Tuesday, March 30, 2010

Because I'm mature

Last weekend was Jackie's 40th birthday. Jackie is a kick-ass woman who works in marketing in San Fran but takes off long periods of time to work for non-profits. Here was her birthday weekend schedule:

Friday: happy hour here at the house (happy hour for us means beer, cookies and chips).

Saturday: Went hiking on Mt. Mulanje then raced to see the sunset while having drinks at Maky's, delicious fancy pizza at Hostaria (Italian restaurant) and fancy deserts at the Protea Hotel's 21 Grill (that is as close to swank as you get in Southern Malawi). It felt very surreal and I kept having to remind myself that I was still in Africa.

Here are some pictures:

Hiking/swimming on Mulanje:

 Will they do it? 
Yes they will.
Second thoughts about risking parasites? Nah. Just trying to get my clothes on before blinding any innocent Malwians.

Sunset at Maky's
Dinner at Hostaria (Ho-zone)

Dessert at the Pro

Yah, life in Africa is hard.

I make it rain!!!

So last Saturday I followed in the footsteps of Will Ferrel and Owen Wilson: I crashed a wedding. Although not sure it counts as wedding crashing when you don't eat any free food or go home with any hot chicks. Oh well.

As the only white person in the room, however, I did follow Wedding Crashers
Rule #7 - Blend in by standing out. [This is mostly for Grant's benefit as he had the WC poster in his room for 2 years].

The wedding was for the niece of one of our nurses, Eleanor. She mentioned in the car on Friday that she was going to a wedding and said that as I had never been to a Malawian wedding, I should stop by. So after debating the awkwardness factor (which was certainly not insignificant as I didn't know the bride and groom and, as the only white guest, would hardly be inconspicuous), I picked up Horace (one of our drivers) and we went to Eleanor's house, picked her up and went to the wedding.

Well, not the actual wedding. The wedding reception. Which in Malawi consists of the bridal party dancing down the aisle to a set of ornately festooned couches. The whole thing is narrated by a shockingly loud DJ who then proceeds to call up certain groups of people to dance with and throw money at the bride and groom. And perhaps I should use the term barker instead of DJ because this isn't just some symbolic gesture: there are cashiers that collect and count the money (as well as break larger bills for people who came unprepared) and the barker gets 10% of what is collected. Eleanor told me that sometimes they can pull in somewhere on the order of K100,000 (about $666 dollars). Given that most people throw 20 or 50 kwacha notes, it takes a lot of charm and insistence on the part of the barker to get people to pony up.

He eventually asks everyone to get up (no matter how many times you've already been called up) and throw money and this is called Pelicani (not sure about the spelling on that one). 

I think that we should import this custom without delay. Except that we should throw money at students who have just graduated from college and are abut to incur massive debt thanks to medical school. Who's in?

Here is an incredibly blurry picture of the money throwing. Before you judge my photography skills, keep in mind I was dancing and making it rain (translation for moms: throwing money) at the same time:

Sad Day.

So I've been trying to get in shape and work off some of that Kazinga+carbs diet. Thus I've been sneaking into the nearby fancy hotel to use their treadmill/free weights. I've been going without incident for 2 weeks. Last Friday, however, I was caught red handed! The security guard was like, "where is your pass?" and I was like, "Uhhhhhhhhh. Well, um I paid for a gym membership but they haven't given me the ID yet."

He brought me to the front desk. Meanwhile, my inner monologue: "Shit! I'm going to prison in sub-Saharan Africa!!!!"

Luckily, in typical Malawian fashion, they were too disorganized to have access to the list of gym members so I escaped scott-free. Now I need to look for a gym that is more reasonably priced.

This is exactly why I hate breaking rules. Never again!

Saturday, March 27, 2010

Happy Birthday Jackie

2 weekends ago- I'm behind in posting obviously- was Jackie's 40th birthday. Jackie is a kick-ass woman who works in marketing in San Fran but takes off long periods of time to work for non-profits. Here was her birthday weekend schedule:

Friday: happy hour here at the house (happy hour for us means beer, cookies and chips).

Saturday: Went hiking on Mt. Mulanje where we swam in a mountain waterfall, then raced to see the sunset while having drinks at Maky's, delicious fancy pizza at Hostaria (Italian restaurant) and fancy deserts at the Protea Hotel's 21 Grill (that is as close to swank as you get in Southern Malawi). It felt very surreal and I kept having to remind myself that I was still in Africa.

