Firstly- I would like to apologise for a previous spelling mistake that my Mum made me aware of. Due to some lapse in spelling abilities I have been spelling "paid" wrong. I'm very sorry and apologise for any other spelling mistakes!
Back to blogging.
After an ambulance ride, a 6hr mini bus ride and a short but expensive "taxi" Alicia and I arrived at Cape Maclear on lake Malawi. It is beautiful here. Our lodge is right on the beach. The waters edge is always busy with locals washing their clothes and dishes, children playing and fisherman tending their nets and boats. The lake is famous for its snorkelling and diving, and also for its schistosomiasis. Schistosomiasis, or Bilharzia, is a parasitic disease that can cause bladder problems in the future. After learning that all the water for showers at our lodge comes directly from the lake, I decided I wasn't going to miss out on the awesome snorkelling here when I had already been exposed by showering (by the way, I had my first shower in six weeks here as our house in Mulanje only had baths that were too slow to fill. Note: I still washed, but with a bucket of cold water).
So yesterday Lish and I went for a snorkel, followed by a hoard of men looking to sell their wares. Unfortunately it is low season here at the moment and during the week the cape has few tourists. As a consequence, many of those who rely on tourism for their incomes, are currently relying on the two of us. We are the only ones staying at our lodge at the moment so a lot of time is spent saying no to the various tradesman (and I am quite bad at saying no, so I usually have to call Lish in to do it for me).
Tomorrow is Lish's birthday so we are going on a boat ride to a nearby island to do some more snorkelling. We haven't done a whole lot here, just relaxing and reflecting on the past six weeks. On the weekend we are off to Lilongwe before flying out to Tanzania for safari. Should be good!
Thursday 23 February 2012
Thursday 16 February 2012
week six
Six weeks has gone by quickly, but at the same time it feels like I've been in Mulanje for ages. I've learnt a lot about the practice of medicine in a developing country, about resource allocation, about HIV, about malaria, about TB, about poverty, about hunger and about pain. However, there is a lot more to learn which I realize would only be possible by spending a much longer time in a place like this.
Last week the hospital was going through a slight crisis. The government had not payed the hospital what it owed it for the month. The staff had not been payed since Christmas time and the effects were starting to show. Some couldn't afford food to feed their families. There is a nursing college here at MMH, and there wasn't even money to feed the nursing students that live here on campus. They were told that they would have to go home on the weekend. Luckily the medical director managed to scrounge up the money to keep them for another couple of weeks, but we really don't know if they will be able to stay much longer unless the government holds up their end of the bargain. The staff were payed a few days ago so that is a great relief. However we are really low on drugs at the moment and there wasn't enough money to complete a full order for the next lot. Last week we also ran out of the reagents to test peoples blood group so we couldn't do any blood transfusions (usually there are many people in need because of anaemia due to malaria and HIV). The district hospital down the road apparently has even less than us right now so are sending sick patients here.
Early on in our stay here, Lish had a couple of kids who were on oxygen die on her ward because the power went off (as it does almost daily here) and so the oxygen concentraters went off too. So yesterday when the power went off, I saw Lish run straight to the paeds ward as she had two sick kids on oxygen. Unfortunately getting the generators up and running for people on oxygen isn't often a priority for nurses and other staff on the ward here. However, when people saw Lish getting straight into action mode and running down to maintenance to get a petrol generator on they were very pleased and thankful. Luckily the power came on later in the night before the generators ran out of fuel (remember there is a fuel shortage here, so running a gen is quite costly). One of the kids did die during the night, but one made it- and Lish had done everything she could, so it was a much better outcome than last time although still very sad.
Yesterday our friend Moses invited us to his house for dinner. His village is a 3km walk from the mission which he does everyday. Moses and his sister insisted on killing a chicken for us to eat with them. A chicken is very valuable and we knew it was a big deal for them to eat chicken- especially in this time of hunger. But it gave them great joy to be able to share with us and it gave us great joy to be invited into their home and eat with them. We also picked some of Moses' maize cobs and he roasted them for us. They tasted like pop corn! I sat on a mat with his nieces, nephews and other village kids and popped off the kernels so we could share together. The kids charged passed at one point chasing the chickens. They caught one, killed it, plucked it and put it on the fire right in front of us. Moses also took us to his field of sugar cane and gave us some to take home. I was then called upon to help make the nsima (as I brag about my nsima making skills quite often). It was much harder stirring on the fire rather than on the stove as I was crying from all the smoke in my eyes! We were very grateful to have spent the entire afternoon there with them. This was the third time I'd been to Moses' house but it was still a confronting experience. This guy is awesome and is always dressed well and speaks English better than any other Malawian I have met, so it's crazy to see all the family he is responsible for and the conditions he lives in. The unfortunate follow up from the village experience is that today I am a little under the weather...
We are now faced with packing, saying goodbye and leaving Mulanje. I will miss the beauty of the mountain, which stands as a tall and majestic reference point from wherever you are in the area. I will also miss the beauty of the people who are so kind and welcoming. Selfishly, I look forward to detaching myself somewhat from the pain here. However I know I must not let myself do this too much and risk forgetting the feeling of discomfort about the state of the world that I hope is the start of living a life that truly makes a difference.
On Saturday we are catching a ride to Blantyre from where we will catch a bus up to Lake Malawi for a week of rest and relaxation before flying to Tanzania for safari. I'm not sure what my blogging capacity will be for those two weeks, but hopefully I'll get some internet access. I am looking forward to seeing you all after the 5th of March when I arrive home.
Last week the hospital was going through a slight crisis. The government had not payed the hospital what it owed it for the month. The staff had not been payed since Christmas time and the effects were starting to show. Some couldn't afford food to feed their families. There is a nursing college here at MMH, and there wasn't even money to feed the nursing students that live here on campus. They were told that they would have to go home on the weekend. Luckily the medical director managed to scrounge up the money to keep them for another couple of weeks, but we really don't know if they will be able to stay much longer unless the government holds up their end of the bargain. The staff were payed a few days ago so that is a great relief. However we are really low on drugs at the moment and there wasn't enough money to complete a full order for the next lot. Last week we also ran out of the reagents to test peoples blood group so we couldn't do any blood transfusions (usually there are many people in need because of anaemia due to malaria and HIV). The district hospital down the road apparently has even less than us right now so are sending sick patients here.
