We've been having a great time with our friends Darlene and Paul Heller who run a crisis nursery in Mzuzu. They've needed a break and so they took some time off. We've traveled around Mzuzu, spent a lot of time in the market, visited Mzuzu University's school of nursing and other health care facilities in the area.
Recently there was some great excitement in Mzuzu. An elephant got into some of the villages around Mzuzu (within a few kilometers) and killed two villagers. Unfortunately, the game wardens had to put it down - it was apparently a big bull. We got to see the elephant, with many Malawians, at the local nature preserve. It was sad they had to put it down - what an amazing animal. It weighed 5000 kg. Interestingly, for many Malawians this was the first time they saw an elephant so it created quite a sensation.
We spent Sun to Tues at a lodge on Lake Malawi where we swam, relaxed, went to market in Nkhata Bay, and played cards. Most importantly, we shared many laughs which is so therapeutic . All in all a very relaxing time. We're now back in Mzuzu and preparing to return to Lilongwe and catch our flight back to Jo-Burg, S. Africa.
Tuesday, April 27, 2010
Saturday, April 24, 2010
Leaving Lilongwe
On Saturday, April 17th we left Lilongwe for a quiet day on Lake Malawi. We headed east to the Rift Valley which is a gigantic fault that runs the length of most of Africa and forms the valley in which most of the anthropologic data on the origins of man has been developed. The living conditions remain basic with wood providing fuel, water sources are tennuous and food is extremely insecure. The amazing thing is how well people do with so little. Currently there seems to be adequate food but there is great concern that the harvest was poor and there won't be sufficient food to get through the dry season.
The lake is spectacular. It is about 50 miles wide and the mountains of Mozambique can be seen across the lake. The lake is very rich with fish and the fisherman fish from dugout canoes in the middle of the night but pull in large amounts of fish - an extraordinary source of protein in a nation very short on protein sources. We spent a delightful day on the lake and then left for Mzuzu where we are staying with our good friends the Heller's who have been working in Mzuzu running a crisis nursery for 2 years for orphans. We did a mobil clinic in a small town about 50 km away. I think the people were the sickest I've seen. There was a huge amount of malaria particularly in the children. Also HIV, schistosomiasis, intestinal helminths, elephantiasis etc.
On Tuesday, we went to Vwasa National Park where we saw a lot of elephants, hippopotomus, baboons, and birds. On Wednesday, the group we've been working with headed back to Lilongwe to prepare for their flights home. We've stayed with the Heller's and did medical exams on the babies in the nursery and all the staff.
On Friday and Saturday we relaxed and celibrated Carolyn's birthday. The internet remains intermittent but we'll try to keep in touch as we go forward.
The lake is spectacular. It is about 50 miles wide and the mountains of Mozambique can be seen across the lake. The lake is very rich with fish and the fisherman fish from dugout canoes in the middle of the night but pull in large amounts of fish - an extraordinary source of protein in a nation very short on protein sources. We spent a delightful day on the lake and then left for Mzuzu where we are staying with our good friends the Heller's who have been working in Mzuzu running a crisis nursery for 2 years for orphans. We did a mobil clinic in a small town about 50 km away. I think the people were the sickest I've seen. There was a huge amount of malaria particularly in the children. Also HIV, schistosomiasis, intestinal helminths, elephantiasis etc.
On Tuesday, we went to Vwasa National Park where we saw a lot of elephants, hippopotomus, baboons, and birds. On Wednesday, the group we've been working with headed back to Lilongwe to prepare for their flights home. We've stayed with the Heller's and did medical exams on the babies in the nursery and all the staff.
On Friday and Saturday we relaxed and celibrated Carolyn's birthday. The internet remains intermittent but we'll try to keep in touch as we go forward.
Friday, April 16, 2010
Chichewe (I apologize in advance for any spelling errors)
English is the official language and is widely spoken in Lilongwe, but not far out of town you need to be able to get by in some of the other languages of the Malawian people. Chichewe is one of the languages of Malawi, and is spoken in the region around Lilongwe and some of Zambia. It is an ancient but interesting language with lots of humorous twists. The words for tea - chombe (more specifically a particular kind of tea grown in Malawi), fish – chambo (more specifically a fish found in Lake Malawi) and marijuana – chamba are beautiful examples. Imagine the surprise on your waiter’s face when you think you are ordering fish or tea but in reality are ordering marijuana!!
A similarly humorous event occurred yesterday in one of the villages where we were seeing patients. I still haven’t figured out all of the linguistic particulars but I was in my “office” (which was really a classroom for the local school) seeing patients when I needed to take break to go to the men’s room. I asked my interpreter where the chibuzi (outhouse) was but apparently mutilated the pronunciation and asked him for the chibanzi (the name of the village) instead. Imagine my confusion when he told me I was already standing in it!
