Sunday, April 25, 2010

Good Friday indeed

(Old post from Good Friday:
People doing stations of the cross in the road. Needless to say we had to just pull over and wait.

Today was Good Friday and we went to Chingale- one of my favorite sites. We have a new student here, Gregg and so we took two cars instead of one. So it was just me, Lacey and Makwinja in the car. Lacey was studying her surgery book so Makwinja and I talked the whole time about inflation and education.

On the way we saw Gift, an 11 yr old who usually helps his mom by bringing one of his twin baby brothers to clinic and another young boy with a sibling who was also heading to Chiponde clinic. Because we had room in the car, we stopped and gave them a ride. Gift's baby brother was absolutely terrified. Like saw the grim reaper terrified. This kid would not stop screaming bloody murder and not just when he was looking at the scary white people. OK lets zoom in on that jeeeeest a little...
Turns out that he had never been in a car before- none of the kids had.

I also saw one of my favorite babies in the whole program- George P. Ahhhhhh I love that lil munchkin. I got to hold him during teaching and even danced with him.

His mom probably thinks I'm going to sell him on the black market.And Lacey accused me of liking the "waif look" in babies. And I'll admit he's kind of a frequent flier with our clinic. But I think Georgie-Porgie would be cute even if he put on like 5 kg. But perhaps I should be concerned that my standards of baby beauty have been warped by treating malnutrition!  

Also it's Gus' 26th birthday so we went to lunch at the Dirty Sun (The Food Court at the Malawi Sun hotel). And then we're having happy hour. Score. Props to Gus for being born.

Yesterday a child pooped on my shirt. I picked up the kid whilst it was naked and it used my shirt as TP. Left me with a visible skid mark. on my white tee shirt. sigh. my life here is so painfully glamorous.

Friday, April 23, 2010

Longchamps

So a lot of the clothing that Malawians wear is used and comes from South Africa, Europe and the US. Here's an example of a used clothes market. The name for used clothes is Kaungika which means piles. And the clothes are mostly sold in piles but some higher end items like these are hung up.


They don't generally have any idea about what is written on their shirts, its always funny to see a Malawian walking in the village with a Red Sox tee, or a muscle-y young man wearing a "Lady Chargers" or a pink "Rush Delta Delta Delta" shirt etc. Here's a cute girl wearing a cheerleader Halloween costume for example. To her its just a shiny dress:

They don't have any idea about brand names and labels and pick their clothes based on fit and durability (shocking I know). And in terms of style I get the impression that things that are kind of showy are embraced because they connote wealth. That's why many little kids wear these princess-type shiny dresses made out of very cheap fabric.

Anyway,  I did triple take at the site yesterday when I saw this:

Can't put that in context? Howssssabout a little help:

http://www.neimanmarcus.com/store/catalog/prod.jhtml?itemId=prod104820036&ecid=NMCIGoogleBaseFeed&ci_src=14110944&ci_sku=H4RFU
 
 That's right. Some Malawian woman is walking around with a $150 tote bag. Which I'm sure she'd gladly trade for a bag with sequins on it. Kind of makes me feel (rightly) silly about our national obsession with brands and prestige.

Thursday, April 22, 2010

Seeing is believing

Sometimes our work gets monotonous. And we see so many kids that it's hard to keep track of them and thus it can feel like working in a vacuum. But sometimes you get the gratification of seeing a kid get better right in front of your eyes.


Here is a good example of kwashiorkor:  notice the skin breakdown and the intense swelling.


Here is a kid at one of my sites with severe kwashiorkor:
Keep in mind that kwashiokor is very very dangerous and frequently lethal. 

 Now...just 2 weeks later! Look at his legs- there is practically no swelling.


Pretty amazing.

Monday, April 19, 2010

Pick up lines

Last weekend was Meg's last weekend in Malawi so I convinced her to go for a beer at the Blue Elephant, a popular bar in Blantyre.

When we were there a man approached us and was trying to spit some game. Now I've heard some weird pickup lines, especially from Malawian guys when English is their second language. Normally, however, they just go for directness: Lets get married! I would like to know you! etc etc

This guy, however, decided that he would go all-out despite his very shaky command of the English language:

Hello! Did you know that there are two Martin Luther Kings? One black and one white?
What? Oh, you mean Martin Luther King Jr and Martin Luther? Umm....yah.
Which one do you think was more intellectual?

