Interesting families

New birthday years’ resolution: drink less and work harder. Yes the usual decision made after I spent most of the day after my 30^th birthday party trying not to remove the lining of my stomach. It was a good night though. Hum. And I’ve managed not to get drunk since – yey all of 3 weeks! It really does feel like I’ve turned over a new leaf in my 30s.

Working harder? Not sure about that but feels like it because everything takes twice as long to achieve. You want an xray on the weekend? Yes- so you have to call the radiographer to come in to do it which requires a driver to collect him from his home which requires calling the driver on the phone which decides there’s no network for half an hour. By the time the radiographer comes in, wheels the patient to xray, the generator stops working- of course the only electricity company in Malawi decides to turn the power off all day, with no warning, to do some ‘essential’ works on the lines during a fuel crisis.

There are constant battles like this- I needed to transfer a patient with severe facial burns who’s throat was occluding to the central hospital – could I find the key for theatre to get airway equipment? No because the key was hidden in a special place which no one knew where it was. Good luck to the mother who needed a caesarean section. Could I find a driver? No he’d gone AWOL. Was I panicking that I’d have to stick a needle in this patients neck? Yes!! It’s terrible - there are so many children with horrific burns now because we’re entering the cold season and they fall into the fire trying to keep warm. And then there’s the 16 year old who was haemorrhaging out of her bottom but not enough blood products, the neonate with tetanus but no immunoglobulin, the baby with an HB of 2 who we couldn’t get access and no I-O needles!

It’s good to be challenged but it gets extremely frustrating when you can’t treat a patient properly because of lack of resources. I’m not going to go into all the issues that are facing Malawi at the moment as it is a bit risqué for a website but do take a look on the net if you’re not already aware.

Going back to the power failures I had a rather amusing incident (in retrospect) when, just as I received a call to go into the hospital for an emergency, the power went. I was in a hurry and had just cooked some food so wanted to stuff it down first (of course). So I rushed to try and light a candle but in the process I started rubbing my eyes forgetting that I’d been chopping chillis- needless to say I experienced severe burning in my eyes and on my finger from the candle that I hadn’t managed to light successfully. I stumbled to the bathroom and tried to wash the chilli out but all that did was to wash it behind my contact lenses and over my whole face which started stinging too. I chose to ignore the pain and tried to eat dinner but as it was dark the mossis came out and one got me on my foot. I tried to put repellent on but somehow managed to squirt the bottle of white lotion all over myself (I’ll leave it to your vivid imaginations about what it looked like) After trying to scrape it off I eventually tried to eat some food, the plate slipped in my lap and curried vegetables added to the mossi repellent decoration down my trousers (must learn to eat at a table in my old age).  Luckily I couldn’t see the full effect as it was still dark from the power cut however I was a little embarrassed once I finally made it into the hospital which still had fuel this time to run the generator for full lighting. Oh well you can kind of get away with having dirty clothes in Africa. On the up side- I’ve bought a device to heat my water so I can now have a hot bucket shower – yippee!

I’ve also been on the up hill struggle of trying to complete my projects. The emergency room is now almost completed- it has instructions on the walls, bars to stop the burglars getting in and extension leads that sort of work. Just waiting for the benches to be made and it’ll be done! Can’t say the same for the treatment room yet though- having some difficulties procuring bulbs for a theatre lamp as unfortunately Malawi has to import most of it’s medical equipment from South Africa and with another fuel crisis hitting the country transport is tricky.

I met an interesting elderly lady on my ward who is the mother in law to a nurse and mother to one of the drivers. She is one of 3 wives of her 2^nd husband who had a rota to seeing his wives so that none of them felt left out. She said didn’t get jealous but was just happy that he had given her 2 girls and 2 boys because her first husband had only given her 3 boys. Unfortunately though, 3 of her children have died of malaria and 2 of HIV so now she only has 2 surviving. She lives with her fathers’ 3^rd wife who is only 2 years older than her! This woman had 9 children but all of them died of malaria and HIV. Polygamy is very common here and is one of main reasons for the spread of HIV but it was good to hear from the first lady that she wants her son to remain monogamous and thinks that polygamy should be a thing of the past.

Other things that have been happening is that my diabetic clinic is running well and I’ve managed to get the new Japanese volunteer nurse on board to do some educational sessions and also a Malawian clinical officer. So hopefully it will continue to run after I have gone (we can hope).

