Back home and at school

I thought I would include a more complete album of my expereinces in Malawi. This link will direct you to my Malawi 2009 album.

-dakotah

Finaly Days in Malawi!

After a wonderful trip with Dr. Eskridge and crew, I have now arrived at Mabuya Backpackers for the final stay of my time in Lilongwe, Malawi. Prior to arriving in Lilongwe, I had been looking for one of my former students whom I was having a hard time frinding; his name is Thomas. He was one of the students who lived with me during my last year of Peace Corps in Monkey Bay (2005). Thomas is an HIV/AIDS orphan who essentially has no family......so one day while I was in Mtunthama I recieved a phone call from Thomas!!! i was so happy to hear from him. He is now sturggling to get by in Blantyre. So I told him that if he could find a way to make it to Lilongwe, I would reimburse him and pay for his trip back to Blantyre.

Initially, Thomas said he was going to catch the 4am bus from Blantyre and arrive in Lilongwe thurday morning (tomorrow). Then catch the bus in the evening back to Blantyre thursday eveining. However just as I arrived Thomas called me and mentioned that he wasn't able to get a 4am bus ticket and instead was going to take the 7pm bus tonight and arrive in Lilongwe around 11:30pm. Then he was just going to hang out in the Bus Depot until Thursday morning!!!! After hearing this, I arranged a bed for him at Mabuya Backpackers and stay with me......I couldn't have him stay at the bus depot with NO bed!!!

I look forward to seeing Thomas:-) Tomorrow we are going to Lilongwe Market so I can buy gifts and other things before I head home.

Ludzi (part II) and Senga Bay

After leaving Mtunthama on a sour note (see previous blog), I arrived in Lilongwe to meet up with Dr. Eskridge (the woman who helped me to organize this entire trip), her son Alex, Jade, and Carol. Jade is a 3rd year resident in Internal Medicine and Carol is a Physical Therapist who recieved funding from her church to go on a Mission trip. Dr. Eskridge as been coming to Malawi at once a year since 2004 and is a member for Global AIDS Interfaith Alliance (GAIA). I met her while I was studying at Cornell when she came as a representitive of GAIA to give a presentation on working as a Doctor in Malawi. GAIA formed in 2000 in response to the growing AIDS epidemic and decided solely to focus on Malawi.

When I met the new group we travelled to Ludzi Mission and visited the same group of Nuns that I started out on the trip visiting:-) It was really nice to see them again. While I was there I managed to visit my old patients that I first talked about -- the man with the worms and the poor lady with the presumed malignant tumor in her cheek (see previous blog post). The man with the worms is now cured from the worms, however he now complained of poor ability to breath (due to his smoking). The woman with the malignant tumor in her cheek, when Dr. Eskridge and Dr. Jade took a look at it determined that it was most likely Birkett's Lymphoma, which is quite common in people who are HIV/AIDS positive. Essentially it is the over production of B-Cell's (a cell that plays a part in the immune system). Unfortunately, there was nothing we could do for her other than to give her a few gauze pads to clean the open sores and reccomend to her to come to the health clinic for draining of the sores.

Following the trip with the Sisters at Ludzi, we travelled to Senga Bay to the Senga Baptist Clinic. It was a great experience! We joined a mobile clinic and went to the rural villages around the Salima yesterday (Tuesday 8-11-09) where we treated about 120 people. Of those people, I managed to treat 8 of them while Dr. Eskridge and Dr. Jade treated the rest. It was here, where I managed to diagnose, prescribe, and treat the patients all on my own (with close observation by Dr. Eskridge). It was a liberating experience. Of the patients I treated, two had eye sightproblems which were corrected with donated glasses from America, one women with an infection underneath her eyelid that was treated with antibiotic eye droplets (but really needed sugery), one patient with an ulcer in his stomach, and a rest treated with quinine for malaria.

The following day (today 8-12-09) we then spent time at the Senga Bay Baptist Clinic were we treated patients who came to the hospital. Again, I managed to treat patients with severe malaria, asthma, stomach ulcers, allergies, Bilharzia, and worms. The trip was a wondeful trip as I was finally able to take all of the knowledge that I learned at the beginning of this trip and begin to treat patients. I really enjoyed it. You can see pictures at the following link. Here are two other pictures (here and here) from the American doctors camera as well of our trip.

One minor problem at Mtunthama

So I am finally able to get on internet as it has been sometime since I have been able to get access. I have finished my time at Mtunthama, St. Andrews hospital. I had a great time with my host family, the Minjale's.....except for one small mis-communication. As I was leaving for Lilongwe to meet up with a group of American Doctors for the next leg of my trip, Peter Minjale the clinical Officer, approached me (one hour before I was to leave) and said he had a problem. Initially, I thought it had something to do with communicating to the American doctors, but he did the typical Malawian way of beating around the bush until I realized that he was asking for money....

