I've just arrived back home in the states and I'm reflecting on my trip to Malawi - the places I've been and the people I met during my time there. I've always felt thankful for the opportunity I have to be a doctor and this adventure has made my appreciation so much stronger. I've travelled many times before but this trip has been different. I saw suffering and smiles, extreme hardship yet unfettered will. I saw people previously paralyzed because of illness get up and walk. I saw dedicated people working to make a difference in a place that needs so much and, I learned just how far a little can take you.
Sometimes after you've been given something you'd like to express your gratitiude but you feel that a simple thank you is not enough. Luckily I managed to pick up a few new words, so I don't have to say a simple "thank you" but can say to the people of Malawi, Zikomo kwambiri!
(Thank you very much!)
Thursday, February 14, 2008
Monday, February 11, 2008
Kissed by the Mulanje Massif
Well I've been away for a while traveling to the districts so I haven't had email access but I'm back in Blantyre and have much to tell. We've had a very busy week back and forth to Thyolo, Zomba, Liwonde and Mulanje. During morning rounds at Thyolo I was brought to see a woman that had been brought in the day before after falling into a ditch from the back of a bicycle. She had a serious injury to her neck, yet 24hrs later she had not yet had her c-spine stabilized nor any xrays taken. She was having difficulting breathing and paralysis of her entire left side and most of her right save her biceps and deltoid muscles. They have no neck braces at Thyolo so we fashioned one out of a sheet, some cardboard and tape. We were then able to get an xray which showed a severe dislocation of her c spine at C5-C6. We placed her on oxygen, got an IV started and placed a foley catheter. In the afternoon I was asked to give a lecture to the hospital staff so I used the case to teach the principles of spine injury management. The clinical officers were all in attendance, about 30 people in all. They were shy at first but really got into it after we got them going. We had alot of laughs but more importantly I think we all learned from it and hopefully they will be able to better recognize these injuries and better manage them once they hit the hospital door.
Wednesday it was back to Zomba - Dzimbiri was excited to learn some surgical skills and had some cases lined up for us. We started with a femur fracture, then a man came in with a partial amputation of his thumb. The tip of his thumb was viable and so I showed Dzimbiri how to pin it and fix the soft tissues. Dzimbiri would have otherwise completed the amputation. During that case an open tibia fracture came in so we finished by showing them how to place an external fixator. At the end of the day we said our goodbyes and thanked them for their hospitality. We stayed that night on Zomba plateau and had fun with the baboons again in the morning.
Friday we drove to Mulanje district hospital, which rests at the base of Mt. Mulanje - one of Africa's tallest mountains. The massif is an impressive sight that towers above the clouds and tea plantations below. The district hospital is set up like the rest - brick walls, clean corridors, and lots of people waiting. We met the OCO and Robert Ayella, the Ugandan orthopaedic surgeon that has been stationed there for 2 yrs. The OCO's office has no working lights so in the afternoon or when a heavy cloud blocks the sun he "sees" patients in the dark.
We saw some very interesting patients in his clinic then went to the wards. Many of the patients come from Mozambique, which is less than 20 minutes by car. We ended up taking a trip to the border during lunch and walked over into Mozambique for a short visit. Back at the hospital in the afternoon, a man was brought with cuts all over his body after being attacked by his wife's ex-husband. The man attacked him with a panga knife (a large curved machete). He had cuts on both arms, his head, his left knee and his right foot all down to bone. His left elbow was fractured in multiple places as was his left tibia and his patell tendon was severed. We fixed him up and used just about all the bandage material the hospital had to cover his wounds.
We ended our day with that and as we drove away from Mulanje I kept looking back at the mountain. I was excited to return the next day to climb it. That night, after dinner I began packing my pack. I put everything in plastic bags to keep them dry and then put them inside my pack - it is sure to rain in the mountain.
The following morning I got a late start because I first had to stop off to get some more supplies. After getting a few things I thought I'd need, I caught the first minibus I saw to Limbe. These minibuses can officially carry about 12 people but in the end there is no limit to how many people they'll pack in - not to mention the goats, chickens and other animals that might be along for the ride. I took 3 minibuses to Mulanje, which took a little less than two hours. The buses stop every time they see someone walking along the road or there's a little extra space on the shoulder to collect and/or drop off passengers. I finally arrived at Mulanje and walked from the bus stop to the sign I saw for the forestry office. The guidebook I had said the road to the office was 2 km (which I planned on walking) but the sign read "Forestry Office 11 km." I looked down the road and it was nothing but mud. I figured by the time I walked 11 km it would be #1 too late for me to hike and #2 I'd be too tired to hike anyway. I looked around and spotted and old, beat up, orange Toyota pick-up truck with a few people in it. I ran up to the driver and asked if they were going towards the office and if I could get a lift. He was, so I jumped in the back and got a lift for 200 kwatcha ($1+). We arrived at a junction 10 km down the road at which point he made a turn and I had to jump out. I walked the rest of the way accompanied by a man named John who told me he could take to Rex, the guide that one of the medical students had recommended I use. We found Rex in a small village near the entrance to the mountain park. I paid the 100 kw entrance fee then gave Rex 500 kw for his food over the next 2 days. When it was all said and done we started our hike at noon, 3 hours later than I had planned and been advised to. The woman at the office questioned if I still wanted to go up at that time and seemed to doubt I could manage - the hike takes 6 hrs on average and it gets dark around 6pm, which meant I'd just make it. Rex, however, said we'd make it and since he came highly recommended I trusted him and off we went.
The hike started through corn fields and I thought it was nice to have some sun and be outside to enjoy it. An hour later I had drank the 3 bottles of water I had brought and was praying for rain. At that point I started thinking to myself that I would not be able to make it another 5 hrs - the heat was oppressive, my pack was heavy, I was dehydrated and the hike was getting steeper. I wondered if it was best to just tell Rex now that we'd have to turn around or give it a little longer. I asked Rex if I could drink the mountain water which he said I could so at the next stream I cupped the water in my hands and lapped it up, and then I filled up my water bottles (which was a blessing and a curse because it made my pack heavier). Soon after that the rains came and cooled everything down. I was soaked and my pack was heavy but I felt refreshed and found my determination to keep moving. We moved at a fast pace and after a while he took my pack.
Other than bugs, we saw a lone monkey on our ascent up the mountain. I might have seen more but I was very focused on where to place my next step, the terrain was so slippery. I did catch a few of the "loggers" - men with contracts to carry Mulanje cedar beams down the mountain. The mountain is too steep for a road so these men carry these huge beams of wood on their heads down the mountain, barefoot! I couldn't believe it.
