Impressed

Today I got a chance to see the infamous Prof. Borgstein at work, a man who has lived in Malawi most all of his life, trained in the Netherlands for peds surgery and has been working here ever since. As soon as I walked into theatre 2 (Dr. J works in Th. 1), I could tell the difference.

The place was organized to a maximum degree even if they were lacking some materials and the autoclave may not be up and running today, the scrub tech knew what she was doing, everyone scrubbed properly and the sterile technique was comparable to what I've seen at home. Phew, so really, not all African surgeons cut corners that shouldn't be cut. Actually, it was an American one who did. Prof. was stern but respectful to all, the way a surgeon should be, AND La Boehm played in the background during the first surgery. I may have to discuss with Prof about this drastic difference and whether they keep track of post-op infection rates of their patients.

It was so nice to get a new perspective of the hospital and how it works. I was beginning to get disillusioned and I had only been around for two weeks. I have hope again that we are doing good here and we can make a difference.

The infamous Prof. Borgstein

Oscar

Theatre 2

Oscar winner

On my way to work today there was a boy walking with his mother in front of me. He had a Star Wars t-shirt on! I am glad the trend transcends culture. His mom eventually taught him to say "Good morning Madame" to me. It brightened my day.

Today was a shorter day at work for me because the peds surgeon was not in for the day, so after morning handover I went to physiotherapy (Physical therapy) and spent time with the children with CP. It was very eye opening, and there was a boy with severe hydrocephalus.

In the afternoon I took a walk to la Caverna/Mandala House where I drank a latte and had Gelatto on the porch during a rain storm. I felt a bit like Karen Blixen on her porch in Kenya. It was beautiful.

This evening was the annual Oscar party, so we got gussied up and went to Chez Mackie, a beautiful restaurant just outside of downtown Blantyre overlooking one of the hills outside of town. Plenty of fun, and laughter. Malawi Carlsberg makes a beer called Kuche Kuche, which is a bit like Natty Light but we were entertained by the label. Dana and I tied for second so we may get an African version of Oscar. Thanks Academy, for this wonderfully fun night!!!

Chez Mackie

The star wars fan

Jeff enjoying his kuche kuche

The walk home from work

Dana and I at the party

Galilea UMC

Today I had the honor of attending the church service at Galilea United Methodist Church in Blantyre. Kara, An old friend of Carl's from the GBOD was a missionary there for two years, ending in Dec. 2011. She was back on business for her new job through the GBOD and had noticed on facebook that I was going to be in Malawi during part of her travels as well. She picked me up and took me to church with her. Her welcome was very warm because the people of Galilea love her and her family very much. She was gracious enough to include me in her morning.

Church was a blessing. The songs of African churches are second to none and I was moved to tears on multiple occasions. They had a visitors welcome where we stood up in front of everyone and said our names and what we were doing in Blantyre and if we would come again. Then they sang a song for us and each and every person in the congregation came to welcome us and shake our hands. I noticed (and remember from Terry's advise) that Malawians shake with two hands. So I tried my best to say "Zikomo guambiri" thank you, very much. There was much singing which was fine with me, and then Kara spoke the sermon. She told a story which I am sure is an African tale:

There were two friends, a caterpillar and a snake. The snake was complaining, "Every time I go into the town, they try to kill me with knives." And the caterpillar says, "Yes, every time I go into town they try to collect me for relish. But I have an idea. So the caterpillar went into his dark cacoon and came out a butterfly. When he went into the village, everyone loved him and was following him and regarding him as beautiful. So he went back and told the snake "It was wonderful, they loved me." So the snake shed his skin, and went to the village. And they still tried to kill him. So he went back and the caterpillar asked him how it went, so he said "They tried to kill me!"

The moral of the story, as Kara taught it, is that you have to go to your dark place, and let God change you for the better in order for the world to see you differently. You cannot just leave the past behind, you have to be transformed.

At the end of the service everyone processed out, starting with the pastors and then the front rows going to the back. Once you were outside, you shook the hands of those in front of you and then stood next to them in the recieving line, so the last people out of the church got to shake hands with the whole line of people. This way, everyone gets to greet everyone else. It was so amazingly beautiful. What a warm welcome it was. I hope I can visit again, if not on this trip, someday. I have already been invited to Bible Study and more events. They sure know how to make an Azungu (white person, literally "someone who roams around aimlessly) welcome.

