Settling In

It’s been while since I’ve written anything sorry! After my hectic New Years celebrations I have kept a low profile and chilled out around Rumphi for the last few weeks. Well that’s not strictly true as last weekend I went to Mzuzu for a friend’s birthday and did a round of pub golf ending up dancing around to electro. But pretty good going for me.

Instead I have been cultivating my garden and having civilised dinner parties! My vegetable patch is looking great and I have harvested my first courgette which was really massive with all the rains! And also I’ve got lots of lettuce and rocket which makes a lovely salad. Yum. The green beans are almost ready and the cucumbers are creeping up the fence too. Soon I’ll have too much veg to eat – I’ll have to set up a stall on the market and start selling it! I have now received some herbs which were hand delivered to me all the way from London strapped to a medical student- thanks to all concerned! So with all this food I’ve been having a number of dinner parties (slightly bad as this is malnutrition season when many Malawian’s starve because of their stores of maize running out). Well I’m occasionally feeding my watchman and 7 months pregnant washerwoman. But I don’t want them to become dependant on a Mzungu otherwise they’ll be in trouble when I leave.

Speaking of my washerwoman, she’s managed not to break anything else of mine thankfully but she has repetitively unplugged my fridge while cleaning and allowed my meat to defrost several times. So big protein load for me. However I have managed to get a wooden structure made which I wrapped some material around and made into a pretty lamp to replace the one she smashed so things are looking up.

The electricity company has been causing me to have grey hairs and also maybe increase my chance of lung cancer from the number of times I have to light my charcoal stove to cook on because of the ridiculous amount of power cuts. Whenever it rains a little the power goes and they never bother to repair the faults properly because the person who gets called to fix it would be upset at losing his job. They also had the cheek to attempt to cut Marianne off, because of a mix up with her bill, after there had been a power cut all day! The president came up to one of the towns near Rumphi to open some new maize silos and there was even a power cut for 2 hours during his speech! He was raging and I think some people lost their jobs.

It’s looking really beautiful now though with the rains- really green and the maize is almost getting so tall I can’t see over it. Hope I don’t get lost.

Building work has begun on the OPD – well actually the demolition has started but not quite the building work- there is no money to pay for a truck and the petrol to collect the bricks and sand. Little bit worrying. I don’t want to pay for everything because it should be a shared project with the hospital and they are more likely to appreciate it if they have paid towards it as well. (That’s what I try and tell them anyway).

Otherwise, I am getting used to the routine of work and everything is becoming ‘normal’ I am unfortunately slowly ceasing to be shocked by what I see. It’s malaria season and there are sooo many sick people especially the children all with Hb’s of <5. Every morning we have a report of the death and the numbers keep increasing. The problem is that it’s difficult to know whether some of the deaths could have been prevented because the documentation in the notes is so poor you can not read through and learn from the mistakes.

Last week we had no plaster to hold cannulaes in or fix dressings so elective theatre cases were stopped until the dutch doctor went to the market to buy some masking tape which we used instead! ‘Just improvise’ is the line I hear so much when there isn’t anything; string instead of staples, torch on phone instead of examining light, washed out antibiotic vials instead of sterile urine bottles You can’t really improvise through when it comes to having no painkillers and no dextrose (sugar) to give someone who’s in liver failure and is unconscious with hypoglycaemia.

The ward does smell a bit nicer now though- the mattresses have been changed and as the old ones were wheeled out there was this horrible stench surrounding them. Patients often just pee through the mattress and a bowl is put beneath the bed to catch the urine as it drips through. Nice.

And last night we had a multiple trauma- a truck overturned and there were loads of people with head injuries and fractures but luckily no deaths. It was complete mayhem! No system is in place to triage the patients and only the orthopaedic clinical officer and DHO turned up- none of the other clinicians! There were lots of nurses though, but they all rushed from the wards leaving nobody on the wards to care for those remaining there. There was absolutely no order to anything, blood everywhere, screaming people and to top it off about 300 locals who’d all come to watch the show as they’d heard the siren go.

Anywho – be thankful you live in a country which has a functioning health system! I hope that 2011 is treating you all well so far and thank you for the Christmas cards that I’m still receiving!

xxx

HAPPY NEW YEAR!

Hope you all had a lovely Christmas and fun New Year Parties! It was very weird being in a hot country for the celebrations, listening to snowy Christmas music while sweating over the roast. We tried to make it as homely as we could though – 2 friends from England, James and Diana, who’ve being working in Mwanza (South Malawi) joined me, Marianne and her bloke for Xmas dinner and we played some quizzes (thanks Dad!) and watched movies. Nice. Only 2 power cuts interrupted our festivities.

For xmas dinner we couldn’t get a turkey so we opted for guinea fowl! We bought them a few days before Christmas and kept them in my back yard trying to fatten them up with maize. Diana and I decided that as we wanted to eat them we should at least be prepared to kill them ourselves, especially after Marianne had taught me how to kill a chicken a few weeks ago.

