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