A Difference

In my experience, if a teenage girl passes out at a party at an American high school, not only do people take note, they sort of spring into action. The girl is, you know, tended to. Like, medically. Her friends would be taken aside by figures of authority. Questions are asked. Has she been drinking? Did she do drugs? Does she have a history of falling down? There would be an investigation, consequences. 

A party at a Malawian secondary school? Not so. Oh, the nurse was summoned. She took a break from mopping the sidewalk and came over to pick grass out of the girl's hair and rub her cheeks. I was not quite satisfied, so I asked around...

Is she okay?

"Yes."

Does she need to go to a hospital?

"No. She is fine."

Does this happen? Does she do this a lot?

"I do not know. Maybe."

Rules for use

In case you unclear about the rules regarding the curtains in the Kamuzu Central Hospital conference room.

Sometimes Malawi is Beautiful

Just for us.

Giving Thanks for the Festival of "Lights"

Thanksgiving and Hanukkah all at once and set in Malawi.  What a noteworthy collision of culture and history to really make us reflect upon our gratitude for the gifts [privilege] that have been bestowed on us [stolen] as God’s chosen [ruthless] people and most beloved [arrogant] of nations.

On that note, here is Andrea’s first attempt at Challah. Yay, Shiksa baking! And our Malawi Menorah!

Here is the Thankgiving storm.

Here is the resulting downed Airtel sign that took with it [our] power lines, leaving us electricity-less (and, hence, pie-less) for 4 days.

Here is a group of expats who, like the pilgrims, are doing their best to make a decent meal in a foreign land with weird ingredients, uniquely small ovens and an overall lack of electricity.

Deep fried turkey made over fire, bread baked over a BBQ pit, people scattered to the other side of town to get the latkes cooked, extra salad, and lots of candles to light the way. Truly a festival of lights.

And Brody missing Texas? Amanda thinks maybe yes.

And rounding out out the weekend with lots of white people singing Christmas carols (and Christmas trees made of garbage) to acknowledge what all this is really about... 

Dat sure is a big lake you got der!

As a Minnesotan, I am used to people talking about “The Lake.”  (Interchangeable with “Up North” for those less attuned to our friendly, long “o”-ed jargon).  The following sentences can be heard among family members or even strangers during the summer months (um, really just June-August) on at least a daily basis.

“Headed to The Lake this weekend?”

“I am so stressed. I just need a trip to The Lake.” 

“Grab the mosquito repellent. You know how they are at The Lake!”

All of the above phrases can also be heard on a regular basis in Malawi (I suspect this is the only similarity between Minnesota and Malawi, by the way.)  The major and fundamental difference being that “The Lake” is literally The Lake.  One big freakin’ body of water that they country can claim! And anyone living in Malawi, talks about it with pride.

We made our first trip out there last weekend trying to change the tides of a very bad week leading up to it.  We stayed in Fish Eagle Lodge which is about 10 km south of Nkhota kota.   There was nothing to do besides eat, swim, rest and read. And teach Brody to play cribbage. We even woke up for sunrise.

The water was cleansing (that is, as long as we didn’t think about the schistocytes) and the sun was invigorating and the whole thing made me first think I could tolerate Lilongwe at least a little longer, as long as we can get the car fixed fast enough to repeat this trip in another 2 weeks!

Anyone missing their death book?

Things you look down and find in an otherwise empty UNICEF box in the hallway in Kamuzu Central Hospital.

Worse than usual at KCH

Nobody tells you how much harder it is to be a doctor in this setting than a non-doctor (or a pre-doctor). Honestly, it is a privileged prospective to have, one that most people do not even know to consider. I did not.

30 October 2013 page 1

30 October 2013 page 2

I came to Malawi with the same luggage, on the same long plane ride, driven by the same belief in justice that had brought me across the ocean into emergency rooms and charity hospitals in the past. However, it wasn’t until I stood inside Kamuzu Central Hospital (KCH) pediatric wards, surrounded by critically ill children crowded onto dirty beds and searched desperately for the last vial of a beta agonist for a 6 year old with asthma and begged a busy nurse to help me hang blood for another child who had been waiting for more than 36 hours for a transfusion that I realized this time was different. I am a doctor now. The difference is one of not being able to do anything to being acutely aware of all that it is that I cannot do.

31 October 2013 article 1

31 October 2013 article 2

Since I have been at KCH, I’ve seen more death than in my entire medical career and, worse, have felt dependent on luck alone to get a sick child stabilized and treated. We have been without everything from gauze to epinephrine to xrays. The drug shortages leave me with little to offer, the human resource shortages make it impossible to care for every patient, and the supply shortages mean that even surgeons, who have a special gift of immediate healing, cannot operate.

1 November 2013 

KCH, in Lilongwe, Malawi one of the most aid heavy cities in the world, is not necessarily suffering from financial limitations, but organizational and bureaucracy issues. The only comforting thing about KCH staff being “Irked” (understatement) and protesting is that I know that the current state of the hospital is particularly bad, even for KCH.

1 November 2013 Letter

Images from the COE: One

From my exam room, I can see this tap behind the building that children seem compelled to battle. This child lost. 

The way home

If there is one thing a group of bleeding-heart, tree-hugging ex-pats know nothing about, it’s auto repair. 