Early on in our stay here, Lish had a couple of kids who were on oxygen die on her ward because the power went off (as it does almost daily here) and so the oxygen concentraters went off too. So yesterday when the power went off, I saw Lish run straight to the paeds ward as she had two sick kids on oxygen. Unfortunately getting the generators up and running for people on oxygen isn't often a priority for nurses and other staff on the ward here. However, when people saw Lish getting straight into action mode and running down to maintenance to get a petrol generator on they were very pleased and thankful. Luckily the power came on later in the night before the generators ran out of fuel (remember there is a fuel shortage here, so running a gen is quite costly). One of the kids did die during the night, but one made it- and Lish had done everything she could, so it was a much better outcome than last time although still very sad.
Yesterday our friend Moses invited us to his house for dinner. His village is a 3km walk from the mission which he does everyday. Moses and his sister insisted on killing a chicken for us to eat with them. A chicken is very valuable and we knew it was a big deal for them to eat chicken- especially in this time of hunger. But it gave them great joy to be able to share with us and it gave us great joy to be invited into their home and eat with them. We also picked some of Moses' maize cobs and he roasted them for us. They tasted like pop corn! I sat on a mat with his nieces, nephews and other village kids and popped off the kernels so we could share together. The kids charged passed at one point chasing the chickens. They caught one, killed it, plucked it and put it on the fire right in front of us. Moses also took us to his field of sugar cane and gave us some to take home. I was then called upon to help make the nsima (as I brag about my nsima making skills quite often). It was much harder stirring on the fire rather than on the stove as I was crying from all the smoke in my eyes! We were very grateful to have spent the entire afternoon there with them. This was the third time I'd been to Moses' house but it was still a confronting experience. This guy is awesome and is always dressed well and speaks English better than any other Malawian I have met, so it's crazy to see all the family he is responsible for and the conditions he lives in. The unfortunate follow up from the village experience is that today I am a little under the weather...
We are now faced with packing, saying goodbye and leaving Mulanje. I will miss the beauty of the mountain, which stands as a tall and majestic reference point from wherever you are in the area. I will also miss the beauty of the people who are so kind and welcoming. Selfishly, I look forward to detaching myself somewhat from the pain here. However I know I must not let myself do this too much and risk forgetting the feeling of discomfort about the state of the world that I hope is the start of living a life that truly makes a difference.
On Saturday we are catching a ride to Blantyre from where we will catch a bus up to Lake Malawi for a week of rest and relaxation before flying to Tanzania for safari. I'm not sure what my blogging capacity will be for those two weeks, but hopefully I'll get some internet access. I am looking forward to seeing you all after the 5th of March when I arrive home.
Monday 13 February 2012
week five
Our house has been a bit quieter this week with only me and Lish now there. Maternity has been fairly busy. I even scrubbed in on a twin c section and watched an emergency hysterectomy. I had a victory this week in that I conducted the maternity ward round one morning by myself in Chichewa!! I had gotten some friends to teach me important questions like:
- mukupita kuchimbudzi? (are you passing stools?)
- mukukodza? (are you passing urine?)
- mukudya Nsima? (are you eating nsima?)
Etc etc
It was very cool.
Our weekend was full of ex-pat fun- going on hikes and swims and lunches out.
Last night we were also invited to the reverends house for dinner which was delightful.
On Tuesday lish and I are doing a presentation on heart failure for one of the weekly education sessions- ironically on Valentines day!
- mukupita kuchimbudzi? (are you passing stools?)
- mukukodza? (are you passing urine?)
- mukudya Nsima? (are you eating nsima?)
Etc etc
It was very cool.
Our weekend was full of ex-pat fun- going on hikes and swims and lunches out.
Last night we were also invited to the reverends house for dinner which was delightful.
On Tuesday lish and I are doing a presentation on heart failure for one of the weekly education sessions- ironically on Valentines day!
Sunday 5 February 2012
week four
As I write this I am in the car with Ruth (medical director) and Lish on our way back from Blantyre (biggest city in Malawi). We went in to town to drop Sophie (UK nursing student) at the airport as she is going home and to get Lish and my visas extended at immigration. We also did a shop at the supermarket where you can get all kinds of things that you can't in Mulanje, such as cheese and yoghurt. It was good to see a big Malawian city as I'd only been to the airport previously.
This week had its ups and downs. Highlights included starting on maternity this week. The labour ward is fairly busy and the midwives do most things. I watched a clinician do a vacuum extraction this week. They use an old school vacuum machine that a nurse vigorously pumps up off to the side. I know I was delivered by vacuum- Dad, was that what they used on my head?
Maternity also meant spending time in theatre for caesarean sections and evacuations. Theatre is bit different to home. Sterility isn't always 100%. Not all procedures warrant the use of a sterile gown, so for these you just use a heavy duty plastic apron that gets hung up at the end for the next person to use. And the scrubs for women are pretty much old nighties. On the plus side there are no scary scrub nurses watching your every move as you put on gloves!
Every week a highlight is always the fun we have hanging out with the other 'Muzungu's' (white people) in the area. Mulanje is big for the tea industry and nut industry so there are quite a few ex-pats around the place. Every week we go to the golf club on Thursday nights for drinks and dinner and the local pizzeria on Friday nights, which actually makes the best pizza I've ever had (crazy for a rural African town!). It's nice to have some company with people who speak English and are from similar places, but most of these guys have quite colonial attitudes, which can often differ from the attitudes that people from the mission have. But it's always a nice outing.
The best thing from this week by far was seeing a patient called Mwandida. If you remember from one of my previous blog entries I wrote about a patient who went into a coma because of gestational diabetes. During this period she also delivered her still born baby. We spent ages trying to save her life and then sent her off to the big hospital in Blantyre. Well, this week she was discharged from hospital- alive, talking and walking! She came back to MMH for an outpatient appointment and everyone was so pleased to see her! Sophie and I especially. When her husband saw me he had a big grin on his face and I was pleased that he remembered my name as he said 'Hi Cait!!!' (everyone calls me Cait here as Caitlyn turns out to be a little too hard to say). I don't know if Mwandida remembered us as she was unconscious for most of the time I knew her, but we were certainly ecstatic to see her and ran straight up to her and had a conversation (even though she speaks no English). Soph and I gave each other a big hug and were pretty happy for the rest of the day. It really showed us that there is hope out here.
