watch the Malawi episode of the Amazing Race in which there was a dugout canoe race, dugout canoes are crazy tipsy, incredibly difficult to balance, and even more difficult to maneuver- but we made it across the bay and back without tipping (although steering was another issue)! It was quite the accomplishment- none of the Mayoke workers thought we could do it! Although, we did stradle the boat with our legs on the outside, instead of the inside, which makes it a wee easier. Next week we aim to successfully complete the Mayoke Challenge- paddle out to the floating dock and back without tipping earns you a free night's stay (legs on the inside, of course)! Then we sunbathed on the floating dock, enjoyed pineapple Fantas, and chatted with a few more backpackers until our cab picked us up at 2pm to take us back to Mzuzu. We were sad to leave.
Backpackers are another kind of people. We LOVED hearing their crazy stories- people that actually QUIT their jobs just to accomplish crazy dreams. Chris put it nicely when he explained to us "I figured I could travel the states and Europe when I'm old, but I had to tough out Africa while I am still young". How can you argue with that? We just listened with awe the things they have done and seen. We want to accomplish these things too! It made me realize that this will certainly not be my last trip to Africa. I'm coming back. There is certainly a sense of longing when you hear their stories and you start planning your trips for the future. But then again, we're HERE too. Right NOW. We ARE accomplishing these things and seeing amazing sights, even for just one month. In this moment, we are all the same. In this moment, everything is perfect. That's Lake Malawi.
1. We are jumping in the lake immediately.
2. We are coming back next weekend.
We stayed at Mayoka Bay, a backpacker's paradise about 10 minutes outside the main town. For $10 a night, we had a brilliant lake view, ate delicious food, and met some amazing people. If it weren't for the lack of plumbing facilities (1 actual toilet and 1 compost toilet for the whole place), I'd call it a resort.
It took about 2.5 hours to get there- I was proposed to by an old Malawian man on our minibus ride to Mzuzu, then our taxi to Nhkata Bay was stopped at all 3 police checkpoints and fined for some minor detail (no fire extinguisher, 8 people in the car instead of 7, having tanks of gasoline in the trunk...) Malawian police have to make their own wages, so they often stop and fine taxi drivers, or elicit bribes. But we finally got into town, then hiked about 20 minutes uphill to the lodge. As soon as we got our rooms (Rhianna, Jenny, and Carol right on the lake) and Julie and I a little higher up the cliff, we changed into our suits and jumped into the lake, swimming out to a little floating dock anchored off shore. The water is clear green/blue, deep, and the absolute perfect temperature. Totally worth the shisto, which we will definitely have by the end of the trip. Oh well, there's meds for that.
After a short swim before dark, we changed (who needs to shower when there's a lake?), and headed down to the main porch/dining/bar area for a BBQ party (SALAD! guacamole, beans, carrot slaw, veggie sausages, eggplant, chili bites) and some "beverages" of the Carlsberg category. We were all staying in little cabins with porches, but there were also many backpackers there camping out in tents. Backpackers are some of the most interesting people. Chris a scuba instructor from South Africa, Vionne a flower harvester for perfumes from South Africa, and Scott a tree climber from Seattle (and younger brother of Cross Country skier Olympian Holly Brooks) had previously met each other on other backpacking adventures, but all decided to meet up again, quit their jobs, and take a year to travel from Capetown to Cairo. Dave and Karen were a young couple from east coast Canada who also quit their jobs to travel through Egypt, Tanzania, Malawi, and Mozambique for 10 weeks and we looking to extend their trip a month longer. Brendan was a young structural engineer from Ireland who had spent 5 weeks in Mzuzu setting up water pipes before starting a new job this spring in Cairnes, Australia. Nicole and Amanda are 2 Dutch sisters working at a hospital in Nhkoma, just outside of Lilongwe for a year. We chatted with everyone and shared amazing stories. It was a really fun evening, which ended to eloquently as Julie and I sat on our porch watching it lightening mystically over the Lake. Words fall short, really.
It thunderstormed pretty severely overnight, but we managed to sleep in/ Julie and I grabbed some brunch (the Breakfast Combo- the most delicious toast with homemade lime marmalade, a bowl of tropical fruit (papaya, mango, apples, bananas, guava), french press coffee that is impossible not to spill, and muesli, a cereal-like mixture of oats/grains/craisins). The food alone is enough of a reason to return. Then we hiked a little down the hill to a small row of craft shops to haggle for some souvenirs and postcards, then returned to the lodge just in time for the Lake Boat tour! This was the excursion of the day.
In a small wooden fishing boat sat Jenny, Claire (who arrive earlier this AM), Carol, Rhianna, and the Dutch sisters Amanda and Nicole, Julie, myself, and our captain named Gift, and a couple other Malawians along for the ride. Captain Gift led us out of the bay and along the coast of the lake where we fed eagles! There are two eagles named Tony Blair and Condoleezza Rice. Gift stuck a small fish with a stick, whistled loudly, and tossed the fish into the air where it landed about 20 ft from our boat (after he had jokingly put the dead fish in his own mouth for a minute or so- EW). Tony left his perch on a tree, fly right over us and dove down to swipe the fish out of the water and flew back to the tree to enjoy his snack. We repeated this a couple more times, I got to throw a fish but purposefully tossed it close to the boat, which didn't please Tony. I had to retrieve the fish and toss it a little further out for his liking. Still got some amazing pictures though. We also saw lizards and monkeys scurrying along the coast. Next we found a nice big rock to go "cliff jumping" (which was really only about 5 meters high). Climbing up the rock face itself was a bit of a challenge (my climbing skills would've made Josh proud!) and being the show-off that I am, I started off with a nice front flip of the rock, but (serves me right) over-rotated and hit the water just perfectly to lose my bikini top over my head. Did I mention how clear the water was? Luckily, I was able to pull my top back over my head before surfacing, but it was still a good laugh for everyone. Gift, Carol, Julie, Amanda, and Nicole (with A LOT of persuasion) made the jump. It was actually so deep right off the rock that I was even able to do a few nice swan dives!
After we had our fill of jumping, we swam over to a collection of rocks perfect for snorkling. We saw so many schools of small fish- some neon blue, some black, some dalmation. It was really something. There were also a few small cave tunnels that Julie and I had fun swimming through. Then we swam to shore and met the rest of the boat on the beach where we had a long jump competition with some of the local children. Julie represented Team Mzungu very well- a smashing third place victory earned her the nickname "Serious" dubbed by Captain Gift. As the daylight started to fade, we boated back to Mayoka Bay, fed Tony and Condoleeza a couple more times, then docked for the evening. Julie and I relaxed with some hot coffee (was getting kind of chilly without the bright sunshine) and the most delicious fresh Bruschetta on homemade baquette. We showered then returned to the porch bar to play some pool with Dave & Karen (we won, obviously), partake in the Curry Night buffet (not quite as good as the BBQ, but still yummy), and sat around the table sharing more stories wtih more backpackers. Jasmine, a Dutch girl who just graduated from law school but decided she didn't want to be a lawyer was traveling alone for 9 months with the ambition to visit 3 continents- South America, Africa, and India, had just arrived in Malawi, starting month 5 of her trek. Exhausted from the day's activites and the blazing sun, we hit the sack pretty early Saturday night, but still took soem porch time to enjoy the lightening over the Lake.
Another full night of thunderstorms, but Julie and I awoke early on Sunday and enjoyed another Breakfast Combo each, plus one giant banana pancake. Then we decided to hop in one of the dugout canoes and paddle around the bay ourselves. For those of you who didn't watch the Malawi episode of the Amazing Race in which there was a dugout canoe race, dugout canoes are crazy tipsy, incredibly difficult to balance, and even more difficult to maneuver- but we made it across the bay and back without tipping (although steering was another issue)! It was quite the accomplishment- none of the Mayoke workers thought we could do it! Although, we did stradle the boat with our legs on the outside, instead of the inside, which makes it a wee easier. Next week we aim to successfully complete the Mayoke Challenge- paddle out to the floating dock and back without tipping earns you a free night's stay (legs on the inside, of course)! Then we sunbathed on the floating dock, enjoyed pineapple Fantas, and chatted with a few more backpackers until our cab picked us up at 2pm to take us back to Mzuzu. We were sad to leave.