We also had our VSO drs and nurses peer support which was another opportunity for me to top up the tan by the lake (in between holding the meeting of course). There was a lot to talk about because it is the end of Phase 2 of VSO’s health strategy and they are trying to plan Phase 3 but unfortunately there are funding issues for a variety of reasons which I won’t go into here because again it may be politically contentious.  

And I’ve been out into the field with a brilliant organisation called HAWIP. It was set up initially by a Malawian to assist those working in the hospital with HIV/AIDS but now he has managed to extend it out into the communities to do HIV peer education and testing of school children and donating goats, uniforms and blankets to families suffering with HIV and those in great need. It is currently funded by Egmont the English children’s charity but of course they are always in need of further funding for all their activities. I strongly believe now that the focus needs to be on these preventative activities in order to reduce the burden of communicable diseases and drain on resources that this country has. Approaching the children while they are still young and getting them used to be tested is definitely the way forward. So I went out to present gifts of uniforms, blankets and goats as the ‘guest of honour’  Mzungu to these sufferring children. In one village they had never seen a Mzungu before so they were very afraid. Their school was just a wooden structure with no walls and a thatch roof. The children sat on the dust, had really dirty clothes and no shoes. It was so sad I had to keep my sunglasses on to hide the tears. I gave them some crayons and colouring books and they were so happy.

Anyway, that’s about it for what I’ve been up to over the last month and can you believe - just over a month left in the country! Hopefully I will have time for one more update before I leave!

Hope you are all well at home and enjoying the summer!

Lots of love

Xxx

Oh yes and I ate a bit of a mouse – urghh!

It's getting cold!

Oh my gosh- the weather has completely turned in the last week- there has been no rain for 3 weeks so the maize has dried out and is being reaped, the hills have turned brown again and it’s become freezing cold!! Well actually the day times are still really hot but at night it must go down to 15 degrees! Brrrr - I have to nestle in my sleeping bag! Crazy- never thought it about central Africa.

I apologise I have not written anything for almost 2 months! So much has happened that there will for sure not be enough space to write it all.

Most importantly the initial part of the project that I have been working on has been completed and now is slowly starting to function. If you can recall I received some funding from Irish Aid in order to build an emergency room and set up a triage system. Everything had to be completed by the beginning of April when Nigel, my old consultant, came out to assist with giving training using funds he’d raised back home (in Mangalande). So I was manically running around trying to hurry the builders, painters, carpenters, electricians up to finish on time. Which they eventually did!- not quite in time for Nigel but in time for the Irish Ambassador who came a week later to open the department and see what I’d done with his money. We had a great couple of weeks, initially giving training on triage to health workers in the hospital using manikins brought over from the UK and then preparing the emergency room for the Irish Ambassador. It was a seriously large job and I definitely could not have done it alone. The hospital organised an opening ceremony with speeches and chewy meat and it was a really wonderful moment knowing that all the hard work had achieved something. The challenges now are whether the triaging and emergency room will function as I want it to and continue to after I leave. However I went on holiday for 10 days immediately after the opening and when I got back I found that the clinicians are starting to get used to resuscitating patients in the emergency room and that the triaging is happening. There are a few minor adjustments that need to be made and a bit of encouragement but I really hope that the project is sustained- the biggest fear of any projects undertaken in such a resource lacking country.

Now I’m working on completing the treatment room for the OPD so that small procedures can be done in it instead of in theatre which contaminates and causes overcrowding. But I’m only here for another 2 and a half months! Time has flown! And still a lot to do before I leave.

Of course in between work I’ve managed a few holidays! My parents came out to visit and we visited the south of Malawi- beautiful Zomba Plateau, climbed mount Dedza (not very high), sunbathed and swam in the lake (hope I don’t start peeing blood) and ate fish on an island. We also went to South Luangwa, a national park in Zambia and very excitingly saw 3 leopards- one baiting a porcupine with all its spines erect and 2 lions. I highly recommend a visit there for anyone wanting safaris- the density of animals that get so close to you is brilliant! 