About half the way up the weather turned for the worse and cold rain began to fall. I put on my poncho to keep some of my heat in. At this point I remember the fatigue I felt. I started getting a cramp in my left leg and my hips ached. I started to talk to myself, asking myself why I had such a dumb idea to do this in the first place. I walked through my delirium and the next thing I knew, Rex was telling me we were near the top. And that's just about when the sleet storm began. I felt like Frodo in "The Lord of the Rings" on this mission through middle earth. The top of the mountain was complete wilderness - rocks covered in white; small windbent trees and shrubs. We entered over a pass between two other peaks and the wind rushed through so fast, there was nothing stopping it. Rex wore only a t-shirt and was shivering madly. I told him to take my poncho for a while which he refused and we argued a bit until I realized he wasn't going to take it from me so I decided to do my best to keep pace and get to the lodge as soon as possible. We jogged when we could and only slowed up in the steeper areas where we had to climb. About 30 minutes crossing over the peak and we began our descent to the lodge a few hundred meters below. When I finally saw the lodge I thought it was just my imagination. I was so happy when Rex pointed towards it, confirming to me that it was indeed real.
The lodge is situated among some trees and a few other small buildings - a bathhouse, latrine, and the caretakers lodge. We had reached the lodge it 4.5 hrs, 1.5 hrs ahead of schedule. Rex would later tell me he was moving very fast due to the bad weather and the impending darkness. We passed the caretaker by his fire on our way straight into the lodge. "We made it!" I said to Rex as I grabbed him and shook him. "We made it!" The caretaker walked in and quickly started a fire and then asked if I'd like a warm bath which I firmly accepted. He went off to prepare it and we stripped out of our cold, wet clothes.
The bathhouse is a small wooden structure with a concrete floor. Inside was a large metal bucket filled with hot water and a pitcher. I stood in the bucket and poured the hot water over my head. I spent about 20 minutes there warming up then I joined Rex back at the fire. Rex made a dinner of rice with tomato, onion and pepper. We ate and then I laid down, exhausted.
We talked for a while and he told me a little about himself. He hadn't finished school. School here is free up to the 8th grade then you must pay. His parents died when he was young so there was no chance for him to continue school so he went to work.
We compared life in Malawi to life in America. I listened to his plans for the future, his business ideas etc. "I'm in a panic now, " he told me "because I don't have enough capital." He's married with 1 daughter, which I found odd because most Malawians have many children to ensure a few will live to be adults. He on the other hand hopes to give the only one he has the best chance he can at a good life, but business is not good so it is getting more and more difficult. There are 30 guides and 70 porters on rotation at the mountain. He went on his last hike 1 month ago - a guide makes 1200 kw a day (approx. $8).
We talked about my work here in Malawi, how I got my education and the possibilities or lack thereof for scholarship. He tells me about his dream to move to a bigger town and get a minibus so he can make more money but he says this takes capital.
He stares at the fire as he talks about his dreams and for a while I wonder if he remembers that I'm still there with him. He's talking and staring into the fire. Then I wonder whether he still really holds onto this dream or he's just reliving the dream he once dreamt. That old dream of his like the fire he's staring into - gone up in smoke.
We talked for a bit longer about other things then at some point (which I can't remember) I fell asleep.
We woke up the next morning to a large raven squawking and banging against our window. The sun was bright and there was but a few scattered clouds in sight. Mozambique was in the not-far-off distance, Sapitwa peak, just next to us (saptiwa means "don't go there" in chichewa).
There are, by the way, many legends amongst the locals about Mulanje. One lady told me she'd never go there because people go there and disappear. Another woman told me that if I'm walking and find a pot of nsima (corn grits) I'm not to eat it because it will kill me. There are many interesting tales, most of which have developed to explain actual tragedies that have occurred in the past.
We ate breakfast then set out for Luchenya plateau. In the light I was amazed to see the route we had taken the day before, crossing over the peak now behind us. We took our time and checked out another lodge and some caretakers grounds where some small huts were located. After about an hour we started our descent. As you can imagine the treck down is quite dangerous because it is very steep at points and very slippery and your momentum is going in the direction of any potential fall. It's on the way down that I had my major fall. At certain points along the hike you're climbing along massive sheets of slippery rock. These can be seen all the way from Thyolo because the water running down these massive sheets looks like white chalk lines on a blackboard hung in the sky. We reached one of these areas and were making our way along the side of a waterfall. There are no good footholds so you step on the lighter colored areas of the rock that are less slippery than the dark black rock. Rex was about 2 m in front of me and i stepped off a safe spot onto an area of redrock - that's when I got a lesson in physics - coefficient of friction = zero! My legs flew out from under me, my walking stick went flying and I slammed down to the rock, my right shoulder hitting first. My momentum caused the side of my head and face to smack against the rock next. It felt like I was back in high school wrestling and had just been slammed to the mat (actually I never got slammed so I really don't know what that feels like but I'm sure Henock knows what i'm talking about). So there I was on the rock. I laid there for a second - my first thought being, well, I'm still conscious, that's good, and I can move everything, that's good, and I didn't get swept off the mountain by the waterfall, that's good. So I stood up and felt my face and head - no blood, only a scrape on my hand and a lump on my cheek. I waited a second for the dizziness to set in or the headache, but nothing happened. I guess my head is as hard as some people say. Rex checked on me, then I collected my walking stick and away we went. I hiked down the rest of the mountain stepping more carefully, praying, and rubbing my swollen cheek.
I reached the bottom of the mountain safe and sound, proud of the accomplishment and the lump on my cheek - realizing I had experienced nothing more than a kiss from Mulanje herself.
At the base of the mountain I shook hands with Rex and thanked him for bringing me back safely. We wished God's blessings on each other then parted. With no other vehicles in sight I now had two options - either walk the 11km down the muddy road or jump on the bicycle taxi that was coming my way. I chose the taxi and jumped on the back of this frail looking bike, wondering how my driver was ever going to make it through the muddy road 11km to the main road. I mean, the pick up truck hardly made it. My driver stood up and put his entire 130 lbs onto each pedal and pushed forward. In the difficult parts I used my walking stick to help push us along. The chain popped off twice but amazingly we made it. It was a surreal experience and I laughed thinking about it as I walked through the market to a small store where i bought a coke and listened to Reggae music coming from the "bar" next door. I spent a half hour or so just hanging out, watching people in the market and a few guys playing a board game next to me.
I fell asleep on the minibus ride home, and then walked through Blantyre to my flat, reliving the experience and looking forward to a hot shower, some dinner and my raggedy old bed.
Wednesday it was back to Zomba - Dzimbiri was excited to learn some surgical skills and had some cases lined up for us. We started with a femur fracture, then a man came in with a partial amputation of his thumb. The tip of his thumb was viable and so I showed Dzimbiri how to pin it and fix the soft tissues. Dzimbiri would have otherwise completed the amputation. During that case an open tibia fracture came in so we finished by showing them how to place an external fixator. At the end of the day we said our goodbyes and thanked them for their hospitality. We stayed that night on Zomba plateau and had fun with the baboons again in the morning.
Friday we drove to Mulanje district hospital, which rests at the base of Mt. Mulanje - one of Africa's tallest mountains. The massif is an impressive sight that towers above the clouds and tea plantations below. The district hospital is set up like the rest - brick walls, clean corridors, and lots of people waiting. We met the OCO and Robert Ayella, the Ugandan orthopaedic surgeon that has been stationed there for 2 yrs. The OCO's office has no working lights so in the afternoon or when a heavy cloud blocks the sun he "sees" patients in the dark.
