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. 

Having been too scared to go to a footy match back in the UK for fear of being glassed, I jumped at the opportunity to go to an international level game in Malawi and sit on concrete bleachers that had been condemned by FIFA several years ago, where we were supposed to be relieved that there were personnel watching over us with their rifles slung over their shoulders. I would have been more reassured if they hadn’t been drunk. And wearing bandannas. I didn’t think bandannas were standard issue? 

We sat in a row of peachy whiteness and the sun promptly came out. The boy selling straw hats had clocked us when we came in and knew we wouldn’t be able to survive without him and just waited patiently until we wilted. And wilt we did, we would have paid whatever price he named but he was merciful with us. 

The first half was a bit disappointing with Guinea scoring a goal from a corner without about 90% of the crowd even noticing; we just wondered why they were walking back to the centre. The second half was much more exciting and Malawi equalised within the first 5 minutes and then went 2-1 ahead with 15 minutes to go. So, I mentioned that the stands had been condemned by FIFA. That didn’t stop the back 20 rows doing a victory dance right where they were. You could see the concrete sway. Maybe that was my imagination.

We walked back home with homemade knitted sweatbands and headbands in the Malawi colours (Green red and black) which had cost us 20p, pressing fists with other jubilant Malawi supporters. They have one more match which decides whether they go through to the All Africa Football Championships but that one is against Ivory Coast. For those who know (which now includes me) that will be a tough game, but Malawi is nothing if not an optimistic country.

Perseid meteor shower Wednesday 12th August

This is a bit of a postscript for the Perseid meteor shower. In honour of the best display of shooting stars for the whole year, I organised a trip up to Zomba where we could watch the night sky unhindered by city lights. What better place on earth than the big African sky to watch a shooting star extravaganza? So we were all a bit keen to leave work early on Wednesday the 12th of August to drive the hour up to Zomba to catch the sunset on top of the plateau and then to stay overnight at the house of one of the Hash members which very conveniently is situated about half way up the plateau. We had a very pleasant meal and then decamped outside with our sleeping bags to watch the sky. Well, some lasted longer than others but there was a steady dribble back inside and a few grumbles that folk had seen more shooting stars on any other night of the year. I saw one, which was about average - the width of the normal distribution being 0 -4; very much skewed towards the 0 mark. I felt responsible for dragging everyone up the mountain and making promises I was in no position to deliver.

I mentioned it to someone at work and he asked where we were watching it from, and then very insensitively burst into an incontrollable cackle when I told him. Needless to say, we were facing the wrong way. We were on the south facing slope of the plateau and all the stars were probably doing loop-the-loop behind us for all we know. Apparently the Northern hemisphere was the place to be that night. Or at least on the other side of Zomba.

The Big Vic Falls Adventure 19-25/8/9

Well,I have been dropping sweet morsels of information about the Vic Falls half marathon through the last couple of months and last weekend we actually pulled the whole heist off. With 48 hours to go we didn’t have a vehicle to take us there, didn’t have accommodation in Lilongwe or Vic Falls, three of the punters didn’t have passports and I still wasn’t sure we were going to get our visas at the border. And that despite having started planning this two months ago. 24 hours to go and everything started to fall in to place. The passports were obtained by one of the pastors from Cure standing at the immigration department and telling them he wasn’t going to leave until they’d given them over and weren’t they ashamed of themselves dragging their heels when they were preventing a bunch of well intentioned (if misguided) people from going to Zimbabwe to raise money for our hospital. Surprisingly enough the passports were printed and handed over within the hour.

One of the Congolese surgeons was willing to let us use his 8 seater 1988 Toyota landcruiser for the journey which I was over the moon about. However, I picked it up the night before we were due to go and should have paid more attention to his slightly worried glances as he said, “I’ve never actually driven it outside of Blantyre”. Let this be a lesson to my listeners - always pay attention when someone says they have not taken a 21 year old bruiser of a vehicle out of the city and you are planning on crossing three countries in it. 

Always pay attention when the vehicle starts to shake above 80 kmph and you have 1,400 km to cover. Dont ignore it when you start having trouble putting it into 3rd gear, then 5th gear, then you have to double clutch for any gear. Difficult to continue ignoring it when you’ve been stopped at a police road block and you are trying to be nonchalant whilst changing gear with both hands, still not managing and the police officers have to help push you into a layby. 

And that was only the beginning. I will spare you the detail. However, if I were to say we broke down on the first leg that would imply that it just happened once. It would be more accurate to say that we were breaking down while on the way to Lilongwe; more of a continuous state than a single event. What started as leaking break fluid and an air trap in the clutch (?) became the battery, then the alternator, the gear box, the main fuse, plus a few other minor ones, such as the lights. We spent the night in a petrol forecourt, got a push start at dawn and arrived in lilongwe at 7am, then spent the next couple of hours in a variety of junk yards looking for spare fuses etc.

We left the landcruiser sulking in a guesthouse car park and took the bus the rest of the way to Lusaka where we stayed with a friend of mine and then on to Livingstone and crossed the bridge between Zambia and Zimbabwe by foot. We got to the registration place with half an hour to spare! Registration was in a hotel complex that would not have been out of place in Las Vagas, but was exceedingly out of place in a country where people die of typhoid for lack of clean water. Three of the boys with us were Malawian and they got stopped at the door for having flip-flops, even though one of the English girls was also wearing flip-flops. I had to go back and say they were with us and get them through the door. It was a distasteful lesson in intra-Africa racism.

