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!!
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