Children's ward

I’m really noticing actually how poor this country is. I spent the week on the paediatric ward and there are so many little babies with big bellies and skinny arms from malnutrition. One little girl was the size of a 1 year old even though she was 13. Another baby was malnourished because her mother was only allowed to cook when she was on her period! It’s coming to the end of the dry season, in fact there was a drizzle of rain today!, and peoples stores of maize that they grew last rainy season are getting really low. And maize is about the only thing they do eat- fruit and vegetables are far too expensive. My guard came asking for a loan for some fertiliser- without it he can’t grow maize to feed his family of 5 for the next year and would starve. So I gave him a loan of equivalent of £80 which only bought 2 bags of fertiliser. He said he will pay me back from his salary over the next 4 months which means he will only get the equivalent of £16 a month of which £8 is his house rent (which has no roof). When I gave him the money he was so happy and grateful to me that I felt embarrassed and ashamed and went back into my house with my laptop, phone, ipod, electricity and running water and then felt guilty. I don’t think I’ll ask for the money back.

Children’s ward has kept me very busy- babies are small so you can fit 3 to the bed. There are so many sick ones and you feel so helpless. One little boy has severe malaria with an HB of 4. He went into heart failure after transfusion with oxygen saturations of 70% and then started fitting and we didn’t have any anti-convulsants. We also ran out of blood so several children with HB’s of less than 4 had to wait 3 days for a car to go and get blood. And now we have no gloves except surgical ones which we use instead but it’s a massive waste of resources and money! For some reason there is no forward thinking and planning and ordering things in advance before they run out. There are also a few safety issues on the ward- a Xray light box that doesn’t have a plug so the open wires are inserted into the plug socket right by a child’s bed, cots with no sides, beds with no springs which the babies fall through.

Of course there are loads of children with HIV and they seem to manage to get pus everywhere! Pus in lymph nodes, the chest, elbow, thigh muscles, scapula like I’ve never seen before. The pathology is incredible- I saw a little baby who had a retinoblastoma that was the size of a tennis ball sticking out of her right eye and covered in more pus. And there is a lot of diarrhoea and vomiting of course and ridiculously dehydrated children giving ‘loss of skin turgor’ a whole new meaning.

I was more impressed with the clinicians on the children’s ward. They seem to be relatively  conscientious and the nurses seem to do a few more of the jobs- still, not all of them ie medications not being given regularly including inhalers to asthmatics - it’s easier just to give aminophylline IV once a day.

I’m finding my practise of medicine is changing to one of- well I’m not sure what you have, I don’t have the tests to look for what a suspect and the ones I have are not very accurate so I’ll just give you some antibiotics and see what happens. And then if they get better you’re not sure whether the diagnosis was the right one and if they die you never know but you probably got it wrong. It’s very frustrating.

The children are really really cute though and it’s funny, because, for many they’ve never seen a ‘mzungu’ (white person) before, except in the books, so my face usually makes them start screaming – and I’m not even white- so maybe it’s just me and children.

Other than work I have managed to see some more of the country- there were some English medical students doing their electives here last week and we travelled to a place called the Mushroom farm up in the hills. It has an incredible view across the lake and to Tanzania and is really remote using water from the mountain and solar power for electricity. We trekked to a waterfall which we then abseiled down- a serious feat for me as I’m terrified of heights and  I was feeling rather pleased with myself that I’d come out unscathed. Then, while walking out of the shower naked, I proceeded to slip on my flip flop which then broke, naturally, landing on my bum, my arm and bending my finger backwards. Nice. The owners had some piglets that needed injecting with iron so sticking a needle into their bottoms helped me get over the pain.

I’ve also been exploring more of Rumphi – by day through trekking round the beautiful hills and by night in the local pool bar/nightclub. Not sure which were the high points- dancing with a sleazy male nurse from work African style or getting asked how much I was to buy for the night. Unfortunately women don’t go out- the only ones that do are prostitutes.

And I know that I’m trying to be a domestic goddess but yes I’ve caved already. I’ve employed a woman to do my washing- I like to think that I’m supporting the local economy. I am still doing my ironing, mopping my floors and experimenting with the cooking though- it’s surprisingly hard following a recipe.

Hope you are all freezing cold in England because I am equally uncomfortable sweating away and hoping not to get some fungal infection. But the rains are coming. Yey!

Lots of Love xxx

The Lake!