The race itself was, I can honestly say, fun! The route went back across the bridge over Vic Falls and then along the Zimbabwe side into a game reserve. Shame there were no big game or I would have got a better time; just a baboon who could have done a fair bit of damage, but he seemed to have his eye on a weaker human specimen than myself and was following her round the course; come to think of it I didn’t see her at the end.

We were interviewed by Zimbabwean national TV for being the biggest non-Zim team and one of our lads was the first non-Zimbabwean home in a time of 1:20! I was obviously hot on his heels, give or take. I’m not sure if they interviewed me just for the novelty factor of having a shot of a glowing red Muzungu, but I’m hopeful for the contract for the sunscreen advert to come through the post.

We spent the rest of the day pottering around the Zambian side of Vic Falls, and even paddled in the pools at the top just a few feet away from the edge. Given my level of co-ordination following the race, that may not have been a good idea but I managed not to trip over or be escorted away to a more benign spot.

The journey back was a bit more epic involving loosing the bus’s luggage on the road and having to prise it back out of the hands of some villagers who thought that it was rightfully theirs seeing as they’d found it. Even when we got back on the bus there were a few scuffles between passengers who believed a scheming elderly couple had taken their dishes... which it turned out they had!

We were reunited with the land cruiser on Tuesday morning and after a rather longer push start we got it back on the road for its last leg. This time, however, we were joined by Jim who in a past life had been comfortable driving tanks and, much like showing a horse who’s boss, the cruiser was much less truculent under his hands. It did decide to blow an ever expanding hole in the exhaust though and we made a few cyclists wobble off the road in shock as we roared past.  We perhaps had a bit too much fun with that trick and stole up behind a bunch of school boys and then rammed on the accelerator. They can jump quite high. Shame about the ditch. 

So, we got back to the hospital grounds by about 4pm on Tuesday afternoon and everyone was exceedingly excited to see us. Goodson, Lawrence and Stanford had been wearing their race T-shirts and finishers medals day and night since we left Zimbabwe and were welcomed back as heros.

Who knows what the impact of this trip has been on them. Verona asked Goodson how he was since he’d been back, and he said, “Everything is different”. Then you catch one of them staring dreamily out of the window and you know they are seeing Vic Falls, or maybe they are reliving crossing the finishing line. They hadn’t even seen warthogs before let alone a waterfall twice the volume of Niagra. On the down side, some of the other staff have made life difficult for them out of sheer jealousy. Was taking them along with us (based on their wiping the floor with everyone else in the 10k back in May) a good thing? Have we made their lives harder because the realities of going back to their tiny houses in the townships are given a harsher contrast. Who knows. But I can say that the race day and the wee wander around the Falls was one of the best days of my life. So glad we pulled it off.

“To mitigate the shabbiness of poverty”

There was a doctor here last year so legend has it, who used to introduce himself with, “Hi, my name’s Dave, what are you running from?” I tried to think what I was running from (the NHS?) but it must be so deeply entrenched in my subconscious that I couldn’t find it. However, I do know that my motives for being here are mixed. I haven’t grown out of thinking that I want to change the world (does that sound like delusions of grandure to you?) and I wanted to do something out of the ordinary, as well as have an adventure. Well the last two certainly hold true but I’m not sure about the first. What change is my being here for six months going to effect? I can’t change policy in that time. I can’t train or teach about anything lasting in that time. I can audit and suggest changes but those ideas for change need to come from someone who lives here, not someone who swans in and out. I may make a difference to the individuals I anaesthetise but what is that against the tsunami of poverty and disease. Today I am meeting up with one of the nurses at Queens to try to thrash out a plan for a paediatrics pain training day for next Tuesday. Kids may be prescribed pethidine (the only opiate we have for post operative pain relief) but they will be lucky to receive ONE dose. Burns dressings changes happen daily with no analgesia, not even paracetamol or ibuprofen; let alone an anaesthetic or sedation which is what the kids get in the UK. 

What strange providence / chance meant that I was born to a Scottish family with all the opportunities and privileges that go with that? How did it fall that I could choose my career, where I live, even to be here when most people in Malawi don’t have those choices.

However, I had time whilst on my exclusive safari in Zambia to think about such matters! (Ironic I know). And there isn’t much I can do about the hand I’ve been dealt and feeling guilty (probably highest on my list of most frequently felt emotions) is not changing anything except making me feel miserable! Which makes me feel better because at least I have the insight to feel bad! But, I am here and I can work hard and maybe I just need to see that I may make a bit of a difference to a few. Maybe I would make more of a difference in public health policy, or education, or microfinance, but I can’t do those things! 

I am reading ‘A Fine Balance’ just now and a paragraph from that expresses these thoughts far better than I can:

 “...he watched. The flat depressed him. He would be gone in less than a year, he thought, thank God for that. But for Dina Aunty this was home. Everywhere there was evidence of her struggle to stay ahead of squalor, to mitigate with neatness and order the shabbiness of poverty. He saw it in the chicken wire on the broken windowpanes, in the blackened kitchen wall and ceiling, in the flaking plaster, in the repairs on her blouse.”

South Luangwa National Park

I am now half way through my time here! I can’t believe it! It also means that last weekend I had to do a ‘border run’ to leave the country and come back in so that I could renew my visa. So the decision was between going to Mozambique to a mining town called Tete, or going to Zambia to South Luangwa National Park to see the lions. I went to Zambia. I saw a whole pride of lions, was flabbergasted by a beautiful leopard,  narrowly escaped being bitten by a monkey (shouldn’t have turned down that rabies jab at the travel clinic) and had to negotiate with some territorial frogs for the use of the loo roll they were sitting on. It was a great few days of escapism from the juggernaught of experiences that is working in Blantyre; and I got my visa. 