The lowest point of the week was having my first patient die on me here. I've been pretty lucky in that the last two weeks I was on the female ward and fortunately no one died in that time. Alicia has had it much harder as she has been on paeds where kids die almost everyday. Usually they die from malaria or from severe HIV and malnutrition.
Moving to maternity means that I come into contact with newborn babies. One baby was born two weeks ago. When it was born it had horrific blister-like skin all over it's chest. Over the next two weeks the blistered skin spread down its entire body and became infected. At first it was thought that the mother might have had syphilis but her test came back negative. She had become HIV positive during pregnancy. No one quite knew what was going on. A visiting pediatrician reviewed the baby and thought it might have some rare congenital skin condition where there is a collagen deficiency causing the skin to break. When I first saw the baby it was pretty sick and pale. Its flesh smelt necrotic. I immediately went into action mode trying to think of a plan, and even taking photos thinking I could send it to a pediatrician back home for an opinion. The baby was transferred to the nursery. As I was writing in the notes, Alicia stumbled upon my ward and I asked her to come see the baby with me. The mother of the baby was around too. As we walked in the room I noticed the baby was very pale- I asked Alicia if it was breathing and we quickly unwrapped it from its numerous blankets to check. He wasn't. He was still warm. We listened for a heart rate while we cleared his mouth of a load of vomit. As I turned him on his side his skin was coming off in my hands. Alicia began compressions while the mother started wailing. We both knew there was no point. We had no oxygen or breathing equipment nearby and he was so sick that any attempt was bound to fail and if it was successful it wouldn't be for long. As the family looked on we called time of death and wrote in the notes. When a kid dies here they finish the note with 'may his soul rest in peace'. Alicia dictated this to me as I wrote and signed our names.
It was a sad experience, but something that happens everyday here. You can tell when a kid dies as you can hear the wailing coming from the children's ward. From the first time I saw the baby, I knew it was going to die, but it was simply in its mothers arms. No drips, no lines, no ICU beds, no monitoring, no sterile dressings, no consultants, no round the clock nursing as he would have had back home. Even then he may have died.
So it was a busy week, but all in all a good week. Only two more weeks now left at MMH before Lish and I make our way up to the lake for some relaxation before heading to Tanzania for safari. Time really does fly!!
This week had its ups and downs. Highlights included starting on maternity this week. The labour ward is fairly busy and the midwives do most things. I watched a clinician do a vacuum extraction this week. They use an old school vacuum machine that a nurse vigorously pumps up off to the side. I know I was delivered by vacuum- Dad, was that what they used on my head?
Maternity also meant spending time in theatre for caesarean sections and evacuations. Theatre is bit different to home. Sterility isn't always 100%. Not all procedures warrant the use of a sterile gown, so for these you just use a heavy duty plastic apron that gets hung up at the end for the next person to use. And the scrubs for women are pretty much old nighties. On the plus side there are no scary scrub nurses watching your every move as you put on gloves!
Every week a highlight is always the fun we have hanging out with the other 'Muzungu's' (white people) in the area. Mulanje is big for the tea industry and nut industry so there are quite a few ex-pats around the place. Every week we go to the golf club on Thursday nights for drinks and dinner and the local pizzeria on Friday nights, which actually makes the best pizza I've ever had (crazy for a rural African town!). It's nice to have some company with people who speak English and are from similar places, but most of these guys have quite colonial attitudes, which can often differ from the attitudes that people from the mission have. But it's always a nice outing.
The best thing from this week by far was seeing a patient called Mwandida. If you remember from one of my previous blog entries I wrote about a patient who went into a coma because of gestational diabetes. During this period she also delivered her still born baby. We spent ages trying to save her life and then sent her off to the big hospital in Blantyre. Well, this week she was discharged from hospital- alive, talking and walking! She came back to MMH for an outpatient appointment and everyone was so pleased to see her! Sophie and I especially. When her husband saw me he had a big grin on his face and I was pleased that he remembered my name as he said 'Hi Cait!!!' (everyone calls me Cait here as Caitlyn turns out to be a little too hard to say). I don't know if Mwandida remembered us as she was unconscious for most of the time I knew her, but we were certainly ecstatic to see her and ran straight up to her and had a conversation (even though she speaks no English). Soph and I gave each other a big hug and were pretty happy for the rest of the day. It really showed us that there is hope out here.
The lowest point of the week was having my first patient die on me here. I've been pretty lucky in that the last two weeks I was on the female ward and fortunately no one died in that time. Alicia has had it much harder as she has been on paeds where kids die almost everyday. Usually they die from malaria or from severe HIV and malnutrition.
Moving to maternity means that I come into contact with newborn babies. One baby was born two weeks ago. When it was born it had horrific blister-like skin all over it's chest. Over the next two weeks the blistered skin spread down its entire body and became infected. At first it was thought that the mother might have had syphilis but her test came back negative. She had become HIV positive during pregnancy. No one quite knew what was going on. A visiting pediatrician reviewed the baby and thought it might have some rare congenital skin condition where there is a collagen deficiency causing the skin to break. When I first saw the baby it was pretty sick and pale. Its flesh smelt necrotic. I immediately went into action mode trying to think of a plan, and even taking photos thinking I could send it to a pediatrician back home for an opinion. The baby was transferred to the nursery. As I was writing in the notes, Alicia stumbled upon my ward and I asked her to come see the baby with me. The mother of the baby was around too. As we walked in the room I noticed the baby was very pale- I asked Alicia if it was breathing and we quickly unwrapped it from its numerous blankets to check. He wasn't. He was still warm. We listened for a heart rate while we cleared his mouth of a load of vomit. As I turned him on his side his skin was coming off in my hands. Alicia began compressions while the mother started wailing. We both knew there was no point. We had no oxygen or breathing equipment nearby and he was so sick that any attempt was bound to fail and if it was successful it wouldn't be for long. As the family looked on we called time of death and wrote in the notes. When a kid dies here they finish the note with 'may his soul rest in peace'. Alicia dictated this to me as I wrote and signed our names.
It was a sad experience, but something that happens everyday here. You can tell when a kid dies as you can hear the wailing coming from the children's ward. From the first time I saw the baby, I knew it was going to die, but it was simply in its mothers arms. No drips, no lines, no ICU beds, no monitoring, no sterile dressings, no consultants, no round the clock nursing as he would have had back home. Even then he may have died.