Blantyre

This weekend Dana and I opted to stay in Blantyre while our housemates took the challenging journey up Mulanje Massif (a mountain I am sure I would not have made it up). We spent the evening last night having craft time and watching the Fresh Water episode of Planet Earth because they feature a segment on Lake Malawi in that one and we only thought it appropriate.

Oh and we saw a Chameleon on the walk home, I almost freaked I was so excited!!!

Saturday was spent bummin' around Blantyre. We went to ShopRite, the South African Grocery store to see what they offered, and road around town in minibuses. No chickens on them today however on my way to work on Thursday and Friday we were definitely accompanied by at least one chicken.

For lunch we went to a house favored restaurant called Veg-Delight. I had Vegitarian Samosas and a Mango Lassi, yum. Then I took off to the curios which is the touristy market where they have baskets, wood carvings and cars made out of wire but I figured I'd hold off because I've been buying a lot of gifts already and have to make sure I don't need to buy a new bag to transport it all home!

So then I went down to Blantyre market to get some produce for the house. I got tomatoes, pineapple, apples, cucumber, and onion. But I could have gotten a whole lot more. Once I ventured into the produce side of the market I realized how deep the place really goes. There is a "stuff" side that is all covered and looks like something out of a movie chase scene where some small local kid is being chased and he dodges in and out of these skinny passageways to evade his pursuers. I did not have the courage to venture into the dark hallways by myself but will before I leave Blantyre, and take pictures. Now I am sitting on the porch, blogging and reading and drinking a gin and tonic (cures malaria;) and just taking in all the awesome weather, wonders and sites that go by. I may even put on Out of Africa in the background.

My chameleon friend

Blantyre Market Below

Our helpful alarm clock, whenever they feel like it.

Third Day of Fasting

So now we're into it. For the first few days of my #fast4freedom I wasn't feeling much of anything. Maybe it was the fact that up until today I was cheating on each 24 hour fast - starting with dinner one night then lunch the next. But today as hour 25 and 26 rolled around, I remembered why this Lenten practice was so hard. Eating one meal a day doesn't feel like what the human body was designed to do. But then I think of those schools in Haiti that my Dad and crew (and a bunch more Methodists beyond that!) have worked at. The large lunches provided to kids for whom this might be their only meal of the day. I'm reminded in those moments that even if this isn't what our bodies are designed for, it is the reality of many lives. This Lent I'm inspired and am trying to follow in the example of people who can gain some experiential knowledge of the other. Whether this means wearing the same dress for 80 days or giving up sleeping on a bed for Lent - something first hand that instructs me about the hardships others face, in some small way. I think in these deserts God reveals something to us. Our brokenness, our complicity in the brokenness of others. I pray all this will too return to dust. But for now, stay strong fellow desert dwellers!

Thursday night sweetness

I don't know what it is but each night at about 9:30-10pm a beautiful fragrance is released and seeps into the windows. It makes living in Africa that much more romantic, and tonight it was during the movie night, Midnight in Paris. Tres Magnifique.

It helped me forget about the four hour emergency surgery we performed earlier today and the "sterile technique" that leaves something to be desired.

And Elizabeth made Apple pie for dessert. Bliss. Thanks for the memories, and now into Friday of our second week. Trying hard not to let these moments slip by too quickly but also looking forward to seeing Carl in a month!

Ash Wednesday daily Groove

I have been here just long enough to develop a routine. I wake up at 6am, pop in the shower if it is free, then make some coffee, peanut butter toast and a boiled egg for breakfast. After that, put my leg on, get dressed and head for the bus. If Lawrence the tailor is there its a bit more hectic because I have to fit in our orders in a short amount of time.

The bus is usually too full in the mornings to catch in front of our house so I have to catch one going down the hill for 50 kwatcha and the one back up from the market over to the hospital for 100 (altogether still less than 75 cents). Consider it a transfer. Yesterday I had to sit on a bag of rice. But it gets me here in shorter time than it would take me to walk.