Mulanjie Mountain Rescue Team 21st - 24th July 2009

Last weekend I went up Mulanje to a hut called Tuchila on the Luchenya plateau. It was a lovely weekend with some folk who are leaving imminently. I had a bad case of ‘Mulanje legs’ on Monday i.e. very sore! However, my vision of a few days rest from exercise was dashed when one of the paediatricians asked me to join a mountain rescue team to find a missing climber. As the only anaesthetist who is not head of department in Blantyre I was free to go. So, 5 am on Tuesday morning found us back on the road to Mulanje. Now, I don’t think I have adequately communicated the scale of this rocky outcrop. The plateau itself is above 1000m (higher than any of the Munroes) and then our base for the rescue effort was at 2217m. The lost climber had set off up the highest peak on the Massif which is greater than 3000m. Because it is winter here the weather is very changeable and a bright morning can turn misty incredibly quickly, much like climbing in the Cullins. We got up to our base camp having seen nothing other than a few feet in front of us all the way. When we got there we dried off and waited for the search team to return. There were about 20 porters and guides in the team and that number grew throughout the week to about 40. We heard that this missing climber had initially tried to set out for Sapitwa (the name of the peak means ‘Don’t go there’) at 4 pm on the Thursday and was persuaded to wait until the next morning. He then left his rucksack with the hut watchman and set out on his own in a pair of sandals without a guide. As you will have guessed the mist came down and he never returned. Also, you will have noticed that we only got there on Tuesday. A couple climbed Sapitwa on the Saturday but found no trace of him. What do you bring up a mountain in terms of resuscitation equipment when someone has been missing for three days already? We didn’t know initially how badly prepared he was and had hoped that we might find him sheltering in a cave or having fallen but equipped for the cold. It became apparent that we were more useful running an aches and pains clinic for the porters, and prescribing metronidazole for a case of bloody diarrhoea.

We went out in three search parties for three days, searching rivers, caves and other peaks but didn’t find any evidence of his having been there. The Brazilian government got involved and scrambled a helicopter from Mozambique which accompanied us on Thursday and Friday, the weather having been too bad before that for it to fly. Nothing. It was perishingly cold at night, and every morning we woke to frost on the ground; the first night was minus 10. It was decided by Friday to scale the operation down and so we left, feeling uneasy but realising that to continue looking was futile. 

Four days of feeling cold, not washing and being covered in soot from the woodfire which was our only source of heat and light is quite a bonding experience and I am very glad that the guides and porters were good company and weren’t scornful of having a woman involved in the effort! One of the guides was 72, and had been climbing in Mulanjie since the 60s! He was short and wiry, walked with a staff, and bearing an uncanny resemblance to Yoda seemed to materialise out of the mist whenever anyone was in trouble. 

Every morning when we woke up we asked everyone else in the hut if they had woken well, (Madzuka blwanji?) which is the traditional morning greeting. The answer, of course, is I have woken well (Nadzuka bwino, zikomo). On Friday morning having gone through this ritual every day, I looked around at everyone’s bleary crumpled faces and said, “But we are all lying! We all ‘woke cold!” It just requires more vocabulary than I have to go off piste with traditional greetings!

It is a desperately sad reason to have been there and regrettable that we did not find him, but I don’t think we could have tried harder. I hope that no one I know ever goes climbing on their own. If you do, don’t tell me about it.

Chichewa Guide For Tourists 14th July 2009

Ask anyone who has been in Malawi for longer than a passing visit if they have seen the Chichewa guide for tourists and they will either laugh or start quoting the ‘useful’ phrases from the book that was originally printed in the 70s. Such useful phrases like, ‘Give me the gun’, and, ‘Don’t shoot until I tell you’, immediately followed by, ‘I have been wounded.’ and, ‘Where is the hospital?’. 

Under phrases useful for camping is the chat up line, ‘There is a fine moonlight’ = ‘Mwezi wawala bwino’, should you find yourself in a position to use it. I might try it this weekend.

And just when I am beginning to despair of ever grasping the language, gems of words present themselves: wilibara (wheelbarrow) and jekeseni (injection) and my favorite, tipoti (teapot).  

Respect for patients 13th July 2009

This week at Queens there is a VVF workshop. Vesico-vaginal fistula (VVF) occurs when a woman has gone into labour but due to the baby not lying the right way, or the mother’s pelvis being too small; the baby can’t come out. If this happened in the UK or even in the city in Malawi, there would be a cesarean section. When it happens in the village here the woman remains in labour for days, the baby dies and eventually is stillborn. As a result of the prolonged pressure the women develop a false passage resulting in a constant leak of urine. Because of the still birth and the smell associated with the leaking urine the women are invariably quickly divorced and become ostracised in their communities. One woman on our list today was 17.  She had already been divorced by her husband simply because she had borne him a dead baby. She had no prospects of re-marriage, no prospects of work; she was destitute.

Sadly, this being treated like dirt sometimes continues in the hospital when they present for their operation. One woman was scolded by the clinical officer because she flinched when the spinal needle was introduced without local anaesthetic. We have local anaesthetic. It takes no time to draw it up. It is a mindset of not considering patient comfort not to use it (Where does patient comfort come in the scale of survival?). The woman didn’t expect to be treated any differently. She was poor. She was HIV positive. She was being treated like scum; she thought she deserved it.  

