The End

There is so much more about being in Malawi than what I have felt free or able to convey. Thank you for all the emails you’ve sent back commenting on what you’ve read. I’m back now so do come round for a drink and we’ll talk further!

Tioanana!!

"In the time of my confession"

Being in a flying tin can for 10 hours affords you plenty of time to reflect. I watched a film called The Soloist about a cello player who looses his mind and ends up on the streets. Then a reporter finds him and starts to write about him and his talent, tries to help him by finding him a cello and a safe place to play it. But all on his terms. Then the homeless man shows up outside the reporter’s office expecting that his friend will be glad to see him. But the reporter comes out and says, “You can’t come here. I work here, you can’t visit me here.”
I thought about that and how it applies to me. I go to Malawi on my terms. I help a few people, I even make a few friends. I go to Zimbabwe to run a half marathon and take a few of my Malawian work colleagues with us. I write about my experiences. My flatmate and I lend someone some money to buy some land to grow some maize on. But its all on my terms. Then some of my Malawian friends get bold enough to ask me for help that I have not initiated or offered. It gets my hackles up. It bothers me. It doesn’t make me feel good about myself. I comfort myself that doling out money is not helping anyone and it is perpetuating a problem rather than empowering people. But the fact is it is inconvenient, and I feel possessive of MY money even though I have plenty and in fact take out of the bank in one go more than most people here earn in a month.
There is a verse in the book of Jeremiah that says, “The heart is deceitful above all things, who can understand it?” I certainly can’t begin to understand the motives that have brought me here! But I hope that somewhere in this mess there have been good things and genuine appreciation of the people around me. My hero Bobby D expresses it well:

In the time of my confession, in the hour of my deepest need
When the pool of tears beneath my feet flood every newborn sea
There's a dyin' voice within me reaching out somewhere,
Toiling in the danger and in the morals of despair.

Don't have the inclination to look back on any mistake,
Like Cain, I now behold this chain of events that I must break.
I am hanging in the balance of the reality of man
Like every sparrow falling, like every grain of sand.

Inter hospital transfers

I have been here for six months and have managed to avoid any transfers which I hate at the best of times. However, in my last week my luck ran out. We had a trauma patient at CURE who needed intensive care and therefore needed moved to Queens, the government hospital which is just two minutes up the road, or maybe 6 minutes if you’re dragging a mattress-with-patient combo behind you.
I was informed that there was an ambulance available for which I was duly thankful until I decided to take a look at it ahead of time. Rather disappointingly, the only thing that marks it out as an ambulance is the red cherry on top. Well, I may be being harsh. It also says ‘Ambulance’ in big letters along the side. The back of the land rover had the seats taken out to make room for a mattress which you slide off the trolley into the back and then slam the door to make sure the patient doesn’t slide out on the way. Oh, I forgot. There isn’t actually enough space for a mattress, so you have to sit the patient up. And bend their legs. Thankfully, my patient had bilateral femoral fractures so I had an extra place to bend them. THEN you slam the door. Then you press the magic button that turns the siren on and off you go. But not before you’ve wrapped your arm round the (free standing) oxygen cylinder so that it doesn’t tip over onto the patient’s head. Lesson learnt.
Another tip about transfers is to make sure that the doors at the receiving hospital open and that the person with the key has not gone home. We reversed up to the doors outside ITU and could open one side but someone had padlocked the bolt on the other door. The helpful theatre assistant tried to ram the trolley through the door but it was a lesson in spatial awareness and he retreated and came back with a narrower trolley. We then dragged my patient onto their trolley, ripping the mattress in the process due to an inexplicable ridge of metal on the floor of the ambulance. We docked in ITU and sorted her out. One of the ITU nurses had been at my brother’s wedding and it was nice to have a quick chat with her. The consultant anaesthetist from CURE had shown up having driven in his own car, and between us we had the task of carting all the equipment back to CURE as the ambulance had left already (A scenario familiar to UK anaesthetists also).
So we picked up all the stuff and made to leave, Roy staggering behind me under the weight of the large oxygen cylinder; when the ITU nurse asked if I wanted to see the pictures of my brother’s wedding that she had on her phone. I had a nice flick through them and sometime during this heard a loud ‘thunk’ behind me which was Roy dropping the oxygen cylinder on his foot in disbelief that I had stopped to admire someone’s photos while he was carrying an obelisk, muttering something about women and weddings. I think he will be thankful to see me go.The patient survived the ordeal and so did Roy’s toes, and I have learnt many lessons in how to be a bit more prepared in the future.

Scenes from the road

Early October is a beautiful time of year here. The weather is getting hotter but not yet blistering. The sun predictably shines every day and the trees produce a profusion of blossoms, from the pink, white and yellow frangipani, the deep red bougainvillea to the utter ebullience of an avenue of purple Jaccaranda trees. There is a particularly beautiful avenue on my way to work, unfortunately it is on my right when I am turning left and I have been known to spend a bit too long at the junction until an overloaded truck bears down on me and forces me into action.Many a time you will be walking or driving down the road here and you will see something you have never seen before. Such as a police officer giving his friend a backkie on his 150cc motorbike, a local car with a roof rack fitted for skis (in Africa?), a woman carrying a folded up umbrella on her head and men on bikes with four or five crates of coke-a-cola stacked skywards on the back. Not to mention the signs: God’s Will Hair Salon (in other words: it isn’t our fault you now look dreadful); Winners’ Chapel and my favourite: a hospital up in Lilongwe named after its Korean sponsor: The Dae Yung Hospital. I’d like to have a look at their morbidity and mortality outcomes.