Labs are a hot commodity at this hospital, and I think they may only make one copy of the results and sometimes you have to "chase results" as an order, which ends up being something you do on your own anyway. One must take the mindset if you want something done (at all), you may have to do it yourself. So here I wait, at the lab, while they look for the labs of my patient who is peeing blood. Alas, the pace of everything in Africa is slower (except the minibuses).

Also, our second crocodile bite in a little over a week came in last night. Although this guy had more morbidity. The croc got his left arm and part of an ear, let's hope he can pull through but he looked close to death yesterday when he came in. Moses, the prior croc attack patient is doing well, considering.

I took the minibus home after buying some groceries, and a snickers bar (funny how those things remind you of home). It took the long way, because the pushy guys had me get on the wrong bus. That's okay because we got to drive through the plant nursery which was super beautiful. And don't worry, they left me right at our house.
And now for a relaxing afternoon of reading, listening to music and reflecting on this life:)
Dust thou art and dust thou shall return.

Here's me on the bus

Me doing ward rounds

The patient's chart- held together with gauze

Week 2

Today was a clinic day which was pretty depressing. Many older men here with BPH (benign prostatic htpertrophy) and they have inadequate ability to treat it. I think there are two Urologists in Lilongwe (a five hour bus from here) but that is all in the entire country. Many men are walking around with indwelling catheters because of urinary retention and then they get a UTI and eventually sepsis. There is no medical treatment (in US, we have drugs for this) and the list of men for prostatectomies is months long. Dr. Johnson (general surgeon, not urology) has made it a goal from January to do one a week. So far he has done zero. So many men here are suffering from a very treatable illness just because of lack of providers and medicines. It is the first thing I have seen that really is so simple in the USA, but so complex and harder than it has to be. It really sucks.

After seeing what felt like about a thousand men who needed prostatectomies I got home and had lunch, then hiked down the giant hill to Downtown Blantyre. I got to the pharmacy for some cheap drugs (prophylaxis, nothing serious), and the supermarket and the fabric store. I was pretty proud I did all that waking after walking home from Queens but by the time I had to walk up the hill I was done, got in a minibus just for the hill;). I got the ghetto wobbly seat you have to sit square in or risk tipping, really safe. They thought I was weird but it helped to take the edge off the walk. And then I took the most glorious nap ever! Felt so good and tired.

Not much else, but Terry left today for USA so we are on our own for ten days! Wahoo, party;)

Cape Maclear

This weekend was crazy and fun. Friday morning was filled with the first day I needed an alarm (thank goodness) as well as a visit with Lawrence the Tailor. He's making me some pants and a satchel out of beautiful African fabric, if you have any requests please let me know!

Then it was off to the hospital for a quick trip. I went out to the location where I was instructed to catch the minibus and wasn't there but two minutes before a car pulled over and a man who look oddly like Iddi Amine (sp?) was like "I saw you yesterday at morning handover, you need a ride to the hospital?" So my dangerdar was a little elevated but he seemed to be saying things that no one else would know to say. Turns out he is an Ortho registrar (resident) at the hospital who happens to be from Zimbabwe. He gave me, along with a man with a chicken a ride to the hospital. No problems. And we even went the back way so it was right near morning handover, hardly any walking.

After a shorter day at the hospital where I got to see the ER which here is called E & A, I disappeared to home to catch our car to the Lake. It is funny because in Michigan a drive up north to our lake destination is about the same drive 4-4.5 hrs. But the drive gave me such an amazing opportunity to take in the countryside. We drove down from the mountains around Blantyre into a much flatter part of the country. We passed grass huts, villages with open markets, termite mounds, thatched huts "football" games, bicycle taxis, lots of goats and cows and lots of maize. It looked like a crazy combo of Hawaii, Iowa and maybe the Appalachian mts. With some adjustments. It's amazing what one can balance with on a bike! Even the smallest of villages had at least one stand where they sold minutes for your phone and coca-colas. There was one town with a wooden, hand painted sign that said "Toys 'R' Us." we all had to laugh.

We even stopped in Lowonde to pee and found a flush toilet with TP! That's high society guys!