Backpackers are another kind of people. We LOVED hearing their crazy stories- people that actually QUIT their jobs just to accomplish crazy dreams. Chris put it nicely when he explained to us "I figured I could travel the states and Europe when I'm old, but I had to tough out Africa while I am still young". How can you argue with that? We just listened with awe the things they have done and seen. We want to accomplish these things too! It made me realize that this will certainly not be my last trip to Africa. I'm coming back. There is certainly a sense of longing when you hear their stories and you start planning your trips for the future. But then again, we're HERE too. Right NOW. We ARE accomplishing these things and seeing amazing sights, even for just one month. In this moment, we are all the same. In this moment, everything is perfect. That's Lake Malawi.
Five Things: How Many Christmases Do You Have?
This weekend (on our fabulous trip to Nkhata Bay... check out Stevie's blog for more details!), a Malawian
man asked me my age by saying "How many Christmases do you have?"
I laughed at first because it was such a funny way of saying "How old are
you?," but later it got us thinking about other simple things that are much different here than they are at home. Each of the five things today have an American
version and a Malawian version - here they are:
1) Rainstorms
American version: In Ohio, rainstorms last all day.... or even all week. There is rarely sun within 24 hours of a storm, and when there is, we all make a huge deal about finding a rainbow. In fact, when I was little, my dream occupation was to become a "rainbow watcher"...my career plan was to hunt down rainbows and take pictures of them - that tells you how rare and special they are!
Malawian version: It's "the rainy season" here, so Stevie and I came well-prepared... new raincoats, umbrellas, ponchos... we almost even wasted precious packing space on rain boots. Little did we know that even on days that it rains (which has only been about 1/2 of the days we've been here), it's 80 degrees and sunny the other 23 hours of the day. The clouds roll in very quickly, usually in the afternoon, and it rains for an hour or so. Don't misunderstand, it rains HARD during that time - the gutters at the hospital are the size of waterslides - but then the sun comes out and dries up all the rain... and the spiders here are not so "itsy bitsy"!
1) Rainstorms
American version: In Ohio, rainstorms last all day.... or even all week. There is rarely sun within 24 hours of a storm, and when there is, we all make a huge deal about finding a rainbow. In fact, when I was little, my dream occupation was to become a "rainbow watcher"...my career plan was to hunt down rainbows and take pictures of them - that tells you how rare and special they are!
Malawian version: It's "the rainy season" here, so Stevie and I came well-prepared... new raincoats, umbrellas, ponchos... we almost even wasted precious packing space on rain boots. Little did we know that even on days that it rains (which has only been about 1/2 of the days we've been here), it's 80 degrees and sunny the other 23 hours of the day. The clouds roll in very quickly, usually in the afternoon, and it rains for an hour or so. Don't misunderstand, it rains HARD during that time - the gutters at the hospital are the size of waterslides - but then the sun comes out and dries up all the rain... and the spiders here are not so "itsy bitsy"!
2) Contact/droplet isolation
American version: These terms are used to describe patients who currently have infectious diseases that can be transferred to other people in the hospital, and are used to prevent disease transmission. For example, anyone with signs of influenza, tuberculosis, etc would have one of these signs hanging outside their door, and anyone who goes in or out of the hospital room would have to put on a gown, gloves, and a mask. Some of the patients with more serious conditions (tuberculosis) are even placed in rooms with negative pressure air filtration systems, and single-patient stethescopes are used.
Malawian version: Tuberculosis is common here, and there is a specific "TB ward" in Ekwendeni hospital. However, this ward is located at the very back of the property, so there is concern that the sickest TB patients (who usually also have HIV/AIDS) do not receive as much attention as they would if they were closer to all the other patients. Therefore, the sickest TB patients are placed in the regular ward with everyone else... kind of counter-intuitive. They are placed in "private" side rooms on the end, but the windows are left open, and often during rounds the patients are not even in their rooms. When we asked Dr. Anneke where the patients go, she said they often go to the market for lunch.... so basically from now on, Stevie and I will be donning our N-95 masks 24/7, and especially in the market at lunchtime.
3) Indecent exposure
American version: It's tough to really think of anything here, because pretty much anything goes in America.... low-rise jeans, tube tops, itsy-bitsy-teeny-weeny-yellow-polka-dot bikinis. Public displays of affection are also common, and you might see 10 different couples kissing during 1 trip to the mall. However, breast-feeding in public is very rare...malls might have a special stall or couch in the bathroom, but it would be strange to see a breast just out in the open. Look what happened to Janet Jackson after her "wardrobe malfunction."
Malawian version: We haven't seen a female knee since we arrived 10 days ago... but we have seen a lifetime's worth of breastfeeding. Women walking down the street are covered from head to toe in fabric, but yet their chest is exposed and they are breastfeeding while they walk. It is completely socially acceptable, which is great for the babies! The other strange thing is that men and women really don't show any affection in public - no hand holding and definitely no kissing. However, same-sex friends often shake hands and then continue to hold hands throughout their conversation. Two men holding hands and walking down the street is very normal, and means nothing more than friendship.
4. Transferring a patient
American version: The process of transferring a patient from an Intensive Care Unit room to a regular ward room can literally take ALL DAY. It might start after morning rounds with the ICU resident calling the ward resident and explaining the patient's hospital course. Then the ward resident would track down her attending physician and clear the transfer with them. Then the unit clerk would have to call the patient transfer center and check for bed availability. And of course the ICU nurses would have to check out the patient to the regular floor nurses....and then maybe by late afternoon, the transfer team would come and move the patient to a special bed, wheel them to a new room, and then put them in their new bed.
Malawian version:
8:05:10 seconds - Dr. Annika tells ICU nurse that Patient X is ready to transfer out of ICU to regular room
8:05:15 seconds - ICU nurse yells across room to Patient X's mother that she can take patient out of ICU
8:05:25 seconds - Patient X's mother scoops up the baby, all of her belongings, and the patient's IV bag and walks 10 steps out of ICU and into regular pediatric ward room
8:05:40 seconds - Patient X transfer complete
5. Nightlife
American version: Young men and women go out late and stay out late (just ask my little sister Elle!) There is really no social stigma associated with being out late at night, and even restaurants and movie theaters are open past midnight. There is also a huge spectrum of "drinking": having a glass of wine with dinner is not the same as being an alcoholic.
Malawian version: Proper women really just don't go out at night, and definitely not without a male companion. I've already written about how things slow down a lot after dark here, and a few nights ago Stevie and I had an interesting experience when we got stuck at the hospital later than usual. We didn't have any dinner planned at the guesthouse, so we had to go into the town to grab a bite to eat. When we left the restaurant, it was completely dark out, and we really only encountered men and young boys on our walk home. (Also strange was that we were the only people with a flashlight - it seems like everyone around here has night vision!) Perhaps the women are at home busy with the younger children by this time, but it's interesting to see that only men really visit bars. In Malawi, either you DRINK or you don't.
Friday, February 17, 2012
Yummy endemic species (we hope!)... without the parasites.
Not a ton to report today. We are minutes away from leaving for Mzuzu then headed to Lake Malawi at Nhkata Bay. Its safe to swim there with less of a chance of getting shisto. We'll seeeee. We are also excited to taste some of the endemic fish species from the Lake- there are over 600 to choose from. Maybe we'll be able to get our hands on some dairy too... yesss... cheeeese. Its the end of mango season, but we heard we can still find some good ones at the Lake, so we'll see. More stories on our cases of mistaken fruit identity later....
Half day at the hospital today. Julie and I rounded on the Female ward again. Everyone is on malaria treatment. This time we made sure the medical officer signed off on our plans- the nurses just went with our decisions yesterday! Can you believe that? Its scary... but then again, in just a few months, we will no longer be students (ok ok, fine, we will always be lifelong learners, but you know what I mean!)
One of my little patients in the peds ward who had severe respiratory distress from malaria yesterday, probably ARDS, started convulsing this morning, so the malaria has gone cerebral. But since then, he is actually looking much better. The young boy that Julie LP'd yesterday was up and playing today!!! He was smiling and talking with us! Just yesterday he was laying on the table seizing before us... kids are SO resilient.
Spent a lot of time this morning in the maternity ward and "neonatal ICU"- basically a small room with beds and a heater. We could not convinve this one young mother to kangaroo her baby. Skin on skin contact is great for temperature control of premature babies, but, even with a Tambuka-speaking nurse, we couldn't get our point across. She preferred to hold the baby in blankets on her lap or hold him up to the heater... it was very frustrating because the poor thing was cool to the touch- not a good sign. Another neonate there with meningitis, 2 with papular rashes, possibly syphilis.