We saw some very interesting patients in his clinic then went to the wards. Many of the patients come from Mozambique, which is less than 20 minutes by car. We ended up taking a trip to the border during lunch and walked over into Mozambique for a short visit. Back at the hospital in the afternoon, a man was brought with cuts all over his body after being attacked by his wife's ex-husband. The man attacked him with a panga knife (a large curved machete). He had cuts on both arms, his head, his left knee and his right foot all down to bone. His left elbow was fractured in multiple places as was his left tibia and his patell tendon was severed. We fixed him up and used just about all the bandage material the hospital had to cover his wounds.
We ended our day with that and as we drove away from Mulanje I kept looking back at the mountain. I was excited to return the next day to climb it. That night, after dinner I began packing my pack. I put everything in plastic bags to keep them dry and then put them inside my pack - it is sure to rain in the mountain.
The following morning I got a late start because I first had to stop off to get some more supplies. After getting a few things I thought I'd need, I caught the first minibus I saw to Limbe. These minibuses can officially carry about 12 people but in the end there is no limit to how many people they'll pack in - not to mention the goats, chickens and other animals that might be along for the ride. I took 3 minibuses to Mulanje, which took a little less than two hours. The buses stop every time they see someone walking along the road or there's a little extra space on the shoulder to collect and/or drop off passengers. I finally arrived at Mulanje and walked from the bus stop to the sign I saw for the forestry office. The guidebook I had said the road to the office was 2 km (which I planned on walking) but the sign read "Forestry Office 11 km." I looked down the road and it was nothing but mud. I figured by the time I walked 11 km it would be #1 too late for me to hike and #2 I'd be too tired to hike anyway. I looked around and spotted and old, beat up, orange Toyota pick-up truck with a few people in it. I ran up to the driver and asked if they were going towards the office and if I could get a lift. He was, so I jumped in the back and got a lift for 200 kwatcha ($1+). We arrived at a junction 10 km down the road at which point he made a turn and I had to jump out. I walked the rest of the way accompanied by a man named John who told me he could take to Rex, the guide that one of the medical students had recommended I use. We found Rex in a small village near the entrance to the mountain park. I paid the 100 kw entrance fee then gave Rex 500 kw for his food over the next 2 days. When it was all said and done we started our hike at noon, 3 hours later than I had planned and been advised to. The woman at the office questioned if I still wanted to go up at that time and seemed to doubt I could manage - the hike takes 6 hrs on average and it gets dark around 6pm, which meant I'd just make it. Rex, however, said we'd make it and since he came highly recommended I trusted him and off we went.
The hike started through corn fields and I thought it was nice to have some sun and be outside to enjoy it. An hour later I had drank the 3 bottles of water I had brought and was praying for rain. At that point I started thinking to myself that I would not be able to make it another 5 hrs - the heat was oppressive, my pack was heavy, I was dehydrated and the hike was getting steeper. I wondered if it was best to just tell Rex now that we'd have to turn around or give it a little longer. I asked Rex if I could drink the mountain water which he said I could so at the next stream I cupped the water in my hands and lapped it up, and then I filled up my water bottles (which was a blessing and a curse because it made my pack heavier). Soon after that the rains came and cooled everything down. I was soaked and my pack was heavy but I felt refreshed and found my determination to keep moving. We moved at a fast pace and after a while he took my pack.
Other than bugs, we saw a lone monkey on our ascent up the mountain. I might have seen more but I was very focused on where to place my next step, the terrain was so slippery. I did catch a few of the "loggers" - men with contracts to carry Mulanje cedar beams down the mountain. The mountain is too steep for a road so these men carry these huge beams of wood on their heads down the mountain, barefoot! I couldn't believe it.
About half the way up the weather turned for the worse and cold rain began to fall. I put on my poncho to keep some of my heat in. At this point I remember the fatigue I felt. I started getting a cramp in my left leg and my hips ached. I started to talk to myself, asking myself why I had such a dumb idea to do this in the first place. I walked through my delirium and the next thing I knew, Rex was telling me we were near the top. And that's just about when the sleet storm began. I felt like Frodo in "The Lord of the Rings" on this mission through middle earth. The top of the mountain was complete wilderness - rocks covered in white; small windbent trees and shrubs. We entered over a pass between two other peaks and the wind rushed through so fast, there was nothing stopping it. Rex wore only a t-shirt and was shivering madly. I told him to take my poncho for a while which he refused and we argued a bit until I realized he wasn't going to take it from me so I decided to do my best to keep pace and get to the lodge as soon as possible. We jogged when we could and only slowed up in the steeper areas where we had to climb. About 30 minutes crossing over the peak and we began our descent to the lodge a few hundred meters below. When I finally saw the lodge I thought it was just my imagination. I was so happy when Rex pointed towards it, confirming to me that it was indeed real.
The lodge is situated among some trees and a few other small buildings - a bathhouse, latrine, and the caretakers lodge. We had reached the lodge it 4.5 hrs, 1.5 hrs ahead of schedule. Rex would later tell me he was moving very fast due to the bad weather and the impending darkness. We passed the caretaker by his fire on our way straight into the lodge. "We made it!" I said to Rex as I grabbed him and shook him. "We made it!" The caretaker walked in and quickly started a fire and then asked if I'd like a warm bath which I firmly accepted. He went off to prepare it and we stripped out of our cold, wet clothes.
The bathhouse is a small wooden structure with a concrete floor. Inside was a large metal bucket filled with hot water and a pitcher. I stood in the bucket and poured the hot water over my head. I spent about 20 minutes there warming up then I joined Rex back at the fire. Rex made a dinner of rice with tomato, onion and pepper. We ate and then I laid down, exhausted.
We talked for a while and he told me a little about himself. He hadn't finished school. School here is free up to the 8th grade then you must pay. His parents died when he was young so there was no chance for him to continue school so he went to work.
We compared life in Malawi to life in America. I listened to his plans for the future, his business ideas etc. "I'm in a panic now, " he told me "because I don't have enough capital." He's married with 1 daughter, which I found odd because most Malawians have many children to ensure a few will live to be adults. He on the other hand hopes to give the only one he has the best chance he can at a good life, but business is not good so it is getting more and more difficult. There are 30 guides and 70 porters on rotation at the mountain. He went on his last hike 1 month ago - a guide makes 1200 kw a day (approx. $8).
We talked about my work here in Malawi, how I got my education and the possibilities or lack thereof for scholarship. He tells me about his dream to move to a bigger town and get a minibus so he can make more money but he says this takes capital.
He stares at the fire as he talks about his dreams and for a while I wonder if he remembers that I'm still there with him. He's talking and staring into the fire. Then I wonder whether he still really holds onto this dream or he's just reliving the dream he once dreamt. That old dream of his like the fire he's staring into - gone up in smoke.
We talked for a bit longer about other things then at some point (which I can't remember) I fell asleep.