During the planning of my Malawian trip, it was at least clear to me that accomodations would be essentially free and allowing me to make contributions to food. Over the course of my four weeks stay I consistently gave gifts, both monetary (MK4500 = $40) and otherwise, to his family. In addition at the beginning of my stay, I asked him up front about offering to help pay for food and any other expenses and responded by saying that the hospital had a budget for visiters like me. So you can imagine how surprise I was when he mentioned for me to pay him one hour before I was to leave....he put me on the spot. When I asked about previous visiters he said the one visitor paid about MK10,000 (~$85) for one week. Since I stayed for about 4 weeks I decided to give him MK20,000 ($175) for a total monetary contribution during my stay of about MK24,500 ($200).......Now to put this in perspective, the starting Clinical Officers salary is about MK29,000 ($225) so I essentially I just paid him an entire months salary for my stay there.

I didn't mind paying him the money, but felt rather put off by him approaching me literally one hour before I was leaving asking for money. Why couldn't he have just been up front at the beginning during the emails or even when I asked him if I could contribute money for my stay? At least I would've been able to plan to give him the money.......

When I look at the overall experience that Peter and his family gave me, the money was well worth it. I had a wonderful time and learned a lot. I got to assist in draining abcess, burn and wound cleaning, helping with 5 baby deliveries, and finally get some clinical experience. I couldn't complain.....so for $200 it was worth it. However the way Peter approached me really put a damper and sour note on the experience. As you can see rather than write a blog about my expereinces at St. Andrews, I find myself immeadiately thinking about being ask for money.....I probably think twice about visiting St. Andrews Hospital again.

PS -- I didn't have time to proof read so I am sorry if there are any grammatical mistakes:-)

Two more weeks left

So i have about two more weeks left in Malawi. It has been such a great trip here. As you will see I have posted some pictures on the link below that show some of my experiences.

http://picasaweb.google.com/daklane/MtunthamaStAndrewsHospital?authkey=Gv1sRgCO6vmZ_hg-SnwwE&feat=directlink

Next week I will be going back to Ludzi on Wednesday, where I did my first clinic rotation. I will be spending the last of my time there before i head home.

Hope all is well back in the States.

Yendani Bwino,

Dakotah

New Post and Pictures

Hi Everyone,

I have finally been able to put on some new posts on my blog as well as some new pictures. I have spent most of my time at the Anglican mission, but this past weekend (July 17-20) went to Monkey Bay to see how my Peace Corps site is doing.

Copy and paste the link to my picasa web album. They contain pictures of my time in Monkey Bay.

http://picasaweb.google.com/daklane/MonkeyBay2009?authkey=Gv1sRgCMnXgfvakJLErAE&feat=directlink

Now I am back at the Anglican mission working at the health clinic under the Peter Minjale, the clinical officer. This morning I saw a underweight baby being delivered. Deliverys are always amazing to watch and witness......It was a complicated pregnancy as the placenta had to be manually removed, rather than naturally......The mother is now well and recovering.

I will write more post when I can:)

Hope your summer is going well.

July 9th – Anglican Village in Mtunthama

Today, I caught a ride with Liza, a 38 yr old white South African, to Kasungu. Liza was born in Southwest South Africa (now Namibia) and grew up on a farm there. Then during the independence, her family fled the violence to South Africa. She grew up under the Apartheid, went to Switzerland where she received a degree in education and visited Malawi for a holiday, loved it so much that she decided to stay and start a life here. We arrived at Kasungu and she dropped me off at the Malawi National Bank.

Then I called Peter Minjale, the Clinical Officer at St. Andrews hospital, to come and pick me up in Kasungu. The hospital is about 25 minutes outside of Kasungu and is part of an Anglican Mission which also includes a Church, a primary school, and a secondary school. When I first arrived I was quite surprised to see many azungu’s (African for white people) there. In fact I was slightly bummed out that I wasn’t the only azungu in the area – I wouldn’t necessarily be the center of attention anymore…..what a selfish feeling to have. In addition, with all of the support the Anglican village was getting I couldn't but help wonder if my support would have done more back at Ludzi Mission......

The first azungu I met was a 19 year old guy named James from England. He is on his “gap” year, which is basically a year sabbatical that English students take after graduating from secondary school before heading off to the university. James was planning on attending medical school this fall and decided to spend three months of his gap year in Malawi at the St. Andrews hospital.

James has had string of bad luck with his health while he was in Malawi. When he first arrived his right lung collapsed and he was bed ridden for the first two weeks here at St. Andrews hospital. Following that he got a viral infection in his throat that quickly became infected with bacteria leading to multiple ulcers that made it hard for him to eat and even talk. Despite all of this he refused to fly home because he loved his experience at the Anglican mission. He would struggle with these ulcers during my entire visit in Kasungu. We later found out that the Malaria prophylaxis, Doxycycline, was known in some individuals to cause these ulcers.

July 8th – Malawi’s Explosive growth and China

So I was supposed to head out to Kasungu today by using public transport, but Stacia mentioned that she knew someone who would be going north that I could hitch a ride with. So today was a chill day. I just rode around with Stacia and Kristoff around Lilongwe.

