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…..

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!

On the road to self sufficiency

So for some reason I thought that all the other hospital staff and volunteers would be dressed in attire that was purely functional and probably not have any money to buy a change of clothes. So I had only packed minimal items of clothing, mainly trousers for work, and all very boring and unflattering, no jewellery and eyeliner and mascara that had almost run out. You can imagine my dismay when I  see all the other volunteers wearing really glamorous clothes and make up, especially for dinner and the workers dressed in suits and the women wearing skirts and definitely NOT trousers while I am left feeling completely asexual, wearing the same clothes over and over again and covered in mosquito bites. So at the weekend I visited Mzuzu the nearest town and did a bit of ‘Eastenders’ - shopped from the second hand clothes market – I was searching for maybe something that I’d put in the ‘charity’ pile when clearing out my room before going away! I managed to pick up some dresses and skirts for work but haven’t been able to wear them yet as it requires the washing/ironing routine which I really can’t be bothered to deal with! My white coat has also turned into a brown coat with all the dust but I’m just enbracing it

The trip to Mzuzu also included another party for a volunteer who is leaving. She had a BBQ and I had the best steak like I never thought I’d get in Malawi. It was really great as well because there were people there from every continent in the world (except the Arctic and Antarctic) and lots of traditional dancing! (If I’d brought my shoes with bells on I would’ve Morris danced of course)

So still on the road to self sufficiency- I made cream cheese! Never realised how easy it was and felt very satisfied eating it with cucumber on bread for lunch. Especially good because it’s really hard to get cheese in Malawi and I’m having cheese withdrawals.

We also keep having power cuts, which is not great for the hospital as they’ve lost the key for the generator and it’s also run out of fuel so it means no operations/ lab tests/ fridges to keep blood cool/lights. Marianne told me that once they had to do a C-section using the front lights of a car shining into the theatre through a window!

On a more serious note though, it meant that I couldn’t cook my dinner and that all the meat I’d bought and stored in the freezer had defrosted and would go off. Rubbish. But I went back to nature and what the locals do and bought a stove and some charcoal and managed to cook some food over it without asphyxiating myself with smoke. Yey!

I think the bravest bit of the week so far though was the chicken killing – sorry vegetarians but it’s all about being self sufficient! Marianne showed me how to do it (vegetarians probably shouldn’t read this bit). She got the chicken as a gift from one of the clinical officers and it was handed to her in the middle of the ward while a lot of the patients and nurses ooed and aahhed at the size of it and wanted to weigh it on the scales normally used for neonates. We began by tieing its’ legs together so it wouldn’t get away and then Marianne stood on it’s wings while holding the head up. She took 3 knives because she wasn’t sure which would be sharpest and unfortunately chose the wrong one. It made a slight slit through the chicken’s neck but it was very much still alive so leaving the only option to try and break it’s neck. Chicken’s neck’s are really quite flexible so it required a 720 degree turn to finally get it to stop flapping! So we sliced the head off then dipped it in boiling water to aid the plucking. I was a bit ranked out by this point and had to wear gloves for that bit. We then cut off the legs and removed the innards (which makes a really brutal squelching noise) and gave them to the guard (apparently they like those bits). Eventually after the skin was removed it started to look like the chickens I’m normally used to looking at in Sainsbury’s at which point I stewed up some chicken curry I’d made the night before and it surprisingly went down quite well.

I have also learnt how to cook their local carbohydrate of zsima preparing enough for 30 people at a party put on for another volunteer who is leaving (boo). Apparently a Malawian man will only marry you if you can make zsima so I was a popular woman after that! Haha!

I’m settling into work a bit more. I’m still on ‘orientation’ so not joined the on call rota yet but just trying to get to grips with the ways things work here. I’m learning that there are problems at all levels in the hospital – from no reagent to do HIV tests, no ink in the photocopier to photocopy forms for test requests, that’s if the power’s working, so it’s just scribbled on bits of paper. (Identity is a bit of a joke as most people don’t know their date of birth.), no spinal needles on the wards so I have to use cannulas (the grey one!) for lumbar punctures –and there’s no local anaesthetic of course. In theatre I managed to get my hands on the right needle for a spinal anaesthetic but got severely told off when I threw it in the sharps bin after use as they only have 4 and all get ‘washed’ and reused.  There are not even any urine specimen pots so we use old glass antibiotic jars. Theatre was interesting. There were no caps so I had to wrap a pair of trousers round my head- elegant. Ketamine is given for most procedures and there was absolutely no monitoring, in fact the anaesthetist wasn’t even in the room.  Recovery means- lie in the corridor until the ketamine wears off.  