We woke up the next morning to a large raven squawking and banging against our window. The sun was bright and there was but a few scattered clouds in sight. Mozambique was in the not-far-off distance, Sapitwa peak, just next to us (saptiwa means "don't go there" in chichewa).
There are, by the way, many legends amongst the locals about Mulanje. One lady told me she'd never go there because people go there and disappear. Another woman told me that if I'm walking and find a pot of nsima (corn grits) I'm not to eat it because it will kill me. There are many interesting tales, most of which have developed to explain actual tragedies that have occurred in the past.
We ate breakfast then set out for Luchenya plateau. In the light I was amazed to see the route we had taken the day before, crossing over the peak now behind us. We took our time and checked out another lodge and some caretakers grounds where some small huts were located. After about an hour we started our descent. As you can imagine the treck down is quite dangerous because it is very steep at points and very slippery and your momentum is going in the direction of any potential fall. It's on the way down that I had my major fall. At certain points along the hike you're climbing along massive sheets of slippery rock. These can be seen all the way from Thyolo because the water running down these massive sheets looks like white chalk lines on a blackboard hung in the sky. We reached one of these areas and were making our way along the side of a waterfall. There are no good footholds so you step on the lighter colored areas of the rock that are less slippery than the dark black rock. Rex was about 2 m in front of me and i stepped off a safe spot onto an area of redrock - that's when I got a lesson in physics - coefficient of friction = zero! My legs flew out from under me, my walking stick went flying and I slammed down to the rock, my right shoulder hitting first. My momentum caused the side of my head and face to smack against the rock next. It felt like I was back in high school wrestling and had just been slammed to the mat (actually I never got slammed so I really don't know what that feels like but I'm sure Henock knows what i'm talking about). So there I was on the rock. I laid there for a second - my first thought being, well, I'm still conscious, that's good, and I can move everything, that's good, and I didn't get swept off the mountain by the waterfall, that's good. So I stood up and felt my face and head - no blood, only a scrape on my hand and a lump on my cheek. I waited a second for the dizziness to set in or the headache, but nothing happened. I guess my head is as hard as some people say. Rex checked on me, then I collected my walking stick and away we went. I hiked down the rest of the mountain stepping more carefully, praying, and rubbing my swollen cheek.
I reached the bottom of the mountain safe and sound, proud of the accomplishment and the lump on my cheek - realizing I had experienced nothing more than a kiss from Mulanje herself.
At the base of the mountain I shook hands with Rex and thanked him for bringing me back safely. We wished God's blessings on each other then parted. With no other vehicles in sight I now had two options - either walk the 11km down the muddy road or jump on the bicycle taxi that was coming my way. I chose the taxi and jumped on the back of this frail looking bike, wondering how my driver was ever going to make it through the muddy road 11km to the main road. I mean, the pick up truck hardly made it. My driver stood up and put his entire 130 lbs onto each pedal and pushed forward. In the difficult parts I used my walking stick to help push us along. The chain popped off twice but amazingly we made it. It was a surreal experience and I laughed thinking about it as I walked through the market to a small store where i bought a coke and listened to Reggae music coming from the "bar" next door. I spent a half hour or so just hanging out, watching people in the market and a few guys playing a board game next to me.
I fell asleep on the minibus ride home, and then walked through Blantyre to my flat, reliving the experience and looking forward to a hot shower, some dinner and my raggedy old bed.
Monday, February 4, 2008
Most Welcome
We've been traveling for almost a week now. Everywhere we go we are greeted with the friendly words "You are most welcome." At Zomba, we ate lunch at Annie's Place and met an administrator for the Ministry of Health. It was an interesting conversation as he told us of many of the difficulties he is facing as he attempts to get more support for the orthopaedic programs here in Malawi. The belief is that these injuries won't kill you and therefore are not that terribly important. He is trying to convince the ministry otherwise.
The mist on Zomba plateau is heavy and had not lifted by the time we awoke Thursday morning. We sat down to a nice breakfast buffet at Ku Chawe Inn on Zomba plateau. Soon after getting my juice and my fried eggs I sat down at our table. Tom and I were then joined by Maura and her 5 month old daughter Imani - Maura is a Kenyan photo journalist working out of Scotland with a organization delivering tools and training to people with disabilities. She is documenting their trip. Anyway, just as we were about to start eating I heard a noise and looked up to find a huge baboon sitting on our buffet table. I startled it when I yelled for Tom and Maura to turn around. It grabbed a donut and a roll, jumped off the table, took one look back at us and scampered out of the open door at the end of the room! The staff thought nothing of it and kept about their business. So, even the baboons here are "most welcome."
Traveling north from Zomba we came to Manchini district hospital in Liwonde. We spent the morning seeing patients in clinic then the afternoon treating fractures. The orthopaedic clinic officer at Machinga is a young, energetic guy and good at what he does although his experience is very limited. After fracture clinic we made our way to our lodge that is located on the Shire (pronounced Shiray) River. The Shire River flows from Lake Malawi and empties into the Zambezi River which empties into the Indian Ocean. Once at the lodge I quickly jumped into a pair of shorts and decided to take a little walk along the river. The river looked peaceful enough but I've become very wary since I've seen more than a few crocodile bites and hippo attack victims. I stayed far away from the river bank but saw a few men fishing from the river's edge. I finished my walk uneventfully and was heading back to the room when I heard this loud grunting noise. I turned back around and walked back to the river. On the other side of the river I saw a group of hippos splashing about in the water, grunting and yawning. It was quite amazing to see them playing. Not too far off was a fisherman in his hand-carved canoe tying his net to the reeds. He kept his distance and the hippos paid him no mind.
The next day we went further north along the Shire River to Mangochi district hospital. Mangochi is a very busy district hospital serviced by one medical doctor. The orthopaedic clinical officer has been there about ten years and sees about 120 patients in his clinic a day. He also sees all of the casualties, and while we were there we had two children come in that had been hit by cars while playing along the road. The first boy was 6 yo and had been side-swiped and fell over into the bushes. He had only minor injuries and no broken bones and was quite lucky. The second was a 3 yo that was also hit by a slow moving car in town. She however had hit her head. I examined her and found her to be lethargic and then noticed blood coming from her ear. We immediately got an xray and found a fracture at the base of the skull. The baby was admitted and given supportive care as we monitored for further bleeding.
We spent the early afternoon rounding on the wards and giving Mr. Kamoto advice on his difficult cases. After rounds we decided to "knock off" early and make our way to Cape Maclear, at the base of Lake Malawi.
Cape Maclear is an amazing place - there are about 17000 people that live in the village. Walking through the village feels like walking through Colonial Williamsburg only the people living in the village are not actors. Many of the houses are made of mud and almost all of them have thatched roofs. The kids love too see foreigners and run up and hold your hand as you walk through the village. Some of them also ask for sweets.
