Emilia in Malawi

Saturday, September 26, 2009

The Fifth-Hottest Place on Earth

Weekend trip to Tete

Another med student here, Charles, did peace corps in Mozambique, so six of us visited his site, Moatize, near the city of Tete. I've heard the Mozambique coast is incredible. Tete is the site of the fifth-highest temperature ever recorded; not exactly an enticing superlative.

It was great to see where Charles lived, meet his friends, and see the school where he taught, but the heat got to me - the hottest day of the year so far, 40 degrees Celsius. We had planned to stay with the current peace corp volunteer, but his house was literally the dirtiest place I've ever
seen (and I saw a few crack houses in Baltimore). An inch of dirt on the ground, silverware cemented in the sink, black bathtub... So instead we stayed in a truck stop / whore house. I had never before stayed in a flea-bag motel, but I have the bites to prove that I have now.

We decided to leave Charles with his friends and take a field trip to a dam and reservoir 150km north of Tete. It was lovely - boat ride, swimming, fresh fish. We’re planning a trip to the coast in November.

Crossing the Malawi-Mozambique border

Lunch in Moatize (Becca, Charle's pricipal, Charles, me, Jon, Seth)

Charles' school

The library that Charles built

Kid outside a barbarshop (note the poster with the different hairstyles to chose among)

Charles in the market. I didn't linger here.. the smell in this section was really intense!

Market. I like this picture because you can see how the women in Malawi and Mozambique carry their babies on their backs.

Clothes market

Drinking beer in the market. Charles gave some medical advice to the shopkeeper about her arthritis. We attracted quite a crowd.

Crossing the Zambeze River in Tete

Once again, hood open, overheated, under the shade of a boabab tree beside a village. (Notice a pattern?)

Arrived in time for lunch!

Sunset boat cruise on the Cahora Bassa

Nick (lodge owner), Jon, me, Seth, Becca

Boat Trouble + Car Trouble, or We Always Make it Home Somehow

Weekend trip to Nkhata Bay, about 300km from Lilongwe, a few highlights:

-'Dug-out canoe challenge': two people have to paddle out into the bay, around a boat, and back. Winners get to stay for free at the lodge. We made it maybe three meters before capsizing. It's harder than it looks!

-Boat trip to a beach for dinner. We went over in two boats, and returned in one. We ran out of petrol, but kept our spirits up with a Beatles sing-along.

(very happy to arrive back at the lodge)

-The maiden voyage of our 1992 diesel Toyota Hilux Surf, affectionately named Big Bertha. We had some overheating issues going to Nkhaka Bay, but arrived without much trouble. The way home was a different story. We overheated about every two kilometers, and eventually started spouting black soot. I thought we would have to abandon the truck and take a bus home, but we successfully traveled the hilly 40km to Mzuzu in three hours. Miraculously, we found a mechanic on a Sunday in Mzuzu (the fifth? largest city in Malawi), and, stopping every 70-80km to add liters and liters of water, arrived home at midnight. She's a thirsty one, that Bertha.
(waiting to cool down)

(I learned a lot about radiators!)

(trying to figure out our distance from Lilongwe)

long overdue update

One day, Maria and I visited traditional birth attendants (TBAs) in the community. Several months ago, the Malawian government prohibited TBAs from conducting deliveries. If a TBA delivers a woman instead of sending her a hospital, she must pay six goats - and the delivered woman pays three goats - to the village chief. This seems to be adequate deterrence; all but one of the six TBAs we visited had closed up shop. It's true that TBAs were not adequately prepared to deal with prevention of mother to child HIV transmission. Now, once labor commences, the women must walk dozens of kilometers an overcrowded, understaffed hospital whose capacity has not been expanded since this problematic policy went into effect. Everyone was incredibly welcoming, especially one little boy who crawled into my lap.

sunset in Senga Bay, about an hour from Lilongwe

hiking in Dedza, about an hour in the other direction

Friday, August 28, 2009

Is that patient on our unit?

The surgical patients are divided into two units. Two or three surgeons are part of a unit, and each patient is assigned to either Unit 1 or Unit 2, depending on who performed their surgery. The patients are not sorted by unit in the wards, and I don’t yet understand how the rounding surgeons know which patients they need to see. There is no master list of patients, as far as I can tell. Rounds occur only Tuesday, Thursday and Saturday, which means these are the only days a surgeon examines the patients and updates their plan of care. Two nurses are responsible for fifty patients. Things get missed.

Walking into the women’s surgical floor this morning, we passed a grey-haired woman curled on her side in bed. “Is that patient on our unit?” Jon asked the nurse. Instead of answering, she felt for a pulse. The patient was dead. A woman I assumed was her guardian sat on the adjacent bed weeping quietly. The nurse put a screen in front of the dead woman’s bed and we continued rounds.

Later, we came to a woman eight days out from surgery to repair a perforation in her small intestine, a relatively common result of typhoid infection here. The patient unwrapped the dirty cloth – not gauze, but the colorful fabric the women here wear as skirts – from her abdomen to show us a baseball-sized opening in her belly. Her surgical wound had opened and her small intestine was open to the air. No surgeon had seen her on Saturday rounds, perhaps she was walking around when they passed by, or maybe she got overlooked by the busy physicians. The patient told us it had been open for a week. Even though here “a week” can mean between two and twenty days, the last time she had been examined was five days ago. She was scheduled to return to the operating theatre to repair the wound, but it did not happen today. Hopefully tomorrow.

Saturday, August 15, 2009


I was very excited to join the American surgeon, Jon, on surgical rounds and call today. It would be my first time on the wards at Kamuzu Central Hospital. I planned to round on the surgery patients in the morning, then join Jon in the OR (called the operating theatre, here) for any emergency cases.
First, Jon gave me a tour of the wards. I had never seen a hospital in a developing country, and KHC was basically what I expected. There are about forty beds in a room, and a family member accompanies each patient to provide basic care and food. The beds look dirty, the patients look sad, and flies are everywhere. Today, the wards were all but deserted, and families gathered in the central, open-air courtyard to enjoy the clear, dry morning.
The first patient we saw on rounds had an infection on his leg and was waiting for a skin graft. Elective cases are only scheduled Monday, Wednesday and Friday, so he might wait a few more days. Jon encouraged him to try to walk, or even move his legs while in bed; no physical therapist would come daily here to help him maintain his strength. The second patient had been burned on his leg in 1999, and his wound never fully healed. In the States, a complicated surgery might spare his limb, but here he was scheduled for amputation. I had seen some dirty wounds on my surgery rotation, but nothing compared to the smell coming from this fellow's gangrenous leg...
I felt a little dizzy, and the next thing I knew, I was being carried down the hall. I had passed out. I have a nice bump on my head and I broke my nose, but Jon cracked it back into place.
What an introduction.