But there seems to be a real lack in communication and working together which is holding the hospital/country’s health system back: no clinicians are allowed to attend meetings with management (so management are conducting themselves as a separate entity from the clinicians- ie spending money on lots of fuel for personal journeys and not spending it on essential drugs etc). And there’s ineffective communication with the Ministry of Health who seem to be blind to the lack of human resources. For example, stating that they have trained more nurses so there must be enough working, ignoring the fact that the majority leave to go to Europe or South Africa, and then deciding to remove the 2, only, auxiliary nurses at Rumphi. We did have a clinical meeting on Saturday though which was surprisingly productive, although Marianna has said that last time they had a meeting (2 years ago) nothing changed. And unsurprisingly no management turned up despite it being planned 3 months in advance

We’ve got some really interesting cases on the ward- a man with HIV who is twitching all down one side and then the next day his parotid glands swelled, now he’s becoming confused and hemiplegic and his blood pressure’s rising! Yikes! We’re thinking toxoplasmosis or mumps encephalitis, treating and hoping for the best (any ideas welcome). Unfortunately as the prognosis for HIV patients is so poor if they get sick the central hospitals don’t really want to take them to their oversubscribed ITU so we keep them here and hope for the best. And unfortunately we’ve had 6 deaths this week. All but one had HIV which were complicated by TB, malaria, sepsis, so kind of expected to die. Unfortunately the other one had a witnessed collapse but no resuscitation was performed as he was ‘dead’- there’s no equipment to resuscitate anyway and no ITU so there is a feeling of ‘what’s the point?’.  Also there is no such thing as palliation because firstly there is no morphine syringe driver or lorazepam but also if you are seen to withdraw any treatment the relatives will think you are trying to kill the patient. There is a huge belief in witchcraft and external forces. Relatives believe that if a patient gets worse in hospital it is because it is cursed and they want to take them away. Also I think that being exposed to so much death in hospital it is no wonder they think bad things will happen to you if you spend too long here. Dealing with death has been an interesting experience too- the relatives don’t accept that the patient’s dead until you actually say it to them upon which they suddenly start wailing. Then more and more join in and the wailing continues during the body being wrapped and slung onto a stretcher- all in full view of the other patients- and processed to the mortuary by which point there are about 30 followers, all wailing. Some of these are ‘professional criers’.

Gosh I think I’ve written quite enough, Hope you’re not too bored by now! Hope everyone is good at home and well. Missing you all.

XXX

Starting Work!

Well crazily enough the Malawian medical council said I could go straight to my placement and not have the normal 2 months orientation in a central hospital, god knows why! So instead Marianne said I should have a mini orientation around Rumphi District Hospital, which I took to mean following the very experienced other Dutch doctor and learning from him. Of course reality was that the dates were mixed up and he was not due back yet and I was left on male ward with a ‘good luck!’ (HELP!)

A clinical officer did show up to start some form of ward round but unfortunately for most of the rest of the week he did a disappearing act leaving me to carry on trying to sort patients out!

So basically everyone has HIV, TB or malaria which I know very little about! – should of read my tropical medicine book before I came out (which I bought about 6 months ago- whoops).  Most of the patients, if in England, would be on an ITU with their presentations, for example we have 3 patients fitting from presumed cryptococcal meningitis, related to HIV,  who we just give diazepam to until they are obtunded. There’s a man with severe pneumonia secondary to HIV who has a blood count of 2.8 (very very low) which the lab could only spare one unit of blood for so one of his guardians (relative or friend) donated a unit- this is common practice as we have very little blood. I tried to get blood for another man in heart failure due to anaemia (HB of 4) and the lab told me there was none but actually they just hadn’t bothered to go get it for me and they don’t get very excited because everyone’s anaemic! 2 of my patients have loads of fluid around their hearts and are in massive heart failure one of which I referred to the central hospital to have it drained only to find that they don’t do it so there’s no point.  I’ve got 3 patients with massive livers and one with tropical splenomegaly! There’s so much pathology but unfortunately there’s not the tests to fully diagnose people so there’s a lot of blanket drug treatment and hope for the best! It’s crazy as well because patients are hardly ever followed up, so if they get better they go home and there’s no further investigation into underlying causes or cancer- mainly because they don’t have treatment for cancer so what’s the point in looking for it? The differential is so different here and difficult to get my head round! I’m also looking after the TB ward so I’m racking up the list of possible diseases I might have – malaria, sleeping sickness, parasitic skin infection from larvae eggs and TB. Nice.