I felt ashamed that she should expect to be treated like this. But how can I comment? I don’t live here. It reminded me of an encounter the Bible says that Jesus had with a woman with a similar problem. She was being hassled by the crowd and didn’t dare to take Jesus‘ attention to ask for healing, so she just touched the hem of his garment and was healed. Jesus stopped and spoke to her as if she were valuable and she is amazed. 

Thankfully, when I went back to Queens on Wednesday, there are different clinical officers and they are kind and address the women as ‘a-Mai‘ which is the respectful term. Surgery for these women has the potential to be nothing short of life changing and it is a privilege to be able to treat them with respect as well as to be part of the process of healing.

Annoyance 13th July 2009

I was cross at work today. I rocked up to obstetric theatres and realised that one theatre was unstaffed by anaesthetists. After asking Beauty, one of the ACOs (anaesthetic clinical officers) about it we decided I should set up in theatre one, Rose would do theatre two and Beauty would do theatre three. So I got busy. Sometimes things wash over you, sometimes you let them wash over you. Today was neither of those days. The theatre was a pig sty. The pressure bag for fluid infusion still had blood on it. There were unsheathed needles on the floor and a discarded scalpel blade on the theatre trolley. The emergency drugs had been left out of the fridge over the weekend and in fact had been drawn up on the 6th of July. Some of them had been partially used, potentially between different patients. I went in a huff and tidied the place up and then asked where the list of patients was and if anyone had seen them pre-op for an anesthetic assessment. No, they hadn’t been seen. No, there was no intention of going to see them, we would just assess them in the corridor when they were taken to theatre. So, my first patient was sitting quietly wrapped in a torn sheet in the corridor on the narrow wooden bench that counts for a sorry reception area. I managed to appropriate a scrub nurse and asked him to translate for a quick history. He was irritated at having to help and in response to my enquiry, ‘Is she taking any medication?’ said, ‘Of course she is!’ I needed to know what that medication was. He said it’s in her notes. I asked if he could find it there because I couldn’t and patients never come with their drug charts. He couldn’t find it and just repeated ‘Of course she will be taking medication on the ward but she won’t know what it is’. 

I then asked if she had a cough or cold, and I caught snippets of the conversation between him and the patient which went something like, 

‘Do you have a cough?’ 

‘Yes’

‘Are you coughing a lot?’

Yes.’

‘REALLY? Surely you are not coughing all that much.’

‘Well, no, not that much.’

Then to me in English, ‘Of course she is coughing: it’s winter.’

He then let his annoyance get the better of him and said, ‘You must learn Chichewa’. I said ‘I am trying!’ but he cut me short and said, ‘No! You must not TRY, you must MEMORIZE! It is simple!’ 

I was hurt, he was annoyed, the patient embarrassed; not a good result.

The surgeon breezed in ten minutes later and informed me that we were not using theatre one today. 

Desflurane and other white elephants 8/7/9

Today I went into the store cupboard at CURE to find giving sets for the intravenous drips. I couldn’t find them so was having a good old rummage around the store cupboard which is an Aladdin's cave of equipment that has been donated from overseas. I had plenty of time so I thought I would have a nosey. In a box by the door I found 16 bottles of desflurane. Desflurane is the most expensive volatile anaesthetic, and we are ‘strongly encouraged’ not to use it back in my base hospitals in London. Not only that, but it needs a special vaporiser with a heating element and a computer chip to deliver it. Needless to say, we don’t have the vaporiser. 

Also found were arterial cannulas (we don’t have the capacity to monitor blood pressure invasively and there is no blood gas analyzer in Blantyre, let alone our hospital); six anaesthetic monitors that we can’t fix because there are no spare parts; and a rather retro square stainless steel unit with a drawer in it that looks like it was used in an American hospital in the 1950s. I have my eye on that wee trolley for a storage unit for my bathroom, but I’m pretty sure leaving the hospital with equipment is not conveying the right impression. So it stays in the store cupboard, next to the relics of anaesthetic memorabilia, taking up room and making no one happy.

Independence day celebrations 6/7/9

So, Monday the 6th of July is Independence day in Malawi. the slogan is “from poverty to prosperity”. I’m not sure it has been that straight a road. The first president was a dictator and people who disagreed with him disappeared. He ruled for 20 odd years but in the way that history gets rewritten by the strong, he is somehow remembered as a good man. The Independence day celebrations were held in a 68,000 capacity stadium named after him (Kamuzu Banda). Some friends from the UK tried to go but the gates had already been closed by 9 am because it had reached capacity. Several Malawians suggested they could easily bribe the police officials to get in, but they thought that was surely the kind of double standard that the independence day was trying to disband! Apparently, from work colleagues who did get in (didn’t ask if they paid a bribe but one of them is related to a police official), it was a brilliant spectacle, slightly tarnished by the presence of a Robert Mugabe. Allegedly, Bingu’s first wife was a cousin of Mugabe and therefore that entitles Bob to guest appearances and even a major highway in Malawi named after him. In return it meant that Bingu’s wife was gifted a farm in Zimbabwe when it was taken off the white farmers. What a disappointment to hear that Bingu is involved in anything to do with Mugabe’s regime. I went to a play by a local theatre group a week after the independence day celebrations and they were very vocal in their distain for Mugabe. And also, even more daringly, challenging Bingu not to be like him. So, at least Bingu allows freedom of speech. I hope that doesn’t change.    