However we did make the mistake of hiring a saloon car instead of a 4 by 4. We ended up in several sticky situations such as on a road naming itself the M10 which in actual fact was a dirt track with pot holes filled with water. The saloon was not loving it- there were numerous back wheel sliding moments, screams of fear and the unnerving feeling that we were going to get stuck somewhere in the bush and get eaten alive by rabid dogs. Then there was the incident of coming across a 100 m stretch of solid water on the road and no way of passing other than paying some men to literally carry the car through. They removed the air filter and covered the exhaust pipe because at one point the water was up to my thighs! We definitely could not have got through without them!


My mother also decided to teach  me how to kill a chicken Malaysian style- which apparently is less traumatic for the chicken- I wish I could up load videos so you could see that it really was not quick and simple! It involved extending the poor chickens neck back behind it's wings, plucking the neck vigorously to expose the vessels and then attempting to slit the throat. Unfortunately the chicken wouldn't stay still, the plucking was not around the neck and the knife was not sharp enough. Nice.

Nigel and I travelled to Nyika where he developed a keen interest in jumping and mushrooms and then we headed up to Livingstonia (no prizes for guessing where the name came from)-Dr David Livingstone, a Scottish missionary, settled and introduced colonialism and Christianity into Malawi. It’s up in the mountains with a university, a church of course and a hospital but the only way to get there is along a ridiculous ‘road’ aka dirt track full of rocks that you can only get up by using a 4 x 4 going 5 mph which winds around the mountain with no edges! Not great if you’re in labour. You can see why they settled there though - it’s cool in the summer and the views from the top are incredible.

We spent Easter at the lake and basically bought a lot of wooden stuff and partied. And we met these amazing Indian Malawians who gave Nigel a lift all the way back to Lilongwe- which was lucky as he had a bag of wood weighing 45kg! and even lent us money to pay bills we owed to wooden sellers when the money ran out and we couldn’t get any more as the only whole ATM machine had been stolen. It’s wonderful the generosity and kindness of people you meet and only have known for a couple of days.

Back in Rumphi now and was surprised to be greeted by my guard wearing all of the clothes Nigel left him-shirt, trousers and shoes! - not sure he’d even washed them. Weird. He has been avidly reading the guardian and really is an intelligent man who wants the best for his children so we have decided to support them through an education.

Since I’ve been back I have been trying to develop my culinary skills by learning from one of the health staff how to make samosas – seriously time consuming and not sure whether it’s worth the small profit they make when selling them! I’ve also been collecting an army of children- un-intentially. I was given 2 balls by the Irish Ambassador to give to the children and eventually decided to give it to a group of boys and a group of girls who live near my house. The day after I gave one ball to them a little girl said ‘please madam take the ball back- they are quarrelling’ so all the children grouped together and gave me the ball back! I couldn’t believe it. But I had to give it to someone so eventually I entrusted it in one of the patient attendants children. But since then my name is called all over Rumphi and children are gathering at my door asking ‘give me ball’. I don’t have any balls left so have been trying to fend them off with crayons and colouring books but the more I give the more children turn up! Argghh! Oh well it’s quite cute really. And I saw the sweetest thing when I was travelling on a minibus. A child who must have been about 9 years old leant out the window and gave some money to another child of the same age who was trying to sell cassava from a tray on her head. She was clearly more poor than the girl in the minibus, although they were both still a lot poorer than us, and this little girl recognised this and showed compassion. It brought tears to my eyes. However poor people are in this country they still seem to smile and be happy and show love.

Now I’m back to the usual work and it’s weird as Marianne has left, boo hoo, and I’m almost the only Mzungu in the town. She really has supported me so much especially when I first arrived so I will miss her- particularly for a greenie and pool partner!

I hope you all enjoyed the royal wedding! I listened to it all on the radio and I’m not really a royalist but it did make me shed a few tears, think of London and feel patriotic. Only 2 and a bit months to go now- the end is fast appoaching and the time has gone so quickly! Still so much to do but hopefully I will complete all that I want to before I leave.

I hope that everything is going well for people at home- seems to be a lot of babies popping out everywhere! Take care and not long until I get to see you again!

xxxx

Fuel!

I can’t believe how time is flying now! And along with that the slight anxiety level that the building work has barely started on the OPD. You may’ve heard of the fuel crisis we’ve been having in Malawi and the planned protests following on from the political unrest in North Africa. Well I had to wait about a month for any fuel to fill the truck in order to collect the materials and as soon as we managed to get the fuel the truck then disappeared down to Lilongwe on a ‘personal’ trip. However eventually the bricks arrived and at last the walls are up but each day I am having to check on the progress and I am getting grey hairs from speaking initially gently and now more forcibly ‘to get the h*ll on with it!’  ‘how hard can it be to do the job that you are being paid for?!’ More and more I am understanding the frustrations of this country.