So it was a busy week, but all in all a good week. Only two more weeks now left at MMH before Lish and I make our way up to the lake for some relaxation before heading to Tanzania for safari. Time really does fly!!
Saturday 28 January 2012
week three- extra
I've got some time with the internet today so here's an extra update, which I felt like writing as I had a confronting experience yesterday.
Yesterday I went on a mini-field trip with a guy called Moses. He works at MMH as an HIV counsellor. This means he is the guy that talks to patients about being tested, does the test, gives the results and then counsels people if they are positive. He is passionate about bringing hope to those affected by HIV/AIDS and lives with some of the consequences himself, as his sister has the disease and is very sick. He now looks after her and her family, paying her kids school fees (as he knows the value of an education) and feeding everyone. He has started a program at the hospital which provides villages with pigs. I didn't quite understand the value of pigs here until yesterday. A pig here is like having money in the bank (which most people don't have). If you have a pig that is healthy, has a good shelter, can have piglets and is taken care of, if anything happens- like you need to pay medical bills, or buy food during famine, you can sell a piglet. This project is a long term one. Moses aims to provide villages (with people, mostly women, affected by HIV or living with consequences of HIV deaths) with a pig. This pig then has piglets, which are distributed to different families in the village until each family has a pig. Then these pigs can have piglets which can be used as a savings fund. Not only is it good economically but having a pig to care for as a community (up to 35 people take care of each pig together) brings people purpose, hope and a common goal.
Anyway, yesterday I went to visit the pigs with Moses, to check that they were still doing well. We went to three different villages on the back of a motorcycle (Mum- yes I wore a helmet). It was very fun and the people in the villages were so kind. Some of the pigs are pregnant right now and are doing well. Others are not as well due to having shelters that are not quite waterproof in the heavy rains we have been having. Moses himself also has some pigs, so he took me to his village to see his pigs, family and house. This was the confronting part. Moses is a super happy guy around the hospital. He is well presented, in a business shirt and nice pants. He works hard. I just never thought that when he goes home at night, he often goes back to hunger. The wages here are pretty low. And he is trying to support an entire family. Right now is hungry season, and he barely has enough money to buy maize flour for his family. His sister is frail and very sick looking. She also has malaria at the moment, but Moses doesn't have the money to take her to the hospital. He built his house himself with a loan from the hospital. It's small and sturdy, but he couldn't afford concrete flooring for the whole house, so most rooms have a dirt floor. His pigs aren't doing too great either as the shelters roof is leaking and the ground is very muddy. He told me about how he can't afford to marry as his responsibilities to his family are already too great.
It was hard to know what to say. I knew I was going home, just a couple of kilometers away, to a house full of electricity and water and bread and milk and beer and coke- enough to feed Moses' family for a week! The cost of my toilet paper here was more than the entirety of what Moses has in his pockets right now!
We always talk about not wasting food at home because of "all the starving people in Africa". It just never occur to me that these people are not all in Somalia in the midst of severe famine. They are all over Africa every day, especially at this time of year. And they are people here that I work with everyday.
Thanks for reading my thoughts- suggestion for how to end world hunger will gladly be taken :)
Yesterday I went on a mini-field trip with a guy called Moses. He works at MMH as an HIV counsellor. This means he is the guy that talks to patients about being tested, does the test, gives the results and then counsels people if they are positive. He is passionate about bringing hope to those affected by HIV/AIDS and lives with some of the consequences himself, as his sister has the disease and is very sick. He now looks after her and her family, paying her kids school fees (as he knows the value of an education) and feeding everyone. He has started a program at the hospital which provides villages with pigs. I didn't quite understand the value of pigs here until yesterday. A pig here is like having money in the bank (which most people don't have). If you have a pig that is healthy, has a good shelter, can have piglets and is taken care of, if anything happens- like you need to pay medical bills, or buy food during famine, you can sell a piglet. This project is a long term one. Moses aims to provide villages (with people, mostly women, affected by HIV or living with consequences of HIV deaths) with a pig. This pig then has piglets, which are distributed to different families in the village until each family has a pig. Then these pigs can have piglets which can be used as a savings fund. Not only is it good economically but having a pig to care for as a community (up to 35 people take care of each pig together) brings people purpose, hope and a common goal.
Anyway, yesterday I went to visit the pigs with Moses, to check that they were still doing well. We went to three different villages on the back of a motorcycle (Mum- yes I wore a helmet). It was very fun and the people in the villages were so kind. Some of the pigs are pregnant right now and are doing well. Others are not as well due to having shelters that are not quite waterproof in the heavy rains we have been having. Moses himself also has some pigs, so he took me to his village to see his pigs, family and house. This was the confronting part. Moses is a super happy guy around the hospital. He is well presented, in a business shirt and nice pants. He works hard. I just never thought that when he goes home at night, he often goes back to hunger. The wages here are pretty low. And he is trying to support an entire family. Right now is hungry season, and he barely has enough money to buy maize flour for his family. His sister is frail and very sick looking. She also has malaria at the moment, but Moses doesn't have the money to take her to the hospital. He built his house himself with a loan from the hospital. It's small and sturdy, but he couldn't afford concrete flooring for the whole house, so most rooms have a dirt floor. His pigs aren't doing too great either as the shelters roof is leaking and the ground is very muddy. He told me about how he can't afford to marry as his responsibilities to his family are already too great.
It was hard to know what to say. I knew I was going home, just a couple of kilometers away, to a house full of electricity and water and bread and milk and beer and coke- enough to feed Moses' family for a week! The cost of my toilet paper here was more than the entirety of what Moses has in his pockets right now!
We always talk about not wasting food at home because of "all the starving people in Africa". It just never occur to me that these people are not all in Somalia in the midst of severe famine. They are all over Africa every day, especially at this time of year. And they are people here that I work with everyday.
Thanks for reading my thoughts- suggestion for how to end world hunger will gladly be taken :)
Friday 27 January 2012
week three
I have made good friends with the clinician I have been attached to for the past two weeks. Her name is Chinsinsi and last night (mid-Aus day BBQ) she came to my house to get me so I could taste a dish she had cooked. It had unripe bananas, tomatoe and onions. Unripe bananas are used here a lot in savory cooking as they kind of taste like potatoe. Back at our house we were having a BBQ for Australia day. We had sausages, eggplant and onion and a rice tomato salad. We thought it was pretty good for the limited ingredients we can get here. During the day we wore and gave out little koalas and Australian flag stickers- many of the nurses and clinicians either donned a small koala or flag by the end of the day. Our British counterparts enjoyed celebrating with us, even if they jokingly referred to it as 'conquering day'.