It was during this time when I realized how quickly Malawi has changed. Malawi, like the rest of Africa, appears to have largely missed the global recession that has hit the western world. African banks were forced by the western world (IMF, World Bank) to keep their banks in order with large enough cash to debt ration and did not over leverage themselves. Ironically, as the western world made sure Africa’s banks where good order, they failed to monitor/regulate their own banks as made apparent by the current financial mess.

The strength of Malawi banks could easily be seen by all of construction going on around Lilongwe. Kristoff, mentioned that for the past year Malawi has had the second fastest growing economy at around 8-9% GDP and I believe it. On the out skirts of Lilongwe there were new suburban American style houses that were being built that the developers are going to rent out for about $1000/month!!! That is an insane amount money for a country where much of the rural population lives on less than two dollars a day.

In addition, I was struck by new Chinese influence there seems to be here. There are new Chinese restaurants and businesses all around Lilongwe. One had to look no further than the new Malawian parliament building to see the strength of Chinese influence. Initially Taiwan offered the Malawian government to build a new Parliament building at a good price for them and even started construction on the building. But then China, with its trillion dollars in cash, came in and told the Malawi government that they will build the Parliament building for free if they renounce their recognition of the Taiwanese government and stop working with Taiwan. The Malawian government of course accepted the deal. But the rumors I hear from some of the Malawians is that China has brought in Chinese prisoners to build the parliament building and is not employing many Malawians for the building project…….a seemingly bitter sweet deal for Malawians.

July 7th – Lilongwe and Madonna’s new secondary school

I did my last rounds with Mr. Stima and Mshanga at the hospital, took some pictures of the hospital, had lunch, and then headed out with Father Kamela to Lilongwe.

After being dropped off in Lilongwe I was picked up by Stacia and Kristoff. They are two former Peace Corps Volunteers who had met when they both were serving in Peace Corps in Jamaica, decided to get married and do one more stint with Peace Corps in Malawi. They arrived in 1996, loved their time in Malawi so much that they decided to settle down and raise a family in Malawi. I got to know them during my time as a Peace Corps Volunteer here in Malawi when Kristoff was involved with some of the training that I had to go through. They were kind enough to allow me to stay with them for a few nights.

They now have one daughter together named Kaliwe, which in Chichewa means culture or being surrounded by people depending on how you interpret it. She is now 10 years old currently goes to the local primary school speaks completely fluent Chichewa. Kristoff supplements her education with home schooling so that she is not missing out on other aspects of her education. Kaliwe is getting a better education than most Americans could ever dream off……

Stacia and Kristoff both are experts in permaculture, which is the use of local plants and very low input farming methods. After Peace Corps, Stacia worked for the WHO cataloging all of the local available and edible plants around Malawi. What she found was surprising; many of the plants that Malawians think of as weeds and remove them to grow Maize are in fact edible and nutritious. When Malawians are told about this, many of them laugh and rely on Maize for their main source of food even though the rains can be unreliable. Malawians have such a narrow margin of failure, that even with a failed Maize harvest, they still have some food. As result, they are resistant to any changes they may leave them with less food than a bad maize harvest. Stacia and Kristoff had decided that they wanted to lead by example and now have a house surrounded by edible plants that provides them with foods for throughout the entire year. It is really cool.

Now back to being picked up by Stacia and Kristoff. After they picked me up, they were on their way to meet with the architects of Madonna’s new school for girls at the planned land site. Madonna is pulling out all of the bells and whistles for this school – it is going to be completely “green” right down the building materials they use for it, much like Oprah did for her girls school in South Africa. Everything is supposed to be bought and built locally. The architects are from New York and will be using water recycling, water harvesting (capturing and storing rain), and solar panels. Since Stacia and Kristoff were local plant and nutrition experts they were being brought in to the team to see what they could contribute to the designing of the project. Their main hope is to incorporate nutritious local plants into the landscape design. This is just the start of the project as they hadn’t even built roads into the land yet.

Not that my opinion counts, but at first I wasn’t sure what to think about Madonna dropping millions of dollars for this school. To me it almost seemed as if it was a “me too” type of project because Oprah did one in South Africa. But after hearing from the architects the project seems really open to new ideas and attempting to keep everything as local as possible.

Pictures of ludzi

I finally found a way to upload pictures to my online picasa web ablums. Please try the link below

http://picasaweb.google.com/daklane/LudziPictures?authkey=Gv1sRgCIb2i_-OjNDz6QE&feat=directlink

July 6th – Following up with HBC Patients

According to my itinerary I was supposed to leave today to go to Kasungu today, but decided to stay an extra day. I had wanted to see the Home Based Care patients who were coming in today and I had heard that Father Kamela was going to Lilongwe on Tuesday so I could get a free ride.

So I went and did the morning rounds with Mr. Stima and Mr. Mshanga. By that time Mr. D Dyelatu had arrived, the patient who had been having three years of abdominal pains. In a weird way, I was particularly excited to see him because I would be able to see his stool and urine sample under a microscope. Again we were expecting either bilharzia or worms to be found in his stool.

