To schisto or not to schisto

So a quick(ish) recap of our trip to the lake last weekend:

The lake is about 4 hours away so we took an extra car and left right from one of the sites. The drive itself was amazing because we weren't cramped in the back of an old truck as per usual. Instead we were luxuriating in a large SUV with a working CD player.

We stayed at Gaia house: a pretty typical Malawian hostel-type place. It cost about $27 to stay for two nights and the rooms had electricity (at least until the power outage). Pretty swank by Malawi standards.

Although I was pretty much the driving force behind the trip I did not, in fact, want to actually swim in the lake. If you are familiar with my Walden Pond obsession (on par with my monkey obsession), this may puzzle you. If you are familiar with my germ/parasite phobia, this would not puzzle you- Lake Malawi is chock full of schistosomiasis. If you are familiar with both obsessions, you may have wanted to take a ringside seat and watch the battle royale between my desire to swim in the amazingly gorgeous freshwater and my desire to avoid offering my body as a breeding ground for parasites.

 

No amount of soap and scrubbing will get rid of the dreaded shistoooooooooo

If you haven't surmised my decision by the language that I just used, I decided against a swim. I did, however, walk along the beach- possibly giving myself "ankle schisto" and I kayaked- which, by virtue of the puddle of water I was sitting in, might give me a case of the dreaded "butt schisto."

In order to make myself feel better about this decision, allow me to quote from the infinitely scholarly font of information that is Wikipedia: "The parasite secretes enzymes that break down the skin's protein to enable penetration of the cercarial head through the skin. As the cercaria penetrates the skin it transforms into a migrating schistosomulum stage....The nearly-mature worms pair, with the longer female worm residing in the gynaecophoric channel of the shorter male. Adult worms are about 10 mm long....Parasites reach maturity in six to eight weeks, at which time they begin to produce eggs. Adult S. mansoni pairs residing in the mesenteric vessels may produce up to 300 eggs per day during their reproductive lives. S. japonicum may produce up to 3000 eggs per day. Many of the eggs pass through the walls of the blood vessels, and through the intestinal wall, to be passed out of the body in feces....Up to half the eggs released by the worm pairs become trapped in the mesenteric veins, or will be washed back into the liver, where they will become lodged. Worm pairs can live in the body for an average of four and a half years, but may persist up to 20 years."


My decision resulted ridicule from most of my travelling companions who simply take medication three months after exposure that supposedly kills the adult worms. To them I say: gross- you have schisto. Nuff said.

In lieu of swimming for hours and hours as I would have wanted- I simply relaxed, enjoyed the view and the company of my coworkers.

Some highlights (with pictures!) from the trip:

-A performance by one of the many "children's bands." I use the term band loosely and use it to include throngs of small children who beat homemade drums and have songs where the lyrics consist soley of "Muli Bwanj? Ndiri Bwino. Muji Bwanj? Ndiri bwino!" (which means: "How are you? I am fine. How are you? I am fine!"

-The highly questionable food. The omelets were rockin' but we had some downright disgusting "pesto" pasta that was certainly not made with basil and had an aftertaste of soap. Also, the ketchup was curdled (see picture). This just drove home the lesson that I should have down pat by now: if it's not fried in Malawi- it's definitely not very good and might be dangerous.

-An amazing long walk along the beach with Lacey. By the end of the walk we were literally trailed by close to thirty children, all of whom were clamoring to hold our hands. One girl kept trying to put her mouth on my arm and I'm still not sure if she was trying to kiss or bite me (what do azungus taste like anyway?). 99% sure it was a kiss but best to leave that a mystery.

-Ample time to relax: I finished my book in the first day we were there.

-Hysterical room name: the first night we all stayed in a "family" room with four beds named Black Madonna. The key had a wooden keychain that said B.M. So (again my maturity level is solidified as "very low." I, like Margaret, sometimes feel more at home with school children) I decided that we should refer to ourselves as the B.M. family. It's funny to me.

On that note, I need to do some errands so I must bid ye adieu until I get the energy to post again.