Another week brought another bunch of interesting medical cases. I returned to the ward after lunch yesterday to a pregnant lady having seizures. My clinician had gone to the bank and had texted me to tell me to ask another clinician for help if anything came up. Luckily, Alicia was with me when I went back to the ward as I wanted her to review a different patient for me. We were able to get an IV in and give her diazepam which eventually stopped the seizures before getting her to the labour ward where the Mag Sulph lives, although she had a normal BP and no proteinuria so we thought eclampsia was unlikely.
MMH is a private hospital so patients have to pay for all their care, drugs and investigations. The cost is nothing in Australian dollars, but it's a lot for the villagers here. This week we had a lady on our ward who is about 30 years old. She has had 9 children already, and 7 are still living. She is pregnant again and came into hospital not being able to pass urine. She had an ultrasound which showed that she has a massive tumour in her bladder.... and she's got twins. The clinicians decided it was probably best that she went to the major hospital in Blantyre so she could get a c-section and possible removal of the tumour at the same time. She was in a lot of pain and very uncomfortable. However, on the day she was going to be transferred her family could not pay the medical bills here, which meant she could not go. That sucked. My friend Sophie and I said we would pay. They were so thankful. It cost us only $30 each to settle her bill. It was so little to us, but everything to them. She was transferred to the big hospital immediately. It's hard to believe we live in a world where the disparities are so great, and the consequences so dire.
On another note, there is a great shortage of petrol in Malawi. I don't understand completely why, but it is very hard to get fuel into the country. When it comes to the petrol station, the line of cars stretches right down the street and people wait for hours hoping to fill up. The fuel is also very expensive. I have never seen a car with a full tank of petrol. The hospital ambulances always seem to be nearly empty or empty. It restricts everyone's movements around the place. Transferring patients depends on how much fuel the hospital has, and trips for enjoyment sake are a luxury!
I am almost half way through may placement at MMH and still loving it. Next week I plan to move to the maternity ward to do some obstetrics which I am looking forward to.
Another week brought another bunch of interesting medical cases. I returned to the ward after lunch yesterday to a pregnant lady having seizures. My clinician had gone to the bank and had texted me to tell me to ask another clinician for help if anything came up. Luckily, Alicia was with me when I went back to the ward as I wanted her to review a different patient for me. We were able to get an IV in and give her diazepam which eventually stopped the seizures before getting her to the labour ward where the Mag Sulph lives, although she had a normal BP and no proteinuria so we thought eclampsia was unlikely.
MMH is a private hospital so patients have to pay for all their care, drugs and investigations. The cost is nothing in Australian dollars, but it's a lot for the villagers here. This week we had a lady on our ward who is about 30 years old. She has had 9 children already, and 7 are still living. She is pregnant again and came into hospital not being able to pass urine. She had an ultrasound which showed that she has a massive tumour in her bladder.... and she's got twins. The clinicians decided it was probably best that she went to the major hospital in Blantyre so she could get a c-section and possible removal of the tumour at the same time. She was in a lot of pain and very uncomfortable. However, on the day she was going to be transferred her family could not pay the medical bills here, which meant she could not go. That sucked. My friend Sophie and I said we would pay. They were so thankful. It cost us only $30 each to settle her bill. It was so little to us, but everything to them. She was transferred to the big hospital immediately. It's hard to believe we live in a world where the disparities are so great, and the consequences so dire.
On another note, there is a great shortage of petrol in Malawi. I don't understand completely why, but it is very hard to get fuel into the country. When it comes to the petrol station, the line of cars stretches right down the street and people wait for hours hoping to fill up. The fuel is also very expensive. I have never seen a car with a full tank of petrol. The hospital ambulances always seem to be nearly empty or empty. It restricts everyone's movements around the place. Transferring patients depends on how much fuel the hospital has, and trips for enjoyment sake are a luxury!
I am almost half way through may placement at MMH and still loving it. Next week I plan to move to the maternity ward to do some obstetrics which I am looking forward to.
Sunday 22 January 2012
week two
The Internet is relatively fast today so I thought I'd use this time for a quick update.
It is raining bucket loads here. The paths around the hospital are pretty much rivers. I just returned from the medical directors house where we had a nice BBQ lunch. Her daughter (also a doctor) is over from the UK so there is a good group of us here at the moment. We took the opportunity yesterday of going on a road trip to a town a couple of hours away called Zomba. It is at the bottom of a mountain which is the second tallest peak in Malawi after Mulanje. There is a top end hotel at the top (Mum - you would have loved it, and Dad- you would have loved the beautiful gardens). It was super expensive so we only had a cup of coffee there. The five of us (Lish, Soph, Ben, Claire and I) then embarked on a bit of a hike up the mountain after going down a bit of a 4WD track. It was very nice, even though it was raining. We were walking amongst the clouds and came across a couple of small waterfalls. We made our way back to the car only to find that both tracks off the mountain were blocked by fallen trees due to the strong winds and rain. Either side of us tall pine forrests were threatening to fall on us as we attempted to pull the trees off the road with the bull bar of the Prado. After hearing one too many cracks of tree trunks we reversed out of one path to the other obstructed path- where we sent off for help from the nearby lodge. A brood of 10 Malawian men returned carrying axes and proceeded to cut the tree from our path for a small fee ($1500 kwacha- about $10, although equivalent to a weeks wages here). We made it down the mountain safely and back to Mulanje.
Sorry for all the medical parts of the blog- I mainly do this for Mum & Dad or other medical family/friends- so if you want to skip the next medical paragraph, feel free!!
