I woke up on the wrong side of the bed

I had such a cranky day today. I didn't want to get up, I was not at all charmed by the kids chasing the truck and shouting "azungu" and everything was making me angry.

Lacey was also feeling cranky and I was quite glad to have her: together we turned our crankiness into snarky humor which alleviated much of the feeling behind the rancor. The HSAs were certainly not helping our mood: they were filling out cards wrong, sitting doing nothing, seemingly making up weights and then staring at us blankly when we tried to correct their errors. During a height board lull, Lacey stands up and goes "I'm going to go rain some fire down on the HSAs." Needless to say I'm happy it was a relatively short day.

A quick mango fix, trip to the Malawi Sun (a food court type place at a local hotel) and sharing some funny stories from the day with the team has taken care of my crankiness and I'm feeling much better.

We're off to Lake Malawi this weekend! We're leaving directly from one of our sites tomorrow so likely I won't be doing any blogging unless I'm feeling ambitious later tonight. Hope everyone is having a good end to their week.

Children hate me

Inspired by the rousing success (read: Sara liked it) of my post on children reactions to me, I would like to start a new series on the fine piece of journalistic brilliance that I call my blog. The new series will be entitled "children hate me" and will feature photos of wee Malawians who are scared out of their mind by the pigment deficient weirdo with the camera. I would like to add a disclaimer, however, for those who don't know me/potential babysitting clients/pediatric residency program directors/the small children who frequent my blog: I have no reason to believe that children do, in fact, hate me. In fact, there is at least limited evidence to the contrary. The title and content of this series is meant purely in a lighthearted and intended to provoke a chuckle (whether reality matches intent is up to you, dear readers). Anywho, here goes:

 

This little girl was so perturbed and disgusted that she gets two pictures. I also particularly enjoy how her mother seems to be delighting in her terror. This is actually quite common: mothers think it's hysterical when their brethren are fear-stricken by the sight of an azungu and generally try to force their offspring even closer to me. This, of course, makes the child even more terrified which in turn makes the mother laugh harder. Perhaps Malawian mothers are the intended audience for this series?

Water, water everywhere?

One of the things I was most surprised by in Malawi was the water system. Every time I’ve traveled to a developing country I’ve taken great pains (with mixed success- right Tanya and Mike?) to avoid
drinking the water or eating anything even washed with water. Here I can fill up my water bottle without worrying that I’ll deplete the stock of Pedialite that I brought. It feels incredibly luxurious to not be constantly worrying about what I drink. Apparently Carlsberg beer, which has quite a few factories here, helps to chlorinate and cleanse the water system in Blantyre and Lilongwe. This is even more impressive given that in the villages the water is fully tainted with Giardia, Chlorea and other fun stuff.

The downside to all of this is that when there is not enough clean water, they just simply don’t pump anything. That means that we might get back from a particularly sticky day at the field and have no water. Usually it will start flowing within 24 hours but until then you have to suffer in your filth or splash scalding water on yourself from the hot water tank. Today is one of those days. Thus, I write to you in a state of less-than-cleanliness. Let's just say that I would not be welcome in most respectable eating establishments at the moment. Luckily I have Purell and a mound of mangoes to keep me company.

Custard Apples

Tried a new fruit today. It's called a custard apple and you kind of eat little hunk and spit out the seeds. It has an almost coconut-y type creamy taste. All in all it's kind of a lot of work for a little pay off but I was kind of into it. Here's a picture I shamelessly stole from google image:

Felt kind of like I was cheating on mangoes but I'd already had 5 mangoes (this is not hyperbole) so I think it's OK.

In my infinite maturity...

That picture of a child's rear end was intended to visually signify that the following post is scatological in nature:

So, in dealing with terrified children you need to expect a bit of messiness of the urine variety. As urine is quite sterile this hardly bothers me at all. Normally I say "clean up on aisle four," pick up the offending child, hand the dripping lil critter to his mother and get the cleaning fluid- all with a smile on my face. Today, however, a mother handed me the study cards for her two children and there was a legit hunk of feces/diarrhea on it. Not a smear, not a smudge, but a thwonk of pure human fecal matter. I must confess that I was pretty grossed out. Many kids here have diarrhea (you would too if you drank the cholera infested water, ate goat intestines and weren't able to refrigerate anything) and on more than one occasion I have seen a kid with diarrhea running down his or her leg. But there was something about being handed this particular chunk that spoke passionately to my gag reflex. For some reason, however, my response was to start giggling uncontrollably and grinning to myself. But I'm sure that's no surprise to anyone who knows my level of humor. Nothing like a set of loose bowels to really make my day.

Some random pictures

And now for some random pictures:

 This little girl looks like she's praying to the study card (or is about to make out with it). Now there's some dedication to clinical research.

This is Chiponde in action. The child must demonstrate that he/she will eat the food before we send them home with a two week supply. If they can't eat it (too sick), we take them to the hospital. However, outpatient therapy has been shown to be significantly more effective than inpatient therapy for malnutrition- even severe malnutrition- so even if a child is quite sick, if they can eat the Chiponde they are sent home. 

Anyone for some Chiponde?

On one of my first days here I had a Chiponde/supplementary food tasting. Let me tell you- I don't hate it. Chiponde is my favorite and it kind of tastes like a really sugary Cliff Bar.

One of the problems that we have is that sometimes a mother will share the Chiponde with other people in the family. While it's understandable, it also means that the child who really needs the nutrients will not recover fully. Another big no-no is feeding the child other foods along with the Chiponde. Chiponde is so energy dense that if you give a child other food, they won't be able to eat all of their therapy food.

It's very important to educate the mothers about these issues so our nurses teach a mini lesson at every site. Part of teaching is always singing. We sing songs that the village women already know and add parts about Chiponde. One of the songs we sing, for example, says "Chiponde ndi mankwala" which means Chiponde is therapy. I tried to post a video but blogger didn't like whatever format my camera recorded it in. Probably for the better as my skills as a videographer are more closely alinged with the creators of the Blair Witch Project then Ken Burns. You would most likely be upchucking your Chiponde if you watched it so a picture will have to do.