Well now we're off to meet Carol, Rhianna, and Jenny and head to the "beach". Beautiful day here today- maybe we will get a chance to work on our tans. Aaand drink a beer ot two... and eat some cheese! Vacation within a vacation- lucky us!3 alF`ing our experiences at the hospital this week, I think we need it.
If you would like a postcard, please email us your address. Mzuzu does have a post office!
Our phone number is 02 097 212
(Not sure of the country code (256, we think?) or how exactly to dial from the US, but we can also get text messages!)
Have a good weekend everyone. Kewo!
Half day at the hospital today. Julie and I rounded on the Female ward again. Everyone is on malaria treatment. This time we made sure the medical officer signed off on our plans- the nurses just went with our decisions yesterday! Can you believe that? Its scary... but then again, in just a few months, we will no longer be students (ok ok, fine, we will always be lifelong learners, but you know what I mean!)
One of my little patients in the peds ward who had severe respiratory distress from malaria yesterday, probably ARDS, started convulsing this morning, so the malaria has gone cerebral. But since then, he is actually looking much better. The young boy that Julie LP'd yesterday was up and playing today!!! He was smiling and talking with us! Just yesterday he was laying on the table seizing before us... kids are SO resilient.
Spent a lot of time this morning in the maternity ward and "neonatal ICU"- basically a small room with beds and a heater. We could not convinve this one young mother to kangaroo her baby. Skin on skin contact is great for temperature control of premature babies, but, even with a Tambuka-speaking nurse, we couldn't get our point across. She preferred to hold the baby in blankets on her lap or hold him up to the heater... it was very frustrating because the poor thing was cool to the touch- not a good sign. Another neonate there with meningitis, 2 with papular rashes, possibly syphilis.
Well now we're off to meet Carol, Rhianna, and Jenny and head to the "beach". Beautiful day here today- maybe we will get a chance to work on our tans. Aaand drink a beer ot two... and eat some cheese! Vacation within a vacation- lucky us!3 alF`ing our experiences at the hospital this week, I think we need it.
If you would like a postcard, please email us your address. Mzuzu does have a post office!
Our phone number is 02 097 212
(Not sure of the country code (256, we think?) or how exactly to dial from the US, but we can also get text messages!)
Have a good weekend everyone. Kewo!
Five Things: Falling into Step
1. Early to bed, early to rise
This whole country wakes up at the crack of dawn. Stevie and I, who do NOT usually wake up at the crack of dawn, have been getting into the swing of waking up and going to bed early. We've been going running every day around 6:15am, and usually heading to bed by 9 or 10. We hadn't really thought much about why the market opens at 6am and closes at dusk until a few days ago, when the power was out in our guesthouse.... this country is built to function without electricity. While Stevie and I could barely figure out how to wash our faces with our headlamps on, Malawian life seemed to go on as usual. We're so dependent on electricity, and they didn't even seem to notice a difference. Sidenote: we LOVE our headlamps. In fact, I don't know how I've come this many years without one... I could have been a lot more "stealth" reading The Boxcar Children" under the covers after bedtime if I'd have had one of these little gems... thanks Dad, and thank you Home Depot.
2. Death in Children
Stevie has been writing about some of the very sick children we've seen at the hospital. While it's very sad at times, it's also important to reflect on how the Malawian culture views death in childhood. Coffin "joineries" are in every town on the side of the road, and from the bus you can see coffins of all sizes. Children here die of things like malaria and HIV, and it's amazing to watch how calm some of the mothers of children in the ICU are. One of the church elders, Helen, told us that families often have more children than they "need" because they do not expect them all to survive to adulthood. Furthermore, they rely on their children to care for them when they are too old to do so themselves, so it's very important to have large families.
3. Netball
This is a game that pregnant women like to play at the hospital to help "induce labor." It's something like basketball... except that there's no net and no backboard... so it's basically just a pole with a rim attached to it. We haven't yet gotten to watch a game of "netball," but just try and imagine ten women 9 months pregnant leaving the maternity ward to throw a ball around in a hospital courtyard in the United States.... not gonna happen in a million years.
4. Language barrier
No matter how many English words Malawians know, we're realizing that there is always a fair amount that is lost in translation. Strangers are extremely friendly and approach us walking down the street, and everyone seems to like to practice their English words. The diversity of languages of visitors in Ekwendeni is also impressive. The Bible study we attended was held in English, but included people who speak Dutch, Chitumbuka, and The Queen's English, if you know what I mean. Stevie and I have been practicing our Chitumbuka when speaking to Malawians, but have also noticed that we have a bad habit of slipping into weird quasi-British/Dutch accents when talking to Dr. Anneke or Dr. Carol. "We're quite keen to head to Lake Malawi this weekend, and will be leaving at half-two"...things like that. On another language note, a 2 year old child that we met seemed to only 1 word in his vocabulary - "mzungu," which is Chitumbuka for "white person." This little guy saw us, pointed, and started shouting "mzungu, mzungu, mzungu" over and over... quite impressive set of lungs for a litte tyke, actually.
5. "Connection"
At Bible Study, we were each asked to choose a word to describe what we were getting out of the session - "connection" was my word, "enlightenment" was Stevie's. Both of us admitted that these words didn't just apply to our experience at Bible Study, but to our trip as a whole. We've already told you about our eye-opening experience at church, and the more time we spend in Ekwendeni, the more we've realized just how connected this town is. People look after each other, and even just within our Bible Study group, there were people who taught school, were ministers in the church, and worked at the hospital. These people have waved to us while we're jogging, stopped by the guesthouse, and worked as our colleagues in the wards. Stevie and I did a lot of reflecting on the passage we read from Romans 12, and agreed that our time in Ekwendeni is a time for us to explore our own personal gifts and talents, and also to renew our minds. We have talked about our many roles in life - students, daughters, friends, granddaughters, girlfriends, sisters - and feel that this trip is helping us to find harmony in all of those roles. By the end of the trip, we hope to have made an impact, however small, so that we can in some way repay a town that has opened its arms to us wholeheartedly.
This whole country wakes up at the crack of dawn. Stevie and I, who do NOT usually wake up at the crack of dawn, have been getting into the swing of waking up and going to bed early. We've been going running every day around 6:15am, and usually heading to bed by 9 or 10. We hadn't really thought much about why the market opens at 6am and closes at dusk until a few days ago, when the power was out in our guesthouse.... this country is built to function without electricity. While Stevie and I could barely figure out how to wash our faces with our headlamps on, Malawian life seemed to go on as usual. We're so dependent on electricity, and they didn't even seem to notice a difference. Sidenote: we LOVE our headlamps. In fact, I don't know how I've come this many years without one... I could have been a lot more "stealth" reading The Boxcar Children" under the covers after bedtime if I'd have had one of these little gems... thanks Dad, and thank you Home Depot.
2. Death in Children
Stevie has been writing about some of the very sick children we've seen at the hospital. While it's very sad at times, it's also important to reflect on how the Malawian culture views death in childhood. Coffin "joineries" are in every town on the side of the road, and from the bus you can see coffins of all sizes. Children here die of things like malaria and HIV, and it's amazing to watch how calm some of the mothers of children in the ICU are. One of the church elders, Helen, told us that families often have more children than they "need" because they do not expect them all to survive to adulthood. Furthermore, they rely on their children to care for them when they are too old to do so themselves, so it's very important to have large families.
3. Netball
This is a game that pregnant women like to play at the hospital to help "induce labor." It's something like basketball... except that there's no net and no backboard... so it's basically just a pole with a rim attached to it. We haven't yet gotten to watch a game of "netball," but just try and imagine ten women 9 months pregnant leaving the maternity ward to throw a ball around in a hospital courtyard in the United States.... not gonna happen in a million years.
4. Language barrier
No matter how many English words Malawians know, we're realizing that there is always a fair amount that is lost in translation. Strangers are extremely friendly and approach us walking down the street, and everyone seems to like to practice their English words. The diversity of languages of visitors in Ekwendeni is also impressive. The Bible study we attended was held in English, but included people who speak Dutch, Chitumbuka, and The Queen's English, if you know what I mean. Stevie and I have been practicing our Chitumbuka when speaking to Malawians, but have also noticed that we have a bad habit of slipping into weird quasi-British/Dutch accents when talking to Dr. Anneke or Dr. Carol. "We're quite keen to head to Lake Malawi this weekend, and will be leaving at half-two"...things like that. On another language note, a 2 year old child that we met seemed to only 1 word in his vocabulary - "mzungu," which is Chitumbuka for "white person." This little guy saw us, pointed, and started shouting "mzungu, mzungu, mzungu" over and over... quite impressive set of lungs for a litte tyke, actually.