So here’s a stepwise account of how it was done in case anyone’s interested in doing the same next xmas?  (squeamish people probably should skip this bit)

Step 1: Catching the birds! James ran around the yard for some time grabbing at thin air, with the guinea fowl running faster and flapping while Diana and I were screaming until eventually my guard overheard us and came to our rescue. He walked straight in, grabbed them by their wings and that was it, much to our embarrassment.

Step 2: The killing. My guard stood on the wings and held the head for me while I used my newly sharpened knife to cut through the throat. Thank god he was holding it down because it started having some kind of oxygen starved fit and if I’d been responsible for it I’d have let go in a panic and you can imagine a headless guinea fowl running around my back yard. Eventually it lay still. Diana’s killing was slightly more Tarantino. She slit the carotid and bright red blood started spraying everywhere upon which she started screaming hysterically. We didn’t expect so much blood- the chicken hadn’t bled so much! My back yard was starting to look like a murder scene (well I guess it kind of was!)

Step 3: The plucking. The feathers are a lot more difficult to get off on a guinea fowl so we had to dunk it in boiling water several times to fully remove all the feathers. At this point we were still in shock so my guard kindly assisted us further whilst laughing at how useless Mzungus are.

Step 4: Removal of the innards. Pretty rank. I had to slice it’s bottom off and then remove the food sack being careful not to spill it as it will make the bird taste bad. It feels really wrong with your hand up a guinea fowl removing it’s heart, lungs and guts etc.

Step 5: Giving it a good wash and putting it in the fridge ready for stuffing and roasting! Yum. My guard took the inards and head for his Christmas dinner (urghh) Don’t worry I also bought him a chicken for his meal too.

It did feel very satisfying that we had a completely organic Xmas dinner which we’d prepared from scratch. This is the way most Malawians prepare meat so you can imagine how shocked they are when I said that at home I sit in front of my laptop, order chicken on the internet and it gets delivered to my door, all while I can remain in my pyjamas. Quite embarrassing really.

On Boxing day we went to Nyika national park again. Then I did feel like I was at home! It looks like England and the weather is very mild so we went for a nice boxing day stroll spotting zebras and antelopes and in the evening we huddled round a log fire in the chalet and played games.

New Year’s was a bit crazy. We behaved like embarrassing drunken offensive English people by heading to the lake and going on a ‘booze cruise’. Well it was a little row boat fitting 10 of us taking us to different bars in Nkhata bay singing inappropriate songs. It felt a bit strange to begin with as I’ve not been round many English people for a couple of months but it didn’t take too long to fully embrace the festivities! We stayed up for sunrise which was a struggle and then a bit rubbish because it was cloudy! Oh well. The lake is absolutely beautiful though and hopefully I won’t have got the schisto from swimming and washing in it (there was a power cut so no electricity which means no water too).

So the cleaner is turning out to be a bit of a disaster! At first I was very impressed with the cleanliness of my house but each time I return home from work now I find something broken! First it was a glass, then my very expensive lamp which I’d only just purchased from Lilongwe (the only place you can buy lamps), then my non-stick frying pan- which she has managed to scour off, then she blocked the sink! She came round the next day dressed in all her finery with her daughter and I waited expectantly for apologies, but no, she had come round to ask for more money! ‘give me new year’. So I said that it probably was not acceptable to ask for money if you trash your employer’s things. But I gave her some anyway coz I felt a bit silly complaining about a lamp that cost more than her monthly salary. But unfortunately when I came home the next day I found that she’d somehow managed to break the bulb that was in the broken lamp! and removed the tiling in my bathroom that keeps it water tight. Arghh! Anyway enough complaining- I’ve not quite reached the point where I want to start doing it myself again. 

Work is going well but very busy over the Xmas period and difficult to get anything done because the holiday runs from 24^th Dec to the 4^th Jan and Xray, lab, pharmacy all decide that they should take all of that as holiday. Things pretty much ran to a standstill. And there’s no blood in the northern region as the school children, who normally donate, are on hols too. It’s malaria season and there are so many patients with Hb’s of less than 5 and I’ve got a poor lady who is O neg and there are very few people of this blood group in Malawi so she’s had to wait 2 weeks for someone to appear who could donate her some blood! So for the first time I donated some blood- I was terrified of the needle and passing out but it was fine! Just hope I don’t get malaria now and become anaemic. And there are a lot of flies. It’s really unpleasant doing an evacuation with flies landing all over bloody genitalia. Puts you right off your lunch. I’m trying to make some adjustments to the ward- ie trying to get the nurses to take observations, the clinical officers to at least check them and have a sick patient bay but so far it’s a serious up hill struggle and so frustrating and I end up doing it myself most of the time. It’s going to take a seriously long time for things to change here.

Anyway hope you are all well and enjoying the New Year! Can’t believe it’s 2011 already!

Thank you for your messages and cards, I love hearing about all the stories at home.

xxxxx