Singing in the church at Mbame 5/7/9

Well, there was a big party out at a village called Mbame on Saturday for a few of the doctors who are leaving. It was an all day and most of the night affair. Some of the people from the village started up a sing song which snowballed into a practice session for church the next day. One of the doctors who is leaving had always wanted to sing with one of the choirs so she volunteered us to join a group of 5 who regularly sing at the local church. Only problem was, this was Saturday night, and they take their singing fairly seriously which means turning up for at least two choir practices a week. So we were cutting it fine, but what could we sing? I’m still not quite sure how it happened but Sunday morning found us taking our turn and singing Joy to the World.  In July. And only two verses. Even then we didn’t get the words right (can you remember the words to the second verse? Exactly: which one is the second verse?) I don’t think the congregation laughed at any of the other choirs. Its not just one church choir at Mbame. There are several groups and each takes a turn at singing a wonderfully harmonised medley of three or four well rehearsed songs. So we slotted ourselves in and sang just the one unseasonal, badly rehearsed song and then skipped back to our seats in a short lived daze induced by lack of insight. The minister then welcomed the visitors ( about 7 stragglers from the party the night before) and then casually suggested that the visitors sing a song all together. Once we recovered from our impressions of zebras pretending that the lions can’t see us if we stay very still, we had a short con-flab and three of us girls got up to sing a song called ‘Father God I wonder...’ which, in retrospect, was quite appropriate. i.e. Father God I wonder how I ever got myself into this / how I can get myself out of this / what possessed the minister to ask us to sing, AGAIN. And I never realised that the key to that song was so tricky. As we sat down, not yet having processed the full embarrassment of our (entire) performance the minister announced that the reason why the church was so full today was because there was a choir festival on after the service. Strangely, we were invited to join as a late entry. Insight having just set in, we declined.

I think we should have given our choir the name, ‘it seemed like a good idea at the time...’.

Toolbox anaesthesia

I have officially arrived as an anaesthetist at Queens, which is to say, I am now the proud owner of a baby blue toolbox. All of the clinical officers carry around a toolbox with their basic drugs and equipment in it and I finally got mine last week which was pretty special. I was also presented with my very own laryngoscope (without the batteries) and allowed to do a pretty tricky case all on my own (with a borrowed laryngoscope). Patient and I are both doing fine. 

  

Communication 1/7/9

Today I’m at Queens. One of the clinical officers has left for the morning and so I’m left to anesthetise a cesarean section on my own. I ask the obstetric registrar to translate and ask the woman a quick history and explain what I need to do (a spinal). Then the obstetric reg has to go and we are left waiting for over 3/4 of an hour for someone else to come and do the case. Its only me and the woman in theatre and my chichewa phrases are not sufficient for more than a few seconds worth of conversation (Good morning. Are you cold? Do you want a blanket?) and so she lies with her face to the wall just waiting patiently for whatever to happen. She is  a little sparrow of a 23 year old and she looks frightened but I can’t do anything other than smile and look like an idiot when I can’t understand her. So much of my job in the UK is calming people down when they are worried about the surgery or the anaesthetic, but I am powerless here, in fact I probably compound the issue because she is worried I won’t understand if she says she is in pain. Eventually a lovely Kenyan trainee clinical officer turns up and says all the reassuring things I should have said if only my brain worked in Chichewa. 

I just mention it for anyone who thinks that anaesthetists don’t have to speak to patients!

My route to work 30/6/9

So, now I have officially started training for the 1/2. Or rather, I have had to give the car I borrowed back and now I have no other way of getting to work which is about 4 and a 1/2 km away. So I run to work a couple days a week. To get to work I turn out of my road onto a main road and then turn down a dirt track that goes past a school. Lots of kids walking to school (which starts at 7:30!) who want a high five and lots of “Chap!” which is kind of a Chichewa version of “Whatz up!”. I then turn down a road which turns into a bit of a hill until a junction right in the centre of town where the traffic lights never work. After dodging the lorries, and Toyota 4x4s, and the women carrying random objects on their heads, I drop down into a bit of a valley where the Blantyre market sits either side of a pretty sludged up stream. During the day you can hardly drive through here in anything above first gear for the crush of people but early in the morning its just people trying to get a lift to work on one of the minibuses. A couple other people are also running to work, but they are all men and none of them have the luxuries of running shoes or music. Its not a game for them, but they wish me good morning in return for my wheezed greeting. Then there is a very long up hill where the minibuses packed to overflowing grind their gears and belch out black smoke. I wonder if it is feasible to walk this bit? The last bit involves a turn off past some nice houses, through the gates to the college of medicine and I duck into CURE using the back entrance which is just as well. I pass the children’s ward on the way to the theatre changing rooms and a few of the kids stare - they tend to stare anyway at any white people who come onto the ward but I am quite sure they have never seen a purple person before.

Victoria Falls Half Marathon 23/6/9

A friend of mine who some of you will know, Beth Capper, is working in Zambia, next door to Malawi. We have been trying to arrange a suitable time and place to meet up but so far have been unsuccessful. Beth emailed the other day and suggested we meet by doing the Victoria Falls Half Marathon in Zimbabwe at the end of August. In my head I said, ‘no way’, but for some reason I emailed back saying, ‘Vic Falls - sounds superb - count me in’. So I now have less than two months to train for a half marathon when the last time I did one it was all down hill and I still promised myself I’d never do one again. The blurb about the race on the web says something rather vague about running through national game reserves but not to worry, they know about the lions. Im not sure if that means they will be keeping the lions away or using them as an incentive for us stragglers at the back.

