From Zomba, Mt. Mulanje is an impossibly tall, dark shadow
that rises out of the ground in the far distance. Looking at it, your brain
says it must just be some odd clouds, it rises so high.
Yesterday we sat down to breakfast a little after 6 am. No
monkeys even dared to be up that early. The wonderful staff at Annie’s had made
us some breakfast and we wolfed it down before loading up the cab we had
ordered the night before. Our driver was a very kind man named Felix with a
deep scratchy voice. He told us tons about Zomba, the harvest, and other Malawi
facts as we left Zomba headed toward Mulanje mountain. At least I bet he told
us lots of facts, because that’s what he was doing 3 minutes into the trip when
I passed out onto my backpack. Ashley did too. Despite the insanity of Malawi
driving, the constant horn, and the very aggressive regions of rumble in the
road, we slept quite soundly until we were so close to Mulanje, all you could
see out the front windshield was mountain. I could not stop staring at this
incredible piece of earth.
Our destination was Mulanje Mission Hospital. Mission
hospitals are sponsored by churches and cost patients a bit more than the
district or central hospitals. Mulanje Mission is a great hospital though
because it is directed by a woman from the UK named Ruth Shakespeare and BOY
does she keep a tight ship. The first thing Penny said to her was how clean the
hospital seemed (most around here are in various states of dilapidation since
upkeep is a lower priority than curing the incredibly ill), and Dr. Shakespeare
responded that there is no excuse for having an untidy hospital because cleanliness
is free. Though she is very kind and compassionate, there is a fearsomeness
about her. I should try to be more like that.
She was so prepared for our visit and had contact persons
for each of us to disperse to our various jobs: Ashley to maintenance to
inventory machines she can make operation checklists for, me to pediatrics to
learn about their malnourishment caseload and protocol, and Penny to the lab to
demo the mtb device and give surveys. Ashley was swept off by a
doctor/maintenance guy Ben, who I’ll explain a bit more about later.
Penny and I did our appointments together since I have
practice running the mtb device. Upon Dr. Shakespeare’s recommendation, we
brought sodas for the lab techs as a thank you for their time and survey
participation. That went over real well. They were also excited that our aim
was to make their workload easier, and they promised to give us some tb slides
too when we came back later to collect the surveys.
blankets they use to warm up malnourished patients
Then we went off to the director of pediatrics, another
woman from the UK named Isobel. She’s been there for 5 months and recommended a
book to me actually when I asked her about her decision to be a provider in a
low-resource country, so we got along well. After our discussion she brought me
to the ward where they had lots of papers about various protocols that were
useful for me, and then I met the woman in charge of malnourishment
specifically, a kind Malawian woman named Leah. Between Leah, Dr. Shakespeare,
and Isobel, here’s some important stuff I found out:
-
While a gadget to measure temperature is great,
the main thing at work against catching hypothermia in the night is culture.
o
In Malawi,
night is for sleeping: In no part due to negligence, nurses on-call at
night just know culturally to go to sleep, so that is why critical changes in a
patient’s health can go unnoticed overnight
o
Some insufficient
health practices are deeply engrained: for example, the Malawi ministry of
health provides a form to record data on malnourished children admitted to the
hospital- no where on the form is there
prompts to log vital signs. The closest is two places to log temperature:
an AM temperature and a PM temperature.
§
In case you missed it, they record a patient’s
temperature two times a day, 6 am and
2 pm- patients particularly prone to dangerous temperature fluctuation. And
those are the official recommendations from the country’s ministry of health
§
When talking to Leah, she pointed out how
difficult it is to see hypothermia in a patient, but that they only take extra
temperatures for patients who are visibly ill. When I pointed out that issue,
she just said “That is how it has been done.” Please make no mistake, this
woman cares about her job and her patients. This is just how they live
~The lesson: many times, culture runs
deeper than reason.
And I believe reasoning is
something you learn which brings me to another important point: many Malawians
don’t lack intelligence, they lack education. Plenty are very educated, but
when a nurse doesn’t think to take a patient with SAM’s temperature through the
night, it isn’t lack of concern or stupidity, it’s culture and lack of
affordable education working against the extraordinary health challenges of
this country.
After all that was done, we were intercepted by Ben, that
doctor/mechanic that had taken Ashley. She was elsewhere with another
maintenance guy, but Ben just said “let’s go get some pizza” or something. I
had never met him but pizza sounded good and his familiarity, albeit confusing,
was refreshing. He made lots of phone calls to try to track down who Ashley was
with but then she just appeared from around a building and we got in Ben’s car
and went to the pizza place. His back seat wasn’t locked in place so Ashley and
I enjoyed sliding toward and away from the front seats as we headed into town.
The pizza place was so good. Ben told us about spending a
decent chunk of his childhood here and returning a year and a half ago and
other parts of his story. He studied medicine in Australia so that was nice. He
was pretty cynical about the outlook for Malawi’s future and its current
leadership, but he must secretly love this place because he came back and you
can just tell by talking to him. He agreed though, the issue in Malawi’s health
system is culture. He pointed out another issue: People wait much too long before going to the hospital here. They
wait until they are in hopeless condition before coming, so that doctors who
could have cured them had they come in sooner, are left to deal with extremely critical
cases. The heart of it all is education. Also interesting, I asked Ben something
like “so you think Malawi is in the worst general shape of any country in this
part of the world” to which he responded, “no, in the world.” I was surprised,
because I’m awfully happy here for being in the country with the direst straits
in the world. It was probably a more specific arena that we were speaking about
but I though it would be spastic to whip out my notebook during lunch so I didn’t
write it down.