So when Cary’s Toyota Surf (which he had just picked up from the mechanic the previous morning for the trip out of town) started spewing black smoke from the tail pipe about 6 km into the 12 km dirt “road,” we buckled down for a long day.  To be fair, Cary’s car gave its best, tolerating an extra kilometer with some rests and even an ill-advised attempt at a duct tape repair before completely dying 5 km from the tarmac. Because there was clearly no cell phone service, we had a lucky break as our new friends Rafa and Emily came zipping down the road (in a Corolla!) and gave Nora and Emily a ride to town to arrange for a mechanic to help us.  Eventually,  the lodge manager, Innocent, showed up to tow Cary (with an old piece of rope and a pickup truck) down the rest of the mountain and lead us to a mechanic (three mechanics, actually) who proceeded to diligently work on Cary’s car for the remainder of the afternoon.

And that is the story of why a group of 11 expats spent the afternoon outside an abandoned building in the tiny town of Ntchisi.  And the photos explain why none of us minded. 

Did you just say, "Mm, cheesy"?

Our October trip was a weekend of wilderness at Ntchisi (rhymes with “Mm, cheesy”) Forest Lodge. The good news is, our new front shocks (i.e. Brody's monthly salary) on our new (read: 1995) 2-door Rav-4 held up on the several kilometers of rugged, dirt road leading to and from the lodge. We were skeptical on the way there, not only about the shocks, but about the label "forest reserve." On that 10 km dirt road there was one tree, a few farming villages and lots and lots of dust.  However, the lodge was beautiful and walking through to the other side, it was obvious it was situated just on the edge of a hill overlooking treetops in deep valleys.

We did 2 main things while there: eat and hike. The hike, again, was unexpected and unreal. One moment, we were walking through dry, crunchy hilltops and the next moment, we were ducking under vines of the rainforest.  Our guide,  Eston, 71, demonstrates how to take full advantage of these vines. Andrea's gymnast temptations get the better of her, too.

We were transported back to the Peruvian rainforest we visited last July. At one point, Andrea muttered, “I swear that’s the same fuckin’ tree we saw in Peru,” as though we were the dupes in some long con of global ecology.  It may have actually been the parasite that takes over the tree from the outside and leaves the actual tree rotting on the inside that disguises all the rainforest trees and makes them look the same. In any case, global ecology is out to play some wicked prank and it is working.



Brody, too, was taken by the hiking spirit. Turns out, what he thought was "hiking" is really backpacking and he actually likes hiking which is more like "walking with some tricky parts." He wore a bandana (Brody's hair issues deserving of a separate blog). To most of us, this screams "I am a douche." To Eston, our guide, it apparently screamed "I carry a knife" the inaccuracy of which disappointed Eston greatly when he was trying to show us a the insides of a rubber plant.










In a full circle of bizarreness, the hike ended to watch the sunset on a big rock in what felt like the dry mountain Colorado air and including an encounter with an actual pine tree with actual pine cones on the ground. Turns out, there is a pine tree farm near by, you know, next to the rainforest, so that's normal and everything.

Dinner at the lodge was delicious. Goulash. With a wet cupcake for dessert. Brody loves wet cupcake. And the room was as comfortable as they come in Africa, with a king size bed (well, two twins pushed together) and a shower that is warm...  made especially luxurious because that wasn't a bat flying around the room all night, but just mice in the wall and ceiling having a party, or staging a military coup. We ate a giant English breakfast in the morning (turns out English people love beans and floppy bacon) and got our kicks playing Bananagrams since ex-pats LOVE games (we belong with these people!)  We set off for home unprepared for the surprise adventure that lay ahead... 

Images from the Academy: One.

A typical classroom.

Moonlight Safari on Horseback

i.e. Night Mares.

Before we can blog about October's monthly outing, we needed to write about September's in Kuti which is as described in the the title. Whatever you are picturing is likely infinitely more romantic and exotic than the 2 hour long [mammoth-size-horse] pony ride we actually experienced. Except for that these lights made us look like care bears (or Iron Man?) which is cool probably beyond imagination.

Notes for the doctor from KCH

In addition to providing primary care to HIV-infected kids at Baylor Center of Excellence (COE), the Baylor clinicians also serve as an HIV consult service on the pediatric wards at Kamuzu Central Hospital.  KCH is next door to the COE. It is a government hospital and is as busy and understaffed as one can imagine. Because they are already stretched thin, the wards service leans heavy on Baylor so "consult service" is a loose term since we order the meds, do the procedures, talk to patients and make the plans. Eventually I will be spending more time at KCH on the wards, but last week gave me a quick taste of what I was getting into. Lessons learned:

1.  Just because there isn't hand sanitizer dispensers or sinks with soap every 6 feet doesn't mean there shouldn't be. 
2. Lumbar punctures on sedated kids in a quiet procedure room are a few pokes easier  than on an uneven dirty mattress  with 2 other children on it with at least 50 people with a direct line of site to what you are doing. 
3.  If you need to leave the hospital at certain time, do not walk into the High Dependency Unit within 2 hours of your scheduled departure or someone will assign you work, after all, you ARE a doctor.  
4. Parents at Texas Children's Hospital need to suck it up and be nice to my colleagues including my co-residents and nurses; they have NOTHING to complain about when it comes to the service they get.
5. That wet spot on the mattress beneath your hand is probably pee. 
6. Kids everywhere love stickers... suckers!