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