This week we had a very interesting patient. A 20 year old pregnant lady came in on Monday with malaria and also she most likely had gestational diabetes. GDM is not really picked up here from what I can gather as blood sugars are not regularly monitored. Unfortunately, this lady was overloaded with fluid in hospital as it seems protocol here is to give everyone an IV line on admission and start fluids. Her baby also died while in hospital. She slipped into a coma- we are unsure why as we do not have a great deal of scope with investigations but it could have been due to high blood sugars, malaria or cerebral oedema- likely a combination. She recovered somewhat after her BSL's were brought down with insulin and labour was induced. The following day she again slipped into a coma due to hypoglycaemia (there is much to be said for diabetes management here) and started to have seizures. Claire (director's daughter who is a second year out doctor) was sent to resuscitate her, and was shortly joined by Ben, Sophie and I. We got her on oxygen, got an airway and jaw thrusted her in turns all day. She continued to have tonic seizures which were stopped with IV diazepam (she didn't have eclampsia as far as we could tell- no proteinuria or hypertension). She was febrile and was still being treated with IV quinine for malaria and IVABs. There is no way to measure electrolytes here so I personally think she was hypokalaemic- potassium was not replaced as we brought down her glucose levels as in the past people have been killed by being given IV potassium boluses instead of K in bags- so the policy is pretty much it's safer not to worry about it. Anyway- the four of us left at the end of the day after instructing her guardians on how to jaw thrust her if her breathing became noisy during the night. To our amazement she lasted the night, despite the on call clinician disregarding our advice of no more insulin (she recieced another 10 units over night and had another hypo) and was slightly more conscious. She has been transferred to a bigger hospital now- although we are not sure if she will receive any better care than the four of us here. They at least can measure her U&Es. I don't think many people understood why we were going to such lengths with her. It was a good learning experience and really highlighted some of the limitations there are over here.
This week I will be working on the female ward, which is usually filled with gynae problems and malaria (+ HIV). We are planning an aus day BBQ - and intend on forcing our British friends to speak in Aussie accents all day- as the three Australians here seemed to have some how picked up a little too much queens english from the Brits.
Hope you all have great Australia days and I'll keep you posted on ours.
Love cy
It is raining bucket loads here. The paths around the hospital are pretty much rivers. I just returned from the medical directors house where we had a nice BBQ lunch. Her daughter (also a doctor) is over from the UK so there is a good group of us here at the moment. We took the opportunity yesterday of going on a road trip to a town a couple of hours away called Zomba. It is at the bottom of a mountain which is the second tallest peak in Malawi after Mulanje. There is a top end hotel at the top (Mum - you would have loved it, and Dad- you would have loved the beautiful gardens). It was super expensive so we only had a cup of coffee there. The five of us (Lish, Soph, Ben, Claire and I) then embarked on a bit of a hike up the mountain after going down a bit of a 4WD track. It was very nice, even though it was raining. We were walking amongst the clouds and came across a couple of small waterfalls. We made our way back to the car only to find that both tracks off the mountain were blocked by fallen trees due to the strong winds and rain. Either side of us tall pine forrests were threatening to fall on us as we attempted to pull the trees off the road with the bull bar of the Prado. After hearing one too many cracks of tree trunks we reversed out of one path to the other obstructed path- where we sent off for help from the nearby lodge. A brood of 10 Malawian men returned carrying axes and proceeded to cut the tree from our path for a small fee ($1500 kwacha- about $10, although equivalent to a weeks wages here). We made it down the mountain safely and back to Mulanje.
Sorry for all the medical parts of the blog- I mainly do this for Mum & Dad or other medical family/friends- so if you want to skip the next medical paragraph, feel free!!
This week we had a very interesting patient. A 20 year old pregnant lady came in on Monday with malaria and also she most likely had gestational diabetes. GDM is not really picked up here from what I can gather as blood sugars are not regularly monitored. Unfortunately, this lady was overloaded with fluid in hospital as it seems protocol here is to give everyone an IV line on admission and start fluids. Her baby also died while in hospital. She slipped into a coma- we are unsure why as we do not have a great deal of scope with investigations but it could have been due to high blood sugars, malaria or cerebral oedema- likely a combination. She recovered somewhat after her BSL's were brought down with insulin and labour was induced. The following day she again slipped into a coma due to hypoglycaemia (there is much to be said for diabetes management here) and started to have seizures. Claire (director's daughter who is a second year out doctor) was sent to resuscitate her, and was shortly joined by Ben, Sophie and I. We got her on oxygen, got an airway and jaw thrusted her in turns all day. She continued to have tonic seizures which were stopped with IV diazepam (she didn't have eclampsia as far as we could tell- no proteinuria or hypertension). She was febrile and was still being treated with IV quinine for malaria and IVABs. There is no way to measure electrolytes here so I personally think she was hypokalaemic- potassium was not replaced as we brought down her glucose levels as in the past people have been killed by being given IV potassium boluses instead of K in bags- so the policy is pretty much it's safer not to worry about it. Anyway- the four of us left at the end of the day after instructing her guardians on how to jaw thrust her if her breathing became noisy during the night. To our amazement she lasted the night, despite the on call clinician disregarding our advice of no more insulin (she recieced another 10 units over night and had another hypo) and was slightly more conscious. She has been transferred to a bigger hospital now- although we are not sure if she will receive any better care than the four of us here. They at least can measure her U&Es. I don't think many people understood why we were going to such lengths with her. It was a good learning experience and really highlighted some of the limitations there are over here.
This week I will be working on the female ward, which is usually filled with gynae problems and malaria (+ HIV). We are planning an aus day BBQ - and intend on forcing our British friends to speak in Aussie accents all day- as the three Australians here seemed to have some how picked up a little too much queens english from the Brits.
Hope you all have great Australia days and I'll keep you posted on ours.
Love cy
Thursday 19 January 2012
week one
I have found that I am really getting into Malawian life. I am trying my best to pick up some Chichewa and am now quite confident in the standard greetings and am starting to learn some verbs and other words. People are very patient with me and I have befriended a few people who have promised to teach me, including the reverend's daughter who gave me a Chichewa lesson and then invited me over to her house where I met her parents. I have also made some other friends, including a healthcare assistant I met on outreach clinic who thinks I might pay for him to go to university here when i return to Australia.
I am also learning to cook Malawian style. One of the hospital clinicians, Mwai, and his fiancée came to our house to teach us to cook ensema- the staple food of Malawi which is made from maize flour. You cook it in hot water and it turns out having a consistency and texture similar to instant mash potatoe like Deb. I cooked it last night for our household and was relieved that it was not lumpy- as lumpy ensema is grounds for a man to divorce his wife here!
On Monday it was a bank holiday so I caught a bike taxi into the nearest decent size village called Chitakle. The bike taxi was loads of fun and dirt cheap. You do feel a bit guilty as the guy riding the bike is panting and straining to move the weight of both of us up hills. I went to the market and bought some 'chitenge's', which is like a sarong that all the women wear here and use for a multitude of other purposes including carrying their babies, carrying things on their heads, as bed sheets etc etc.