Moving house 24/6/9

So! I have finally left the guest house and moved into a house vacated by the last orthopaedic registrar. Its in a district called Namiwawa on the other side of Blantyre to the hospitals. I have a little verandah out the back which looks onto a garden of frangipani trees (my favorite!), borganvillia, poinsettia and hibiscus. Oh, and did I mention the mango and papaya trees? I have the house to myself for a few weeks until the new orthopaedic registrar and his wife arrive. It has got bitterly cold over the last week, though, so I am not getting the benefit of a house made to lose heat! I was out watching wimbledon last night with my beanie hat on and seeing the cloudless blue sky in London and feeling very jealous. Its not supposed to be that way round! 

Religious differences

I was chatting to some of the clinical officers at Queens today during a lull in proceedings and it became apparent that they did not think I was a Christian. I said that I was and one of them looked shocked and blurted out, “but you’re white! I thought all of you foreign doctors were pagans.” Those were her words not mine! It amused me that the perception in the UK is that Christian belief is a simplistic way of looking at the complexities of life, whereas here it is the case that the Malawians see us westerners as being narrow minded in our agnosticism. It turned my way of viewing things on its head. 

The Malawian midge.

Having been bitten alive by many a cloud of midges on the west coast of Scotland I did not think there could be any competitors for the title of most irritating insect. However, after spending the weekend up Mulanjie again this weekend my ankles were the location for a midge smorgasbord, and the effect is much longer lasting than a Scottish midge bite. Imagine, on the monday morning, trying to site a spinal (a very small needle with no guiding introducer into a very small space) with size eight gloves (size six hands) whilst trying not to hop or jump up and down with the urge to itch the 20-30 welts that have come up on each ankle. Thankfully, the spinal went in a treat and I was able to retreat to a corner and whimper. I think my legs are going to stay white from lack of exposure from now on. Apparently the pests that bit us are the type that carry river blindness, but only cause symptoms to worry about after chronic exposure. I wonder how chronic is chronic and can you have all your chronic exposure in one day?

Botched attempt at departmental patch-up 23/6/09

So, early on I said one of the clinical officers made it quite obvious she didn’t want me here. I have tried most tricks in my power to win her over but so far have not made much headway. So, this week I did the British thing and invited the two clinical officers and the other UK anaesthetist and his family to my house for tea. However, earlier that morning, the Moody One asked to go to the bank and then didn’t return ‘til the end of the list! In fact, I found her at 3pm texting in the changing room where she had intended to stay! All I could think of to say is “oh, you’re back.” Not really dealing with the issue. We then finished late but she and aunty P wanted to have showers before coming to mine. So, we arrived at my house an hour later and as we approached I was aware of the lack of lighting in my neighbors houses. Again, showing a remarkable ability to ignore the issue I continued to park, get everyone out, unload the shopping, unlock the front door and switch the lights on. Only when the lights did not obediently come on did I accept that we had a power cut. In the hospital guest house we had power cuts about twice a week but I had only moved into this house last week and hadn’t had a power cut yet. So, it was bound to happen, and bound to happen when I had invited people round for dinner.  So we bundled back into the cars, me trying to make erudite comments and witty conversation and drove across town to Roy’s where I cooked an average curry and a less than average desert. Certainly not a Babette’s feast suitable for bringing about reconciliation! I am still smarting this morning at the failure of it and the lack of ground gained, other than them seeing that I live in a disproportionately large (although dark) house and that my cooking skills are not up to much. 

Safety in practice - an ammendum 22/6/9

So, a couple weeks ago I was holding up lists to dutifully put monitoring on everyone. This week we had over 20 women on an afternoon list. You can’t rebook them tomorrow as there will be a roughly equivalent number   

again. So I morphed into a finger-on-the-pulse anaesthetist and used a solitary oxygen saturation probe (a clip on the finger). I later found out the blood pressure cuff didn’t work anyway. And the ECG stickers had perished months ago. We still overran, which means leaving after dark, not a problem for me as I have a car but it is a problem for those who walk home. I end up driving around Blantyre giving people lifts home, and then feeling awkward and guilty because even the relatively well paid clinical officers live in the townships. Being here certainly doesn’t make you feel good about yourself.

Presidential helicopters 19/06/09

A helicopter has just flown overhead. Not that weird in London or the Highlands but there is only one helicopter in Malawi and it belongs to the president. There is an international trade fair in Blantyre starting today and he has gone to open it. The Malawian economy is one of the poorest in the world with 80% of the population earning less than a dollar a day, but last year the GDP grew by 8%. Bingu seems to be a rare breed of African president in that he has plumbed the money handled by the government back into the country’s infrastructure and has made some wise trade decisions and everyone is very thankful that he got re-elected. Perhaps the British MPs should take notice.   

Hippos, bartering, and a car full of maize

There is a camp on the Shire river where, once you’ve taken a small river boat across from a rickety jetty you can watch hippos wallowing from the front of your hut. The banks of the Shire river at that spot have remained untouched, it seems since the dawn of creation. As we crossed the river we wondered what might have been going through David Livingstone’s mind as he contemplated the same scene. It is a beautiful slow meandering river and it was a gift to be able to sit and relax there. 