Here are some pictures:

Hiking on Mulanje:

Sunset at Maky's

Dinner at Hostaria (Ho-zone)

Dessert at the Pro

Yah, life in Africa is hard. 


A day at clinic

Well the"o" and the "l" key still aren't working so unless I copy-paste every single one- and this sentence took about 5 full minutes-  I still can't really update uness yu want t read a bg ike this. Which is hw I've sent a few emais.
I thought, however, that I'd make a few "picture-centered" posts.

Here are a few pictures from clinic at Thumbwe- a Thursday site. I gave my camera to Makwinja- the driver and he was totally psyched to take pictures. He got the hang of the camera very quickly. The following is a play-by-play of what happens at a typical clinic.

At the start of the day we collect all appointment cards from moms who are returning (already in the program and receiving therapy) and find their study cards on which we record all the pertinent data (length, weight, edema y/n, fever, cough, diarrhea, vomiting and any meds they are receiving).

Then the moms both new and old go get their kids weighed. This is Lydia, one of our nurses who is uber-competent. She's directing the HSA who is running the scale to do something. Makwinja, who loves making fun of Lydia was delighted to get a picture of her bossing someone around. 

Then the moms go to the height board to get length measured.This is the line for the height board. Malawians don't really understand/respect the queue so we spend a lot of time and energy trying to get the moms to "Panga mzele!" make a line).

If the child is new- we look at their height vs. length Z score to determine if they are moderately or severely malnourished. We also check for bipedal pitting edema to see if they have kwashiorkor  (http://en.wikipedia.org/wiki/Kwashiorkor). If the moms are returning we monitor the growth of the child to determine if they should graduate or if they need an HIV or TB test etc.

Sometime in the middle of clinic we have the nurses teach. During teaching they talk about the research we do, advise the moms not to share the food and talk about other issues ranging from cholera to family planning. My favorite part of teaching is the singing and dancing.

At the end of clinic (an average clinic takes about 5 hrs) we meet with the HSAs and discuss how clinic went. We mostly use this as an opportunity to remind the HSAs how important it is for them to spread the word about clinic throughout their villages.

After that we're done and we head back home where we enter data, re-pack our boxes, re-stock the food and other administrative tasks.

Monday, March 22, 2010

A day at the museum

Makwinja-one of the drivers- grew up in the area right near one of our clinics and really wanted to take us to a museum that was near his home village. He's seen the place and had never been so we decided to go after Thumbwe last week because its a short day. A museum after work? I know, I know- pure class. To paraphrase the words of the great Mike D: "I am so cultured it's disgusting. I'd better take a shower because the classiness is clogging my pores."

The museum was in an old slave house that was used by slave traders on the slave trafficking route from Malawi through Mozambique. The museum was locked but we got the curator to open it and show us around.

Well it was more like a store room than a museum. No exhibits, no display cases, just boxes. Apparently it's the only storage place for "cultural artifacts" in Malawi.

The first room was full of dinosaur bones. Just sitting on a shelf. The nurses and Makwinja had no reverence (probably not having been to many if any museums before) and were knocking on the bones and testing their tensile strength while Gus and I held our breath praying they wouldn't snap the million year old fossils.

The second room held pottery. We just pointed a box that seemed interesting and he'd pull it down for us and let us see what was inside. We were remarking that despite the fact that these are supposed to be relics, the look an awful lot like some of the vessels that we see in the villages. Guess not that much has changed in some parts of Malawi.

The last room had bones that had been dug out of graves. Some were from young girls that were buried alive with the body of a dead chief.

In sum: locked when we got there at 3pm, no exhibits, shoddy facilities, storage of priceless artifacts in cardboard boxes, really cool old stuff. Exactly how I pictured a Malawian museum.

Ah, and lest I forget: HAPPY BIRTHDAY J0SH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Sunday, March 14, 2010


We went to Muloza today which is in the prettiest part of Mulange district. The drive is literally incredible. And Nesta brought me an mphatso (present) of sugar cane from her garden. Clinic was good, nothing shocking or even hilarious.

Actually, I take that back. I was hilarious today. I led my favorite song in teaching and started dancing. The mothers were going wild to see me making a fool out of myself. They started doing this Malawian thing that is kind of like a whoop that involves moving your tongue sideways back and forth really quickly.

What was even funnier than a white girl dancing, however, was the car ride home. We took two cars- one full of azungues (white-ies) and the other full of our nurses. The idea was that they and we could get home quicker that way. Except that we had Makwinja, one of the Malawian drivers in our car because he's on our way (of course the nurses loved that and were calling him azungu the whole time).