This week I have started to work on the wards and in outpatients, following one of the female clinicians around. She can't be much older than I am, but after three years of training she acts as a sort of GP/physician/surgeon/obstetrician etc. Practicing medicine is therefore very different here from Australia. Most things are done just because they are, and not necessarily based on evidence. But saying that, the hospital and clinicians do remarkably well given there limited resources and theoretical training. I managed a lady today who came in after ?electrocution. She had a GCS of 3 (which means totally unresponsive) but was still alive with a regular pulse and BP but severely raised respiratory rate. I was fairly worried, but no one else seemed that fazed. All I could do was to improve her airway by lifting her head and then take regular observations myself. Thankfully she came around. The ECG machine here is rarely used - few know how to use it or interpret an ECG. I used it with one of the other Australian med students yesterday on a lady who came in with heart palpitations. I think most people laughed at us being so intent on it. Today I was going to use it on the electrocuted lady but the power at the hospital had turned off so I had to leave it. You can get x-rays and ultrasounds, but there is no full blood counts or thyroid function tests. You can get a hemoglobin, and now you can use a glucometer as we brought one over here with us thanks to our university. For many of the clinicians it is the first time they have used one. There is a lot of death here. Kids die almost every day, usually of malaria. Most patients in the hospital have either malaria, HIV or TB, or a combination of them. There are many AIDS complications and many people who look like skin and bone.
Church on Sunday was great. The music was awesome- there are many choirs around the place and they all come to church and sing for everyone. It was beautiful- there were a few traditional choirs singing in four part harmony beautifully. There was also the worship choir which had sweet little dancing kids. They were really great singing "as the praise goes up, his glory comes down". Parts of the service were very presbyterian traditional (the mission was started by David Livingstone). We recited the apostles creed and lords prayer and sang old english hymns acapella. Other parts were very Africa with clapping and dancing with the worship choir.
Things are going really well. I'll upload this now before the power goes out again!
Love cy
I am also learning to cook Malawian style. One of the hospital clinicians, Mwai, and his fiancée came to our house to teach us to cook ensema- the staple food of Malawi which is made from maize flour. You cook it in hot water and it turns out having a consistency and texture similar to instant mash potatoe like Deb. I cooked it last night for our household and was relieved that it was not lumpy- as lumpy ensema is grounds for a man to divorce his wife here!
On Monday it was a bank holiday so I caught a bike taxi into the nearest decent size village called Chitakle. The bike taxi was loads of fun and dirt cheap. You do feel a bit guilty as the guy riding the bike is panting and straining to move the weight of both of us up hills. I went to the market and bought some 'chitenge's', which is like a sarong that all the women wear here and use for a multitude of other purposes including carrying their babies, carrying things on their heads, as bed sheets etc etc.
This week I have started to work on the wards and in outpatients, following one of the female clinicians around. She can't be much older than I am, but after three years of training she acts as a sort of GP/physician/surgeon/obstetrician etc. Practicing medicine is therefore very different here from Australia. Most things are done just because they are, and not necessarily based on evidence. But saying that, the hospital and clinicians do remarkably well given there limited resources and theoretical training. I managed a lady today who came in after ?electrocution. She had a GCS of 3 (which means totally unresponsive) but was still alive with a regular pulse and BP but severely raised respiratory rate. I was fairly worried, but no one else seemed that fazed. All I could do was to improve her airway by lifting her head and then take regular observations myself. Thankfully she came around. The ECG machine here is rarely used - few know how to use it or interpret an ECG. I used it with one of the other Australian med students yesterday on a lady who came in with heart palpitations. I think most people laughed at us being so intent on it. Today I was going to use it on the electrocuted lady but the power at the hospital had turned off so I had to leave it. You can get x-rays and ultrasounds, but there is no full blood counts or thyroid function tests. You can get a hemoglobin, and now you can use a glucometer as we brought one over here with us thanks to our university. For many of the clinicians it is the first time they have used one. There is a lot of death here. Kids die almost every day, usually of malaria. Most patients in the hospital have either malaria, HIV or TB, or a combination of them. There are many AIDS complications and many people who look like skin and bone.
Church on Sunday was great. The music was awesome- there are many choirs around the place and they all come to church and sing for everyone. It was beautiful- there were a few traditional choirs singing in four part harmony beautifully. There was also the worship choir which had sweet little dancing kids. They were really great singing "as the praise goes up, his glory comes down". Parts of the service were very presbyterian traditional (the mission was started by David Livingstone). We recited the apostles creed and lords prayer and sang old english hymns acapella. Other parts were very Africa with clapping and dancing with the worship choir.
Things are going really well. I'll upload this now before the power goes out again!
Love cy
Saturday 14 January 2012
arrival
Sorry this is late to upload- Internet has been down for a few days.
So we made it to Malawi, only losing one bag on the way. Luckily for Lish and I, it was nothing we needed personally. Unluckily for the hospital, it contained surgical gloves that are desperately needed here due to great difficulty getting them to the country.
Mulanje is beautiful. We have an awesome view of the mountain (Mt Mulanje- 3000m high)- you can see waterfalls cascading down a sheer face. We share a house with another Aussie medical student from the university of Melbourne and a nursing student from the UK. The house is pretty nice- and we have a night watchmen (who mainly sleeps and reads his bible outside our front door from 6.30pm to 4.30am) and a lady (ironically) called Martha who comes everyday and does dishes, washing and cleaning!
The hospital is fairly well equipped with X-ray & ultrasound, a lab, a theatre, male & female wards, paeds & neonatal wards and a maternity wing. However, drugs and other essential supplies run out. Each week the medical director does not know if there will be enough HIV drugs to get through the week. Malawi has one of the highest HIV rates in Africa, and the Mulanje district has the highest rate in Malawi with around 22% of people affected. 5000 people receive HIV treatment at the hospital.
There is only one doctor at the hospital, who is the director, and does mostly administration and public health. The hospital is run by clinical officers who are practically trained in Malawi and do everything from diagnostics to performing caesarean sections and other surgical procedures.