On the way back, we stopped at a roadside stall and instead of money the guy asked if I had any clothes or shoes to barter. I had my Aviemore half marathon T-shirt with me so he swapped me a carved hippo for my T shirt. I would like to think that the Highland tourist board will see an increase in visitors from the tourists who stop and see him wearing my promotional T-shirt.

Further down the road we stopped to buy some plant pots. Sat to the side of the stall was a woman with a baby on her lap, three sacks of maize, an oversized battered suitcase and a bag of beans. She had been waiting for someone to stop to give her a lift to the next town but hadn’t got anywhere because of all of her stuff. Even the minibuses weren’t stopping for her. So we loaded our car with suitcase, baby, sacks, beans and sizable woman (by the name of Modesta) and off we went. I could only think of the little white van which listed to one side when Mma Ramotswe sat in it. She had no English  and we next to no Chichewa but I’m reasonably confident we dropped her off where she wanted to go. I would like to think I would have given her a lift anyway but I’m sure our good deed was in part to offset the uneasiness at having spent a relatively luxurious 24 hours at a safari camp that most Malawians can’t even begin to contemplate staying at. Motives are difficult things to decipher.

Advanced Life Support teaching 12/6/9

This afternoon was the second teaching session in the resuscitation training course I have been asked to run. Last week’s basic life support seemed to go well and I was expecting the same people again this week. However, the word had spread and several more people turned up this week who hadn’t even done the basic life support course. Not only that, it became apparent that only one or two of the clinical officers knew how to read an ECG - which makes interpretation of the ALS algorithm difficult! I ended up spending a long time talking and not enough time actually doing scenarios so it was a lesson in knowing your target audience and quantifying who is going to pitch up! We had one functioning resus dummy and one broken one between 14 so we muddled through. I imagine less people will be turning up next week!

The girl who is always jumping 11/6/9

I think it is an indictment on my inability to relax at work that one of the clinical officers referred to me as the girl who is always jumping instead of drinking tea. I think there is probably a happy medium as tea break for her means an hour out of theatre, but perhaps I also need to learn to slow down. I rarely finish my cup of tea even when I have it. I think I will have to make that a mid-year resolution.

evening worship 10/6/9

I am writing this at quarter past 7 in the evening at CURE as the electricity has gone off at the guest house. I am upstairs on the admin corridor. Downstairs, the staff are having their evening worship session. I wish I could record the singing. I have yet to meet a Malawian who can’t harmonise, let alone sing. They are singing a song just now that roughly translates to, if I were to entrust anyone else with my cares they would all run away but Jesus is strong enough to take whatever we commit to him. Songs are a great way of learning chichewa! I was at a church in a village outside Blantyre this weekend and they had awesome singing. Even the women’s guild were fantastic...no warbling falsettos and not a single sharp note. 

moving and handling

It is a good job there’s not much of a problem with obesity here as we do a lot of hauling patients off operating tables onto trolleys. No pat slide and it is often just two of you. I’ve usually got the head end which in the UK just means holding the head whilst at least three others slide the patient across, but here means that I haul the upper body and someone else gets the legs and hips. Arms can be a dreadful bother when you’re trying to move a sleeping patient. Or if its only me, I pull the top half of the patient across, walk round and then line up their bottom half and hope the table and the trolley don’t slide apart in the interim. Strangely, though, I haven’t heard of anyone being off sick because of their back.

safety in practice 8/6/9

So, this afternoon I found myself doing a gynae procedures list at Queens. The gynae / obstetrics theatre is  in a separate building to the main theatre block and has three operating theatres. Well, two and a cupboard which doesn’t even have a door just a curtain. I was in the cupboard as these were all minor procedures. So 5 women at a time pitch up and just sit in their chitenjes (like a sarong) waiting outside. They come in hop up onto the table and get a concoction of diazepam and ketamine. I held the list up because I put monitoring on everyone. Apparently thats not how its done. I came here thinking that if there’s monitoring I’d use it but now I wonder if maybe I’m being too obsessive. One of the clinical officers kept coming in and switching all the monitors off when I wheeled patients out. I think he was trying to give me a hint but I just switched them all back on.  The gynae surgeon even said ‘ aren’t you using ketamine?’ in effect saying, why are you bothering with monitoring and oxygen when you’re keeping them spontaneously breathing. I don’t know if what I did was right. All the clinical officers keep a finger on the pulse even when using monitoring and there’s a lot of information to be gained from a precordial stethoscope. I’d like advice if there’s any out there!

Yanganan'i pan chombo = look at your belly button

I have asked the clinical officers to teach me some useful work phrases like, ‘take a deep breath’, ‘open your eyes’, ‘are you ok’, and my personal favourite, ‘look at your bellybutton’ which is exactly the position you want someone in to do a spinal, but not much use in social interaction. Perhaps I should concentrate on ‘Hello, what is your name?’ but then why start at the beginning.

I have started getting Chichewa lessons on a thursday evening which is a disillusioning hour of stumbling my way through sentence structures that I haven't had to think about since school. In fact, my teacher asked to finish the lesson early this week, apparently to go get tickets for the Malawi Ivory Coast game this saturday, but I'm not sure that he wasn't nursing a sore head.  

First day at Queens 25/5/09 Mainly of anaesthetic interest!