Sure enough, we found LOTS of worm eggs in Mr. D stool sample and only white blood cells in the urine sample (see picture of stool sample). Based on the eggs seen in his stool the lab tech determined that Mr. D had Ascaris species of worms. There are a total of five different worms that can be found: Ascaris (Round worm), Pinworm, Hookworm, Tapeworm, and Whipworm. The majority of these worms are spread by feces-to-mouth transmission – meaning an infected person goes to the bathroom, forgets to wash his/her hands, then proceeds to use their infected hands for daily task (cooking, eating, shaking another’s hands). You can imagine how quickly these worms can spread. I only wonder how many people Mr. D infected during his three year infection.

After seeing to Mr. D treatment, I went with Brother Patrick who was studying under Father Kamela to the Catholic Mission garden. They have such a nice and well tended garden. The mission is located right on the Ludzi river, so they have access to water throughout the entire year. The surplus of the food first goes to feed the children at their orphanage and then they sell the rest and use the extra money to support the mission (hospital, primary school, etc.). They also fish ponds, raise goats, pigs, cattle, and chickens. The entire operation is self supporting.

Following my tour of the garden, Father Kamela took me to see the Kacebera Seminary School. This school is used to train the future Catholic priest. It sits, literally, on the Malawian-Zambian border. It was built back in the colonial days and is a very nice building. I don’t know how priest are able to commit their entire life to God.……

Then Father Kamela took me to see his family’s land near the seminary. His father was a Member of Parliament and is now retired. He has ten brothers and sisters. The entire family bought a plot of land near their home village, built a house, and now the retired parents live there and take care of the garden. When I arrived they were harvesting their latest maize crops. Also as we were waiting there were some older village women who started singing some welcome songs for me and even did some dances for me. There was one particular woman who looked like she was in her 50’s and only had one tooth – she kept smiling, dancing, and singing. Her laughter and happiness was infectious.

Following our visit to Father Kamela’s house we drove back to the mission for my last meal with the sisters.

This last meal was wonderful. The sisters gave me a big jar of ground nuts (peanuts), Malawi curios, and some Guava wine for my trip home. They told me that all of these gifts are for my wife because she couldn’t come. It was very nice of them to give me. In return, I had brought some of my Uncle Willie’s smoked and canned salmon for the Sisters. They absolutely loved the salmon.

July 5, 2009 – Home Based Care: HIV/AIDS, Worms, and Tumor

Today, Sunday, we had mass at 8:30am. It is a huge church that seems to hold about 200 hundred people. Malawian Catholic mass is longer than that of in America and last about 2-3 hours rather than the short 45min to an hour mass that we typically find in America. While that may seem long, it is made short by the beautiful voices of the Malawians – the priest would say few things then there would be about 10 minutes worth of singing. It is almost like going to a concert.

I was also reminded of how time is different here. There are no appointment that one has to get too, no pre-arranged plans; one just has to know that it is going to happen in the morning or after lunch. Today, after the mass and lunch I knew that Mr. Stima, the hospital clinical officer, was going to meet me after lunch and we are going out to visit some of the villages for Home Based Care (HBC). During these visits the clinical officers donate their time to visit patients who are unable to make it to the hospital or afford to pay the consultation fee at Ludzi Health Clinic – remember it cost about MWK300 (~$1.87) for consultation, which if the average Malawian lives on less than a dollar a day is quite expensive.

The Home Based Care visits are actually quite fun, we get to use motor cycles to go to the villages that are only accessible by walking, cycling, or by motor bikes. When I found out that I would be riding motorcycles the first thing that I thought was about the story that my mother and Grandma always told me about to scare me from riding motor bikes – when Uncle Clint was younger (in his teens) and was visiting a friend who had a motor bike. Grandma Chris, knowing about the motor bike, specifically told him not to ride because he would get in accident. Well sure enough, Uncle Clint rode the motor bike AND got in an accident. Fortunately for me, I didn’t get into a motor bike accident so mom and grandma you don’t have to worry:-)

This trip to Home Base Care was a great experience and allowed me to see the country side. I went with Mr. Stima (the hospital clinical officer) and Mr. Kaziputa, who is in charge of administrative duties for Home Base Care at the hospital. We took two motor bikes and went to visit the Village Headman to request permission to visit his villages (yes it is plural as he is in charge of multiple villages) and their respective Home Based Care patients that we know about. Shortly after leaving the village headman’s house one of our motor bikes broke down and we had to stop at the local mechanic to get it fixed.

Following that, I was astonished to find out how big of an area we had to cover in order to get to our first patient as it took about 25 minutes after our break down to get to our final destination – it was a good thing we were using motor bikes. Our first patient was Mrs. M and she was on HIV/AIDS anti-retroviral (ARV) treatment. According to my clinical officer, three months ago she was bed ridden, very weak, suffering from TB, and was struggling to provide care for six children – two of whom were hers and the rest were her deceased sister’s children. Mrs. M’s mother was helping as best as she could. Additionally, Mrs. M's husband had two other wives and had not been tested for HIV/AIDS and rarely was able to provide for financial support their two children. But she was put on the free HIV/AIDS ARV treatment provided by the Malawian government and the difference was astounding – she had been able to fight off the TB infection, had a healthy weight and expressed no visible HIV/AIDS symptoms. However, now that Mrs M, with the ARV treatment, had been able to bring her HIV/AIDS infection to manageable levels she was now struggling to find enough food to feed her and the rest of her family. The Mr. Stima was pleased to see her in improved health and had now decided to continue to provide her with counseling and emotional support. He had arranged to visit her again the next time.

