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."