I went from that to my first day at Queen Elizabeth Central Hospital where I was put onto an obstetrics and gynaecology list, but thankfully not on my own and was shown how things are done by some very fine clinical officers. For the non medics you should look away now! Queens use draw over vaporisers and glostavents so I was glad I went on the course in Uganda last year so I didn’t look too clueless. Recovery is an unstaffed corridor with no monitoring, no oxygen, just trolleys lined up along the wall but there were, I’m glad to say, no untoward events! One effect of my time here is that I will appreciate recovery staff more when I go back to the UK! 

In the afternoon there was an emergency cesarean section. The mother’s uterus was necrotic from having been in labour for days as she had come in from the village and as a result the baby was stillborn. The woman continued to haemorrhage but there was no blood to give her and no oxytocics (drugs to tighten the uterus and stop it bleeding) beyond syntocinon so she ended up having a hysterectomy. All together the situation was really well managed and the mother well cared for. Queens run an ongoing audit of maternal deaths and they have only had one since January which is amazing in a country where the maternal mortality is staggering. Still births, however, are sadly not that uncommon. There is no paediatric or neonatal intensive care so if a baby has appalling apgars (a scoring system for the health of the newborn baby) they just don’t make it. Rather than be shocked by the equipment they don’t have here I was impressed by what they did do really well in spite of the lack of resources. The clinical officers work really hard, and there aren’t enough of them. 

My next day on obstetrics I was asked to step out and help cannulate a baby. When I looked in the corridor there was a cot unattended that one of the nursery sisters had left outside the theatre. I looked inside and pulled back the swaddling and inside was a scrawny scrap of premature humanity, probably about 6 weeks premature. I have never cannulated a newborn baby let alone a sick prem and the thought that I would be best at this was a joke. Thankfully one of the senior clinical officers saw my eyes standing out on stalks and gave me a hand and was successful with the cannulation. Premature births here are very common, Maternal HIV often results in early delivery and I don’t envy the paediatricians who try their hardest to throw what they can at these kids to give them a chance of life but without recourse to a neonatal intensive care. 

It was a couple of days of having my head submerged in the grime of unacceptable poverty but a day where I believe the care given to these women was outstanding and I was humbled to be witness to it. I think that’s why I have been away most weekends since I’ve come here. Work is a sensory overload and people choose to escape from that in various ways. 

Lujerie tea estate 23-25/5/09

Well, I’m not sure if I should really confess to having spent the weekend on a tea estate just in case there were still a few people remaining who thought that I was toughing it out in a mud hut somewhere. 20 of us, mainly people working between the government and the mission hospital went away to Lujeri which is about an hour and a half’s drive south of Blantyre. We went for walks, swam in natural pools and threw ourselves off waterfalls, and then chilled out with dinner on the verandah of the main lodge. It did me the world of good.

Man-Malaria

One of the doctors at Queens has come down with malaria. He was out for dinner with a few of us the other night and he felt a bit fluish. He went to work the next day and did a blood film and it came up with 1+ of malarial parasites. I was shocked but the seasoned infectious disease doctors here were un-impressed as the scale goes from 1+ to 6+. Which means he has the sub-saharan equivalent of man-flu and as a result has received no sympathy. 

0 - 60mph in a day

I have already mentioned that CURE have had to reduce their paediatric operations, which are performed for free, because so much funding has been withdrawn because of the global recession. So I have been feeling a bit frustrated as there are two clinical officers, a consultant anaesthetist and me...for two theatres - and even then there are maybe 3-4 cases on each theatre list each day instead of double that number which was their norm until January. So some days we are finished at midday. It adds to the thought ‘what am I doing here?’. 

So, today I went across to Queen Elizabeth Central Hospital which is the government hospital up the road. The head of the anaesthetics department has been away til this week. So I tracked him down and he was more than glad to have an anaesthetist working for free! So I am now going to work at Queens on Mondays and Wednesdays and alternate Thursdays and CURE Tuesdays and the other Thursdays. That leaves Fridays when I will do audit / research / teaching at CURE. The teaching programme starts in two weeks, as does a big audit of pre-operative nutritional status in the kids at CURE. 

I shouldn’t have complained about not being busy.

General elections 19/5/09

Today is a national holiday to allow everyone to vote. The urban areas are strongholds of the incumbent president but the rural areas are strongholds of one of the opposition candidates who it has been suggested was responsible for his opponents ‘disappearing’ at previous elections. Malawi is 80% rural, 20% urban - the opposite of most developed countries - so the race is certainly not over although it seems Bingu is in without a fight here. We have been praying for wisdom in voting but also peace around the elections. I wish I could show you a picture of the snaking lines out of the polling booths...if only I could upload it!

CURE 10k fun run

Today was the 10k fun run to raise money for the hospital here. It was a cloudless sky and although the run started at 8am I still got tatooed by the sun with a nice T-shirt line round my neck. The executive director tells me he has a picture of me after I’d finished, but I’m sure the glare from my bright red face would have ruined the exposure. I have been trying to add photos to this blog but it takes so long just to upload words that I have usually lost patience before the photo appears so I’m afraid you’ll never see that photo. Shame. 

Gaining ground 15/5/09

If you read the entry ‘clash of agendas’ you will know I’ve found it difficult gaining the friendship of one of the clinical officers. I have been advised that taking her out for steak in an overt display of bribery should help! (thanks Liz!) My heart soared today though when the more senior clinical officer had a quiet word in my ear and gravely said, “You are now ok to be on your own in theatre”. That is commendation indeed! Especially as I have had to learn how to use Halothane (hardly ever used in the UK any more - I’ve never seen it used ‘til now) and get used to putting in caudals (like epidurals) with large gloves as thats all we have!