There are a number of lodges along the Cape that are run by foreigners. We stayed at Cape Mac Lodge, a lodge owned by a french woman. It is very nice and has great views. We met a man named Isaac that has a motorboat and made plans to visit the neighboring islands offshore. The following morning we jumped on his boat and he took us to the Domwe island where we saw/fed the eagles and then went snorkeling (I'll have to take medications later as the water is known to have bilharzia). He cooked fresh fish, rice and tomatoes (which I would later regret as it gave me food poisoning). We met some other travellers on the island then headed over to Otter's Island and went diving off the rocks. We spent 2 nights at the Cape and had beautiful weather.
I drove back to Blantyre sick and tired but made it despite all the potholes and goats that tried to stop us. This week we will be making more visits to the districts and will go to Mt. Mulanje on Friday. I plan on climbing the mountain if all goes well.
The mist on Zomba plateau is heavy and had not lifted by the time we awoke Thursday morning. We sat down to a nice breakfast buffet at Ku Chawe Inn on Zomba plateau. Soon after getting my juice and my fried eggs I sat down at our table. Tom and I were then joined by Maura and her 5 month old daughter Imani - Maura is a Kenyan photo journalist working out of Scotland with a organization delivering tools and training to people with disabilities. She is documenting their trip. Anyway, just as we were about to start eating I heard a noise and looked up to find a huge baboon sitting on our buffet table. I startled it when I yelled for Tom and Maura to turn around. It grabbed a donut and a roll, jumped off the table, took one look back at us and scampered out of the open door at the end of the room! The staff thought nothing of it and kept about their business. So, even the baboons here are "most welcome."
Traveling north from Zomba we came to Manchini district hospital in Liwonde. We spent the morning seeing patients in clinic then the afternoon treating fractures. The orthopaedic clinic officer at Machinga is a young, energetic guy and good at what he does although his experience is very limited. After fracture clinic we made our way to our lodge that is located on the Shire (pronounced Shiray) River. The Shire River flows from Lake Malawi and empties into the Zambezi River which empties into the Indian Ocean. Once at the lodge I quickly jumped into a pair of shorts and decided to take a little walk along the river. The river looked peaceful enough but I've become very wary since I've seen more than a few crocodile bites and hippo attack victims. I stayed far away from the river bank but saw a few men fishing from the river's edge. I finished my walk uneventfully and was heading back to the room when I heard this loud grunting noise. I turned back around and walked back to the river. On the other side of the river I saw a group of hippos splashing about in the water, grunting and yawning. It was quite amazing to see them playing. Not too far off was a fisherman in his hand-carved canoe tying his net to the reeds. He kept his distance and the hippos paid him no mind.
The next day we went further north along the Shire River to Mangochi district hospital. Mangochi is a very busy district hospital serviced by one medical doctor. The orthopaedic clinical officer has been there about ten years and sees about 120 patients in his clinic a day. He also sees all of the casualties, and while we were there we had two children come in that had been hit by cars while playing along the road. The first boy was 6 yo and had been side-swiped and fell over into the bushes. He had only minor injuries and no broken bones and was quite lucky. The second was a 3 yo that was also hit by a slow moving car in town. She however had hit her head. I examined her and found her to be lethargic and then noticed blood coming from her ear. We immediately got an xray and found a fracture at the base of the skull. The baby was admitted and given supportive care as we monitored for further bleeding.
We spent the early afternoon rounding on the wards and giving Mr. Kamoto advice on his difficult cases. After rounds we decided to "knock off" early and make our way to Cape Maclear, at the base of Lake Malawi.
Cape Maclear is an amazing place - there are about 17000 people that live in the village. Walking through the village feels like walking through Colonial Williamsburg only the people living in the village are not actors. Many of the houses are made of mud and almost all of them have thatched roofs. The kids love too see foreigners and run up and hold your hand as you walk through the village. Some of them also ask for sweets.
There are a number of lodges along the Cape that are run by foreigners. We stayed at Cape Mac Lodge, a lodge owned by a french woman. It is very nice and has great views. We met a man named Isaac that has a motorboat and made plans to visit the neighboring islands offshore. The following morning we jumped on his boat and he took us to the Domwe island where we saw/fed the eagles and then went snorkeling (I'll have to take medications later as the water is known to have bilharzia). He cooked fresh fish, rice and tomatoes (which I would later regret as it gave me food poisoning). We met some other travellers on the island then headed over to Otter's Island and went diving off the rocks. We spent 2 nights at the Cape and had beautiful weather.
I drove back to Blantyre sick and tired but made it despite all the potholes and goats that tried to stop us. This week we will be making more visits to the districts and will go to Mt. Mulanje on Friday. I plan on climbing the mountain if all goes well.
Wednesday, January 30, 2008
Zomba
Today we traveled to Zomba district hospital, located a hour and a half north of Blantyre. It is a bit difficult trying to find these places as the directions we're always given are very non-specific and there are no street signs. Zomba hospital has been around since colonial times and part of the buildings are over a hundred years old and quite amazing. We met Dzimbiri, the orthopaedic clinical officer and Robert Ayalla - a Ugandan orthopaedic surgeon that comes to the hospital once a week to operate. We advised on one surgery then had lunch and then went to see the patients on the wards. You think you've seen the worst of it and then you see more. This hospital is crowded with people and since there is a big push to teach the mothers how to properly breastfeed, there are breasts out everywhere!
I saw a few patients in clinic - one of which I admitted - a 5 month old girl that was brought in because her mother fell while carrying her and the baby hit her head. Her head is now swollen and she is crying alot. We got the xray and found she has a skull fracture. Her mother was checking her in when we eventually entered the peds wards. There are so many difficult problems that it's hard to know where to begin or what to do. Victoria (another OCO) took us to see a 9yr old boy that has an infection that has destoyed his entire femur and subsequently he has sustained two fractures in this femur such that the middle of the bone is just floating free. His leg is shortened and very swollen and draining pus. He's malnourished and of course he's in pain and scared. It's very hard to know what to do - he'll probably need an amputation in these conditions but it's hard to take off a little boys leg. We decided to do our best to get him over to the children's hospital in Blantyre and go from there. I covered him back up and was about to leave and Victoria asked us to see another boy just a few beds down. His leg is swolllen and shortened and when I looked at the xray I couldn't believe it. He has the same problem only he also has HIV. I just couldn't believe it.
We left the ward and walked to the car where we realized our battery was dead. I began pushing while Dr. Witschi steered. Quickly a few men joined in and we built up speed and Dr. Witschi threw it into gear and got it going. Some bystanders laughed at us which made me laugh too. I thanked the men and jumped into the car and off we went.
Zomba plateau is located high in the mountains and is reached via a winding road made for the transporting lumber. The top of the mountain is covered by a heavy mist. We drove past a few rockslides, a small waterfall, and a damn then slipped off into the mist. We just now found our lodge and I am anxious to get some sleep.
Tomorrow we head further north to Manchini distict hospital in Liwonde, Hippo country.