This week I am concentrating on primary health care. Each day I have been going out on outreach clinics to nearby villages. The similarities between outreach here and outreach clinics in Derby are amazing, but they are also very different. Driving into each clinic there were at least one hundred women and children waiting to be seen. They run under 5s clinics, antenatal clinic and family planning clinics. Antenatal clinic is pretty much the same as in Australia, except there is no Doppler (so we use the Pinnard's stethoscope) and there is no dipsticking of urine. In family planning women are given depo provera injections (contraception for 3 months). There is a major condom shortage here- which is bad for contraception and bad for HIV. Under 5's clinic is screening and immunisations. Kids get diphtheria, tetanus, pertussis, hep b, hib, pneumococcal, measles and bcg vaccinations. I am very impressed with these primary health clinics and I spent today jabbing child after child. Sadly, today we noted that lots of kids were underweight. One of the guys from the hospital explained to me that January is hungry season as the maize (Malawi's staple food) is not ready for another 3-4 months.
I am becoming vegetarian for the next 6 weeks as meat is hard to come by and when you do see it, it looks a bit questionable. We are brainstorming ideas on creative ways to cook pumpkin, onion and tomatoes. Mangoes and pineapples are in season so also take up a large portion of our diet.
Internet is super super slow and unreliable here- so emails/Facebook/blogging will be intermittent. Power outages are also common place.
I'm really enjoying myself here so far, so I'll try keep you posted as much as I can!
Love cy
So we made it to Malawi, only losing one bag on the way. Luckily for Lish and I, it was nothing we needed personally. Unluckily for the hospital, it contained surgical gloves that are desperately needed here due to great difficulty getting them to the country.
Mulanje is beautiful. We have an awesome view of the mountain (Mt Mulanje- 3000m high)- you can see waterfalls cascading down a sheer face. We share a house with another Aussie medical student from the university of Melbourne and a nursing student from the UK. The house is pretty nice- and we have a night watchmen (who mainly sleeps and reads his bible outside our front door from 6.30pm to 4.30am) and a lady (ironically) called Martha who comes everyday and does dishes, washing and cleaning!
The hospital is fairly well equipped with X-ray & ultrasound, a lab, a theatre, male & female wards, paeds & neonatal wards and a maternity wing. However, drugs and other essential supplies run out. Each week the medical director does not know if there will be enough HIV drugs to get through the week. Malawi has one of the highest HIV rates in Africa, and the Mulanje district has the highest rate in Malawi with around 22% of people affected. 5000 people receive HIV treatment at the hospital.
There is only one doctor at the hospital, who is the director, and does mostly administration and public health. The hospital is run by clinical officers who are practically trained in Malawi and do everything from diagnostics to performing caesarean sections and other surgical procedures.
This week I am concentrating on primary health care. Each day I have been going out on outreach clinics to nearby villages. The similarities between outreach here and outreach clinics in Derby are amazing, but they are also very different. Driving into each clinic there were at least one hundred women and children waiting to be seen. They run under 5s clinics, antenatal clinic and family planning clinics. Antenatal clinic is pretty much the same as in Australia, except there is no Doppler (so we use the Pinnard's stethoscope) and there is no dipsticking of urine. In family planning women are given depo provera injections (contraception for 3 months). There is a major condom shortage here- which is bad for contraception and bad for HIV. Under 5's clinic is screening and immunisations. Kids get diphtheria, tetanus, pertussis, hep b, hib, pneumococcal, measles and bcg vaccinations. I am very impressed with these primary health clinics and I spent today jabbing child after child. Sadly, today we noted that lots of kids were underweight. One of the guys from the hospital explained to me that January is hungry season as the maize (Malawi's staple food) is not ready for another 3-4 months.
I am becoming vegetarian for the next 6 weeks as meat is hard to come by and when you do see it, it looks a bit questionable. We are brainstorming ideas on creative ways to cook pumpkin, onion and tomatoes. Mangoes and pineapples are in season so also take up a large portion of our diet.
Internet is super super slow and unreliable here- so emails/Facebook/blogging will be intermittent. Power outages are also common place.
I'm really enjoying myself here so far, so I'll try keep you posted as much as I can!
Love cy
Friday 6 January 2012
preparation
I am going to Africa.
Tomorrow I am going to Malawi to spend six weeks at Mulanje Mission Hospital for my final year medical elective with my good buddy Alicia.
I will be in Africa for two whole months. In a way that's a really short amount of time in which to experience a new place and a new way of life. But it's also a very long time. Having only just arrived home from the Kimberley I'm really enjoying the comfort of familiar people and places. Planning this trip has been hectic- especially this week with flights being cancelled and new flights being purchased. But we are all sorted now, and (God willing) will arrive in the city of Blantyre, Malawi on Sunday afternoon.
About Malawi.
Malawi is a small country in South-Eastern Africa, situated on Lake Malawi, with the rift valley running through the country north to south.
There are about 15 000 000 people, with 80% being Christian.
It is one of the least developed countries in the world, with the economy based mostly on rural agriculture.
The life expectancy in Malawi is 51.7 years.
510 women die during childbirth per 100 000 live births and,
81.04 infants die per 100 000 live births.
11% of the population live with HIV/AIDS.
6.2% of GDP is spent on health care (that's $50 a person).
And there is not even close to one doctor per 1000 people in the country (0.019 to be exact).
If you compare this to Australia, it really puts it into perspective.
Our life expectancy is 81.81 years.
Only 8 women in 100 000 will die during childbirth and,
only 4 infants die in 100 000 live births.
0.1% of Australians live with HIV/AIDS.
$3, 382 is spent on health care per person.
And there are almost 3 whole doctors per 1000 people.
Despite some of these dire statistics, Malawi is apparently a pretty awesome place. It's nicknamed "the warm heart of Africa" for its kind and friendly people, and has some of the most beautiful and untouched pieces of land on earth.
So.
I hope to keep this blog updated while I am away so I can keep in touch with everyone, and so you know what to pray about for me! Right now the biggest thing is praying we are able to get a bunch of medical supplies we are taking on all our flights (preferably as free extra weight!) and through customs, and that we get to Blantyre safely with no more flight cancellations!
I'm back on March 5th, so I'll see you then. But please keep in touch while I'm away - hopefully I will have regular internet access.
PS. if you happen to see my Mum while I'm away, please give her a hug for me and tell her I'll be home soon.
I'm back on March 5th, so I'll see you then. But please keep in touch while I'm away - hopefully I will have regular internet access.
PS. if you happen to see my Mum while I'm away, please give her a hug for me and tell her I'll be home soon.
love cy
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