Annnnnnyway: the azungus were in the black truck (which has the only music system) and I asked Indi to turn up the music: "Grinch- pump my jams!" is actually what I said.

[Side note: Indi is the only doctor here right now. He runs the study that I am doing and he is a fellow in emergency medicine and infectious disease. But even though he is kind of my boss, he never ever acts above me or anyone else. He's just a part of the team and we all tease each other mercilessly. We call him the Grinch because he eats raw onion and makes curmudgeon-y jokes sometimes.]

Lacey was trying to explain to Makwinja what the Grinch was. "He's a monster [blank stare]. Ummmm. Like a beast [blank stare from Kwinj]. Grrrrrrrrrr [makes scary face] [met by blank stare from Kwinj]. Like something children are afraid of... [tries to think of Malawian example]....like the thing in N'Darande that people are saying kills women!"

At which point Makwinja looks shocked and then breaks into peals of hysterical laughter while looking at Indi.

So to recap: Lacey told Kwinj that we call Indi a woman-killer (and, we decided, probably a rapist).

Then Indi, trying to explain about the bad jokes, says "I am always saying terrible things to these girls when no one in around." Not exactly helping his case.

I was too busy dying laughing in the backseat to make any sort of rectification or meaningful contribution.

Note: this was on Wednesday and, to my infinite amusement- Makwinja is still obsessed with this. Friday during our car ride he was like, "Hayley, I want to teach you something. Chi-pants. It is the name of that man in Ndarande who has killed those women."

So now we have taken to calling Indi Chi-pants. Appropriate it is not. But still hysterical.

Here's a pic of Chi-pants and the Kwinj:

A feast for the eyes

I am going to take this opportunity to add some pictures to posts that I couldn't illustrate before because I couldn't hook up my camera.

Specifically, I'm going to add some pictures of Zambia and the debacle that was the drive from Lilongwe to Blantyre. So chickity check that post out.

Here are some other other Zambia pics that didn't make it into that post:

Tuesday, March 9, 2010


Still no "o" or "l" or "9" working on the other computer so I snuck onto this one for a quick update- apologies for any typos or non sensical thoughts (at least now I have an excuse for the latter).

So I snuck into the gym at the fancy hotel in Blantyre called the Protea (we call it the "Pro"). Most of you who know me well realize that my breaking a rule is a huge deal. I hate it. I never even snuck into the cafeteria at school and they practically require you to. Anyway, I needed to move the 'bod and thus found myself trying to walk casually by the front desk of the Pro. My palms were sweating and I had tried to compose my face into a mask of calm. I think I ended up looking constipated or slightly drunk. But luckily I remembered to wear my white skin and no one questioned me. Working out felt awesome so, riding this wave of endorphins: here are some thoughts that are held together only by their mutual randomness:

-Went to the market today. Always a chore because you spend 94% of your time fending off requests to carry your bag, sell you an avocado, watch your car, sell you a DVD, sell you a better avacado, give you a plastic bag, "madam this is best avocado, good price good price," lead you to your car, ask for money etc ad nasuem. Today I swear a kid looked at me and said "give me sex." That was certainly a first.

-Another funny market interaction. There is a leaf-thingy called rape (Has anyone else heard of this? Can someone who is not cullinaryily impaired tell me if we call it that in the US?). Buying it always makes me feel weird because the conversation always goes something like this:

Me: What is that leaf?
Her: Rape.
Me: How much for rape?
Her: 20 kwacha

Why do we always get louder when we want someone to understand us?

-Fantastic day at clinic today. One of my favorite sites: N'Tonya. You know that the day is going to be awesome when you are greeted by a smiling toddler who runs up to you as soon as you get out of the car and won't stop beaming. School kids were playing a basketball-type game throwing a corn husk through a rusty hoop nailed to a pole. Saw quite a few moms and enrolled 28 new patients. Got peed on 3 times. Diarrhead on once (OK it was on the scale). Teaching was particularly fun. I started dancing and let me tell you, white people dancing is a crowd pleaser. It always kills.

-Everything here is precious. There basically is no trash. For example, I use bottled water to mix antibiotics and I always find a mom to give the empty bottle to. We also give away the empty cardboard boxes that hold chiponde. These things are reused until they fall apart.