5. "Connection"
At Bible Study, we were each asked to choose a word to describe what we were getting out of the session - "connection" was my word, "enlightenment" was Stevie's. Both of us admitted that these words didn't just apply to our experience at Bible Study, but to our trip as a whole. We've already told you about our eye-opening experience at church, and the more time we spend in Ekwendeni, the more we've realized just how connected this town is. People look after each other, and even just within our Bible Study group, there were people who taught school, were ministers in the church, and worked at the hospital. These people have waved to us while we're jogging, stopped by the guesthouse, and worked as our colleagues in the wards. Stevie and I did a lot of reflecting on the passage we read from Romans 12, and agreed that our time in Ekwendeni is a time for us to explore our own personal gifts and talents, and also to renew our minds. We have talked about our many roles in life - students, daughters, friends, granddaughters, girlfriends, sisters - and feel that this trip is helping us to find harmony in all of those roles. By the end of the trip, we hope to have made an impact, however small, so that we can in some way repay a town that has opened its arms to us wholeheartedly.
Thursday, February 16, 2012
Yewo
(The best word in Malawi, used for "yes, ok, thanks, hello", and pretty much anything else. Its our go-to response- hope no one catches on to us)
So the really sick children Julie and I were praying for pulled through and made it through the night. For severe malaria, the first 24 hours are the most critical, so its a good sign. Unfortunately, the peds ward was crazy busy again this afternoon- another cerebral malaria (Julie did a very difficult LP on this little bucking bronco) and a septic child... I guess we will be getting more comfortable dealing with really sick kids. Don't ever want to get too comfortable though...
One man with HIV & TB in the male ward is deteriorating quickly and they say there is nothing we can do. "He's terminal".
On the other hand, it was a party in the female ward this morning as Julie and I conducted rounds ON OUR OWN. We have one vocab sheet and lots of hand gestures, but we get by. Luckily, most of the women were feeling better and going home. They enjoyed laughing at (with?) us during each patient encounter. At least we could bring them cheer. We did have to remind the nurse that someones hand to sign off on our plans before he started processing our orders.
The shocker this morning was that our 81 yo with diarrhea passed away about a half hour before we arrived at the hospital this morning. It really surprised us, but then again, she was really sick, probably (actually, definitely) septic, although there was really no way of telling for sure. Who knows if she actually received the fluids we ordered. Its funny- doctors at home get called by nurses for the tiniest details, but no one called a physician overnight when her temperature dropped to 33C... the only progress note in the chart after our morning rounds note was acknowledging her death, followed by "Sorry" and a signature. Not much else we really could have done for her. It made Julie and I stop and think though. The protocol for caring for this woman would have been completely different back home. It's easy to get lazy/comfortable just rolling with what's only available. Maybe we could have been more aggressive that she received fluids, given her hypotension? Or maybe we could've suggested starting antibiotics... but just for what seemed like a simple case of diarrhea, which had improved over her first day here? Who knows what was actually going on with her body. We are in no way blaming ourselves, but it was a reality check that we shouldn't just forget our training because its not what they do here. Maybe we can help people get creative with the resources available. Now were are not going to forget to use our fresh minds.
On a lighter note, we are making plans for the weekend at Lake Malawi in Nhkata Bay. Going with Dr. Carol, Rhianna (a Dutch homeschool teacher), and 2 midwifery students from Northern Ireland- should be a good time! THe highlight of the trip will be grocery shopping in Mzuzu on the way back on Sunday. If Julie and I are lucky, the store will be stocked with some sort of dairy product, preferably cheese... any kind of cheese, really... even if it comes out of a can. Noodles/rice/nsima and chicken for every meal are starting to get old. We are avoiding the goat's feet.
So the really sick children Julie and I were praying for pulled through and made it through the night. For severe malaria, the first 24 hours are the most critical, so its a good sign. Unfortunately, the peds ward was crazy busy again this afternoon- another cerebral malaria (Julie did a very difficult LP on this little bucking bronco) and a septic child... I guess we will be getting more comfortable dealing with really sick kids. Don't ever want to get too comfortable though...
One man with HIV & TB in the male ward is deteriorating quickly and they say there is nothing we can do. "He's terminal".
On the other hand, it was a party in the female ward this morning as Julie and I conducted rounds ON OUR OWN. We have one vocab sheet and lots of hand gestures, but we get by. Luckily, most of the women were feeling better and going home. They enjoyed laughing at (with?) us during each patient encounter. At least we could bring them cheer. We did have to remind the nurse that someones hand to sign off on our plans before he started processing our orders.
The shocker this morning was that our 81 yo with diarrhea passed away about a half hour before we arrived at the hospital this morning. It really surprised us, but then again, she was really sick, probably (actually, definitely) septic, although there was really no way of telling for sure. Who knows if she actually received the fluids we ordered. Its funny- doctors at home get called by nurses for the tiniest details, but no one called a physician overnight when her temperature dropped to 33C... the only progress note in the chart after our morning rounds note was acknowledging her death, followed by "Sorry" and a signature. Not much else we really could have done for her. It made Julie and I stop and think though. The protocol for caring for this woman would have been completely different back home. It's easy to get lazy/comfortable just rolling with what's only available. Maybe we could have been more aggressive that she received fluids, given her hypotension? Or maybe we could've suggested starting antibiotics... but just for what seemed like a simple case of diarrhea, which had improved over her first day here? Who knows what was actually going on with her body. We are in no way blaming ourselves, but it was a reality check that we shouldn't just forget our training because its not what they do here. Maybe we can help people get creative with the resources available. Now were are not going to forget to use our fresh minds.
On a lighter note, we are making plans for the weekend at Lake Malawi in Nhkata Bay. Going with Dr. Carol, Rhianna (a Dutch homeschool teacher), and 2 midwifery students from Northern Ireland- should be a good time! THe highlight of the trip will be grocery shopping in Mzuzu on the way back on Sunday. If Julie and I are lucky, the store will be stocked with some sort of dairy product, preferably cheese... any kind of cheese, really... even if it comes out of a can. Noodles/rice/nsima and chicken for every meal are starting to get old. We are avoiding the goat's feet.
Wednesday, February 15, 2012
FAQ
Just to answer a few of the similar questions yall seem to have...
1. Time difference between Ekwendeni and Columbus is 7 hours (8 hours
for Chicago). Sun rises at 530am, sets at 630pm and FAST. It gets dark
within 5 minutes here, kinda crazy...
2. Julie and I are sharing a room in the guest house. Along with many bugs.
3. Internet access is available at the College of Nursing down the
road from us. Its very SLOW and often crashes, but works ok.
4. Weekend plans: We are going to head to Nkata Bay on Lake Malawi
this weekend. Hope we don't get shisto (parasites!) from swimming in
the lake- will probably be a gametime decision. Can always take meds
later....
5. DVT = deep vein thrombosis = blood clots, usually in legs
6. Will post our phone number next time when we have it with us. You
can try, but there is a 97% chance we won't pick up. Its mostly off
and very difficult to use. What we thought as of purchasing minutes,
is actually units. And you use more units for each minute on
long-distance calls... will buy more units at the next opportunity.
1. Time difference between Ekwendeni and Columbus is 7 hours (8 hours
for Chicago). Sun rises at 530am, sets at 630pm and FAST. It gets dark
within 5 minutes here, kinda crazy...
2. Julie and I are sharing a room in the guest house. Along with many bugs.
3. Internet access is available at the College of Nursing down the
road from us. Its very SLOW and often crashes, but works ok.
4. Weekend plans: We are going to head to Nkata Bay on Lake Malawi
this weekend. Hope we don't get shisto (parasites!) from swimming in
the lake- will probably be a gametime decision. Can always take meds
later....
5. DVT = deep vein thrombosis = blood clots, usually in legs
6. Will post our phone number next time when we have it with us. You
can try, but there is a 97% chance we won't pick up. Its mostly off
and very difficult to use. What we thought as of purchasing minutes,
is actually units. And you use more units for each minute on
long-distance calls... will buy more units at the next opportunity.