So there’s a massive list of problems of course! The wards are really old, patients lie in really old beds with no curtains for privacy. There’s no oxygen in the hospital just the air concentrators, even in the anaesthetic room, but a lot of the patients refuse oxygen because they think if they have it they will die as they’ve seen others die who’ve needed oxygen. There is one thermometer on the ward and no blood pressure monitor. Observations are not done except maybe on presentation if you’re lucky and if they’re abnormal they’re not repeated. So I’m having to draw on my distant memory of clinical skills to work out peoples state without machines which dossing around at home for 2 months really didn’t help develop! Notes and requests for tests are scribbled on bits of paper and stapled together so you’re lucky if the nurses get the message to do their jobs and especially lucky if she has time to do them. The nurses don’t do nursing care like they would in England like bathing, changing and feeding the patients- this is left to the family and friends so if you have none you don’t get washed or fed. Instead they act like a junior doctor putting lines in, taking bloods and ordering tests the clinical officer or doctor has requested as well as ‘giving’ drugs. In inverted commas because drugs are often not given for days, also there are hardly any drugs to give! No paracetamol, penicillin, steroids, no inhalers or nebulisers for asthmatics- just intravenous aminophylline and oral salbulatmol. The lab can only test for very few things ie HB and then tropical stuff - HIV, TB, Malaria, schistosomiasis and trypanosomiasis- helpful when the patient has a tropical disease but not when they have something else! So I’m just guessing what peoples’ white cells, kidney and liver function etc might be according to how they look. There’s no resuscitation equipment but then if you were to resuscitate someone there’s no where to put them as there’s no ITU or ventilator. There is an ECG machine but no one knows how to use one or how to read an ECG and I needed to catheterise someone and there were no catheters! And to top it off there are chickens running about all over the ward.

So all quite exciting stuff and a seriously big learning curve!- when I get home from work I’m so tired that after the ordeal of cooking I go to bed really early! However I did have a bit of a late one last night Stephen and Wilson had been given a goat as a gift by a community so they decided to have a party,  (using a massive amp that VSO had kindly given them for their community work), slaughter the goat and we ate it on the BBQ and in curry! It actually tastes quite nice! I met a visiting volunteer team from Mwanza (in the south) and discovered 5 German gap year students who are also volunteering in Rumphi so it ended with lots of boogieing to a mixture of techno (which I sneakily put on),MJ and dodgy Malawian music.

Hope everyone is well. Missing you all loads. xxx

PS If anyone wants to post me recipes please feel free- I’m getting fed up already with my limited repertoire! Vegetarian ideas welcome too please coz after I’ve eaten my store of meat I can’t get anymore in Rumphi.

PPS Cockroach count - too many to count and apparently it’s going to get worse in the rainy season! There’s sooo many bugs.

Week 2

So surprise surprise the second week begins with the usual transport disaster!

My ‘truck’ picked me up nice and early, 8 am from the hotel in Lilongwe ready to embark on the 5 hour journey up to Rumphi. About an hour into the journey I questioned why they had sent a truck to collect me- it was then that we realised that it was to carry all my furniture for my empty house up from Liliongwe! So we had to turn all the way back to then spend another 2 hours loading up, from a dusty shed, old, used dining table and chairs, a bed and mattress and sofa onto the truck. We finally got on our way with my whole life plus a couple of Malawians, who wanted lifts, on the back of the truck. 2 hours into the journey what happens? A flat tyre. Joy. But when that was sorted, and I thought we were  finally on our way, oh no, it turns out that it is quite a useful time for the driver to run some errands such as – spend 1 hour in the bank, try and buy planks from the side of the road and collect a bed from another district. Along with travelling at no more than 70kph because the tyres were all bald we finally made it at 8pm by which time it was pitch black- no street lights of course! And I’d had no lunch so you can imagine how weak and irate I was by that point!

