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.