Certificates

Having finally completed the resus training that we started in June I thought it would be a good thing to give out the certificates of completion in the once weekly ‘family meeting’ as its called where the whole hospital meets in the chapel on a Tuesday morning for a short service and the usual announcements. I had designed it myself and was rather proud of it. Roy, the consultant anaesthetist said a wee schpeil about how hard everyone had worked and then read out the names and I gave out the certificates. They all did a good job of looking pleased but without exception frowned when they sat down. After chapel we all trundled back to theatre to start work for the day and a couple of them cornered me in the coffee room. “So, these aren’t the real certificates are they? You just did these paper ones in order to have something quickly for the chapel service, didn’t you? When will you do the laminated ones?”

Having given myself all of a second to feel deflated I made a quick recovery and said, of course, I just dont know where to get the laminated ones, I’ll get round to it.

Feeling a little jaded by that slap in the face, I was stopped about half an hour later by one of the lads who had come to Vic Falls. He had his own template of a certificate that he wanted me to design and have the hospital director and myself sign it and... you guessed it.... then laminate it.

I didn’t realise you get a certificate for anything here so you’ve got to make it special.

Come to think of it, I should have given my electrician a certificate.

Electrician - no more problem no more plug 2/10/09

The electrician came round this morning because one of the plugs kept blowing up. I left him to it with a big glass of Sobo squash and some Coconut Cookies. He emerged a few minutes later saying that he’d found the problem. It was the plug for one of the lamps, not the wall socket at all. And to prove it he bit through the wires for the lamp and deftly inserted them into the wall with his bare hands. Sure enough the lamp lit up. He stood up with the air of a man who has wrestled a lion and won. I said, well, what do I do with the lamp with no plug. Which was the wrong thing to say. Trust me to pick on his one area of weakness when he had conquered everest. He weakly suggested I buy a new plug and fit it myself. Which I accepted. I need to learn these things. In the mean time I suppose there’s nothing for it but to rip the plastic coating off with my teeth and insert the bare wires into the socket.

A chicken, a crate of Fanta and a 5kg bag of rice

Should you ever wish to get married in Malawi just let me know and I can pass on a few tips. My big brother and his fiance came out to visit last week and got married in the old mission church in Blantyre. It was such a warm and beautiful ceremony and the general secretary of the Church of the Central Africa Presbytery had invited all his cronies to take part, all of whom were pleased as punch that Ian and Carrie had decided to come all the way from Scotland to get married in their church. Apart from a few minor hitches like my tripping over a pew and nearly taking out the bride and the small issue of having almost missed out signing the marriage certificate it all went very well. Then at the end the minister got up and announced that there would be a reception at my house and did I want to come forward to give the directions? While he was perfectly correct in saying that we had planned a reception at my house, I had not bargained on inviting all of the people who had walked in off the street to see some strange men in kilts and a blonde bride. My flatmate who was on BBQ duties paled, and I tried the tripping up thing again but unfortunately got to the microphone unhindered. So in my best quiet Hebridean voice I gave what I thought were accurate directions to my house but not many people can hear when you stand two metres back from the mike.

So after a few pictures outside of the church it was time to get back in the car. I got in the drivers side only to find that an unknown traditionally built woman was casually climbing in the passenger side. So Carrie, Ian and Ian’s best man, Douglas, got in the back. I asked this woman who was obviously dressed for the occasion if she was one of the minister’s wives. “No”, she replied,”my husband died nine years ago.” Oh. So....Thats really nice you could come. It was obvious she thought she deserved to be in the bridal car and there was no way of asking what she thought she was doing there without her taking offence, so we just had to ask the photographer to get a minibus to my house. I assumed Carrie must have made friends with her, but Carrie was busy thinking the same thing about me from the back of the car. Once we got to my house the guests were all assembled in the garden and there were four chairs set in a row for the bridal party: Ian, Carrie, best man and bridesmaid, I assumed. However, I was attempting to get my laptop to play music loud enough for the bride and groom to arrive to. It was only moderately louder than a mosquito’s drone and the guests strained and leaned forward to hear it. I then turned to sit down, only to find my seat taken by Mystery Woman in Wedding Outfit. So I perched on a wall behind the bridal party in my pretty frock and no one batted an eyelid. Later I asked one of the ministers’ wives who this woman was and she said she had no idea. So, it would seem there are such things as professional wedding crashers even in Malawi. And she got the best piece of steak too. Humbug. 

Any gathering in Malawi has to have a programme and this was no exception. The minister had asked another of his friends to be an MC and he opened in prayer, then there was a musical item, then grace, then food, then the speeches; after which everyone took off home as it was getting dark. A select few enjoyed the champagne that we couldn’t bring out earlier as Malawian Christians are T-total: the bride and groom having toasted each other earlier with fanta.

The minister was happily dispatched with his standard payment: a chicken, (frozen, not live) a crate of fanta and a 5 kg bag of rice; my having been let in on this expectation by the session clerk the week before.

So, despite doing our own flowers on the morning of the wedding; frantically undoing the mulit-storey construction that a very particular Malawian lady had made out of our hair that morning and then my losing the car keys at 5 to 2 (the service was to start at 2) and then vastly underestimating the number of expectant mouths it was a fantastic day. 

I think Ian and Carrie enjoyed it, or they wouldn’t have let me gatecrash their honeymoon while we toured round the country. The four-people-in-a-two-man-tent was, admittedly, a low point. And the baboon rifling through Carrie’s suitcase and chewing on the post-it notes at 6 in the morning. But, thankfully, bride and groom are two of the most laid-back people you’ll ever meet and took it all in their stride. 

I am available for future wedding planning in any exotic location of your choice. I only ask that you fly me there for the necessary preceding month. Anything can be arranged in a month.