Marianne, the other VSO doctor, who’s brilliant, met me at my house and showed me around- it looks very cute from the outside and blue and white striped! But the inside looked like a barn with walls and no ceiling. And there are a lot of bugs!! Cockroach count 4 so far and I’ve killed them all with ‘DOOM’! So I guess I expected to live in impoverished conditions but when I was confronted with it it was a real shock that I really was going to be living in a small village in Malawi with only very basic amenities. Arghh! We moved in the furniture, well as much as we could, because the bed wouldn’t fit through the door! Kindly Marianne let me stay round her house that night and the next 2 nights in fact! Until I had a bed.

The next day Marianne showed me round Rumphi. It’s a pretty little village set between mountains which means it gets really windy (I  feel like my house is going to blow down!) and it’s very dusty and hot at the moment so my feet end up being ‘tanned’ after about 5 minutes of walking around.  It actually has more things than I expected: 2 banks, several little shops selling pots and pans and household wares and a place they call a ‘peoples trading centre’ or PTC which basically looks like a shop you would see during the war with products being sold with the labels on indicating exactly what was inside with big letters. It also sells bread but hasn’t since I’ve been here because the bread maker has broken and sometimes you can get cornflakes. Unfortunately there’s no where to get meat unless you want to off the street with flies all over it and no cheese so I’ll have to eat lots of nuts to keep my protein content up- saying that I haven’t seen any nuts on sale either.

There’s a nice market which little wooden shacks selling essentially the same thing but also some tomatoes, onions, bananas and dried fish.

It’s very poor; most people live in brick or wooden shacks without electricity particularly in the rural villages and cook on charcoal, the dust gets all over peoples clothes of which they have very few and they’re usually torn and have no shoes, most families live off less than £10 a month and there are many mouths to feed as families want to have many children, to work in the fields, and there’s very little family planning. There are soo many babies- so cute wrapped around on the back of the mum while she is also carrying wood/water/ washing on her head. It’s the dry season now and last years rainy season was not good so people are getting desperate for the rains to come so that they can grow their crops again to survive.

I’ve also met some of the other volunteers, Rina a lab tech who lives with Marianne, who’s really lovely, Stephen from Uganda and Wilson from Kenya who were my absolute saviours the next day!

I was really overwhelmed with everything and all the stuff I had to do- it’s like moving into a new house in England which is empty, buying stuff for it, letting elec, water companies know that you’ve moved in etc etc but instead in remote Africa where everything takes so long and it’s so hot!

It began with an attempt to treat my mossi net but then finding there was no tablet of insecticide, to then attempting to boil some water to sterilise my water filter and discovering I had the wrong plug on the electric hot plates. If it wasn’t for Stephen and Wilson finding me in my house looking bemused about what I was going to do next then god knows what I’d have done. They brought round my fridge, had some carpenters come and make me some shelves at local price not ‘mzungu’ price, changed my plug on my cooker and helped me open a bank account! It’s really nice that the volunteers  support each other out here and there seems to be a good network across the whole country and in fact a national conference in a few weeks time. I also managed to get a couple of beds from the hospital store room one of which didn’t fit in the car so a few locals carried it to my house for me! One woman had a baby on her back- I did feel slightly guilty about that!

Marianne has also shown me round the hospital! It’s actually bigger than I thought. There’s a female ward, male ward, TB, maternity and paediatric wards and they have an outpatients, antenatal care, orthopaedic/physio area and a place where they can make things for disabled people and an HIV clinic. There is a measles outbreak across the country at the moment and they have a tent for people to be in isolation which gets pretty hot at midday! But there is also a theatre with air conditioning! Although very basic like something you might see in a museum at home. They also have one XRay machine and an ultrasound too. Since I was assigned they’d also managed to get one Malawian doctor 3 weeks ago and a dutch doctor who works with the UN. So relieved that there is help at hand! I think I may be allocated to female ward which currently has 24 beds but there were 2-3 patients per bed and lying on the floor too. And there is no doctor for paediatrics so I may be doing that too, as well as some anaesthesia. Resources are pretty bad- there’s no paracetamol and they’ve run out of condoms, not great if you’re trying to promote prevention of HIV spread.

I’m getting there with cleaning and furnishing my house now, after a trip to Mzuzu, the nearest city- I use that word loosely as it’s actually just 2 roads of shops essentially selling the same sort of things! But very exciting I got to buy some chicken and some cheese and chocolate spread for a serious amount of money! Everything here is actually quite expensive as it all needs to be imported!