As we narrowed in on our destination, the mountains seemed to be right in front of us and I had no idea how we'd get through, but we turned down a dirt road and so gracefully the mountains parted in front of us to lead us to the beautiful town of Cape Maclear. The Lake is divinely beautiful, out of a dream sequence. As we are laying down our heads the children are still playing games outside our walls. They sound so happy. Sleep now. Peace.

Just kidding, because after about an hour of sleep our bed became infested with Ants. Liz and I talked to the worker who then gave us a new room (upgrade) for the night.

Then on Saturday we woke up early to see the colors of the sunrise over Lake Malawi. After some photographs and a hammock nap, we took a boat to the closest island for a snorkel and some bird watching. The water is freshwater but warm with bright colored fish, almost tropical reef-like!

In the afternoon I took a walk through the town and found a cute little shop with jewelry and bawa boards, the official board game of Malawi. Mac, the shop owner taught me the rules and said " Yes, teaching is free." I bought a few gifts from him since he was so generous with his time. And now that I taught him, Jeff is an avid Bawa player.

Before dinner we took a walk over to Hiccups Bar where we had the pleasure of a real Malawian jug band setting up right out front. The bass was a jug, and homemade drums and guitar. I got some of their song on film. Wished Carl was here to see that one!

On Sunday morning we spent more time in hammocks and then Jeff, Yvette , Liz and I rented tandem kayaks and explored the lake a bit. We went out to this channel between the mainland and a close island that I thought looked like something out of a movie.

I also met the owner of the Gecko Lodge (a very nice place despite ants) who is in a wheelchair! He's a British ex-pat and came out here to help the community and provide lodging for visitors. He has done a clean water project for the area, among other good things. I like his style.

When we got back and cleaned up it was nearly time to leave so we packed up and were waiting for our driver Tamandani, who was late, after 30 minutes Yvette called him and we found out HE HAD LOST THE KEYS!!!! As we were waiting, frantically trying to set up a plan B but also trying not to be alarmed, after about 45 minutes of figuring out possible other arrangements he was in the lake and came up from a dive with keys in hand. Phew! That worked out to be the best Plan B possible. So off to home away from home!

Our boat ride with snorkeling and eagle watching

African Jug band

Liz and Ang on the boat

The sene we arrived to on Friday

Ant bed

That little opening is where we kayaked to.

My Gin and tonic in honor of my hubby

QECH

Queen Elizabeth Central Hospital is home to many wards, specialties and levels of education. It is the training location for Malawi College of Medicine students to train as well as many residencies. There are hundreds if not thousands of patients at all times, L&D averages 15,000 deliveries a year. The hospital is set up like a big grid which Dr. Taylor likes to compare to the human circulation with the main hallway in the middle as the aorta. Always people going here and there.

Each ward serves a different purpose. This week I'm working on 5A, the men's surgical ward. The hospital has a BYOB policy (brig your own bedding) an when you ask someone if they have been able to eat, you always have to ask the follow up question "was there food?"

It is a beautifully sad place with much palliative care because most disease here presents at a stage that is beyond the level of treatment that can be offered/available. The patients are very willing to do whatever the doctors say, but whether or not that is always the right thing, I do not know. I was excited when one man was refusing BL amputation because I think they may be quicker than in the states to jump to that solution for a diabetic foot ulcer. And it made me sure that he knew what they were proposing, whereas sometimes it seems patients go to the OT (*OR) not really realizing what they are getting themselves into.

Yesterday I spent the day in Operating Theatre One. Gloves, masks and gowns are in short supply and sterile technique leaves something to be desired, however, even though it is soo different it also feels surprisingly familiar. The OT has air which is nice compared to everywhere else. There is a ventilator, intubations and succinylcholine just like in the USA. But the OTs are not sterilized between patients, they just put a new sheet on the table after one is done and it's time for the next. Some of these things occur, I know, out of short supply but others I think more of ignorance. Or just laziness on the part of some visiting physicians.

I took my first minibus to work today, with the help of our guard Christopher. Turned out the one we took was actually a private driver on his way back from dropping some rich kids at school, but he charged the same rate, I guess he just wanted the extra Kwatcha. More on the minibuses later.