Namandage

Last week I got the good news that I was going on the bi-weekly overnight trip to Namandage. Why was I so excited? The chance to see a different part of Malawi? Time to hang out with our nurses and drivers in a non-work setting? The dinner which always includes chicken (protein is almost non existent in my diet right now)? Sleeping in an extra 15 minutes? No, no and no. I was excited because I would get to hang out with a monkey.
Namandage is the base of operations for Father Samoso- an Italian priest who helps run a rural hospital. The reason we stay there is because we serve a site on Friday that is 3 1/2 hours from Blantyre so we'd need to get up at 3:30 am to get there on time. So, on Thursdays, we stay at Namandage which is between Chamba (the site we serve on Thursday) and Chipolonga and Chikweo (the sites we serve on Friday). But enough explanation- back to the monkey.

Much like every other sentient being in the 1990s, I had a serious thing for Aladdin. Putting aside blantantly racist imagery, Aladdin is one of Disney's masterpieces. Specifically, I loved Abu: Aladdin's plucky and sometimes pesky simian sidekick. My obession with Abu, combined with seeing a documentary  about Jane Goodall, left me with a hankering for a monkey friend.

Well, my friends, I finally got to play with a monkey. Father Samaso has a pet monkey named Figo who lives and plays at Namandage and I couldn't wait to to meet him. Yes, I know its unethical to keep monkeys at pets. Yes, I know monkeys probably have plently of nasty diseases. But c'mon- I got to play with a monkey!

Figo was quite the little rascal- he lives outside but kept sneaking inside to steal bananas and break cups.

Namandage was great in other ways: I got to take a long walk through two villages where we were followed by the usual gaggle of awestruck children, stupified stares, shouts of "azungu," butchered English and double-takes. But any chance to walk through Malawi is worth capitalizing on because it is such a beautiful country.

 

Mr. Figo

Me and Figo

Crazy weather at Lake Malawi

 

Storm rolling in

 

My three travel buddies watching the storm come in

 

Rain hits Lake Malawi (cleared up about an hour later).

And the walls came tumbling down...

So Malawi is finally getting going with the rainy season. This is great news for the whole country because the majority of residents are subsistence farmers, so no rain means serious problems. The fact that the rains started late is quite problematic in and of itself so we'll see what the future holds for the chimanga (corn) crop.

But despite the slow start, mother nature has been making up for lost time. It's been raining all day in Blantyre. As today was the cook's birthday, I offered to drive her home so she didn't have to walk. It took me a second to find the keys to an automatic car (driving lessons haven't been going as well as I'd like) but as we were ready to go...BOOM....we heard a big bang!

We thought that the down house had been struck by lightening- but it turns out that the the wall diving our house and the neighbor's property had totally collapsed. Luckily no one was hurt (especially lucky it was raining because normally all of the kids play in the driveway.) And we realized that if I had found the keys a minute earlier we might have been hit with the wall.

Here is a picture of the wreckage.

We survey the damage.

Vella

 

Vella- one of the little girls who lives in our compound. I love her shy smile and her tiny little braids. I promised everyone a Malawian baby and I don't think I could do much better than this lil critter. 

On a lighter note:

So it feels kind of weird following a more serious post with a silly anecdote. The truth is, however, that this sort of juxtaposition has become commonplace. Even after a serious day, we always end up laughing and cracking jokes. It works quite well as a coping mechanism even if it seems kind of callous.

Tonight, for example, Courtney happily informed me that she had a name to add to my list of African baby names: Faggles. Yes- Faggles. Not even Faggle. Faggles.

Nothing like a lil bit of parental ingenuity to end my day with a smile.

Quite a Monday

So I'm going to post about the lake but first I wanted to post about my draining but satisfying day:

You know your week (and month for that matter) is going to be interesting when it starts with a toilet that doesn't flush, spilled placebo (juice) and a skinned knee. Luckily, after these minor issues (the last being the biggest blow...to my pride), Gus came to my rescue. After falling, I got up, tried to play it off like it was no big thing, fell again and finally staggered to the car. When I opened the door, however, Gus was playing Leona Lewis at full blast even though I already told him that BBC Africa was OK by me. Ah, the restorative power of bad pop music.

