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