Yah. Gotta appreciate a pickup line with some historical relevance!

Saturday, April 17, 2010

A healthy dose of negativity

My bittersweet face

So I’ve been overwhelmingly positive in my posts thus far- cherry picking all the fun/interesting/meaningful/strange/cute/hysterical moments from my time here. But I’ve been here for more than three months and I have more than a month left. Clearly my time here hasn’t been all sunshine and puppies (or in this case mangos and babies). I have enjoyed my share of the mundane, the annoying and the downright infuriating. So, in the spirit of optimism: here have been my least favorite things about Malawi aka the things I will miss least:

1) Living and working with the same people 24/7. I really really really like the people that I work with. In fact, I would say that they are the best part of my experience here. That being said, I get to love ‘em in the morning at 4:30am love ‘em during the day at clinic as we rush to get the moms in and out, love ‘em as we enter data, love ‘em over dinner, love ‘em after dinner etc etc etc. Living and working with the same people, even if you really like them, is quite trying at times. A minor annoyance at clinic (someone was short with someone else) weighs on you more heavily when you never spend more than 5 minutes without that person for the next 4 days.

2) The food. OK so I kind of did talk about this (guess I’m not as positive as I envision myself) but it bears repeating. It’s bordering on impossible to eat a healthy diet. I am a diehard carbs fan but even I am so sick of carbs that I think I’ll need a carbcation when I get home. I love junk food but I love it more as a treat than as an exclusive diet.

3) Being the object of curiosity wherever you go. I am never invisible in Malawi. Even when I look disgusting or am tired or in a hurry- people stare. It’s the worst in the villages where they scream and point but even in town I attract attention. It’s funny and fine 95% of the time but 5% of the time I find it tiring. Like when I go to the bathroom. No one wants that to be a spectator sport. Ahhhhh look! I just saw a white girl come out of the outhouse!

4) Lack of Internet access: self explanatory. 2 accounts for 8 people.

5) 4:30 wakeup time.

6) Miscommunications. Which I am using as a euphemism for “people don’t understand you/choose to ignore you.” Everything here is a production. Yesterday I asked for no mayo on a sandwich I was buying. Got extra mayo (We call this getting “Malawied”). Or when I tell an HSA to fill out the data card in private and 5 minutes later I see them surrounded by a crowd of moms. I know its not intentional but it gets frustrating for everyone involved.

7) No sushi.

8) Did I mention the wakeup time?

9) Not being able to communicate easily with those I love. This is probably the hardest. I am very lucky that I have periodic internet access and can even talk to people on my Malawian cell phone if they get a calling card. But it’s really hard because as much as I like my coworkers/housemates, they don’t know me that well. I miss being able to talk to people who know my moods, my likes and dislikes and can let me blow off steam without having it color their judgments of me. And given that I’m trying to decide where to attend medical school next year, being on a different continent from the people who know and love me makes things very complicated.

10) No paper towels. Probably the worst thing ever.

But the truth is that I am really very happy here. I am also very happy to be going home soonish so I can enjoy my super clean house, eat my fresh food and see Rocky.

Thursday, April 15, 2010

When Nature Calls...and I do mean nature.




When you gotta go, you gotta go, right? Even when "going" means availing yourself of a mud hut with a hole in the floor. Which isn't even really that bad. In fact, I've devised a rating system that scores the facilities at each of our clinics. It's the same as a ski run, with green being the easiest and triple black being the hardest.

A green bathroom would be a toilet of any description- flushing and seats are extras but not expected and toilet paper is simply unheard of.

A triple diamond would be the bathroom at Thumbwe. You need to go into the outpatient clinic, knock on the door (scare all the children in your path and attract a crowd of people) ask for the key, go around the back of the health center, jump off a small ledge and walk what feels like miles (but it probably like 100 yards) through the weeds to a locked outhouse. When you finally get there you expect that maybe this guarded treasure will contain a golden toilet seat, a cache of fine soaps and cremes, or at the very least some TP. Nah, it's just a hole in the concrete floor.  With bugs and lizards as voyeurs to watch you relieve yourself. And then you get to walk the key back up to the health center and run back to clinic.