Next we went on a quick errand to the Mulanje Mission
Secondary school, which is about 1 tea plantation away from the hospital. There
we met 3 boys being sponsored through school by members of the Blacksburg
Presbyterian School. While Ashley and Penny met with the headmaster of the
school I got to talk to the boys.
across the tea plantation by the school
It was the best moments I’ve spent in Malawi so far. Their
names are Bright, Patrick, and Louis, and they’re all in their final year. They
were such a joy because they were just happy and curious. They were so easy to
talk to because they wanted to talk about everything- they asked about my
family, the weather at home, my husband (sorry to disappoint them), high
school, university, chores, everything. The best was our discussion of dating.
They asked when I’d get married and I said something to the effect of how on
earth am I supposed to know. Louis said he would get married after exactly 2
years of courtship so that he can know all her characteristics, build a house,
and have time to get angry at her. It was a really wise plan. Bright’s tactic
was a bit different. He said “I don’t want to courtship, I’m just going to get
married right away, what’s the point.” He was the jokester, he made me laugh so
much. Louis also indicated that Bright
gets all the girls so that adds up. They were just so much fun. Despite the
fact that they are orphaned, bathe in a river rather than a hot shower, and
walk 50 minutes to school rather than waking up 6 minutes before class, we just
connected. Because people were created for people, and nothing on earth can
make us happier.
me with Bright, Patrick, and Louis
By the time we got back to the hospital and got the slides
from the lab we were a little behind schedule. It’s pretty dangerous to travel
anywhere at night in Malawi, simply because poverty can make people desperate;
it’s true anywhere in the world. Felix was on his A game though and got us home
shortly after sunset. He also played fantastic music- someone look up the
imphatso band for me. So that was our day in Mulanje.
Today was much much less exciting. I was a big dummy and
stayed up late to make an app to demonstrate the alarm system for the thermistors
so I could show Hendrina, the head of pediatrics today. I had to make a new app
because I am having trouble writing the Bluetooth scanning and pairing
processes from scratch for the real app, so I just made one that shows the
capabilities and simulates the temperature being too low and setting off an
alarm. I’m happy with how it works and sort of amazed I could do it in one
night, but it was foolish to stay up so late before going in at 7 am for the
surgical meeting. I couldn’t shadow surgery today since I had engineering things
to do but I wanted to go to the meeting and say thank you to Dr. France and
Wilson.
Dr. France was the first to arrive in the conference room.
He laughed when he saw me writing in my PMDI book and said “I do enjoy your
writing.” He has a point, he saw me taking notes after every case on Wednesday
and then I was taking notes in a conference room by myself. I finally was alone
with him so I got the chance to ask how he came to be in Malawi.
Dr. France- they
mystery unveiled
HE’S FROM HOLLAND mystery solved. He said back in the 70s
Malawi was newly independent and only had FOUR doctors. So it and a few other
African nations appealed to the governments of northern Europe looking for
physicians and Dr. France came to Malawi. He was here for a few years and then
went back to Holland to have a career and then retired and came back here in
2009 because of all the fond memories. Now he is doing really amazing work in
the surgical department at ZCH and everything is great!
Then I went outside, bought some more phone minutes for my
Malawi phone, and sat on a wall to write more until Penny and Ashley got there.
Soon after we started our demo and survey collecting work in the hospital I
started feeling like garbage so when we took a taxi to Annie’s for lunch they
let me off the hook for the day and I slept for 5 hours while they went to
Domasi Rural. That was really really great. They woke me up when they got back,
concerned that I had been sleeping so long but I felt super and then we went to
dinner. I had fish sticks made of chambo, the fish that’s commonly eaten in
Malawi. Dinner was so much fun- Ashley and I sat with the Radford/Tech T&L
girls and we recounted our Mulanje adventures to them. I was able to make jokes
and be sarcastic, really for the first time since coming to Malawi, and it was
such a relief to feel like myself. It also meant a lot that though the T&L
girls were finishing their dinner when we came to sit, our conversations were
so great they stayed until long after Ashely and I had finished. After we all
went to our rooms, Penny came in so we could have a call with Dr. Muelenaer and
Dr. Bird so we could plan the way forward with the device. I think they’re
happy with what I’ve been able to make for demo purposes and there’s still
plenty of data I can collect on the connectivity capabilities of the
thermistors in the hospitals, so I can continue to work hard. Now I get to stay
up super late since I slept all day, right? Excited for the weekend ahead!
With love and chambo fingers,
Lauren
June 2
I am grateful for…
Wilson and Aciatu and the surgical
staff
The gift of indoor heating at home
A childhood without hunger
What will I do to make
today great?
Listen hard to Ruth Shakespere
Write about my time in the Theatre
Sit outside and read
Daily affirmations. I
am…
Excited about people
3 Amazing things that
happened today…
Talking with Louis, Patrick, and
Bright at MM Secondary School
Meeting foreign young medical
professionals and hearing their stories
Dinner discussions with Ashley and
Penny
How could I have made
today even better?
Breathing and letting go of stress
June 3
I am grateful for…
Bright, Patrick, and Louis
Android app studio (never thought
I’d say that)
Sunrise
What will I do to make
today great?
If Wilson gets my thank you note
Seeing Domasi rural (whoops)
Relaxing a little big for the
weekend!
Daily affirmations. I
am…
Hardworking. sometimes
3 Amazing things that
happened today…
Laughing with the T&L girls,
being myself
Learning about Dr. France
Catching up on sleep
How could I have made
today even better?
Gotten more sleep last night
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