Finally, in Malawi when one is riding in a lorry with 25 other people to go to a clinic in a small village and you need to go to the bathroom, the proper way to make your needs known is to say (in English or Chichewe) “I need to wash my feet”. I leave it to your imagination to figure out where this phrase came from!
We continue to enjoy our trip to Malawi and the people are truly wonderful and extraordinarily grateful to have us here to help. Carolyn and I are both enjoying practicing medicine again and are grateful to the Malawian people for reminding us what a great privilege it is to be a physician. To work in Malawi we had to get a license which cost $250 each – a price arrived at after a few days of negotiations! We are now free to practice throughout Malawi. We continue to see extremely interesting patients. We are seeing a lot of malaria (including a case of cerebral malaria that needed to be rushed to hospital – on the back of a motor bike), tuberculosis, starvation in all its horrible but varied presentations and of course all of the various parasites. We also see diabetes, heart disease and hypertension although in much lower frequency than in the US.
We hope all is well with you and we think of all of you frequently.
English is the official language and is widely spoken in Lilongwe, but not far out of town you need to be able to get by in some of the other languages of the Malawian people. Chichewe is one of the languages of Malawi, and is spoken in the region around Lilongwe and some of Zambia. It is an ancient but interesting language with lots of humorous twists. The words for tea - chombe (more specifically a particular kind of tea grown in Malawi), fish – chambo (more specifically a fish found in Lake Malawi) and marijuana – chamba are beautiful examples. Imagine the surprise on your waiter’s face when you think you are ordering fish or tea but in reality are ordering marijuana!!
A similarly humorous event occurred yesterday in one of the villages where we were seeing patients. I still haven’t figured out all of the linguistic particulars but I was in my “office” (which was really a classroom for the local school) seeing patients when I needed to take break to go to the men’s room. I asked my interpreter where the chibuzi (outhouse) was but apparently mutilated the pronunciation and asked him for the chibanzi (the name of the village) instead. Imagine my confusion when he told me I was already standing in it!
Finally, in Malawi when one is riding in a lorry with 25 other people to go to a clinic in a small village and you need to go to the bathroom, the proper way to make your needs known is to say (in English or Chichewe) “I need to wash my feet”. I leave it to your imagination to figure out where this phrase came from!
We continue to enjoy our trip to Malawi and the people are truly wonderful and extraordinarily grateful to have us here to help. Carolyn and I are both enjoying practicing medicine again and are grateful to the Malawian people for reminding us what a great privilege it is to be a physician. To work in Malawi we had to get a license which cost $250 each – a price arrived at after a few days of negotiations! We are now free to practice throughout Malawi. We continue to see extremely interesting patients. We are seeing a lot of malaria (including a case of cerebral malaria that needed to be rushed to hospital – on the back of a motor bike), tuberculosis, starvation in all its horrible but varied presentations and of course all of the various parasites. We also see diabetes, heart disease and hypertension although in much lower frequency than in the US.
We hope all is well with you and we think of all of you frequently.
Sunday, April 11, 2010
Getting Down to Work
Muli bwangi (how are you in Chechewa) to family and friends,
I apologize for not writing sooner, but we have been incredibly busy. In the last week we have seen things that I must say I never knew existed.
We have visited two clinics in the bush - Khwamba and Salengo. We get up at day-break and ride many kilometers over very dusty, deeply-rutted and pot-holed dirt roads. As you might imagine the trips are interrupted by the occasional flat tire! Literally hundreds of people walk many kilometers to see us. Usually we are greeted by mobs of children and when we get to the villages the populace sings as we set up. The Malawians love to sing and dance and they are
quite good at it. They sing songs with multiple harmonies and of course it’s all a capella. The villages are very poor - no phones, power, running water or toilets but the kids are quite resourceful (see the picture of the kids with their "soccer ball").
We have seen a lot of malaria and parasitic infections. April is the end of the rainy season so malaria is rampant and the people have not seen a doctor in months because the villages are inaccessible in the rainy season. We’ve also seen a lot of diarrhea and the usual pneumonias, hypertension and “I hurt all over”! Fortunately, we have an outstanding lab technician (Stanley) who is very good – particularly in malaria and parasites. We are of course at risk for malaria as well but are on prophylactic medications and sleep under a mosquito net (see picture).
We visited three hospitals in Lilongwe. One was a government hospital for obstetrics. They do about 1100 deliveries a month (as a point of reference, Crouse Hospital does about 200). The amazing thing is that they do this including C-sections without a doctor! The care givers are all clinical officers – high school graduates with only three years of education. The hospital is spartan by American standards but clean and neat.