So when they said that the VSO national conference would be at Kande beach I didn’t put my hopes up for anything better than a skank hotel, which was trying to jazz itself up, somewhere in Malawi. In actual fact it was at a beautiful beach resort on the lake shore. This was the first time I’d seen the lake so was in complete awe and excitement at the gorgeous white sands, warm blue water, pretty fishes and bilharzia. Well I don’t seem to have caught it yet but I’ll let you know if I start peeing blood. So you can imagine what ‘conference’ meant to me– swimming, jumping off rocks, topping up the tan (how cold is it in England by the way? ;), drinking a lot of ‘green’ (Carlsberg), playing pool and table footie, drinking more green and dancing on the bar. So, not quite the change in my attitudes and behaviour I was threatening you guys with when I said I’d be living in a developing country for a year. It was a lot of fun though. I met up with the other new volunteers and lots of the old ones and we shared stories, discussed how we were coping and our bowel movements. The docs also had a chance to get together and chat about issues, do presentations about experiences and educational stuff.

Marianne and I decided that we were having such a lovely time that we would stay for an extra night at the expense of travelling back on a Sunday with no vehicle. I’m sure you can all guess, as this is becoming a standard thing for me, what happened – the usual transport disaster! We left bright and early on the Sunday and walked to the road where we then waited. The first thing that came along was a ‘matola’ – ie a truck where everyone just sits in the back, on maize and with goats and chickens, and holds on tight round the bends hoping the thing won’t turn over. Joy. We did enjoy, though, the sunburn and the driver using a ladies bathroom mirror as his wing mirror.

This took us as far as Nakata Bay when we then had to transfer into a minibus- chosen because the corners for the next section really were nail bitingly sharp and we didn’t stand our chances of survival in the matola. So for the next leg of the journey I rested my head on a radio hanging from the roof, with wires dangling everywhere, blaring at maximum volume with 4 other people on a seat made for 2 and sweating quite a lot.

Next stop was Mzuzu, so almost home- only 1 hour away and all we needed to do was get a minibus to Rumphi. Except there were no minibuses, in fact there was very little transport moving at all – it was all standing in a long long queue outside the BP garage with a lot of people twiddling their thumbs. A pretty standard scene in Malawi- no fuel. It costs, per litre, the same amount as England unbelievably because of importing costs, and Malawi has no forex so always struggles to purchase anything from abroad.

So we waited… and waited, ‘yes yes madam a bus is just coming’- yeah right. And then suddenly, a surge of panicked cars racing from one filling station to the other. I think the Malawians were doing a British queuing thing and just following each other without realising that the tanker was actually filling to the other petrol station.  Eventually we managed to pay a taxi a lot of money to get us back to Rumphi just before dark- the trip that took 3 hours to drive there on the first day took 9 hours to get back- not that bad I guess.

To try and get around the costs of high petrol the President opened an ‘inland’ port last week at the southern part of the lake in order to transport goods down the river instead of over the road. The trouble with it are 2 things- first that the port buildings are practically non existent so it can hardly be called a port and the second ‘small’ problem is that Mozambique, the country that the river runs through to get to Malawi has not actually given permission for the waters to be used. Probably should have been sorted out before the decision to open it for ‘use’. So the goods have been sent by road and according to the papers it will only take several years to resolve!

This week I’ve been working on female ward. Pretty hard core. There are loads of patients, they just keep coming. When all the beds are filled they double up and then lie under the beds - like a kind of bunk bed but probably more uncomfortable. And it smells quite bad too- that sort of musty bloody infected miscarriage smell. But there’s some really interesting pathology like Steven- Johnson’s syndrome- her whole body has blistered off, hemiplegia’s in young women, kaposi’s sarcoma of the thighs, sleeping sickness (the parasites look really rank under the microscope), lots of TB and malaria. Unfortunately I had a 21 year old Jehovah’s Witness die of malaria in front of me. Her Hb went down to 2 and she went into heart failure but still refused blood and oxygen.

I have my portable oxygen saturation probe but I’m not sure it’s been very helpful yet- ‘oh dear you’ve got sats of 75%- have we got any oxygen to give? No? oh right’ or if we do manage to acquire the concentrator the patient will refuse it believing that it will speed up death.

I’ve also been very busy trying to apply for some funding from VSO for creating a triage system in the outpatients department. – It’s like our A and E department at home seeing all the new attendances but with no system in place other than a time order one which means that sick patients are often left waiting hours to be seen and when they are there is no where to then treat them. So they are sent to the ward in the hope that a nurse may be free to attend to them before they get  even sicker and die.

The trouble is there is only a very small pot of money and loads of volunteers apply so I probably won’t get the money but I am still hoping to set up a service here anyway but it will be with less resources. Cross my fingers anyway.

You’ll be pleased to know that I’ve made a new friend. The fact that it has 8 legs and looks quite scary is a small point because it also, much to my delight, eats cockroaches!

Hope everyone is good and enjoying the Christmas music which I’m sure is playing in all the shops!