Then again we hoped on our bikes and headed out to our next patient which was a 20 min ride away. Our next patient was Mr. D an older man who was in his late 60’s and has been suffering from chronic abdominal pain for three years. He eyes looked sunken, he was always weak, generally malnourished, and could not walk far – significant when men are expected to work their fields and grown crops. Additionally, he said that whenever he ate foods high in fibers he got real bad stomach cramps and about the only thing he was willing to eat was nsima (basically maize flour and water). His stool was yellow “like bamboo.” Additionally, he was having dysuria (painful urination).

Now the trick was to try to figure out based on his symptoms what it could be…….Yellow stool can mean many things but two things came up in my mind: giardia (sp?) or a reflection of his maize diet. Giardia is a bacterium that when it gets in your digestive tract and causes the patient to have sulfuric gas (burps and farts) and yellow diarrhea. However, Mr. D explained to us that he was not having diarrhea and Mr. Stima reminded me that giardia does not cause dysuria (painful urination). So that ruled out giardia…….

After much discussion with Mr. Stima, we had decided that the most likely suspects of Mr. D abdominal pain were either Bilharzia or worms. Bilharzia is a water born parasite that lives in the snails in the local waters here. It spend most of its life in water snails until a human passes by and it moves from the snail, burrows into the human skin, hits the blood stream, and finally settles in the kidney. Upon arrival in the kidney, the parasite then begins to reproduce eggs. The eggs then burn their way through to your bladder to be excreted out in the urine, which explains way patients infected with bilharzia have painful urination (dysuria). To diagnose for bilharzias, one can take a urine sample and look for eggs under a microscope. There are many types of worms that can infect the GI system and all of them can cause abdominal pain. The only way to tell if one is infected with worms is to take a stool sample and look at it under a microscope.

Next we told Mr. D what we thought could be causing his abdominal pain and told him the only way we could treat him was to have him come to the clinic to give a urine and stool sample. However there was a problem because Mr. D could not afford the hospital consultation, lab fee, and drug treatment which was about MWK750 ($5.00)…….think about it. All he need were some simple test and drugs but couldn’t even afford to pay $5!!!! He lived with this abdominal pain for three years!!!!!

Realizing this, I decided that I would be willing to pay all of his fees and told him to come to the hospital the next day for treatment.

We then hoped on our bikes and headed out to visit our last patient – Mrs. A. She was unfortunately afflicted with what was presumed to be a malignant tumor (presumed Birkitt's Lymphoma) on the left side of her face. Initially you couldn’t notice the tumor because she was able to hide the tumor by using a head scarf tied around her face, much like many Muslim women do in the area. However when she took off the scarf the tumor took up much of her face (see attached picture). It was extremely painful and she had gone to Lilongwe for surgery to remove the tumor, but the surgeons decided against it because the tumor was complicated. I am sure she was living with excruciating pain as there some open sores on the bottom of her cheek that looked infected. There was nothing we could other than to tell her to come to the clinic to treat the open sores and some free pain killers (morphine).

By that time it was getting dark and we had to make it back home. It was great day and I was able to see much of the country side and had a great opportunity to help as villagers as best as we could.

Updated Blog

hi everyone,

So I have updated the blog up through July 5th, during my time at the Ludzi Convent in Mchinji, Malawi. I am still writing for the rest of the time there and here.. There are multiple post so be sure to scroll down to view them all.....

Right now I am in Kasungu, Malawi at an Anglican Mission. It is wonderful here too.....I will try to add some pictures.

hope you all had a wonderful July 4th!

-dakotah

July 5th -- Hospital Theater and night out at the bar

I failed to mention that my day starts with mass at 6 am!!!! The sisters attend mass in there chapel in the convent on the weekdays and then on the weekends attend mass in the parish church at 7am. I am still recovering from my jet lag.

Again today, I did the rounds seeing many of the same patients and even releasing some of the Malaria patients who showed improvement. But in the afternoon, Sister Bernadatte wanted me to come with her and the hospital drama group. The hospital drama group visits various villages and performs a few dramas that are funny, yet informative. They include stories on the importance of expectant mothers to come in for a prenatal checkup early, rather than show up at the health clinic when they are in labor. Or in another play, they tell mothers in labor should not go to traditional midwives because they sometimes used dangerous traditional medicines. The picture shown, shows the actors in front of a large audience.

