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!!