Five Things: (Belated) Lover's Day Edition
1. Polygamy
Marriage is all about love, and what better way to have more love than to have more marriages... right?! Technically polygamy is illegal in the Church of Malawi, and wives 2+ are not allowed to receive communion. However, polygamy often occurs in smaller villages because while wife #1 is busy working in the fields, there has to be a wife #2 in the kitchen cooking dinner, and maybe a wife #3 taking care of the children (makes sense to me, I could use a couple of wives of my own to help out :) ) The church encourages divorce, but the problem comes after a divorce occurs and the woman is no longer seen as a "prospect for marriage"... not because she is no longer "pure," but because she can't obey a husband. This concept is hard for a couple of independent thinkers like Stevie and I to even grasp, but unfortunately many women here are not even given an option regarding who they will marry. Elders often arrange marriages, and courting is forbidden. This also leads to secret rendezvous between teenagers, increased HIV transmission, and high divorce rates.
2. When life gives you trash... make a ribbon
The kids here are awesome. They play outside from dawn until dusk, and they can make a toy out of just about anything. A couple days ago we saw a group of about 5 young boys with hula hoops. They were short one hoop, though, and the last child was running down the street with a reel of old camera film streaming behind him like a ribbon in the wind. We saw another kid with a "car" consisting of an old steering wheel attached to 2 wheels, and you could tell he loved that thing as much as I loved my first motorized Barbie car. It's amazing to see how happy and resilient children are regardless of their circumstances, and it makes seeing sick children in the hospital a bit easier to handle. It also helps that Stevie and I are basically like some type of fascinating museum exhibit to these kids - they gather in crowds behind us and follow us as we walk down the street, and approach us for hugs like we've known them their whole lives. As we watched them play soccer one day, we even taught them some American sports cheers/chants, which they loved. Sometimes we don't know if they're mocking us or laughing with us, but we just smile and laugh :)
3. Salt of the Earth
Literally... if the world runs out of salt, it's because the Malawians ate it all. They use salt shakers with giant holes and liberally add salt to every dish... it makes me thirsty just writing about it. It's kind of undestandable when you try their favorite food, nsima, which is a cornmeal side dish with a VERY bland texture and taste. It's probably most comparable to dried marshmallow, or maybe styrofoam. People keep offering to teach us how to cook it properly so we can cook it for our families in the United States, but we're unconvinced.... we'll keep you updated if we learn to love it, though!
4. The sickest child gets the oxygen
After just a few days in the hospital, one of the most striking differences from American health care is paucity of resources. When a very sick child came into the pediatric intensive care unit (which is really just a small room with 6 beds and no fancy equipment), we had to take oxygen from another child who was "less sick" but still definitely needed oxygen. Glucometer strips are difficult to obtain, and are kept hidden in a locked desk for special circumstances. Caps, gloves, drapes, and gowns from the operating room are washed and reused. There is an x-ray machine somewhere in the hospital but there aren't any films available right now. These are just a few of the situations we have encountered where efficient resouce utilization has been a top priority, and it has already been a very eye-opening experience.
4. Media isolation
One week ago I had Facebook and Twitter updates and ESPN Score Center at the tip of my fingers on my smartphone. I had watched almost every OSU basketball game and was definitely up-to-date on The Bachelor. 2 nights ago Stevie and I were woken up by Malawians cheering because Zambia won a futbol game... last month I didn't even know that Zambia was a country (for all of you who didn't know that Zambia was a country until just now, it borders Malawi to the west :) ). Our lack of cultural awareness really struck us when we saw giant poster of Obama hanging in a restaurant here in Ekwendeni. Children on the street ask where we are from and when we say "America," they respond by asking about Obama and our government. It is a harsh awakening about our priorities in America and our narrow world view.... but seriously, did Courtney get kicked off The Bachelor yet or WHAT?! Just kidding, please don't tell us... they're DVR'ed :)
BYOBD: Bring your own blood donor
Hi everyone- sorry for the delay...internet was down for a while and we were crazy busy at the hospital, so were unable to post about our last 3 days finally working! I also apologize for the numerous typos in this post. It is our lunch break so I am typing quickly and will not have time to proofread...
Oh, and Happy belated Valentine's Day!
WOW. The hospital is incredible- as in very few resources. What a sight to see... hopefully we can post some pictures. Where to start? I guess I will describe the hospital first, then give you a glimpse of what we've seen/done each day.
Ekwendeni is a primitive, resource-poor place.
BYOB: Bring your own blood donor.
BYOCT: Bring your own caretaker
BYOEverything: Bring your own bed sheets, clothes, food, drinks... Patients have family members or friends here 24/7 to help take care of them. Nurses strictly take vitals, put in IVs, and administer medications and fluids (many of which they have mixed themselves). Family members do everything else for the patient. In between all the buildings there are people lounging, wandering around, hanging laundry to dry. Patients sometimes go down the street to the makret themselves. There is a building for families to store their own grain and maize. There is a porridge factory, but is often not functional (like right now). MDs do everything - they are the internist, surgeon, pediatrician, obstetrician all in one. There is a female ward, male ward, both with beds in the back porches for TB patients, a maternity ward (w/ private birthing rooms- very luxurious), neonatal "ICU" where there are basically just beds for mothers to lay and kangaroo the premies for warmth, since there are no incubators. All babies sleep in bed with mother. There is also a building for expecting mothers 8 months+ preganant. They can come here prior to labor because if they go into labor in their home village, they may not make it to the hospital in time. There is a pediatric ward, which is the most busy, especially now during malaria season. There are 2 operating theaters (major room for C-sections, another for minor surgeries like hernia repairs and Incision & Drainage of abscesses; all surgeries are done by any physician or medical officers (malawian physician assistants). There is an outpatient department adn several clinics, such as Antiretroviral CLinic, Palliative Care, Family Medicine. The Emergency Department is basically a room of supplies that is kept unlocked so people can access some supplies if absolutely necessary. No medicines are kept there. Most of the time, patients are carried directly into their respective ward. There is a small pharmacy and a lab that can process only Hgb, Hct, urine dipstick, CSF studies, stool studies, blood films, VDRL, HIV, TB, and CD4 counts. There is 1 ultrasound machine and one CXR machine, but currently there are no films to take XRs.
Staff: 3 physicians; Dr. Carol is from Scotland and has been here 2 years, Dr. Martha who is from Amercia but away this week so we have not met, and Dr. Annika from Holland who we have been spending the most time with. She is here for 4 years with her husband and threee children (ages 1, 4, and 6). There is 1 nurse per ward and about 3 medical officers that share call (and surgeries) with physicians.
Day 1: After a tour of the hospital, Ijoined Medical Officer Albert for Adult Ward rounds: 2 women with TB, and men with enlarged prostate (was transferred to Mzuzu), 2 drunks, psychogenic heart palpitations, shin lac, astham exacerbation, and 2 very sick HIV/TB patients. Then I joined JUlie and Dr. Annike in the pediatric unit where rounds were taking place. This occurs in one large room, where parents sit in a circle with their sick child on the lap and we literaly go around the circle (ROUNDS, haha) one at a time. Some interesting cases, but mostly children with malaria. The sickest ones have malaria that has gone to their brains. There was one child with sickle cell crisis who probably had a stroke becasue she couldn't move the left side of her body. At one point, a child came in convulsing, most likely a complication of malaria. Annika did a crazy fast perfect LP. They actually took oxygen off a sick child to give to this sicker child. Then the power went out and no one had oxygen until the generators kicked in!
Minutes after that chaos, Annika was called to perform a C-section on a 17 yo girl for breach presentation. US surgeons would scoff at the procedure- so primtive. It is much like I would imagine an ED physician performing an emergency C/S. Plus everything in the theater is re-used including sterile equipment. Scrubbing means washing your hands with a abr of soap. In the theater we adorn a scrub-like dress, welly boots, a plastic apron that is wiped "clean" after every surgery, a cap, mask, glasses, and double gloves. Everything but the gloves are washed again and re-used. She used every last centimeter of suture before opening another. Only used 2 packs for the entire surgery. Instead of a time-out, Annika said a quick prayer. 2 quick incisions, pulled the baby out (quite difficultly, might I add. The incision was a bit small and they ranked that baby so much at its neck I was glad to see it could move all its limbs after birth). Then sutured the uterus and belly right back up.
This was all before noon. The rest of the day we checked on all of the patients, helped with vitals in the pediatric ward. Then passed out in bed early that night.
