HAPPY CHRISTMAS!!!

OK, don’t say I told you so, but, I’ve given in and hired a cleaning lady. The floors were just getting way too dusty and need mopping so much that I’ve not had time to do it and she does do a really good job of it, much better than I could do. It’s also handy that she decides to wash my dishes and clean my windows as well. And of course I’m helping the local economy- £12 a month- not bad. Hum.

Unfortunately VSO have not received enough funding through DFID this year and although they approved my project for making an emergency room in the OPD they then had to deny the funds for it and all of the projects the other volunteers had applied for. I was getting a bit depressed about it when, amazingly for me, I met a woman through a friend who works for Irish Aid. And they’ve agreed to fund my project instead! I’m very pleased about it and hopefully I will be able to get started on it next week. In order to complete the paperwork, though, I had to make a hurried journey to Mzuzu to send a letter by DHL. Of course whenever there is a time pressure there will always be a transport disaster. Not sure how many of you know but the ‘minibuses’ here don’t run to a timetable- they just leave when they’re full. So nice and early I arrive at the bus stop feeling rather pleased with  myself that the bus I’d got on was full so expecting a departure any time soon. But oh no, full is not when all the seats are taken, but actually when a bus with capacity of 11 has 18 people, 2 babies and a load of bags in it too. So half an hour of occasionally revving the engine to maybe convince people that we were going to leave anytime soon ‘so you’d better hurry and get on’, and of lots of changing around of passengers- god knows why- if you’ve decided to get on a bus to go somewhere why do you decide to get off after 20 mins? - we eventually set off.  Only to find after 500m - a police road block checking for overcrowding of the buses. The way the fine is avoided is by a passenger getting off and running down the road past the road block and then they are picked up further on. Got through that one ok but at the next road block the driver was not so lucky. We clearly had way too many passengers but for some reason the driver thought it was worth debating the issue with the police officer for quite some time. I was getting more and more agitated- the plan was to arrive in time for the 9am DHL to Lilongwe and it was already 8:30 so I was losing hope. Suddenly though the bus full of us started rolling backwards! The driver had not put the brakes on properly. Everyone started shouting and the monsoon drain by the side of the road was looking dangerously close. So I tried to instruct a front passenger to pull the hand brake but they just weren’t getting it!- not their fault really that they couldn’t understand English. (Must add that to essential lines to learn in Chitimbuka.) Luckily the driver spotted that his bus was rolling towards him when it shouldn’t have been and managed to run and put the brakes on! Phew. Really didn’t want to end up in the drain. He eventually paid a 2000MK fine (about £8) and then we were on our way, full of confidence. The rest of the journey was made up of a ridiculous number of stops, filling up the bus to overflowing capacity- well the fine had been paid now so how else were they going to make up the money lost?, and a woman who vomited all over her baby.  Well it may not surprise you that I did not get there til 10:30 (only 60km distance) and I missed the DHL for that day.

Work is going well and I had a session educating diabetics about diabetes (obviously) and ran a clinic for them. Unfortunately glucose and protein is out of stock so I couldn’t test their urine, some of them ate before their fasting blood sugar and most had run out of their drugs several days before. So slightly difficult to decide on what treatment they should take and how much. Anyway most of them attend just so they can have the free food!

The drug situation is getting a bit dire, still no diazepam, no normal saline, no paracetamol, no oral antimalarials!! etc but, there is omeprazole!- what?! Obviously the most essential drug. And the student nurses have just been told that they can not continue to study as the government have not paid the college fees. But of course there are enough nurses so no more need to be trained right?

I’ve been getting my hand into a bit of operating too which is quite exciting- did an umbilical hernia repair and some evacuations which is quite unpleasant. I am getting quite pained by the lack of monitoring of patients though. I had a lady who was vomiting blood ++ , had an HB of 6, heart rate of 150 and BP of 80. So all I wanted was at least some regular monitoring- but when I reviewed her the next day, because the clinician forgot, absolutely nothing had been written on the charts since my last entry. Grrr! Luckily she’s still alive. Because of this I am trying to change the ward around and put all the sick patients in one section which should hopefully encourage the nurses to closely monitor them like a mini HDU.

And last weekend I went down to Mwanza in the south for the leaving party of Diana and James and couple of Dutchies. So we planned a competition England v Holland. They had to do a mixture of  English Dutch, and Malawian challenges. For example- 3 legged egg and spoon race and the ridiculously named ‘spikerpoopen’ where you have to put a nail into a bottle that’s tied to a string around your waist. We also got the girls to balance pots on their heads and make nsima which the Malawians loved laughing at how useless they were at it!

I can’t believe its Christmas in less than a week when it’s so bloody hot- but I hear you have blizzards at home! Maybe it’ll be a white Christmas? I’ve tried to get into the spirit of it by putting some tinsel, I bought from Lilongwe, up on the walls and I have a nice 1.5 ft tall pink Christmas tree kindly donated by Marianne and Rina. This will be my first Christmas away from home! Boo. But I will be with friends and we’re eating guinea fowl so I’m sure it will be fun.