The power of these plays became evident to me when after the plays were completed and Sister Bernadette held a brief discussion with the audience; asking them what they thought of the play. One of the women in the audience responded by saying that what happens in this plays occur in real life because they happened to her; in particular the play with using the traditional mid-wife. This women was previous pregnant with twins and went to a traditional midwife instead of a health clinic. Her first child was born with no complications, but problems developed when trying to take the second child out. The traditional midwife responded by giving her traditional medicines to try to induce the second child to come out. When the mother eventually passed out due to the loss of blood, the midwife finally decided to take her to the health clinic. At the health clinic, the clinical officers recognize the this woman and her still unborn child are beyond their ability to help her, so they send her to district hospital for more professional care – who knows how much time has elapsed since her complications started to develop. Finally at the district hospital they were able to get the second child out and within an hour the child died……but they were able to save the mother.

That night the clinical officers wanted to take me to the local bar since it was Saturday night and the next day neither of them had to work. There was a new type of beer called Carlsberg Elephant that wasn’t here when I was in Peace Corps. I didn’t think there would be any problems about me leaving the convent so late. But unbeknownst to me when Sister Bernadette found out from Mr. Stima about me coming with them just for a few drinks she decided to consult the rest of the sisters at the convent. After much discussion they had decided that it was ok for me to go with Mr. Stima and Mr. Mshanga for a drink BUT only on the condition that I be home at 9pm. I could only laugh because I felt like I was back at home during high school or something…..does this sound familiar to you mom???

Anyways, I had no problem coming home at 9pm because I didn’t want to stay out that late. I also really appreciated their concern for my safety. However, you should probably know that the bar is about 100 meters from the convent entrance so I wasn’t going that far from the convent.

So I have dinner with the sisters at 6:30pm and then Mr. Stima and Mr. Mshanga come to meet me at the convent and we headed out to the local bar. As usual there are only men there as no village women would be caught there for fear of being thought as a prostitute. Culturally speaking too, Malawians tend to separate by gender in all aspects of life – women eat in separate rooms during supper, at church men and women sit on opposite sides of the church, etc. It is quite the shock to my own culture.....I was happy to have the excuse of having to be home by 9pm. The picture shown is the night I was with Mr. Stima and Mr. Mshanga.

July 4, 2009 – My first day in the Clinic -- PART II

On the first glance it is easy to think that the USA has a better health care system (and overall we do). However, some of the same problems that are faced by Malawians where you can pay to go to a better hospital or go to the free hospital but receive worst care are analogous to what the uninsured face in America.

So, back to my experience in Ludzi, in the morning I would do the rounds with Mr. Mshanga of the in-patients and then in the afternoon I would spend with Mr. Stima with the out-patients.

On my first round, I put on my white coat grabbed my stethoscope and blood pressure cuff and was ready to learn, not really knowing what to expect. It turns out that out of roughly 30-40 in patients about half were mothers who brought in their baby infants and toddlers. Of these infants and toddlers most were in for malaria treatment with the rest in for diarrhea or pneumonia. It is too bad because when questioning the mothers whether or not they sleep under mosquito net to protect their children all of them said “No, it costs too much.” Meanwhile the money they have spent for treatment is about the same amount it is to buy a mosquito net….But even at the clinic; they don’t have their in-patients sleep under mosquito nets. Frustrating, to know that there are simple things that one could do to improve their health but don’t……I always have to remind myself that the Malawian patients are no different than Americans. For example, Obesity is an alarming and growing health problem in America – Americans know that they shouldn’t eat McDonald’s everyday or should avoid eating fried foods, but they choose to continue to eating those same foods.

After going the pediatric rounds, we then continued to the female wards. Their health problems ranged from late term miscarriages, malaria, to treating abscesses. One lady in particular stood out, she was on anti-retro viral treatment and two abscesses, one in her groin area and one on her butt. Abscesses are areas of infections that can be caused by an ingrown hair or even just a small cut. But since this lady was on HIV/AIDS treatment her immune system was down and, as evident by her abscesses, has a hard time fighting off infections. As a result, the abscesses grow and form these deep holes – in this patient one abscess formed a hole that was three inches deep and three inches in diameter. It was very painful, she could hardly walk or sit and had to lie down on her side. The only that we could do was to treat her for pain and keep the wound clean, but with her HIV/AIDS treatment her bodies immunity is questionable.

Finally in the afternoon we saw some out-patients and I had the opportunity to spend time with the lab tech. They brought in a baby suspected of having malaria; she had all of the signs of cerebral malaria with fevers and even convulsions (epileptic like seizures). The lab tech pricks the baby’s finger, draws a small blood sample onto a slide, and then I was able to see through a microscope all of the malaria parasites. It was pretty cool! Well, I mean that it was cool to see the malaria parasite under a microscope, not necessarily because the patient had malaria.

By then it was nearing 4pm and the end of the work day for Malawians. They are on a much different work day than we are – 8am start work, 10 am tea, noon is lunch, and 4pm we are done. What a work day…..