Here we are, nearing the end of week one already. Tonight is movie night and The Help is cued up. This trip is amazing and tiring and hard and great and sad and all of the adjectives you could think of combined so far. It will surely fly by, but as often as I can, I am trying to mentally stop and take it all in.

5A men's surgical ward

The Aorta of QECH

The "hallway" to the surgical teaching room

Where they lay the sheets to dry

The road to travel home

Better day

So today was still very hard on my leg, etc...but it was more organized anyway. We did ward rounds with the Consultant (attending physician) and determined who would be booked for the Operating Theatre for the next two days. It was interesting and obvious how disease and infection spread easily here as we saw 98 patients and the physician touched all of them and didn't wash his hands once. It was pretty awful, and he was the head teaching physician, great example guy.

After rounds we were done by noon. Saw 98 patients between 9:30 and noon? Crazy right? So we headed home for lunch and a little R&R, then off to downtown Blantyre for exchange of money and purchases of fabric for our hand made future clothes. Also, we stopped at the travel agency to book our weekend trip to lake Malawi for this weekend.

The hustle and bustle of the city was so interesting to see. Lots of tailors with their old pedal singer sewing machines on the sidewalk ready to make you a shirt. The smell of gasoline after each car drove by made my throat hurt and they put dye in their rubbing alcohol so people won't drink it (and go blind).

Now we are finished passing out the money and just chilling. The evening dinner is a large lot of us. I'm finally feeling sleepy so hopefully I will sleep tonight. Love you all!

Hardest day

Today was really, really hard. I attempted the walk to the hospital and then had plenty of hours of standing and walking from here to there inside the spread out hospital campus. After being thrown into the mix, my friend Dana and I spent four or more hours in the men's surgical ward rounding on patients with the interns.

Our first patient of the day was the most exciting part of the day. He was a boy who was fishing on a river and got attacked by a crocodile! What a story. We definitely don't get those in the states. Don't worry, considering, he is actually healing pretty well and scheduled for a skin graft on Wednesday which I hope to see.

After that it was all down hill, we were rounding for 4.5 hours, hot and very dehydrating, I didn't bring enough for lunch and I still hadn't gotten any Kwatcha ($) exchanged so I couldn't buy anything for lunch. We were told before we broke for lunch to be back "after two" to help finish some stuff and that the registrar (British for resident) would meet us at 3:30pm to pull out some chest tubes. We stopped by at 2:15 and could find no sign of anyone, then came back at 3:10pm and as we walked into the ward hall, the intern walked out with chest tube and machine in hand. And I was like "you're finished" yup. "with all of them!?" yup "all three?!!??" yup. We had stayed around and missed the one cool part of the day. So with a FML attitude we began to walk home after a recent storm with more clouds looming. Luckily the rain was finished for the day and we made it home but I immediately had to take my leg off for the rest of the day. Everyone says the walk is 15-20 min. But I can't make it in less than 30.

So when we came home to no Internet, no power, we just met Yvette on the porch and griped about our days until we were clean out of complaining.

Then the lights came back on at 8pm and it was 1 hour after match results came out. So we all checked and I got my #3 choice of St. John's Providence. After a day of multiple defeats, this one was the straw that broke the camels back. Not that I won't get a good education there but it feels like a cold shoulder and like I didn't win the popularity contest.

Sorry no pictures today but I was just too tired. Like the mom on Bridesmaids says, if you've hit rock bottom, there is no way to go but up!

Malawi 1.0

I finally made it to Blantyre, Malawi yesterday and was met at the airport by Dr. Taylor. How nice it is to have a familiar face in a foreign land bring you to there home and welcome you with Steak dinner, Maize bread and Mango crumble for dessert. I don't think I will go hungry here.



I arrived just in time to get the last bottom bunk, few. And there is an old tub in the bathroom so bathing won't be an issue!



The house here at the Blantyre Malaria Project is full of people. And Dr. Taylor knows many people around town, and they know her.



After waking up in the middle of the night I finally got back to sleep for a bit and it wasn't until closer to six that a duck qwacked outside sounding exactly like my alarm on my phone. So I was up.