Highlights from Day 2: Valentine's Day! I saw lot's of patients with TB. Julie performed a successful lumbar puncutre on a 2 yo with convulsions, probably complication of malaria. We went to round on the maternity ward and walked in two find one girl who had lost 2 liters of blood overnight after giving birth. She was taken to the theater and 2 cervical lacs repaired. Around 5pm, Julie and I admitted an 81 yo lady (very rare in Malawi, considering the average lifespan is 46 years!) with severe watery diarrhea and0wT%du0Q_ntus. Probably hypoglycemia and dehydration secondary to dysentery... but had to rule out... you guessed it!.. MALARIA. The nurse started her on fluids. I don't think she was seen by a physician until the next morning.
Now it is the afternoon of Day 3. Julie and I rounded together in the female ward (many admissions last night, mostly malaria or pregnancy complications) then prewented to Dr. |Annika. A nurse was not available to translate, but I think we did quite well using our limited vocabulary sheet and many hand gestures. When the nurse returned, she scarily started implementing our plans on all the patients before Annika could even sign off on them! This morning was also a crazy morning in the pediatric ICU (1 table where the sickest children receive fluids & blood). 2 children came in with severe malaria- one convulsing, one in respiratory distress & severely dehydrated. This time I got to do the LP on a 26 month old (champagne tap, might I add- well... it was clear and one stick- there's no CSF cell count available). Julie constantly ran back and forth from the lab with blood and the single glucometer in the hospital. The pharmacist was on lunch break and not responding to Dr. Annika's calls. I was filling fluid bags and adding quinine or dextrose, literally approximating IV drips. One child still needs blood, but hopefully the lab tech will return and the child will be ok when we check on him this afternoon. I've certainly started to experience dealing wtih really really sick children. Its really scary. These extremely lethargic children would definitely be admitted to the ICU at home, but instead, here, they lay on a single table together, receving fluids and/or blood, quinine for malaria, and get their vitals and blood sugars checked.
PHEW! Has it only been 2.5 days?
Oh, and Happy belated Valentine's Day!
WOW. The hospital is incredible- as in very few resources. What a sight to see... hopefully we can post some pictures. Where to start? I guess I will describe the hospital first, then give you a glimpse of what we've seen/done each day.
Ekwendeni is a primitive, resource-poor place.
BYOB: Bring your own blood donor.
BYOCT: Bring your own caretaker
BYOEverything: Bring your own bed sheets, clothes, food, drinks... Patients have family members or friends here 24/7 to help take care of them. Nurses strictly take vitals, put in IVs, and administer medications and fluids (many of which they have mixed themselves). Family members do everything else for the patient. In between all the buildings there are people lounging, wandering around, hanging laundry to dry. Patients sometimes go down the street to the makret themselves. There is a building for families to store their own grain and maize. There is a porridge factory, but is often not functional (like right now). MDs do everything - they are the internist, surgeon, pediatrician, obstetrician all in one. There is a female ward, male ward, both with beds in the back porches for TB patients, a maternity ward (w/ private birthing rooms- very luxurious), neonatal "ICU" where there are basically just beds for mothers to lay and kangaroo the premies for warmth, since there are no incubators. All babies sleep in bed with mother. There is also a building for expecting mothers 8 months+ preganant. They can come here prior to labor because if they go into labor in their home village, they may not make it to the hospital in time. There is a pediatric ward, which is the most busy, especially now during malaria season. There are 2 operating theaters (major room for C-sections, another for minor surgeries like hernia repairs and Incision & Drainage of abscesses; all surgeries are done by any physician or medical officers (malawian physician assistants). There is an outpatient department adn several clinics, such as Antiretroviral CLinic, Palliative Care, Family Medicine. The Emergency Department is basically a room of supplies that is kept unlocked so people can access some supplies if absolutely necessary. No medicines are kept there. Most of the time, patients are carried directly into their respective ward. There is a small pharmacy and a lab that can process only Hgb, Hct, urine dipstick, CSF studies, stool studies, blood films, VDRL, HIV, TB, and CD4 counts. There is 1 ultrasound machine and one CXR machine, but currently there are no films to take XRs.
Staff: 3 physicians; Dr. Carol is from Scotland and has been here 2 years, Dr. Martha who is from Amercia but away this week so we have not met, and Dr. Annika from Holland who we have been spending the most time with. She is here for 4 years with her husband and threee children (ages 1, 4, and 6). There is 1 nurse per ward and about 3 medical officers that share call (and surgeries) with physicians.
Day 1: After a tour of the hospital, Ijoined Medical Officer Albert for Adult Ward rounds: 2 women with TB, and men with enlarged prostate (was transferred to Mzuzu), 2 drunks, psychogenic heart palpitations, shin lac, astham exacerbation, and 2 very sick HIV/TB patients. Then I joined JUlie and Dr. Annike in the pediatric unit where rounds were taking place. This occurs in one large room, where parents sit in a circle with their sick child on the lap and we literaly go around the circle (ROUNDS, haha) one at a time. Some interesting cases, but mostly children with malaria. The sickest ones have malaria that has gone to their brains. There was one child with sickle cell crisis who probably had a stroke becasue she couldn't move the left side of her body. At one point, a child came in convulsing, most likely a complication of malaria. Annika did a crazy fast perfect LP. They actually took oxygen off a sick child to give to this sicker child. Then the power went out and no one had oxygen until the generators kicked in!
Minutes after that chaos, Annika was called to perform a C-section on a 17 yo girl for breach presentation. US surgeons would scoff at the procedure- so primtive. It is much like I would imagine an ED physician performing an emergency C/S. Plus everything in the theater is re-used including sterile equipment. Scrubbing means washing your hands with a abr of soap. In the theater we adorn a scrub-like dress, welly boots, a plastic apron that is wiped "clean" after every surgery, a cap, mask, glasses, and double gloves. Everything but the gloves are washed again and re-used. She used every last centimeter of suture before opening another. Only used 2 packs for the entire surgery. Instead of a time-out, Annika said a quick prayer. 2 quick incisions, pulled the baby out (quite difficultly, might I add. The incision was a bit small and they ranked that baby so much at its neck I was glad to see it could move all its limbs after birth). Then sutured the uterus and belly right back up.
This was all before noon. The rest of the day we checked on all of the patients, helped with vitals in the pediatric ward. Then passed out in bed early that night.
Highlights from Day 2: Valentine's Day! I saw lot's of patients with TB. Julie performed a successful lumbar puncutre on a 2 yo with convulsions, probably complication of malaria. We went to round on the maternity ward and walked in two find one girl who had lost 2 liters of blood overnight after giving birth. She was taken to the theater and 2 cervical lacs repaired. Around 5pm, Julie and I admitted an 81 yo lady (very rare in Malawi, considering the average lifespan is 46 years!) with severe watery diarrhea and0wT%du0Q_ntus. Probably hypoglycemia and dehydration secondary to dysentery... but had to rule out... you guessed it!.. MALARIA. The nurse started her on fluids. I don't think she was seen by a physician until the next morning.
Now it is the afternoon of Day 3. Julie and I rounded together in the female ward (many admissions last night, mostly malaria or pregnancy complications) then prewented to Dr. |Annika. A nurse was not available to translate, but I think we did quite well using our limited vocabulary sheet and many hand gestures. When the nurse returned, she scarily started implementing our plans on all the patients before Annika could even sign off on them! This morning was also a crazy morning in the pediatric ICU (1 table where the sickest children receive fluids & blood). 2 children came in with severe malaria- one convulsing, one in respiratory distress & severely dehydrated. This time I got to do the LP on a 26 month old (champagne tap, might I add- well... it was clear and one stick- there's no CSF cell count available). Julie constantly ran back and forth from the lab with blood and the single glucometer in the hospital. The pharmacist was on lunch break and not responding to Dr. Annika's calls. I was filling fluid bags and adding quinine or dextrose, literally approximating IV drips. One child still needs blood, but hopefully the lab tech will return and the child will be ok when we check on him this afternoon. I've certainly started to experience dealing wtih really really sick children. Its really scary. These extremely lethargic children would definitely be admitted to the ICU at home, but instead, here, they lay on a single table together, receving fluids and/or blood, quinine for malaria, and get their vitals and blood sugars checked.
PHEW! Has it only been 2.5 days?