We also visited an AIDS hospital run by the Partners in Hope. It also was quite basic but does an excellent job of taking care of AIDS/HIV. The anti-AIDS medicines seem widely available in Malawi. Amazingly, they can do much of the most sophisticated AIDS testing involving complicated equipment but can’t do something as simple as creatinine to measure renal function. Clearly there are very different priorities in Africa.
We also spent time at Daeyang Luke Hospital. This was a gorgeous hospital built by a Korean shipping magnate. I gave a lecture there on AIDS nephropathy that was well received. The hospital has a very open layout with many breeze ways and a gorgeous view of the valley and distant mountains. All of the hospitals require the family to provide a guardian to accompany the patient in the hospital to help provide care. If you can’t provide a guardian, they won’t accept you as a patient – an interesting concept that deserves some consideration in the US.
Chickens are every where in Malawi but as you can see from the picture to the left they are not permitted in my exam room!
I apologize for not writing sooner, but we have been incredibly busy. In the last week we have seen things that I must say I never knew existed.
We have visited two clinics in the bush - Khwamba and Salengo. We get up at day-break and ride many kilometers over very dusty, deeply-rutted and pot-holed dirt roads. As you might imagine the trips are interrupted by the occasional flat tire! Literally hundreds of people walk many kilometers to see us. Usually we are greeted by mobs of children and when we get to the villages the populace sings as we set up. The Malawians love to sing and dance and they are
quite good at it. They sing songs with multiple harmonies and of course it’s all a capella. The villages are very poor - no phones, power, running water or toilets but the kids are quite resourceful (see the picture of the kids with their "soccer ball").
We have seen a lot of malaria and parasitic infections. April is the end of the rainy season so malaria is rampant and the people have not seen a doctor in months because the villages are inaccessible in the rainy season. We’ve also seen a lot of diarrhea and the usual pneumonias, hypertension and “I hurt all over”! Fortunately, we have an outstanding lab technician (Stanley) who is very good – particularly in malaria and parasites. We are of course at risk for malaria as well but are on prophylactic medications and sleep under a mosquito net (see picture).
We visited three hospitals in Lilongwe. One was a government hospital for obstetrics. They do about 1100 deliveries a month (as a point of reference, Crouse Hospital does about 200). The amazing thing is that they do this including C-sections without a doctor! The care givers are all clinical officers – high school graduates with only three years of education. The hospital is spartan by American standards but clean and neat.
We also visited an AIDS hospital run by the Partners in Hope. It also was quite basic but does an excellent job of taking care of AIDS/HIV. The anti-AIDS medicines seem widely available in Malawi. Amazingly, they can do much of the most sophisticated AIDS testing involving complicated equipment but can’t do something as simple as creatinine to measure renal function. Clearly there are very different priorities in Africa.
We also spent time at Daeyang Luke Hospital. This was a gorgeous hospital built by a Korean shipping magnate. I gave a lecture there on AIDS nephropathy that was well received. The hospital has a very open layout with many breeze ways and a gorgeous view of the valley and distant mountains. All of the hospitals require the family to provide a guardian to accompany the patient in the hospital to help provide care. If you can’t provide a guardian, they won’t accept you as a patient – an interesting concept that deserves some consideration in the US.
Chickens are every where in Malawi but as you can see from the picture to the left they are not permitted in my exam room!Yesterday, we spent at the Crisis Nursery in Lilongwe examining staff and people in the neighborhood. So many patients came that we had to send them away – our staff tried to screen them so that the sickest were seen first.
Today is Sunday and in Malawi it is a quiet day. We went to church and were the honored guests. Again the singing was beautiful. On our way to church we went through an extremely poor urban neighborhood where the children were picking through large rubbish piles looking for anything useful. There are many sad things to see here.
This afternoon and evening we’re planning to just relax and spend time with our new acquaintances. I suspect next week will be extraordinarily busy as well.
We miss you all.
Saturday, April 3, 2010
We are getting into a routine here in Lilongwe.
We are staying with most of our group at Nelly's Guest House. It is a small place on a side street in a nice neighborhood. As with all of the homes in Lilongwe, the compound is enclosed by a tall brick wall with a gate and a 24 hour guard. We're not sure if this is for security or is a status symbol! Inside the wall is a pleasant garden, the main house, and a row of other rooms.
After breakfast (which most mornings has been cooked on a charcoal grill since the electricity is very unreliable), we are met by the van from Ministry of Hope which takes us to the Crisis Nursery.
The drive is fascinating: only the main roads are paved; the rest of the roads are rutted red clay. In many places the driver has to creep along to avoid the deep pot holes. Along every road people are walking: men, women carrying bundles on their heads, children. There is little public transportation and most people walk to work or to distant bus stops. Crops are planted right up to the side of the road, mostly corn but tobacco is a big crop for export, too. Right now everything looks very lush at the end of the rainy season, but we are told that in October all of the vegetation is brown.
