No worries. No hurries.

One thing I have always admired about my younger brother is how everything just works out for him with very little planning on his part. I used to contribute this to his lack of decision-making capability, but I think maybe he’s actually on to something. Since Julie and I have been in Malawi, rainstorms, fuel shortages and lack of time orientation have prevented us from planning very far in advance. But somehow, everything just works out. These past few days, our last in Ekwendeni and northern Malawi, are the very example of this…

After blogging during lunch on Wednesday, we returned to the hospital. It was a quiet afternoon so Julie and I roamed the hospital wards. At the very end of the day, we discovered a patient that had been admitted on Tuesday night around 8:30pm and hadn’t been seen by a clinical officer or physician yet- the only note in the chart was by the admitting medical student, did not include a physical exam, and was not signed off by a clinical officer or physician- that’s 21 hours in the hospital without being seen! Furthermore, this was a sick child. The chart described a burn on her arm, but upon actually examining the child, she had second degree burns on her right arm, right chest and abdomen, and right leg, where boiling water had spilled off a table onto her. And now the child had a fever! Julie and I immediately set to work finding the staff nurse, calling the officer on call, and ordering fluids and antibiotics, based on the hospital’s burn protocol. Although there was a miscommunication somewhere regarding the care of this child, she faired well. This is a rare occurrence, but dangerous and concerning to us. Yet another shocking reality of medicine under entirely different circumstances. At home it would have been a major lawsuit!

The rainy season reached a monsoon-status downpour Wednesday evening, which we trekked through to Bible Study. It was a very fun evening- we broke up into small groups of 3 or 4 to discuss various assigned passages, then returned to the large group to first mime the passage for the group to guess, then summarize our discussion on the passage. It was entertaining! Futhermore, when Julie and I announced that this was our last Bible Study night and that we were leaving for Lilongwe on Saturday morning, one of the visiting physicians, Colin, told us he was driving south on Saturday and offered us a ride! This meant avoiding another 9-hour public bus ride back to Lilongwe, so we immediately accepted.

Our last two days in Ekwendeni were a blur. On Thursday, Julie won our coin toss to scrub in with Dr. Anneke for a C-section. We also learned a valuable lesson about delivering bad news in Malawian culture. One of the Malawian nurses was upset because a physician had spoken to a terminally ill dying patient’s family, explain that the patient was dying and there was nothing more we could do to treat her disease, but we could make her more comfortable. Although this is a totally appropriate conversation in Western medicine, people do not speak so openly about death in Malawi. One is supposed to explain to family members that the patient is “very sick”, nothing more. While we might consider this an inaccurate portrayal of reality, the seriousness of the situation is implied in Malawian culture. The family should “just understand”. From their perspective, only God decides who is dying- not the physician. It is not the physician’s role to state this. Definitely not what we learned in CAPS class! This is yet another example of the intimacy between religion and medicine in Malawi.

On Thursday night, Anneke and Martign had us over for dinner and to play with the children. We had a blast and enjoyed some delicious homemade pizza!

Julie and awoke on Friday morning at 4:45am in order to climb Mt. Chinongu for the sunrise. Although the lighting was really beautiful, the clouds and fog made the sunrise look more like an orange-ish blob rising behind the distant mountains. Just like it gets so suddenly dark in Malawi, it gets so suddenly light. And as soon as there is light, the village wakes up and there was noise surrounding us. It was surreal.

After watching a couple more procedures in the theater (an evacuation and an EGD) and doing a little ultrasound scanning, Julie and I finished our work at the hospital. We took the afternoon off to head into Mzuzu to run a few errands- such as shopping for chitenges at the Tanzanian market (the skirt covers that all Malawian women wear every day) and hitting the grocery store for a few local goodies. However, the return trip to Ekwendeni was more difficult. The fuel shortage has made taxis very scarce, and there was an aggressive crowd waiting for only a couple taxis driving back and forth from Mzuzu and Ekwendeni. After almost taking a cigarette to the face, Julie and I managed to wrestle ourselves into a taxi and make it back to Ekwendeni before dark.

Back in Ekwendeni, we met up with our friend, Sweet Man, who wanted to show us his family’s farm before we left. We had been trying to do this all week, but the rain and late work days had prevented this visit. We walked the village road behind the primary school, past maize fields and sweet potato plots to Sweet Man’s farm. We met his family (still not sure which of his extended family he actually lives with) and he showed us his room- it is in a small concrete building, next to a rabbit and pigeon hutch , with two rooms: one for him and one for the family goat. His room barely fit a bed and a coffee table inside. In fact, the door didn’t even open all the way because it would hit the bed. It was amazing to be invited to his farm and witness the actual living conditions of the villagers. Sweet Man was one of our friends throughout our stay in Ekwendeni and we were really honored to be invited to his farm. From the stories he’s told us, his family has really been through a lot. Both his older brother and sister have died, and his mother, who is very ill, does not live with them, leaving his widowed sister-in-law to run the household. But they persist and continue to sustain themselves and live happily. What a place this is!

Finally we ended the evening with dinner at Carol’s house, where she served us homemade mac ‘n’ cheese (CHEESE!). It was really nice to spend time with everyone and wish them well. The hospitality in Ekwendeni has made us feel so welcome and at home during our trip. It was a sad late night packing our bags.

If Julie and I had bought our bus ticket to Lilongwe in advance in order to secure our seats, we would never have experienced the most beautiful and relaxing weekend yet. Early Saturday morning, Colin drove us along the Lake Malawi coastline to a Senga Bay, a town on the Lake just one hour outside of Lilongwe, where we decided to stay for the night. The drive was awe-inspiring. We passed rubber tree farms, maize fields, and sugar cane plantations, interspersed with views of the sparkling Lake Malawi and a distant mountain backdrop on one of the most beautiful days we’ve had yet. We had no idea where we were going to spend the night, but, of course, the first lodge we called had their last dormitory, with 2 single beds, available. And so somehow we ended up with another unplanned weekend at the Lake in the very beautiful, secluded, and hip Cool Runnings Lodge. It was 11:30am and we were at the beach. No worries. No hurries. It all works out. This is Malawi.