I saw a few patients in clinic - one of which I admitted - a 5 month old girl that was brought in because her mother fell while carrying her and the baby hit her head. Her head is now swollen and she is crying alot. We got the xray and found she has a skull fracture. Her mother was checking her in when we eventually entered the peds wards. There are so many difficult problems that it's hard to know where to begin or what to do. Victoria (another OCO) took us to see a 9yr old boy that has an infection that has destoyed his entire femur and subsequently he has sustained two fractures in this femur such that the middle of the bone is just floating free. His leg is shortened and very swollen and draining pus. He's malnourished and of course he's in pain and scared. It's very hard to know what to do - he'll probably need an amputation in these conditions but it's hard to take off a little boys leg. We decided to do our best to get him over to the children's hospital in Blantyre and go from there. I covered him back up and was about to leave and Victoria asked us to see another boy just a few beds down. His leg is swolllen and shortened and when I looked at the xray I couldn't believe it. He has the same problem only he also has HIV. I just couldn't believe it.
We left the ward and walked to the car where we realized our battery was dead. I began pushing while Dr. Witschi steered. Quickly a few men joined in and we built up speed and Dr. Witschi threw it into gear and got it going. Some bystanders laughed at us which made me laugh too. I thanked the men and jumped into the car and off we went.
Zomba plateau is located high in the mountains and is reached via a winding road made for the transporting lumber. The top of the mountain is covered by a heavy mist. We drove past a few rockslides, a small waterfall, and a damn then slipped off into the mist. We just now found our lodge and I am anxious to get some sleep.
Tomorrow we head further north to Manchini distict hospital in Liwonde, Hippo country.
Che Ntemba & the Blue Elephant
If you look on a map of southern Africa you'll find Malawi wedged between Mozambique, Zambia and Tanzania. Blantyre is one of two major cities in Malawi, the other being Lilongwe - a few hours north. The city is very small relative to our standards but it is full of life - we travel to the market everyday to pick up food and people-watch...(sorry, just lost my train of thought - all our lights went out, you see electricty is a luxury here, as is water and we fill up buckets of water at night to use the next day when at some point the water goes out). Anyway, there is so much to see at the market, people going to and from carrying all sorts of things, most of which is balanced on their heads. Live chickens for sale etc. The vendors either sell their items from mats on the ground or use wooden kiosks (if I can call them that). Quite funny are the "telephone bureaus" which sell cell phone service from these very basic wooden structures.
This past weekend I ventured out to check out the night life. I set out by car from my flat in the hills of "Sunnyside" avoiding as best I could the potholes and the wild dogs on my way to the Blue Elelphant, a restaurant/bar that is popular here among the locals and expats. I located the Blue Elly by following the sound of music that I could hear as I drove down Haile Selassie Rd. on my was to Kumuzu highway. It is a nice "pub" with a large outdoor area that is covered by a tent. The dance floor is adjacent to the tented area - it is not covered so that when it rains, as it inevitably does, you get a bit of a shower. I've become used to the showers at this point and no longer look for shelter or carry an umbrella. There is a very good DJ at the Blue Elly and he plays a very wide selection of reggae, hip hop and african dance. I grabbed a drink and a burger while I listened to the music and checked the place out. After about fifteen minutes one of the medical students I have seen at Queens Hospital came up to me and introduced himself. He then introduced me to all of his friends and for the rest of the night we hung out, playing pool and listening to the music. Eventually they decided we should go to another place and I tagged along and ended up at two other places that I could never find again even with a GPS. We stayed out very late and when the crowds started to thin and I decided I should get some rest and save some of my energy for later.
The next night it was back to the Blue Elly and then to Che Ntemba, another club more in the center of town. From the outside Che looks a bit dodgy, but I've never let that stop me before so I decided to take a look. I payed the 500 kwacha cover (approx. $3.25) and was let into the gate. Iwalked in and quickly noticed that there were 2 floors. I went upstairs and began looking around when I ran into Job, a Malwian I had previously met at the Blue Elly. He is a very vibrant and animated Malawian and greeted me as if I was his long lost friend. We grabbed a drink and walked over to the balcony that overlooked the dance floor below. After a few minutes he pointed into the crowd below and said, "She is so beautiful, that one! I must go speak to her." I looked down and amongst the sea of people I saw a beautiful Malawian women. I agreed with him , patted him on the back, and wished him luck. He left very excited and determined to talk to this beautiful woman. I kept my eye on the woman but never did see him walk up to her. Later, I decided to go downstairs. "Ah, there you are! Let me introduce you to such a beautiful woman as this," he said. He bent over and whispered to a woman that was seated facing the opposite direction. She stood and faced me. All I could think of was "Shallow Hal" because she was not the woman I thought he had been pointing too but the woman that had been standing next to her. I thought it was so funny because she was not an attractive woman, at least to me western eyes, and (the funniest part) she was so much larger than he, nearly doubling his 5ft 120lb frame. "Such a beautiful woman," he said beaming with pride. I spent the rest of the night with them and their friends and realized it didn't matter what I thought, she was beautiful to him.
Sunday I woke up to beautiful singing - church music from a distance. Many of the Malawians are Christian, but there are also a number of Muslims and Hindus as well. I left the flat and sat outside to listen to the music and catch the bit of sun that was out before the rain came. On my way out I scared a bunch of monkeys that were hanging out under the tree that is next to my flat. I wasn't sitting for more than a couple minutes before Zendi, my 8 yr old neighbor, came out with his soccer ball. He gave me a big hung, as he always does when he sees me and asked me why I was just sitting there. "Let's play," he said as he kicked the ball to me. I got up and we started playing. Shortly after Otis showed up and then Zeithwa, then Oath (Otis' sister). Yemlak, a 13yr old aspiring actress from Ethiopia came next followed by Alex. We played all types of games until I was dead tired, then I sat down and they sat next to me and started asking me all sorts of questions - did I know any celebrities, did I drive a fancy car etc. Zeithwa told me if he had a car he would "Pimp my ride" (he's seen the show on MTV). Once the rain came I decided to head inside so i said goodbye and they started playing again.
Monday I operated on a 25yr old teacher that is unable to walk because he has tuberculosis in his spine that has destroyed two veterbrae and left him with a deformity that is compressing his spinal cord. With a rickety old anesthesia machine and one unit of blood we opened up his chest & abdomen and decompressed the area including the large absess under his psoas muscle. The case took us 6 hrs and we shipped him off to the ICU in stable condition, thankfully. We postponed the second cases - a boy that has a football sized mass in his forearm.
Post op day #1 and our 25yr old teacher is out of the ICU sitting up in bed doing his breathing excercises and telling me he is ok.