Mondays we always visit sites in the Shire (pronounced she-ray Valley which is, in the words of our team: dirty hot. And Mitondo, the site we went to this week, is also a dirty long drive. As Gus had kindly indulged my prediliction for horrible music, however, I could have sat in the car for another couple hours. When you roll up to a site listening to Akon's "So Paid," you know that your week/month is irrelevant because you are so freaking happy at the moment.

But I digress. Our clinic went fairly smoothly although Mitondo is kind of annoying because the moms were showing up late and sort of trickling in which makes it very difficult to get things done in an efficient manner. We'd measure 10 kids, go help weigh some, measure a few more, make some antibiotics, weigh some more kids, wander around, measure some more etc etc ad nauseum.

When we finally finished at clinic we determined that our day was not quite over. We would have to make a home visit. When a mother fails to show up to clinic, we create a "send the message" card and give it to the HSA that is responsible for that family's village. The HSA delivers the card to their house and lets them know when the next appointment is. In order to find these missing children, we always ask directions to the home on the original study form. Now when I say "directions," I don't mean the kind that MapQuest gives. A typical "directions" section reads like this: "from Namphungo Health Center, go down road until Nhware village. Once there, go to second bore hole and ask about family at Mr. Nrwutu's home behind maize mill." Amazingly, the HSAs seem to find these families with no issue. They generally are able to get the mother to come to the next village or bring back news that the child has passed away.

Today, however, this mother had failed to respond to two separate send the message cards and the village HSA was working with us at clinic and informed us that the child was still alive. On our way home, therefore, we stopped on the road and, with the HSA, ventured into the village to find the mother. When we got to the hut we found the child and the father. The mother was inside and, they informed us, had just given birth the night before. This sent the HSAs into a tizzy becuase giving birth at home is illegal- mothers must go to the local Health Center or they must give a goat to the village chief as a punishment. This is policy is apparently meant to discourage home birth because of the increased risk of complications (although having seen the Health Centers which are little more than Tylenol dispensaries with a row of dingy old beds I think that the increased benefit is minimal).

I told the HSAs that they could deal with the unauthorized birth later and asked the mother to bring her older child to the road so that we could measure her. We determined that this child (the older one who was in the study) was fine and asked the mother why she had missed clinic. She told us that she had run away from the child's father and was gone for several months. They apparently reconciled because she was back in the village living with him. In the course of the conversation, however, the HSA informed us that the mother said that her new baby was 2 months premature, hadn't cried and wouldn't nurse. As this was clearly a serious situation, we told the mother to go get the baby and we would bring the baby to the nearest Health Center where they could get an ambulance to the district hospital. As the mother turned around to go back and get the infant, however, she basically collapsed. We picked her up, put her in our car, went and got the baby ourselves and headed to the Health Center. During the ride to the health center I had this tiny baby in my lap. It was so cold and so puny. It's hard to describe how I felt: it almost didn't seem real but at the same time I felt protective and scared.

When we got to the health center, however, there was no clinical officer and no ambulance.  So we piled back into the car and drove an hour to the hospital. During the ride, I was trying my damndest to keep that little tiny thing warm. It was barely moving and it was taking labored breaths. As soon as we stepped out of the car at the hospital, however, the baby had begun to sort of mew in a high pitched voice. We left the baby and mother at the maternity ward and finally headed home.

While I feel good about the fact that we took the baby to the hospital (it almost certainly would have died at home because it was too small and lethargic to nurse), it doesn't feel like a clear victory. The hospital, while better than the health center, is abysmal. The mothers lie on garbage bags instead of sheets, the water is most likely infected with cholera and the resources are severely limited. Add to that the fact that this woman's husband is probably a dead beat and you begin to realize that you may have helped the baby but you did not save the him or his family by any means. I comfort myself, however, with the knowledge that we truly did the best we could.

As we were leaving the hospital, Rose, one of our nurses, turned to me and said: "that baby was so very warm as if he had been with his mother. You did an amazing job of taking care of the baby." And that is what I am going to take away from this hectic Monday.