My next task is varnishing my kitchen bench, washing my used bed sheets from the market, which then need to be ironed because of the Tumbu fly which lays eggs in the material which then infest my skin!, finish mopping my house and making my curtains! Never thought I’d become this domesticated did you?! And also so resourceful- nothing is getting thrown away- my left over dinner goes to my guard! Feels really wrong but otherwise he doesn’t have anything!

I’ve also managed to be a bit of a tourist in amongst my home sorting! Went to the Vwaza marsh national park and saw loads of elephants and hippos! It’s the dry season so they all go down to the lake to drink and it was easy to spot them, so beautiful but did get attacked by tsetse flies, hopefully won’t get sleeping sickness!

Anyway I think that’s enough for this week! My next update will be about my first week in the hospital -arghh!!  I hope everyone is well at home. I’ve managed not to get the shits yet but you’ll be the first to know if I do!

The First Week!

Monile! Muli uli?

Oh my gosh what a week of mixed emotions! It started off with transport disasters- as per usual!

I like to be on time for flights but the journey began with a road accident, luckily not us, the air ambulance, massive delays on the A4 and big hissy fits from me panicking that I wasn’t going to make the flight! We did eventually make it- obviously- and the next pleasure to be endured was the flight with Ethiopian Airlines. Let’s just say I didn’t think they made planes that economy anymore. It was very old, smelly, with no leg room, no in flight entertainment, no space for overhead luggage and to top it all off a crying baby in the seat in front- who cried alllll the way. I then wasn’t overly reassured when the plane, after taxiing out to the run way then decided that there was a ‘technical problem’ and made it’s way back into the airport docking back where we’d started and then opening the doors. After waiting for around an hour and a half we did finally take off despite the rather overpowering smell of oil and burning rubber. The next leg from Ethiopia to Lilongwe, Malawi, was equally pleasurable as we ended up stopping off in Uganda on the way, as you do, for around 2 hours where we were strictly told ‘No standing!’ and ‘No going to the toilet!’ (I was really desperate and full of aeroplane gas) because apparently they were refuelling and you can’t move when that is happening.

I’m pleased to say though that that is where the transportation issues ended- all my bags arrived! Yipee! And a VSO rep was there to meet us in the airport. She’s called Mphatso (pronounced M-pat-so) and I met up with 6 other volunteers and we took a jeep to the hotel where I am now and where we are staying for the first week of training.

So the hotel is amazing! And not a true picture at all of what it’ll be like in my little house which apparently has nothing in it- joy. So I have been buying things to cook with- yes I am going to cook! And clean with- shock horror!

We have spent the week basically learning about Malawian Culture, our health programme, sorting admin out etc. It has been quite hard core- getting up for 8am starts and concentrating until 6pm! (I haven’t been working or used my alarm clock for 2 months!) And they have been seriously feeding us! I’m carbo loading (getting fat) in case I can’t get food where I’m headed or I get the shits. They have an interesting food called zima which is basically a large ball of maize and very plain but apparently if a Malawian doesn’t get it for dinner they ‘haven’t eaten’.

We’ve also been learning Chitumbuka which is actually a different language from the rest of Malawi who speak Chichewa (so lucky I didn’t bother learning any before I left!) It’s difficult but I plan to be a pro by the end of the year, hum.

The other volunteers (23 of us) all seem really nice and there’s a serious number of doctors! We’re getting posted all over the country – some in little rural hospitals like me and some in large places where they’re lecturing or teaching. There seems to be a good volunteer network and we’ve had reps speak to us about events where we meet up and I’ve already been roped into talking at some conference thing. Joy.

I’ve also managed to have a few beers- yippee! –There was a BBQ at the country directors house and last night we went to ‘the shack’ which is a bar/club with volleyball courts! Still was in bed by 10:30pm though!

Scarily the medical council have said I don’t need to do my orientation, which normally take 4-8 weeks, in another hospital before going to my little one! God knows why! So I’m going straight there on Saturday-argghhh! Luckily there’s another dutch doctor Marianne who’s there already and I think she’ll be able to induce me!

What I’ve seen so far or Malawi (out of the jeep window because we’ve been almost penned into the hotel other than visits to programme office) is it’s beautiful and reminds me of when I was in East Africa before. It is very poor but the people are lovely and smiley and friendly and I hope that they are up in Rumphi where I’m headed!

That’s all for now if you’ve managed to get to the end! I’m hoping the internet will be ok in Rumphi and if not I’ll get a Dongle – only 2G though, and continue the blogging!

Hope everyone’s well. Love and miss you lots