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! 

Freeze: Mr. Lipton Teaches Improv to 10-Year-Olds, Day 1

“Do I look good in this shirt?”

“No. It looks terrible on you.”

“Give me another shirt.”

“No. We don’t have any.”

“Where is your manager?”

“You’re talking to him.”

“You suck.”

“No, you suck. Get out of my store.”

“No, you get out.”

"Fine."

(Both exit.)

*     *     *

“Help me dig this hole.”

“Okay.”

“We need to find gold.”

“Yes.”

“I’ve fallen in the hole!”

Freeze. Audience, look at this pose. What might be going on?

“Two guys digging a hole.”

Right, but what else?

“One fell in the hole.”

Right, but what else?

“They are looking for gold.”

Right, but aside from that - that was the previous scene they just did - what else might be going on based on this pose?

“They are looking for silver.”

*     *     *

“You poor hobo. Let me help you.”

“Thank you, madam.”

Okay, audience, what should happen now?

“He should rape her.”

Le Club

What is happening now?

“It is Monday. We are having clubs now.”

Every student is in a club?

“It is required. Yes. And each club has a patron. Will you be patron for the Drama Club?”

But I teach drama all day. Is there a Chess Club? Or an Art Club? Like drawing and painting?

“Hm. Ah? Okay, I will talk to the vice principal. Maybe we can have this.”

(Later…)

“Okay, I have talked with the vice principal. You can be patron for the Art Club, but it must also be French Club and Writing Club.”

But I do not speak French.

“It would only be a little bit French.”

I do not speak any French at all.

“No?”

No. None at all.

“But with the art and the writing, this could be okay.”

A Chichewa Lesson: The Staff Room

“Mr. Lipton, her surname, Mzengo, comes from Nzengo. It means sticks. A pile of sticks.”

Oh, okay. Cool.

“And Mr. Banda’s name means big ant.”

Alright. Wow.

“And my name, Mandala, is these. On your face. Spectacles.”

Cool. And the students tell me that Ms. Kambewa’s name means small mouse.

“HAHAHAHAHAHAHAHAHAHA! Yes. A small one.”

Ministry of Road Traffic won't get lost in the shuffle.

 Normally, I advocate for a divide-and-conquer approach to errands. However, having spent some time in, well, Africa, I know that there are certain day-to-day tasks and events that come together to shape one's overall experience of, well, Africa.

Therefore, when it was time to go to the Ministry of Road Traffic (i.e. Malawian DMV), I forced Brody to come along. "We came together to share this experience... so we have to share this experience."

He thought I was being dramatic, but nodded knowingly as soon as we arrived and saw their filing system.

Aside from having to go to the
Ministry two days in a row since I initially was missing the correct documents (about which there is no website and 5 different experienced people will tell you 5 different things), highlights included:

1. Being led alone (Brody inexplicably not allowed in) into a room with a large, Black man in a pinstripe suit behind a huge desk as he skeptically glared at me before finally doing me the favor of signing my papers.
3. The young man in the "No one knows I am a lesbian" shirt.
4. Actually making it through the 4th, no, the 5th line I had to stand in without getting cut. (The trick is putting your nose into the back of the person in front of you.)
5. Driving over the just-narrow-enough 10 foot cement pit with stairs leading into it for the automotive fitness exam.

Teaching in Malawi: Conversations & Revelations

I. A Conversation with a Student

“Is it wrong to be homosexual in America?”

It is not wrong to be homosexual anywhere.

“In Malawi, it is illegal.”

Just because something is illegal does not mean it is wrong.

“But in America, being gay, is it proper?”

It is as proper as not being gay.

(Uproar.)

*   *   *

II. A Conversation with a Class

“Mr. Lipton, what was wrong with your hair yesterday?”

“We saw you out the window and it was like WAH!” (gesturing ‘all over the place’)

Yeah, it gets a little crazy at the end of the day. It’s too long.

“No!”

Yes, I need to cut it, but I cannot find a barber who cuts white people hair.

“No, you must not cut it.”

“It looks proper this way.”

Long? Crazy?

“White.”

*   *   *

III. A Conversation with a Department Head

Am I right in understanding that there is a limit to how many students may sign up for a Form 6 class?

“There is a limit, yes.”

The limit is five?

“Yes, five.”

You cap Form 6 classes at five students?

“Yes, only five students. It is the limit. Why? How many do you have in there?”

Sixteen.

“Mm. That will be a challenge.”

*   *   *

IV. A Conversation with a Student

How does discipline work at this school?

“If you do not have discipline, you get punished.”

What sorts of punishments do they have?

“Chop down a tree. Dig a hole as big as yourself. That stuff.”

*   *   *

V. A Conversation with a Teacher

Is it true students have to chop down a tree as punishment?

“Yes. Usually it’s just water flowers. Or some mopping.”

Or dig a hole as big as yourself?

“That is for if they are caught dating.”

A Lilongwe Private School: Five Conversations

I. A Conversation with the Principal
You know, I have no experience teaching drama. In school, I studied theater and playwriting, but I've never taught it-

"Yes, okay, that is not a problem. You have never taught it, we have never offered it. We will learn together."