So that unlocked mud hut you see above is actually a blue square. Clearly my standards are pretty low (evidenced by the fact that I raved over the facilities at a gas station in Zambia). Makes the bathrooms in my freshman dorm seems downright palatial. Heck, even the bathroom in the basement of 444 seems luxe. Nah, I take that back- I'd take a mud hut over that cell of horrors any day.

Tuesday, April 13, 2010

Kangaroo?

Sometimes language barriers can be hilarious. Check out this card where the HSA got confused by the question, "Has the child been to the hospital or the NRU (nutritional rehabilitation unit) before....and if so, why?"

Thursday, April 8, 2010

Roomies!

This? Oh this is just a glamour shot of my favorite roommate: Mr. Disgusting Hairy Tarantula, who I fear is in my bed every night. Say hi, Mr. DHT.

Tuesday, April 6, 2010

The Joys of Children/STDs of the eyes?

Ah- how I love working with the wee ones. They give me hope. They give me joy. They give me acute viral rhinopharyngitis?

Yes, one of these little buggers has given me the gift of a nasty cold. I've been sniffling, sneezing nose-running all over clinic.

But I should hardly be surprised- "baby" is the Chichewa word for crying/pooping vector of disease. No, I kid! But seriously, these kids need to learn how to use Purell. Or at least they should let me dip each baby in a vat of Purell before I handle them.

Actually, I should be happy to only have a cold. Especially since I was talking to the doctor I work with about the flies that are always in these kids' eyes and noses. Apparently the flies give the kids chlamydia which sometimes makes them go blind. Yah, chlamydia. The flies carry it from the lady-parts to the kids eyes!

So yah, I'll just keep blowing my nose, batting flies out of my eyes and counting my blessings.

Chikonde

 Man with a plan

HSAs hard at work. This picture was posed. Before I took it- three of these guys were sitting down and eating sugar cane.

This is Chikonde, a Tuesday site and one of our biggest and busiest clinics- Lacey and I always leave exhausted. One of the charming/annoying things about Chikonde is the nearby school which feeds us a constant supply of school aged children who want to watch the goings-on, yell “give me [pen, money, Chiponde etc]” or repeat everything we say in Chichewa and laugh hysterically. No matter what we do, we are surrounded by a crowd of staring children. It’s very much like being in a zoo. You might say “hello!” or “bobo” (like whats up in Chichewa) and they will shriek with laughter and repeat what you said like you’ve told the best joke ever.

Here are some kiddos helping pack up the empty bottles and carry desks (which we use to do heights and weights) at the end of clinic in hopes of scoring an empty carton. This picture was taken before they noticed the camera:


Here they have caught on to the camera:
Here I told them to act naturally!!! so they threw up the power fist. Which is exactly what I do when I’m acting natural.

Here is Mr. Liwonde, the head HSA for Chikonde. Always a trendsetter: he wears a mini backpack on his front:
His main function seems to be to chase the school kids with a stick. Today I was trying to be constructive and told him that a) I think that is makes it a game for the kids and makes the problem worse b) We don’t allow physical violence at Chiponde clinic and c) it was OK if they watched as long as they didn’t take anything.

So after my anti-violence lecture he gave a long speech to the kiddles in Chichewa and I heard the word “atupa” which means swollen (we say it to ask if the feet of the babies are swelling). “What are you telling them?” I asked. “I am telling them that they have a choice. They can go back to school or they can stay here and I will beat them until they are swollen.”

Uhhhhhh. Guess my anti-violence talk didn’t translate well. None of the kids seemed the least bit perturbed, however (even the ones that he chases come right back as if this were the best game ever) , laughed hysterically when he was talking, and continued to wreak havoc until we left (with them chasing the car of course).

Monday, April 5, 2010

Elephant Marsh: fail

So this past weekend we tried to go to a nature preserve called Elephant Marsh. "Tried," however, is the operative word here. There is only one guidebook to Malawi and no reliable roadmaps.

The guidebook says things like "you may want to check to see if the bridge is operational or flooded before you leave." Oh really, Mr. Briggs? And who exactly am I going to check with? The little man who lives in a hut by the bridge and has a satellite telephone?

