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.
Wednesday, January 30, 2008
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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