This past weekend I ventured out to check out the night life. I set out by car from my flat in the hills of "Sunnyside" avoiding as best I could the potholes and the wild dogs on my way to the Blue Elelphant, a restaurant/bar that is popular here among the locals and expats. I located the Blue Elly by following the sound of music that I could hear as I drove down Haile Selassie Rd. on my was to Kumuzu highway. It is a nice "pub" with a large outdoor area that is covered by a tent. The dance floor is adjacent to the tented area - it is not covered so that when it rains, as it inevitably does, you get a bit of a shower. I've become used to the showers at this point and no longer look for shelter or carry an umbrella. There is a very good DJ at the Blue Elly and he plays a very wide selection of reggae, hip hop and african dance. I grabbed a drink and a burger while I listened to the music and checked the place out. After about fifteen minutes one of the medical students I have seen at Queens Hospital came up to me and introduced himself. He then introduced me to all of his friends and for the rest of the night we hung out, playing pool and listening to the music. Eventually they decided we should go to another place and I tagged along and ended up at two other places that I could never find again even with a GPS. We stayed out very late and when the crowds started to thin and I decided I should get some rest and save some of my energy for later.
The next night it was back to the Blue Elly and then to Che Ntemba, another club more in the center of town. From the outside Che looks a bit dodgy, but I've never let that stop me before so I decided to take a look. I payed the 500 kwacha cover (approx. $3.25) and was let into the gate. Iwalked in and quickly noticed that there were 2 floors. I went upstairs and began looking around when I ran into Job, a Malwian I had previously met at the Blue Elly. He is a very vibrant and animated Malawian and greeted me as if I was his long lost friend. We grabbed a drink and walked over to the balcony that overlooked the dance floor below. After a few minutes he pointed into the crowd below and said, "She is so beautiful, that one! I must go speak to her." I looked down and amongst the sea of people I saw a beautiful Malawian women. I agreed with him , patted him on the back, and wished him luck. He left very excited and determined to talk to this beautiful woman. I kept my eye on the woman but never did see him walk up to her. Later, I decided to go downstairs. "Ah, there you are! Let me introduce you to such a beautiful woman as this," he said. He bent over and whispered to a woman that was seated facing the opposite direction. She stood and faced me. All I could think of was "Shallow Hal" because she was not the woman I thought he had been pointing too but the woman that had been standing next to her. I thought it was so funny because she was not an attractive woman, at least to me western eyes, and (the funniest part) she was so much larger than he, nearly doubling his 5ft 120lb frame. "Such a beautiful woman," he said beaming with pride. I spent the rest of the night with them and their friends and realized it didn't matter what I thought, she was beautiful to him.
Sunday I woke up to beautiful singing - church music from a distance. Many of the Malawians are Christian, but there are also a number of Muslims and Hindus as well. I left the flat and sat outside to listen to the music and catch the bit of sun that was out before the rain came. On my way out I scared a bunch of monkeys that were hanging out under the tree that is next to my flat. I wasn't sitting for more than a couple minutes before Zendi, my 8 yr old neighbor, came out with his soccer ball. He gave me a big hung, as he always does when he sees me and asked me why I was just sitting there. "Let's play," he said as he kicked the ball to me. I got up and we started playing. Shortly after Otis showed up and then Zeithwa, then Oath (Otis' sister). Yemlak, a 13yr old aspiring actress from Ethiopia came next followed by Alex. We played all types of games until I was dead tired, then I sat down and they sat next to me and started asking me all sorts of questions - did I know any celebrities, did I drive a fancy car etc. Zeithwa told me if he had a car he would "Pimp my ride" (he's seen the show on MTV). Once the rain came I decided to head inside so i said goodbye and they started playing again.
Monday I operated on a 25yr old teacher that is unable to walk because he has tuberculosis in his spine that has destroyed two veterbrae and left him with a deformity that is compressing his spinal cord. With a rickety old anesthesia machine and one unit of blood we opened up his chest & abdomen and decompressed the area including the large absess under his psoas muscle. The case took us 6 hrs and we shipped him off to the ICU in stable condition, thankfully. We postponed the second cases - a boy that has a football sized mass in his forearm.
Post op day #1 and our 25yr old teacher is out of the ICU sitting up in bed doing his breathing excercises and telling me he is ok.
Friday, January 25, 2008
The Road to Thyolo
Yesterday I visited Beit Cure Hospital, a non-profit ortho hospital with pretty nice facilities. In the afternoon I was in clinic. My first impression of clinic was that it was going to be similar to our own clinic experience as I walked into a room full of patients. Quickly I realized there were significant differences - first, the patients wait patiently. Second, the patients come in with real problems, not just a little ache or pain as alot of our patients do. I saw alot of pathology and a few very interesting follow-ups. We saw a women that had intitially lost the ability to walk due to tuberculosis of the spine and had been operated on by Dr. Mkandawire, the chief. That was two months ago. Now, she hopped around the room and proudly showed of her beautiful surgical scar. Later I met a woman with epilepsy that fell into a fire while having a seizure. She sustained significant burns on her body including her hand and subsequently developed a flexion contracture of her wrist and thumb. We decided to operate on her. She is now collecting her guardians in preparation for her hospital stay. Her name is Athaonse, which means in Chichewa "everybody's gone." She was named this because all her older siblings had died prior to her birth. We look forward to seeing her again and doing our best to help her. I also met a beautiful old lady that came in because she could not lift her right arm much anymore. She had a mass the size of a large grapefruit in her scapula and a mass in her thyroid. There is little that can be done for many of the cancer patients here and as she was being told what she had she nodded occasionally. She then sat quietly for a minute or so as we wrote her visit notes then she said, "Maybe I am going to meet God then." She dressed, took her notebook filled with healthcare notes and left as quiet as she came.
The clinic seemed to move quickly with so much interesting pathology and stories.
Today, I went to Thyolo District Hospital. The road to Thyolo is what is called a "proper road" that winds along south of Blantyre through thousands of acres of tea plantations and mountains. It is really striking land. Thyolo is about an hour south of Blantyre and the homeotwn of the President. After his election, he quickly moved to have a very fine hospital facility built in Thyolo. We met Mr. Kennedy the orthopaedic officer there and he began showing us around. We ran into two Danish doctors that have been working in Thyolo for a year doing their "tropical medicine" rotation. The were extremely excited to have us there because they have many patients and many orthopaedic problems and limited orthopaedic experience. But they are working hard and doing the best they can - doing amputations, skin grafting, traction, stabilizing cervical spine fx/dislocations etc. They had many questions for us and really needed our input on many cases.
After finishing the ortho cases they took us to the only restaurant in Thyolo. We walked through the market - filled with people and animals to a very small but clean building. Walking through the sheet that covered the doorway we entered the restaurant and were seated at one of the tables. We ate chicken, greens and seema (a corn based grit). Utensils were optional so I just dug in. It was pretty good actually except for the neck of the chicken that I was given. I didn't really know what to do with that.
After lunch we were asked if we'd see a few other medical patients with them. We saw a young women who was having seizures on a daily basis now with no apparent diagnosis. We examined her and found some significant findings and just as we were about to check a few other things she had a seizure. I held her head to give her some support as they got some diazepam. We gave her the medication and then another dose and finally she broke out of the seizure. She mumbled things at first then began calling out names then eventually singing a song, then she fell asleep. Quite an experience. We recommended a transfer to the Queens hospital for further workup including a CT scan of her brain.
We saw a few more patients then made arrangements to return in about a weeks time. They are going to gather cases for us in the meantime.