Sunday, February 12, 2012
5 Things
Taking a cue from one of my favorite fashion/lifestyle bloggers, I'm
going to structure my posts in a format called 'Five Things.' Each
post will contain a combination of 5 things that Stevie and I would
like to reflect on or tell you a little bit more about. That way
Stevie can provide the play-by-play, and I'll be more of the color
commentary :)
Five Things: The Start of A Journey
1. Time only matters to people who wear watches.
Before we left, we were told by several people that the concept of
time in Malawi was different. We understood what they meant to a
degree (mostly from trips to the South!), but had no idea how much
patience would be required. For example, we had to take a bus from
Lilongwe to Mzuzu yesterday, and were told that it was a 5 hour trip.
We were instructed to get to the bus station 'early,' so we arrived at
6:40am (quite impressive in itself!). We were the first 2 people on
the bus and sat for 2 hours before the bus even left.... and then the
ride took 7 hours instead of 5. People got on and off at multiple
different stops, probably for bathroom breaks, but Stevie and I were
way too nervous that the bus would leave without us so we sat for 9
hours straight... I know that will make my Dad proud, since we were
taught to 'hold it' on road trips! :)
2. Clean vs. Dirty: it's all relative.
A hot shower can go a long way. But then again, when no one else has
showered in a long time, a quick jump in the pool is better than
nothing!
3. 'Savior, Savior, hear my humble cry'
Stevie and I had the opportunity to attend church this morning with
the people of Ekwendeni. We sat very near the front, and were called
forward to introduce ourselves to the congregation. The mass was
beautiful - 4 or 5 different children's choirs performed, and the
homily focused on God's calling of His people. Up until today I had
thought of this trip as more of an 'adventure', but now am already
starting to see that it will likely be a period of great spiritual
growth as well. Malawians are very thankful for all that they have,
and though they do not have much money, they value family and
friendship very highly. The people of the parish were incredibly
friendly, and we were invited for coffee at one of the church elder's
homes after mass. Starting our stay in Ekwendeni with mass was
definitely a great way to feel like part of the community. On a side
note, we also learned an important lesson: bring 1 church-appropriate
outfit on any trip... Crocs, flip flops, and old tee shirts do not
count!
4. Americans should really learn to 'use their heads' more.
The people of Malawi can carry ANYTHING ON their heads. Not just fruit
baskets or pottery.... yesterday we saw a woman walking with a
full-sized suitcase balanced atop her head. Coming from the medical
student perspective, we're clearly worried about cervical spine damage
and other injuries, but it's seriously impressive.
5. 'Long Walk Part of Gift'
I remember my Mom using this 'Old Indian Guide' expression to remind
us kids that sometimes the gift isn't just the present itself, but
also the work and time that's put into creating the gift. The
expression popped into my head yesterday as we were finishing up our
72 hour journey from Columbus to Ekwendeni. Our global health
experience did not start when we arrived in Ekwendeni - it started the
second we left America!
going to structure my posts in a format called 'Five Things.' Each
post will contain a combination of 5 things that Stevie and I would
like to reflect on or tell you a little bit more about. That way
Stevie can provide the play-by-play, and I'll be more of the color
commentary :)
Five Things: The Start of A Journey
1. Time only matters to people who wear watches.
Before we left, we were told by several people that the concept of
time in Malawi was different. We understood what they meant to a
degree (mostly from trips to the South!), but had no idea how much
patience would be required. For example, we had to take a bus from
Lilongwe to Mzuzu yesterday, and were told that it was a 5 hour trip.
We were instructed to get to the bus station 'early,' so we arrived at
6:40am (quite impressive in itself!). We were the first 2 people on
the bus and sat for 2 hours before the bus even left.... and then the
ride took 7 hours instead of 5. People got on and off at multiple
different stops, probably for bathroom breaks, but Stevie and I were
way too nervous that the bus would leave without us so we sat for 9
hours straight... I know that will make my Dad proud, since we were
taught to 'hold it' on road trips! :)
2. Clean vs. Dirty: it's all relative.
A hot shower can go a long way. But then again, when no one else has
showered in a long time, a quick jump in the pool is better than
nothing!
3. 'Savior, Savior, hear my humble cry'
Stevie and I had the opportunity to attend church this morning with
the people of Ekwendeni. We sat very near the front, and were called
forward to introduce ourselves to the congregation. The mass was
beautiful - 4 or 5 different children's choirs performed, and the
homily focused on God's calling of His people. Up until today I had
thought of this trip as more of an 'adventure', but now am already
starting to see that it will likely be a period of great spiritual
growth as well. Malawians are very thankful for all that they have,
and though they do not have much money, they value family and
friendship very highly. The people of the parish were incredibly
friendly, and we were invited for coffee at one of the church elder's
homes after mass. Starting our stay in Ekwendeni with mass was
definitely a great way to feel like part of the community. On a side
note, we also learned an important lesson: bring 1 church-appropriate
outfit on any trip... Crocs, flip flops, and old tee shirts do not
count!
4. Americans should really learn to 'use their heads' more.
The people of Malawi can carry ANYTHING ON their heads. Not just fruit
baskets or pottery.... yesterday we saw a woman walking with a
full-sized suitcase balanced atop her head. Coming from the medical
student perspective, we're clearly worried about cervical spine damage
and other injuries, but it's seriously impressive.
5. 'Long Walk Part of Gift'
I remember my Mom using this 'Old Indian Guide' expression to remind
us kids that sometimes the gift isn't just the present itself, but
also the work and time that's put into creating the gift. The
expression popped into my head yesterday as we were finishing up our
72 hour journey from Columbus to Ekwendeni. Our global health
experience did not start when we arrived in Ekwendeni - it started the
second we left America!
When dehydration is a good thing
So we last left you just after Julie and I made it to Lilongwe. Other than the gentleman we met at the Internet "cafe", pretty much no one was nice to us. So much for the "warm heart of Africa". I think after leaving Korea Garden, we walked directly into the wrong part of town. It was a busy place and we passed the black market and a river where people were simultaneously bathing and peeing in... However, we found our way into another section of town where everyone was super nice. Julie tried to buy a postcard at this little sourvenir market and was instantly surrounded by about 7 men shoving different cards in her face. The post office was closed anyway, so just tried to walk away- but one certain vendor, Andy, should get some credit for his persistance as he followed us several blocks to Kiboko Safaris. We were able to purchase a SIM card and minutes for our phone and book a safari! We will be spending the last week of our trip on a Safari in Zambia!!!!! All those exclamation points should emphasize how pumped we are about this trip. All we have to do is find some sort of documentation that we don't have yellow fever... yet.
All in all, it was a successful afternoon of running errands until everything closed at 5pm. As we returned to Korea Garden for dinner, we met a young man named Happy George as he taslked to us about Malawi and tried to sell us his bracelets. But being the shoppers we are and with always an eye for a bargain, Julie and I returned to Korea Garden sourvenir-free (mainly because we had enough baggage to lug around alaready). For dinner, Julie had a delicious chicken kabob and I chose fish with garlic bananas- very unique, but excellent! Then I pretty much passed out in bed at the late hour of 8:30pm.
In the morning, we awoke at 545am, showered and packed, and hitched a taxi to the bus station in order to get a bus to Mzuzu, supposedly a 5 hour drive. I can't even accurately describe the chaos and trash that surrounded the bus station, but Julie and I found the bus quite quickly and loaded our bags. We were told that the bus would leave once it was full- and they meant FULL. People were standing in the aisle! So after sitting in our seats on the bus in the bus station for 2 hours, we finally began what turned out to be a 9 hour trek to Mzuzu. Apparently, this was a local bus that made many brief stops along the one road through Malawi at the small towns to drop off and pick people up. At every town, people came up to the windows trying to sell us hard-boiled eggs, cookies, rolls, bananas, and sketchy bags of water. Julie and I were afraid to leave the bus for fear it would leave without us, so luckily, we were dehydrated enough to last the whole trip without having to go to the bathroom!
Driving through the country of Malawi was quite a site. The scenery certainly changed as we traveled north. Cornfields lined the road almost for the entire trip. It was a lot like driving through Illinois- except with more goats and cows and shanty towns and women carrying pots on their heads. At first, the land was very flat, with bushes and mid-sized trees. Off into the distance you could spot random round hills/mountains popping out of nowhere. Then the vegetation became very low-lying with only bushes and very small trees. Then finally, as we passed central Malawi into northern Malawi, the road became winding and hilly. There was lots of grass and very tall trees lining the roads. The stops became fewer and shanty towns sparser, and maybe even poorer. Instead of brick houses, we saw many wooden huts and shelters with no roofs at all. Fewer people wore shoes.