We went to hike mombezi which is a mountain just outside of Blantyre. The city is surrounded by three beautiful mountains. I did not make it to the summit but I made it about 1/3 of the way up. About a 2.5 hour fairly technical hike. There were even two river (small one) crossings that I didn't fall in to. I was pretty proud that I did that and did not fall, but any more would have been too much.

The rest of the group went with a guide to the summit so I followed the fork in the road down by myself, not following proper boy scout protocol I'm sure. But I made it back okay. At one point the signs (painted rocks) said "Hyenas Quiet Hide." And since I wasn't with the guide I took this to mean that if I saw any I should be quiet and hide. So I picked up the pace a little, getting out of there as quickly and quietly as possible. I was saying in my brain "Carl would be so mad at me if I got eaten by a Hyena." so I got down the mountain and when all was said and done Dr Taylor came to pick us up. She informed me that the sign was indicating a "hide" for viewing the hyenas, with a similar meaning of a hunting blind, a noun not a verb. I had to laugh at myself for how I read the sign and my thoughts about it.

Then after showers and some rehydration we took the walk over to the hospital for the tour. On our way it started to drizzle a bit and out came a double rainbow. Yes, it was all the way across the sky. But our tired selves had left all cameras at home. Still, it must be a good omen. God's promise of things to come.

All in all a pretty good start to this crazy thing I'm doing here. And here are some photos: the house, a few of the trail and view and one of me asking myself "what have I gotten myself into"

Becoming the minority

Traveling from Detroit to Amsterdam to Nairobi to Ethiopia to Malawi is a very interesting transition into the African continent. First the people around you have different accents and are speaking different languages. Then when I was in line for the flight to Nairobi the population became close to half white folks traveling to Africa and half black folks headed home or to see family. Then I was met at the airport by Ashford, who will lead my trip with Carl to Meru in March, and suddenly I was the only white person I could see. I am now on an Ethiopian Air flight and am definitely in the minority. It is very humbling. And one might think since I live in Detroit where the majority is African American that I would feel similar but when you go anywhere else in SE MI you will be mostly surrounded by white folks. The airport is mostly white in Detroit, the restaurants we frequent are pretty white, etc. But here it leaves you with a feeling of vulnerability that I wonder if that is what a black person in a mostly white world is feeling regularly, daily.

Speaking of vulnerability, part of my nerves of going on this trip were due to the recent violence in Africa, Kenya in particular being surrounded by Sudan and Somalia to the north. But one of my seat mates on my Nairobi flight was with a group headed into Sudan to work at an orphanage for a week. And I realized, the places on my itinerary are pretty tame in comparison. So if people are brave enough to go into those countries who have even more struggle, I can be brave enough to live in Malawi and travel to Kenya. Screw you state department warnings;)

I met a white woman from Connecticut while waiting in line for Visas at Nairobi. She had spent some of her years in Ann Arbor and commented on how people tell her she has more of a Midwestern personality. She said that she cried a lot when she first moved back to Connecticut because the people were like Ice. I'm glad we Midwesterners are a friendly folk, I think that has helped me meet many cool people along the way.

In Limbo

Beginning two straight days of travel (almost three) is a daunting task...but as I walked to my departure gate I was met by reminders of a home I love. National Coney Island was right next to my gate and across the way was a Michigania store with all of my favorite Pure Detroit apparel, Zingermans coffee beans and other things that I love about home. The TSA guy was complimenting me on my I (*outline of Mi map) MI shirt. It is somehow easier to leave knowing I have a loving family and home that I love so much to come back to.

Another comforting factor is being surrounded by traveling veterans. They know how it's done, and it's nice to know that there are people making these trips every day. The man across the aisle from me was speaking Italian and the men in front of me are speaking in German. I overheard another woman's conversation about how her dad speaks fluent Swahili and she's been traveling there with him for years to work in outreach programs. And another feature of my trip so far that comforts me: for my first 7.5 hour flight, I get the whole seat to myself! How often does that happen??

And there's nothing like a little in flight complimentary wine to calm the nerves. So anyways, off I go to the wild blue yonder! I'll try to keep the blog talking regularly! Love you all!