But I digress. The guidebook showed two ways to Elephant Marsh so we chose what looked like the shorter way. Turns out that they don't differentiate in the guidebook between paved roads and roads that are dirt/mud/mostly potholes/winding through the mountains/in the middle of nowhere and sometimes end in a random field.

And we weren't exactly inconspicuous with our white skin and bright yellow Land Cruiser:


At one point we got out of the car to stretch our legs and this guy comes up and says "you are at my home! [pause] I am very interested to see you here..." This was a Malawian way of saying "What the f**k are you white people doing here!?" Believe me, my man, we were very surprised to be at your home as well. I then showed him the picture I took of him and he goes, "Ahhh but it is very beautiful!" Yes, yes you are.

Needless to say we took a nine hour drive. I wasn't sure that we'd ever find our way back. Many of the roads we were on ended up as dead ends and many times we asked for directions and it went like like:

"Do we go to the left?"
"Yes!!"
"Or the right?"
"Yes!!"
"Wait, the left or the right?"
"Yes, go to the end and stay to the left right-hand side."

Yah, I'm not sure what he meant by the left right-hand side but eventually we made it to the marsh. And discovered that, as promised, the bridge was flooded. We asked these people about the bridge and they were like, "Well you can't use the car. But if you want to go by these boats you can just leave the car here." Seems like a fair trade to me: our car for a 1 hr boat ride. Should have taken them up on it. Meh, hindsight is 20/20 and all that.

 This guy gave us directions to Mkanga and then said, "I am from there- I will be seeing you." Hahaha, yah right we said. We are in a car, my friend and you're riding a bike. Well after hitting the dead end of a flooded bridge, we had to turn around and go back through Mkanga. Guess who we saw wizzing by on a bike and waving?
 

Thought we'd have another 9 hr journey retracing our steps but luckily we found another road. Although at one point we asked the way to Blantyre and the person just burst out laughing. It was like being in Denver, CO and asking a passerby how to get to Orlando.

Here are some pictures from our journey and people who helped us along the way:

Saturday, April 3, 2010

Tour of Queens

On Thursday I had a chance to take a mini tour of the pediatric section of Queens Hospital (the biggest hospital in Southern Malawi) with Erika, an attending physician from WashU who is living with us for a few weeks and working on an HIV study there.

Queens is huge and very sprawling as it needs to be all on one floor because elevators+frequent power outages would be a terrible combination. Like everywhere in Malawi, there are people everywhere. Families sleep on the floor near the patients bed and do their own laundry and cooking outside on the covered walkways so there is a colorful mishmosh of people, clothes, food, chickens, dogs etc.

As you might expect, it was sorely lacking in certain ways. There were no linens for the beds so patients sleep on their own chitenjes or nothing at all. The beds are all lined up next to each other so viral illnesses are easily communicated between patients. The patient: nurse ratio ranges from 1:25 to 1:50 or more ( especially during the night) so parents have to be trained to monitor their children for signs of trouble.There is little to no cardiac care at all so patients with heart issues generally die if they don't have the means to get to South Africa. Even mosquito nets are in short supply so patients frequently get malaria while staying at the hospital.

I was most surprised, however, that they did not quarantine patients with tuberculosis (which is very serious and spread by coughing). They did have a room where they had quarantined measles patients (they were having an outbreak) but, in typical Malawi fashion, the door was open.

I was pleasantly surprised by a few things: They have a child protection program which handles "defilement exams" (for victims ofrape) for example. Even if offenders are rarely (if ever) prosecuted, the fact that they have dedicated and trained group of people to help is great. They also had a pediatric palliative care program (which Madonna is apparently very fond of). There is also an effort to get everyone tested for HIV upon admission to the hospital which would be great but there is a shortage of reagents for the rapid test right now. They also had a new pediatric emergency room and triage system so they have fewer kids dying in the waiting room.

I'm hoping to spend some time at a comparatively more rural and basic
hospital to have something to compare this to. All in all, however, given the facilities, the staffing, the risk of contracting an illness from fellow patients and the fact that you need to be accompanied by a family member to take care of you (thus losing their labor at home and in the field), I can understand why people wait until they or their children are very sick before coming to the hospital.