At the nursery, we have been busy sorting medications which we will take to the clinics next week. We are getting to know the others in our group: Ken Root (a neurologist who is the organizer of the group), Jim Schumaker (a family physician from northern Wisconsin who is making his second trip to Malawi), Caryn (a fourth year medical student who is going into pediatrics), Donna (a fourth year medical student who is going into Internal Medicine), Mary Jo and Pete (members of a church from Hilton Head that supports MOH), and Fran (a nurse from Phoenix who has been involved with MOH in the past.) Every now and then we take a break to play with the babies.
Back at the Guest House in the late afternoon, Paul and Jim have started a tradition: they have one Kuche-Kuche, an almost non-alcoholic beer, before dinner. This is a good time for more good conversation, frequently to candle light because the power has been lost. The generator eventually comes on, but only powers the lights and not the air conditioning, refrigerators, wireless router, etc. This makes for early bedtimes.
Tomorrow we will go to a Malawean church for Easter Sunday. Everyone tells us it will be a remarkable experience. We are looking forward to it.
We are staying with most of our group at Nelly's Guest House. It is a small place on a side street in a nice neighborhood. As with all of the homes in Lilongwe, the compound is enclosed by a tall brick wall with a gate and a 24 hour guard. We're not sure if this is for security or is a status symbol! Inside the wall is a pleasant garden, the main house, and a row of other rooms.
After breakfast (which most mornings has been cooked on a charcoal grill since the electricity is very unreliable), we are met by the van from Ministry of Hope which takes us to the Crisis Nursery.
The drive is fascinating: only the main roads are paved; the rest of the roads are rutted red clay. In many places the driver has to creep along to avoid the deep pot holes. Along every road people are walking: men, women carrying bundles on their heads, children. There is little public transportation and most people walk to work or to distant bus stops. Crops are planted right up to the side of the road, mostly corn but tobacco is a big crop for export, too. Right now everything looks very lush at the end of the rainy season, but we are told that in October all of the vegetation is brown.
At the nursery, we have been busy sorting medications which we will take to the clinics next week. We are getting to know the others in our group: Ken Root (a neurologist who is the organizer of the group), Jim Schumaker (a family physician from northern Wisconsin who is making his second trip to Malawi), Caryn (a fourth year medical student who is going into pediatrics), Donna (a fourth year medical student who is going into Internal Medicine), Mary Jo and Pete (members of a church from Hilton Head that supports MOH), and Fran (a nurse from Phoenix who has been involved with MOH in the past.) Every now and then we take a break to play with the babies.
Back at the Guest House in the late afternoon, Paul and Jim have started a tradition: they have one Kuche-Kuche, an almost non-alcoholic beer, before dinner. This is a good time for more good conversation, frequently to candle light because the power has been lost. The generator eventually comes on, but only powers the lights and not the air conditioning, refrigerators, wireless router, etc. This makes for early bedtimes.
Tomorrow we will go to a Malawean church for Easter Sunday. Everyone tells us it will be a remarkable experience. We are looking forward to it.
Thursday, April 1, 2010
On to Lilongwe
Today after a 5:15 am start we headed back (with all our luggage!!!) to the airport in Johannesburg. Despite getting there over 3 hours ahead of time we didn't get to the gate too early. We also had to pay a substantial bill to get all our supplies to Malawi. It's a bit frustrating when you realize that all of the supplies were donated from Americans, you would think South African Airlines could cut us some slack.
Anyway, be that as it may, the flight to Lilongwe was smooth and almost on time. The Lilongwe airport is a sight to behold. At least 2 flights came in at once and there is only one luggage carousel. The crowd must have been 5 people deep. Eventually, we got all the supplies and met the people from the Ministry of Hope who will be guiding us around for the next few weeks.
Our first stop was the Crisis Nursery in Lilongwe. They have about 22 orphans under the age of two there. The staff is phenomenal. These kids look amazingly good, particularly when you realize how sick they were when the came to the nursery. The staff is technically good with limited resources and they have a huge amount of love for the kids. Not being able to resist, we got involved right away (see the picture if I can get it to upload). Some of them are HIV positive and the one on the left was thought to have malaria but the blood test is still pending. Note how much thiner and floppier he appears. My years of doing pediatric nephrology are already starting to pay off in Africa.
Tomorrow we will start to get all the supplies organized and ready for our trips to the villages. The people of Lilongwe look well and properly nourished but we're told that in the villages it's quite a different story. The landscape is verdantly green at the end of the rainy season and there are crops everywhere, even in the city. At this point it is hard to know why there is so much starvation although I'm sure we will be learning much more. Sometimes the up-coming dry season is called the "season of starvation".
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