-Some great names (I always change a little part so patients can't be identified FYI): Fraction, Treesha Tomato, Peace Spores, twins named Handsome and Beauty. I also love when a kid has a very American name like Mike. We were at a site and there was a kid named Mike. When they are talking to him it sounds like "iojfkmewofjfojekfwe MIKE iohoialjdpwa MIKE iosrjfewocdkm"

-Had to say goodbye to Courtney, the 4th year med student I was sharing a room with. Very sad because I really liked her. But we had an epic goodbye weekend where we ate out basically every meal. We even tried this place called Debonaire's- it's a South African chain and it's kind of like a McDonald's for pizza. It's joined to a gas station if that tells you anything. But it looks like it could be in America and it's kind of a scene for Malawians who have the money. Very surreal to eat somewhere like that, I didn't feel like I was in Africa. Except when I ordered and had to speak to like 3 people, was told that they didn't have any change at the moment so they would bring it to me with my food and then had to go up and check 3 times before getting my food.

It's especially weird to eat somewhere like Debonaire's when you go to the field on Monday and see how different it is in the rural villages. The very idea of disposable silverware is unknown to them. Most kids at school, for example, use their finger to eat porridge- only a lucky few have a utensil. And we distribute 1 plastic spoon when a baby first gets Chiponde and the moms guard that spoon like gold.

OK I will try to keep sneaking onto a computer to update but no promises.

Saturday, March 6, 2010

Excuses Excuses

Sorry I've been MIA. Here is a few tidbits:

-Great trip to Zambia. Saw your standard safari animals: elephants, zebra, lions, hyena, hippos etc.
-We got really up close and personal with the lions: during one of our night drives they were lying in the road and refused to move. Our driver moved the spotlight to the side of the car there was another lion crouching in the bushes just looking at me, probably 10 feet away (and the car had no top or real sides). "Remain seated," said our driver nervously. Luckily it just walked slowly by the car and slunk off.

Journey home from the safari
-Stayed with Mrs. A in Lilongwe where our safari left from. Mrs. A is the mother of Mrs. K, our Malawian project manager/liason/fairy godmother. Mrs. A speaks very little English and mostly giggled. She did cook us two delicious meals: chambo (local fish) with nsima (cornmeal paste/patty) and chicken and rice (we saw the chicken being plucked). Both of these meals we ate with our hands in the traditional Malawian style.

-She also basically held us hostage in her house. We took a bus to Lilongwe but she was going to drive us back and kept pushing our departure time back until we finally had to insist that we leave and practically force her out the door.

-And when I say "drive us back" I mean that she had me drive. In her Mercedes. While yelling "REDUCE YOUR SPEED" when I got even 1/2 a km/hr over 80 (she watched the speedometer like a hawk). This, combined with the car sized potholes, the frequent police checkpoints, the people and livestock in the road and seeing 4 serious accidents within the first 15 minutes almost gave me an anxiety attack.
-The aforementioned anxiety attack caused my driving to become less than steller. And thus I hit a goat. I'll say it again: I hit a goat while driving an old lady's Mercedes. It made a sickening "thunk" but I'm happy to report that the goat lived and even ran away. Needless to say I made Courtney drive after only an hour.

-When Mrs. A finally took the wheel, however, she proceeded to drive over 100 km/hr and although I was tempted to give her a taste of her own "REDUCE YOUR SPEED" medicine, I refrained because I wanted to get back as soon as possible.

Life and times back at the ranch
Some pictures from Kabula Hill where we live. The first is the porch at the middle house where I live with Gus and Lacey (who are married, Lacey is a third year med student) and Courtney (my roommate and a fourth year med student who is sadly leaving tomorrow!).

-Good to be back at work
-Some drama here between the students/doctors actually living and working here and the administration. Luckily it doesn't affect my day to day life here.
-No water or power for a few days which made internet a no-go and showers and flushing toilets a distant dream. Seems like we're back on track for the moment save a few hours today without water.
-The computer I've been using here is no longer functional so I'm without a regular computer fix. This might mean a slowdown of blog posts- sorry!

Here is what I'll be doing instead of posting....working! Wooohoooo. Here are some visuals from clinic:

Listening to the nurses during teaching. Teaching is when they tell the moms about the different foods that we give and remind them that chiponde is a medical treatment (in order to discourage sharing and increase adherence to the feeding protocol).
Getting a kid to be weighed. This picture must be from the beginning of clinic because usually there is an unruly mob of moms surrounding the scales, height board etc. We spend 1/2 our time yelling "azmai! panga mzeleh!" (mom! make a line) but it usually devolves quickly into anarchy.

Anyway- sorry I can't post a more detailed account of my Zambia trip or anything else but now we have one computer for 5 people so I'll just have to wait and see if the other Mac gets fixed.