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"!

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.