Hope you all have wonderful Xmas’s!!!

The next installment

Well I’ve rather neglected the blog for a couple of weeks what with all the washing, mopping, ironing I’ve had to do! Hum poor excuse- I’ve actually been busy having CPD sessions with Marianna- ie watching Grey’s Anatomy and shouting annoyed at the screen about how unreal the medical conditions are! Ever heard of a hemi-spherectomy for a 5 year old with a twitchy leg?

Anyway I have now settled back on female ward where I’m battling through the daily 45 patients, to only 24 beds, but they keep coming in as fast as I try and discharge them! The ward really is too tiny to manage with the number of admissions and it’s quite uncomfortable trying to see patients when there are 3 sharing a bed in which the mattress has completely given way in the middle of it so that they all sink towards the centre. It’s smelly and stuffy with little ventilation- apart from the smashed window with shards of glass exposed next to a patients’ bed that no one had bothered to fix, despite me asking daily. In the end I frog marched the maintenance man to remove the broken glass which he had to do with bare hands in the end as he claimed there were no gloves. This brings me onto the frustrations of today with the complete lack of resources. I have a patient who I came across on the ward round- of course no one had highlighted that this patient might be sick and need more urgent attention- they were having fits every 2 minutes, and had been like this over the whole weekend but no one was called to se them because apparently they are known epileptic so it was ok. Nevermind that they had a fever and headache. Anyway I attempt a resuscitation- oxygen? the machine’s not working, diazepam? there isn’t any, phenytoin? no, phenobarbitone? none either. So I tried Mag Sulphate- no effect. The patient is still fitting every couple of minutes so I decided to send her to the central hospital just to get diazepam. Is there a vehicle to send her there? No. (I’m tearing my hair out by now). Eventually after a lot of feet stamping I managed to get an ambulance to take her to the central hospital - only 4 hours after the initial decision! Very frustrating.

Other things in which we are lacking- no gloves- which means- no blood taking, no blood testing in the lab, no internal examinations, no results no diagnoses- stuck. And also we have no normal saline and no dextrose- not great when you need it to give quinine intravenously for malaria, especially not great when there is no oral quinine so you have to give IV. Not entirely sure how we can run as a hospital. Apparently there is a car going in a few days to get some drugs. But I’m learning lots on female ward- I’ve always shied away from gynae things coz I’m not a great fan of it but I’m forced to learn it here as there are so many miscarriages that need manual evacuations. And I’m still seeing fascinating pathology- an elderly lady came in this evening with a black leg for 2 weeks!! Like properly black from lack of blood- pretty nasty.

Unfortunately for us but good for him we have lost a clinician to the College of Medicine to study medicine which means we are even less and there is no one to cover the OPD which is the busiest department. I worked in OPD last week which runs like an A and E at home. I quite enjoyed it except for the fact that once the patients knew there was a Mzungu there they all wanted to see me! And again there were frustrations as there is no equipment to examine/investigate/ treat people – this is what I applied the funding for. VSO had actually offered me the money which was great news but now there are issues with the VSO budget so I am not sure whether I will be receiving it. Boo.

I’ve had an excellent couple of weekends too going to Nyika national park which is absolutely gorgeous and strangely looks like the rolling hills of the Yorkshire dales! Reminded me of the trek we did across England earlier this year. There were even some blackberries growing amongst the ferns. We camped in the park and it was freezing!! A real shock to the system and I spared a thought (and a chuckle) for all you poor soles in the UK snow! And I also went to Vwaza again this weekend and saw loads of hippos yawning! Yey! But I also managed to get eaten alive by tsetse flies and now my toe has become all blistered and horrible.

And I’ve been enjoying more nightlife in Rumphi. We saw 2 famous African bands in the local watering hole and as if its’ not hot enough we danced around in a sweaty mosh pit to bum wiggling (which I’m not good at) African music.

My domestication is going well!  Well sort of. I made a potato salad and added a mixture to it that was made of oil, water, vinegar and eggs to create a curdled sauce wondering what the hell is was supposed to be and thinking that I what I really needed was some mayonnaise. Marianna later informed me that in fact that was how you made mayonnaise! Just not quite right- hum try again. I’ve also tried curry- realised that you had to simmer is for ages, got bored and ate it anyway so it didn’t have much flavour and am becoming rather good at French toast. But my garden is coming on well! I’ve planted lots of exciting things in my nursery- tomatoes, cucumbers, rocket, lettuce, green beans, beetroot, peppers and soon they will be ready to transplant into the garden! Can’t wait to have more veg to eat.

The rains have come too – I can barely hear myself think when it’s coming down over the corrugated iron roof. But thankfully at last the air has cooled down and with it brought a lot of bugs which swarmed into my house last night and I looked like I was trying to o some tribal dance attempting to kill them all. I gave up in the end.

Anywho I hope that all is well at home and you’re tucked up in your beds away from the cold.

Until next time…..