Tonight the partying will begin and I plan to check out the bar/club in town. Drop down and get your eagle on...
The clinic seemed to move quickly with so much interesting pathology and stories.
Today, I went to Thyolo District Hospital. The road to Thyolo is what is called a "proper road" that winds along south of Blantyre through thousands of acres of tea plantations and mountains. It is really striking land. Thyolo is about an hour south of Blantyre and the homeotwn of the President. After his election, he quickly moved to have a very fine hospital facility built in Thyolo. We met Mr. Kennedy the orthopaedic officer there and he began showing us around. We ran into two Danish doctors that have been working in Thyolo for a year doing their "tropical medicine" rotation. The were extremely excited to have us there because they have many patients and many orthopaedic problems and limited orthopaedic experience. But they are working hard and doing the best they can - doing amputations, skin grafting, traction, stabilizing cervical spine fx/dislocations etc. They had many questions for us and really needed our input on many cases.
After finishing the ortho cases they took us to the only restaurant in Thyolo. We walked through the market - filled with people and animals to a very small but clean building. Walking through the sheet that covered the doorway we entered the restaurant and were seated at one of the tables. We ate chicken, greens and seema (a corn based grit). Utensils were optional so I just dug in. It was pretty good actually except for the neck of the chicken that I was given. I didn't really know what to do with that.
After lunch we were asked if we'd see a few other medical patients with them. We saw a young women who was having seizures on a daily basis now with no apparent diagnosis. We examined her and found some significant findings and just as we were about to check a few other things she had a seizure. I held her head to give her some support as they got some diazepam. We gave her the medication and then another dose and finally she broke out of the seizure. She mumbled things at first then began calling out names then eventually singing a song, then she fell asleep. Quite an experience. We recommended a transfer to the Queens hospital for further workup including a CT scan of her brain.
We saw a few more patients then made arrangements to return in about a weeks time. They are going to gather cases for us in the meantime.
Tonight the partying will begin and I plan to check out the bar/club in town. Drop down and get your eagle on...
Tuesday, January 22, 2008
Mortuary - One Way Out
I haven't found a way to upload my pictures to the computer so for now it's just text. First, thanks for the hello's and "big ups."
I am just starting day three at the hospital. Yesterday I did my first surgery - a femur fracture non-union that we took down and put in a IM nail. They use the K nail here and we don't have intraop xray so everything is open. I scrubbed with the first year ortho registar (who, like at home, had to push to get the case started) and a medical student (currently I am at one of four major hospitals and home of the University of Malawi Medical School). This is one of the more advanced hospitals but, as it is government run, it is overrun with problems, as they all are. Manuel is the young guy I operated on, and this morning his is doing extremely well. He is excited that he had the operation and showed me how he can lift his leg slightly. I was extremely impressed how little pain he is experiencing or how much he can bear. After surgery he thanked me kindly then asked if i would be seeing him tomorrow. I told him I would, then he said, "OK, you are dating me then," his way of saying "it's a date. " I laughed and so did he. I will be traveling to the "district" hospitals starting Friday and will continue throughout the weeks. The district hospitals are in much more rural areas and a bit isolated. There are no orthopaedic doctors at these hospitals and it sounds like there is much work to be done with little resources. I look forward to seeing what we can do.
As in any hospital there is death. We park in the back of the hospital by the mortuary. Next to the sign for "Mortuary" there is another sign to direct traffic that reads, "One Way Out."
I am walking down a corridor following Master Yesiah
along the walls of the corridor there are many women
the women are singing
they are expressionless
yet much emotion is felt in their song
I am swept up by them
I do not know how to react
I hesitate to smile and so I stare at them at first as I walk
and they sing
I am lost in them
I drop my head and focus on Master's feet as I follow him
the women, they are gathered...
Later, Master tells me the women are the guardians
Someone has died he tells me and the women are the people - the family, friends - the community
they are guardians
they have been told of the death and so they gather
The body is lifted from its bed and placed on a stretcher
It is covered
The women line up behind the stretcher in two lines and they sing
The body is taken to the mortuary
And they sing
I've been sitting in the office for about an hour
I have heard the woman's song four times now
The woman are gathered
And they sing.
It seems to me there is more than One Way Out.
I am just starting day three at the hospital. Yesterday I did my first surgery - a femur fracture non-union that we took down and put in a IM nail. They use the K nail here and we don't have intraop xray so everything is open. I scrubbed with the first year ortho registar (who, like at home, had to push to get the case started) and a medical student (currently I am at one of four major hospitals and home of the University of Malawi Medical School). This is one of the more advanced hospitals but, as it is government run, it is overrun with problems, as they all are. Manuel is the young guy I operated on, and this morning his is doing extremely well. He is excited that he had the operation and showed me how he can lift his leg slightly. I was extremely impressed how little pain he is experiencing or how much he can bear. After surgery he thanked me kindly then asked if i would be seeing him tomorrow. I told him I would, then he said, "OK, you are dating me then," his way of saying "it's a date. " I laughed and so did he. I will be traveling to the "district" hospitals starting Friday and will continue throughout the weeks. The district hospitals are in much more rural areas and a bit isolated. There are no orthopaedic doctors at these hospitals and it sounds like there is much work to be done with little resources. I look forward to seeing what we can do.
As in any hospital there is death. We park in the back of the hospital by the mortuary. Next to the sign for "Mortuary" there is another sign to direct traffic that reads, "One Way Out."
I am walking down a corridor following Master Yesiah
along the walls of the corridor there are many women
the women are singing
they are expressionless
yet much emotion is felt in their song
I am swept up by them
I do not know how to react
I hesitate to smile and so I stare at them at first as I walk
and they sing
I am lost in them
I drop my head and focus on Master's feet as I follow him
the women, they are gathered...
Later, Master tells me the women are the guardians
Someone has died he tells me and the women are the people - the family, friends - the community
they are guardians
they have been told of the death and so they gather
The body is lifted from its bed and placed on a stretcher
It is covered
The women line up behind the stretcher in two lines and they sing
The body is taken to the mortuary
And they sing
I've been sitting in the office for about an hour
I have heard the woman's song four times now
The woman are gathered
And they sing.
It seems to me there is more than One Way Out.
Monday, January 21, 2008
T.I.A. !!!
Arrived in africa safely and have settled into our flat. I'm driving around town like a pro now - my training in Jamaica has suited me well. I have just made rounds in the wards for the first time. This can't be described in such short time but if I have time later will share. There is alot of TB spine, osteomyelitis, femur fractures, tumor cases, trauma and then your occasional crocodile attack victim! Pictures will follow if I can find a way to upload them. I will be either scubbing on a TB spine case in the afternoon or doing fracture clinic, so I'll let you know how this goes. Having a great experience so far with just a few days into it and, like the rains - much more to come!
j
j
Wednesday, January 16, 2008
Packing
ok so time to start packing. tomorrow I'll be on my way to AFRICA! I'll do my best to keep you guys posted on my exploits!
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