Finally, after sitting on a bus for 9 straight hours, we made it to Mzuzu (it will be a miracle if we don't have DVTs by the end of this trip). Our time there was quite a blur, as Julie and I lugged are bags through town in search of an ATM, all the while being harassed by taxi drivers and vendors. A word to the wise- if you are traveling to Malawi, Visa is what you need! It is the only card accepted almost anywhere. We had to find a specific ATM that accepted my Mastercard debit card. But we did. And we found a taxi to take us to Ekwendeni, since the mini buses looked a little sketchy and we were already weary from the crowd on our AXA bustrip up.
The taxi ride only lasted 25 minutes and the driver kept changing the radio station to find American songs. Enrique Iglesias serenaded us as we pulled up the small town of Ekwendeni. The taxi dropped us off directly in front of the guest house where we will be staying for the next 3 weeks, right behind a BEAUTIFUL church. After finding the guest house manager, Sam, and checking into a room, we unpacked. Sam cooked us a simple but delicious meal of chicken, rice, and some sort of green vegetable resembling spinach that he called "vegetable". We also met the night watchman, Ellison, father of 7 children and native of Lilongwe. Once again, I managed to stay awake all the way until 8pm! We were supposed to meet with Dr. Carol Jack, with whom we had been communicating, at 7pm, but she never showed... until she called and woke us up at the wee hour of 9pm. Time and schedules do not really exist in Malawi, but more on that later....
The bright sunshine glared into our room, waking us up at about 5:30am. Trying to sleep more somewhat successfully we finally got up, showered (no pool to jump in now), and got dressed for church- there was to be an 8am service in English and a 10am service in ___ , the language of northern Malawi. Sam cooked us eggs and toast and we made it to church on time... unlike the rest of the town. There were less than 20 people when we first arrived and were mesmerized by the adult choir, the Warriors of Christ. But after a few hyms when the church announcer asked guests to stand and introduce themselves to the congregation, we turned around to speak to at least 300 hundred people. The asked us to speak a greeting in , but I'm pretty sure we butchered it. Anyway, the service was absolutely beautiful and the sermon very touching. He spoke about what it is to receive not just a calling, but a holy calling from God. Julie and I prayed and listened and sang with what seemed like the entire town for two hours- such a beautiful service, with incredible choirs. After the service, Helen, a school teacher at the girls secondary school from Scotland who has been living here for 11 years invited us to tea and we explored the Ekwendeni and the market all afternoon, which brings us to now.
So, as you can see, we are finally at our main destination for the month. The trip was quite long, much like this blog post, but an adventure nonetheless (just like this blog post?). We will leave you here.
All in all, it was a successful afternoon of running errands until everything closed at 5pm. As we returned to Korea Garden for dinner, we met a young man named Happy George as he taslked to us about Malawi and tried to sell us his bracelets. But being the shoppers we are and with always an eye for a bargain, Julie and I returned to Korea Garden sourvenir-free (mainly because we had enough baggage to lug around alaready). For dinner, Julie had a delicious chicken kabob and I chose fish with garlic bananas- very unique, but excellent! Then I pretty much passed out in bed at the late hour of 8:30pm.
In the morning, we awoke at 545am, showered and packed, and hitched a taxi to the bus station in order to get a bus to Mzuzu, supposedly a 5 hour drive. I can't even accurately describe the chaos and trash that surrounded the bus station, but Julie and I found the bus quite quickly and loaded our bags. We were told that the bus would leave once it was full- and they meant FULL. People were standing in the aisle! So after sitting in our seats on the bus in the bus station for 2 hours, we finally began what turned out to be a 9 hour trek to Mzuzu. Apparently, this was a local bus that made many brief stops along the one road through Malawi at the small towns to drop off and pick people up. At every town, people came up to the windows trying to sell us hard-boiled eggs, cookies, rolls, bananas, and sketchy bags of water. Julie and I were afraid to leave the bus for fear it would leave without us, so luckily, we were dehydrated enough to last the whole trip without having to go to the bathroom!
Driving through the country of Malawi was quite a site. The scenery certainly changed as we traveled north. Cornfields lined the road almost for the entire trip. It was a lot like driving through Illinois- except with more goats and cows and shanty towns and women carrying pots on their heads. At first, the land was very flat, with bushes and mid-sized trees. Off into the distance you could spot random round hills/mountains popping out of nowhere. Then the vegetation became very low-lying with only bushes and very small trees. Then finally, as we passed central Malawi into northern Malawi, the road became winding and hilly. There was lots of grass and very tall trees lining the roads. The stops became fewer and shanty towns sparser, and maybe even poorer. Instead of brick houses, we saw many wooden huts and shelters with no roofs at all. Fewer people wore shoes.
Finally, after sitting on a bus for 9 straight hours, we made it to Mzuzu (it will be a miracle if we don't have DVTs by the end of this trip). Our time there was quite a blur, as Julie and I lugged are bags through town in search of an ATM, all the while being harassed by taxi drivers and vendors. A word to the wise- if you are traveling to Malawi, Visa is what you need! It is the only card accepted almost anywhere. We had to find a specific ATM that accepted my Mastercard debit card. But we did. And we found a taxi to take us to Ekwendeni, since the mini buses looked a little sketchy and we were already weary from the crowd on our AXA bustrip up.
The taxi ride only lasted 25 minutes and the driver kept changing the radio station to find American songs. Enrique Iglesias serenaded us as we pulled up the small town of Ekwendeni. The taxi dropped us off directly in front of the guest house where we will be staying for the next 3 weeks, right behind a BEAUTIFUL church. After finding the guest house manager, Sam, and checking into a room, we unpacked. Sam cooked us a simple but delicious meal of chicken, rice, and some sort of green vegetable resembling spinach that he called "vegetable". We also met the night watchman, Ellison, father of 7 children and native of Lilongwe. Once again, I managed to stay awake all the way until 8pm! We were supposed to meet with Dr. Carol Jack, with whom we had been communicating, at 7pm, but she never showed... until she called and woke us up at the wee hour of 9pm. Time and schedules do not really exist in Malawi, but more on that later....
The bright sunshine glared into our room, waking us up at about 5:30am. Trying to sleep more somewhat successfully we finally got up, showered (no pool to jump in now), and got dressed for church- there was to be an 8am service in English and a 10am service in ___ , the language of northern Malawi. Sam cooked us eggs and toast and we made it to church on time... unlike the rest of the town. There were less than 20 people when we first arrived and were mesmerized by the adult choir, the Warriors of Christ. But after a few hyms when the church announcer asked guests to stand and introduce themselves to the congregation, we turned around to speak to at least 300 hundred people. The asked us to speak a greeting in , but I'm pretty sure we butchered it. Anyway, the service was absolutely beautiful and the sermon very touching. He spoke about what it is to receive not just a calling, but a holy calling from God. Julie and I prayed and listened and sang with what seemed like the entire town for two hours- such a beautiful service, with incredible choirs. After the service, Helen, a school teacher at the girls secondary school from Scotland who has been living here for 11 years invited us to tea and we explored the Ekwendeni and the market all afternoon, which brings us to now.
So, as you can see, we are finally at our main destination for the month. The trip was quite long, much like this blog post, but an adventure nonetheless (just like this blog post?). We will leave you here.
Friday, February 10, 2012
Culture shock
Julie and I are safe in Malawi! We made the long trek to Lilongwe
(several movies, attempted naps, and hours of listening to African Chill
radio on the airplanes) and got settled into our guest house Korea
Garden, jumped in the pool, and now we walked to the downtown area in
search of money exchange and the bus station we have to take tomorrow to
get to Mzuzu. Obviously, we found an internet cafe! Paying by the
minute, so more to come later... Weather isn't too bad- pretty muggy when there's no breeze, but very comfortable. Lots of poverty EVERYWHERE. And everyone just stares at us.
Tuesday, February 7, 2012
Where we be
Departure
Columbus to DC 2:20-3:37pm 2/8
DC to Senegal 5:40pm - 6:10am 2/9
Senegal to JoBurg 7:10am - 5:40pm 2/9
JoBurg to Lilongwe, Malawi 10am - 12:25pm 2/10
Weather in Malawi over the next week: Scattered thunderstorms, High 81, Low 57
DC to Senegal 5:40pm - 6:10am 2/9
Senegal to JoBurg 7:10am - 5:40pm 2/9
JoBurg to Lilongwe, Malawi 10am - 12:25pm 2/10
Weather in Malawi over the next week: Scattered thunderstorms, High 81, Low 57
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