July 4, 2009 – My first day in the Clinic -- PART I

Having problems with posting long blogs so going to split it up. here is the first part:

Sister Bernadette had arranged for a whole day at the hospital today for me. This would be the first time I would finally be able to work in a hospital and I was excited to see what the day would bring. I would be spending the entire day with the clinical officers at the hospital since there are no doctors at the clinic. The clinical officers would be the US equivalent of a physician’s assistant – they have gone through about 3 years of training after secondary school. They are very good at treating the most common diseases and there is much I could learn from them. There are two clinical officers, Mr. Deeper Mshanga and Mr. Stima (never got his first name). Mr. Mshanga has been working as a clinical officer for about 10 years and Mr. Stima for about 5 years.

Additionally, there are brand new buildings for the clinic, courtesy of GAIA – the organization whom helped arrange my trip to various health clinics in Malawi. In fact, they just opened up two of the examination rooms a few days before I arrived. They building are slated to be used for examining patients, bathing room for the sickest of patients, a pharmacy, a lab room, and a cashier’s office. This is a paying clinic rather than a government run clinic and on average they charge about MWK 300 (~$1.80) per patient. The cost includes lab tests and a bed. The difference in service and cost between this hospital and a government hospital is significant – the government hospital there is longer lines, the hospital staff has little time with each patient, the care is poor, but it is free. Meanwhile at the Ludzi health clinic which is staff by government paid workers (clinical officers and nurses) but run by the Catholic mission and charges a fee but is able to provide better service and care.

July 3, 2009 – Ludzi Mission, Nun convent

I arrived at the Ludzi Mission yesterday after finally being able to find a driver, Francis, who was willing to take me out here. I had accidently forgotten to write down the name of the person whom I was supposed to meet and was a bit anxious. Fortunately, when I arrived at the Mission, I ran into Father Kamela. He was an older charming Malawian, whom had spent the last 11 years serving a parish in New Foundland, Canada. After spending his time there he had decided it was time to return to his homeland so that he can be near his family.

Father Kamela, then introduced me to a Sister Bernadette who was in charge of the hospital. She was happy to see me and because I hadn’t arrived the day before and didn’t think I was going to come. Sister Bernadette is a tiny woman who commands the respect of those around her and has an organize manner about her. She then directed to me take my luggage to her and the sisters covenant….I was surprised – who would’ve thought I would be staying in a covenant.

By this time I settled in it was getting dark and dinner time so I didn’t have really much time to explore the area around the hospital.

I had a really hard time sleeping that night…..my body was still adjusting to the time difference. Since landing I had this problem where I sleep till about 1am and then lay there wide awake until about 4-5am.

July 3, 2009 – Ludzi Mission, Nun convent

I arrived at the Ludzi Mission yesterday after finally being able to find a driver, Francis, who was willing to take me out here. I had accidently forgotten to write down the name of the person whom I was supposed to meet and was a bit anxious. Fortunately, when I arrived at the Mission, I ran into Father Kamela. He was an older charming Malawian, whom had spent the last 11 years serving a parish in New Foundland, Canada. After spending his time there he had decided it was time to return to his homeland so that he can be near his family.

Father Kamela, then introduced me to a Sister Bernadette who was in charge of the hospital. She was happy to see me and because I hadn’t arrived the day before and didn’t think I was going to come. Sister Bernadette is a tiny woman who commands the respect of those around her and has an organize manner about her. She then directed to me take my luggage to her and the sisters covenant….I was surprised – who would’ve thought I would be staying in a covenant.

By this time I settled in it was getting dark and dinner time so I didn’t have really much time to explore the area around the hospital.

I had a really hard time sleeping that night…..my body was still adjusting to the time difference. Since landing I had this problem where I sleep till about 1am and then lay there wide awake until about 4-5am.

On my way to Ludzin Parish

Alright yesterday, I was able to find a driver who would be able to drive me to Ludzi Parish, near the Zambian border town Chipata about 1.5 hours from Lilongwe. yea!!!! It will cost about $35 to bring me there and $35 to bring me back to lilongwe.

Some of you may be wondering why I am trying to arrange a driver instead of taking public transport? Well when I was planning the plan was for me to go to Chitedze Agricultural Research Station, which is a Malawian run farm that supposedly has some great farming practices. It is on the way to Ludzi, but you need private transport to get there. So I will spend some time visiting Chitedze Agricultural Research Station, before heading to Ludzi Parish.

It is at Ludzi parish that i will finally be able to start working at a clinic. I will be there till Monday (July 6th) before driving back to Lilongwe to spend the night.

I have spoken to Chikondi and June in Monkey Bay. Chikondi is a student that my family has been sponsoring to attend college here in Malawi. June is a 75 year old British expat whom lives in Monkey Bay and we become good friends while I was working there as a Peace Corps volunteer.

Well I have to get going.

Yendani Bwino! (translation: "go well")

P.S. For those of you who like to recieve emails when I have updated this blog, you can click on "Follow" in the upper right of the blog.

Lilongwe and lost driver-- 1-Jul-09

Now I have just arrived in Lilongwe and spent the night at a nice hotel for about $40. For my first night it was a good place to try to get over my jet lag. I didn’t sleep well because my body hasn’t adjusted to the time difference.