We are also beginning to despair of the electricity company who decided to spend 2 days doing some renovations on the lines, but of course didn’t think it was sensible to inform the hospital first. We have a generator for when there are power cuts but it uses 25L of diesel for only 1 hour of power. So you can imagine the cost of running it, coupled with the fact that there is a fuel crisis - it wasn’t surprising that the generator ran out of fuel. We had no power in the hospital for 24 hours which meant no instruments being sterilised, no ventilator in theatre – an acute bowel obstruction had to be sent to another hospital, no oxygen for the little children, one died last week because of it, no lights (working by candle light at night), no laboratory tests – there were 2 meningitis suspects who we couldn’t do LP’s on, and no clean sheets as the washing machine was not working, no Xrays. And if there is no fuel then that means the vehicles don't run either so we can't transfer the patients or collect them from rural hospitals- a woman ruptured her uterus and had a still born baby after waiting more than 4 hours for a vehicle to then be told there wasn't one and spending 2 months earnings on a private car. 

On a slightly less serious note, all my meat defrosted so I had to have a bit of a meat feast and my beans that I spent ages soaking, bagging and freezing to save time in the future defrosted as well.  Unfortunately I then forgot they had defrosted and it took me some time to discover that they were the source of an awful smell emanating through the whole house!

Power cuts do give me a bit of fire lighting practise though which, I like to think I’m getting rather good at. But unfortunately after 2 boxes of matches, almost passing out from ‘providing the fire with oxygen’ and a very hungry belly I let my watchman assist me to light the baula (stove) and had a very nice curry.

Sad news for the courgette and cucumber patches- they got some kind of disease- the leaves went white and the vegetables went soggy so I’ve had to destroy them and start again. But the lettuce, rocket and coriander is doing really well. I never knew that lettuce grew upwards and almost looks like trees! Weird. I’ve also got green beans now and the peppers and tomatoes are coming through too.

My house has become dirty. This is directly related to the fact that my then heavily pregnant cleaner has now popped and is holding a baby to her breast. She only wants 1 week off work however! I’m not complaining as it’s been so long since I’ve held the mop that I’ve almost forgotten how, and I wonder how many times I can wear the same underwear?

There is a distinct lack of stairs in Rumphi and as I only have to walk 5 minutes to get to my place of work I am becoming very unfit and lazy. So I’ve been on some long exploratory walks aiming for the hills and each time the people who I meet ask the same questions ‘where are you walking?’ and ‘why are you walking?’ It seems absurd to them that I should just be going for a stroll and to climb a hill with no real purpose other than to be alone with my thoughts and to get fit. They work hard all day if not in their regular jobs then farming their maize, so why would they need to do more exercise? But it was great walking - I met lots of children; children playing in dirt, children farming in the fields, children selling tomatoes, children getting water from a saturated river bed and children just following me- at one point I felt like the pied piper!

We had another clinical meeting this weekend and despite the usual issues- lack of attendance, lack of  human resource, lack of houses, an argument about rosters where everyone was talking at cross purposes - it felt good that at least we were talking about issues and actually had a meeting 3 months since the last one, unlike the 2 year gap previously. Other important issues were discussed such as the importance that the person on night call attended the meetings in the morning to give a handover and that everyone should be on time. So first morning report for duties on the following Monday - was anyone on time? No, were all the clinicians there? No, was the night clinician there to hand over? No. Hum. We can but hope.

I’ve been doing my fair share of greenie (Carlsberg) and Malawi gin drinking too. A couple of the volunteers had a leaving party at the lake and I got to see Imogen and Dharini, 2 volunteers who started with me and are based way up north in Chitipa, so it would have been rude to have abstained. And this weekend Nick, the first person I met as I went into the departure lounge at Heathrow, came up to visit so of course I had to show him the late night haunts of Rumphi.

Well that’s all from Rumphi for now. Hope everyone is well and that you are safe from all the awful things that are happening in the world at the moment - natural disasters, protests and wars.

Love to all

xxx

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 

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…..