But teaching English, I have years of experience-

"English teachers, I have English teachers. It is my dream to have drama at this school. You, this class, you are seeds that we will plant, you, here, now. And four, five years, you will grow into a drama department at this school."

...Do we have copies of any plays?

"No."

*   *   *

II. A Conversation with Some Administrative Guy
"I have a very bad flu."

Oh, no.

"Yes, and malaria."

Oh...

"And here is a book you can use for taking attendance."

 *   *   *

III. A Conversation with a Different Administrative Guy
"How do you like the new schedule?"

I had eleven classes. Now I have nineteen.

"Yes. Here." (He hands me a pink folder.)

Thank you. Is there something I'm supposed to do with this?

"You put things in it."

 *   *   *

IV. A Conversation with a Class (Form 3)
"You must not eat anything you buy from the side of the road."

Why not?

"Because witches put juju in it and you will see things."

Really?

"Also, it is not sanitary."

*   *   *

V. A Conversation with a Class (Form 6)
So, in addition to drama, I have been hired to teach this group General Paper, but no one has told me what that is. Everyone says, "Yes, someone will explain that to you." I asked for a syllabus and everyone says, "Yes, someone will get that for you." But no one has. And finally, today, I said, "I have to teach General Paper today and I still don't have a syllabus." And they said they would print one for me, but there is another blackout today and so the printers cannot print.

"Welcome to Malawi."

Light switch: Engage.

This post is dedicated to Jean Luc Picard. In the year 2500, despite being able teleport, travel at warp speed and, most relevantly, to video chat with alien species on different space vessels, he did not have a freakin' wireless video camera. This was an inconvenience when his away team when on missions:  "Number one, tell me what you are seeing down there?" Riker does a good job, though, at keeping it fresh with a new description of the same set as the last planet. 

We sympathize with Captain Picard's lack of a technology he should have been able to rely on given the century. But brownouts/blackouts are part of the daily Malawi routine. Usually it is just a couple of hours a day (and usually just before dinner is cooked enough to be edible, no matter what time we start.) but right now Malawi is having rolling blackouts so it is a little more extensive.  So far today, we woke up and left the house without out it. When we got home, it was out (still or again?). And last night, we went to bed early while the electricity was out (The dark is sleep inducing. Cave man remnant. It's science.) It is a little annoying, but we make the best of it. 

Here is a photo from our first blackout soon after we arrived. I never thought I'd eat so much cheese and crackers in Malawi considering the cost of cheese, but it has turned into a blackout dinner staple and I am ok with that. Also, yes, we are watching TNG starting from season 1. Thank goodness laptops run on battery!

Excuse me, waiter. There is a hippo in my soup!

Stephanie Marton would be proud that we fit in our first away adventure just before the one month mark!The goal is at least one per month. Which is good for you guys, because it means more blog posts for you guys!

Liwonde National Park served as Brody’s first safari-like experience. Liwonde is about 3.5 hours south of Lilongwe on the M1 by car. (That information is for you, Marc!) We arrived on Saturday afternoon, met some of Katie Simon’s friends from Neno and went on boat ride on the Shire River (Don't worry, it was a proper tour boat! We know to avoid being served to crocodiles as a dugout canoe delicacy.) We saw plenty of hippopotamuses, a crocodile and a huge herd of elephants. Aside from the excitement of seeing these animals in their natural setting, the river was beautiful, lined with baobab trees, glimmering with the sunset and dotted with graceful fishing boats.

 Afterwards, we had dinner at the Hippo View Lodge. We were casually enjoying our veggie curry when a HIPPO WALKED THROUGH THE RESTARUANT! It lumbered up from the water towards the bar (walking about five feet behind my chair!) and around the next table (about 10 feet away!) and, presumably, back down to the water. I was surprisingly calm and tried to take a photo, but it was too dark by the time I was ready and, despite my general sense of immortality, I did think it best not to use a flash in that situation. Did you know, hippos will kill you? Like, seriously kill you? They are said to be one of the most aggressive animals in the world along with sharks (and HIPPOSHARKS!) and will attack humans with no provocation. They weigh 3,000-4,000 lbs average (though “they are difficult to weigh in the wild because of their size…” No shit, wikipedia!) They are primarily vegetarian and eat 150 lbs of grass a day. No word on how they are so fat with a such a healthy diet. Also, no word yet on whether they suffer from cardiovascular disease secondary to their body habitus. However, there is word that they will, indeed, kill you along with the other 2,999 people per year because they just straight up charge people (and probably chop their heads with those tusks too, I bet.) Also of note, they spin their tails while they defecate, reportedly to mark their territory, but I wouldn't be surprised if they did it just to be jerks. 

 

We stayed in Bushman’s Baobabs Camp which was quite far from the tarmac road and made me realize why you need 4 wheel drive to go anywhere outside of Lilongwe. Because the dorm beds were full (noisy Australian youths!) we got a free upgrade to a private tent with en suite bathroom which, obviously, was pretty fancy. We escaped the whole weekend without any noticeable mosquito bites (the only African animal more deadly than hippos!) for which we thank the dry season. We arrived back home safely in time for... remember when that hippo walked through that freakin’ restaurant?!

Enjoy these shots from the boat ride. Also, you should probably watch  this related video.