Initially the plan was for me to use a Malawian driver, named Chichi Nkhona, to take me to Ludzi Parish for the weekend. But the phone number I was given doesn’t work and I will be spending one more night in Lilongwe. When I tried to arrange for separate transport, it would have been a little more expensive than if I had gone with Mr. Nkono. Fortunately, I do have his email and I am hoping that I can track him down today….

I will be staying at a backpackers, Mabuya Camp, tonight. It will be significantly cheaper too. Perhaps it is not a bad idea for me to stay one more day in Lilongwe. I can relax, do some shopping, and allow my body to get over the jet lag.

Tomorrow, regardless of whether I arrange for private transport, at the very least I will be heading out to Ludzi parish on public transport.

For those of you who haven’t heard, I now have a cell phone and if anyone needs to reach me for emergencies (or even just to chatJ) you can reach me at 011-265-993-437-664.

love you all!!!!

Useless Year of Medical School -- 30-Jun-09

About half way through my flight when most of the passengers were sleeping and I was watching a movie, I was surprised to see two male South African flight attendants carrying a female passenger to the back – she looked completely incapacitated and they had already put an oxygen mask on her. Shortly thereafter, I heard a flight attendant announce over the intercom “Is there a medical doctor or medical technician on board? If so please proceed to go the back of the plane.”

I froze. Thinking to myself that I am not technically a doctor, but I guess I could be considered a medical technician. At the same time the only thing I felt I could contribute was my rudimentary first responder training (and never used) that I got at the beginning of my school year. I was also slightly embarrassed because at the beginning of my flight I proudly told the passenger next to me that I had just finished my first year of medical school and was going to be working in some health clinics in Malawi. She instinctively looked to me to do something……man, I felt like I learned nothing of practically value during my first year of medical school and was frustrated at myself. In the minute it took me process these thoughts and finally muster up the courage to go back there, I was relieved to see other passengers getting up at the same time, presumably doctors, and making their way back there. At which point I then said my neighbor next me “Oh there are doctors on the plane, looks like they don’t need me” and sat back down. I only laugh now at what a chicken I was…..I don't really think my first year of medical school was useless (as my title suggest), but rather just am anxious to get started with the practical part of my medical training.

As an interesting side note, during 9/11 the first and second year medical students of Weill-Cornell Medical College also found themselves in a similar position. The students were ready to help in any way they could, but felt that they had no practical skills which to contribute. For those of you not familiar with medical school the first two years are spent studying the books – anatomy, physiology, microbiology, and more. Then the third and fourth years are spent doing clinical rotations, where you get your practical experiences. In response, the Weill-Cornell administration decided to give the first responder course that I wrote about earlier.

Preparing for trip

So I sit here, two days before I leave, and I realize how unprepared I am. But then again, maybe you can never feel fully prepared. I am nervous -- nervous about going to Malawi again and nervous to leave my lovely wife a day after our one year anniversary. Prior to this we had been planning for Jessica to come to Africa for about two weeks in August. We had vague plans for her to arrive in Zambia, where she did Peace Corps, and I would come and visit her after my time in Malawi. She was quiting her job August 7th and was planning coming to Africa till August 20th. Alas because of her commitments to work and that fact that I bought an "unchangable" ticket, she decided that she won't be able to go:-( This is a major bummer since we will be separated for more than 47 days and the fact that Africa means so much to both of us -- it is where we met and we both had wonderful Peace Corps experiences there.

That being said, I now have to pack my stuff. I plan on bringing only one backpack for my personal effects and two suit cases full of gifts. I want to bring only the bare essentials:

• toiletries
• a netbook (a small 10' laptop)
• camera
• blood pressure cuff
• stethascope
• rubber gloves
• 13 weeks worth of anti-malarial pills (mefloquine)
• three pairs of underwear
• three pairs of socks
• flip-flops and one pair of tennis shoes
• two t-shirts
• one pair of pants (that I will wear on the plane)....the kind that you can zip off to make shorts from REI
• My white coat that I used when shadowing doctors during my first year at Weill-Cornell Medical College

I know it seems like so little, but after my peace corps experience, I found that it is best if I buy clothes from the market in malawi. It is cheaper, less stuff to bring, and I can give away my clothes when I finished there. I am excited and can't wait to see all of my friends and students that I have there. This brings me to my itinerary. So far my plans are as follows:

• June 30th -- Arrive in Lilongwe. Stay one night there.
• July 1st -- head to Mtenchi (sp?) agricultural center.
• July 6th-August 7th -- drive to St. Andrews mission in Kasungu
• August 8th -- meet up with Dr Eskridge. An american Docotor who help organize my trip and we will travel to Senga bay.
• August 14th -- Leave malawi for home

Well I will do my best to keep everyone posted an updated on my expereinces there. I doubt I will have complete interenet access while I am there and won't be able to update my blog regularly. However, I will be keeping a journal on my laptop of my time there and will attempt try to keep my post updated.

Peace Out,

Dakotah