monday

I walk into H’s room to the sight of his bloodshot eyes open wide in panic, coughing harshly and pulling away from his wife who is pouring a white liquid into his nasogastric tube. I hold my hand out and shout, “Wait!” startling the family surrounding his bed.

H has been confused and lethargic since he came in yesterday and now he sits nestled in between his son’s legs, his head resting on his son’s chest. I have no idea what I’m doing but I’m pretty fucking sure that ng tube is in his lungs instead of his stomach. I listen to his stomach as I use a syringe to blow air into the tube but I don’t hear the abrupt gurgle of bubbles. I try again. No difference. I tell his family again to stop and wait with as many hand gestures imaginable. I don’t want to freak them out but I also don’t want them to drown their already sick father. The son, who looks like a shorter Charles Barkley, seems to understand.

I find Grace, a young nurse who looks like the prototypical 1950s nurse of pin up dreams with her nurse cap and uniform and high cheekbones. Except she’s African.  I ask her if they did an X-ray to confirm placement of the ngt but know even as I ask that it’s a stupid question. X-rays are expensive and patients foot the bill for their healthcare costs. She tells me the ng tube was working fine earlier and that someone else placed it. I make Matt take a look at it and we remove it, ordering another to be inserted. We leave to see a surgical consult: breast mass. A petite lady takes off her wrapper and she’s holding what looks like a cantaloupe. The biggest galactocele either of us have ever seen. After several unsuccessful attempts to drain it I return to Mr. H. Still no ng tube. The older nurse who placed the first one yells at me for taking it out and tells me they’re too busy to replace it. I finally beg Stella to help me place it and with only 30 min left in her shift I don’t think she’s happy about it but she complies.

Later at the guesthouse I complain that it’s almost worse than working with the nurses at the va hospital. Matt makes a good point and says the difference is that the va nurses are (or should be) aware of the harm they’re causing. Dr. Kamwendo admits it’s frustrating to wait. Wait for lab results, glucose checks, and meds to be given. It’s been hard to get the employees to take ownership, he says. Dr. Hayton’s culturally sensitive explanation is that Malawians have the belief that they are not in control. Whatever will be, will be; regardless of whether the ng tube gets placed or meds get given or labs drawn.  Meanwhile, he says, Americans have the opposite problem – we think we can control everything. He cites the serenity prayer often: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Americans lack wisdom, and Malawians have too much serenity, he says. It must take a lot for him not to turn into the angry white man when things don’t get done. He doesn’t though. He doesn’t turn into the spluttering angry white surgeon when the scrub nurse tells him to close up a bleeding wound since it’s 4am and everyone is tired. Talking with Dr. Crounse this morning in his small overstuffed office, I could tell that he was tired and weary. Still, he is hopeful for change. But change is hard.

They say patients can survive with bad doctors, if they have good nurses. But if nurses are bad, patients die even with good doctors.

Before we send more doctors here, we need more good nurses.

 

Sunday

Last night I met all the missionary families, the Haytons, the Crounses, the Blanchards, and their beautiful children. All I can say is that when five kids <6yo get together the energy is bananas. These mission wives and their families are brave and resourceful and sweet. And complex in ways I don’t know how to write about yet.

I slept in til eight today. Woke up and just lied there not wanting to leave the warmth of the bed. The blankets are 담요’s, thick polyester blankets that are like the ones every Korean family has by the dozen. I wake up to emails and texts which make me happy.

The sky is blue and dotted with fluffy clouds. The air smells clean the way it always does after a rainstorm.

Hours pass the way it can only on quiet Sundays with no plans. I get restless and go for a walk, still too gun shy to wander too far though. They call me mzungu, and it’s funny how the word for foreigner is almost always the word for white.

At night we head to Dr. Kemwendo’s house to watch the game. We crowd around a 18 inch TV sitting on an assortment of chairs and a mattress to cushion us from the concrete floor. Along with a table, that makes up all the furniture in the living room and I guess that they are stilling waiting for their things to be shipped/mailed/moved. We don’t need furniture tonight though. All we need is the TV and Dr. Fekadu yelling his high pitched screams and shouting “Beautiful!” over and over again. We drink the overly sweet and tart sobo orange soda and eat popcorn and turnovers that Gloria made for us, the ragtag guests and doctors. We leave at midnight. Tomorrow will be the first real work day.

 

Saturday

I woke up in the middle of the night again but I’m still surprised at how well I sleep here.

Gathered my things to do yoga and devotional this morning, but saw Amanda eating breakfast and dressed for church. I decide to go with her. It’s drizzling slightly when we head out and I feel a little silly wearing flip flops but it was either that or my converse. By the time we get to church the backs of my legs and hem of my dress are splattered in red mud and I feel horrendously underdressed. Not many of the ex-pats attend the English service and I don’t know if that’s because it starts at 730am or because the members are mainly students who are required to attend. They all look young and are dressed smartly. The girls wear heels and stockings. One of the ushers wears a light blue bow tie, magenta dress shirt, and brown velvet blazer. So much swag.
It’s not often that I feel embarrassed at church but I do. It sounds silly to say but the people here are much more, for lack of a better word – affluent than I expected. In Haiti we wore the same run down clothes in clinic and church. I’m further embarrassed when I realize I didn’t bring any money for tithe. When you’re a foreigner it feels like you’re in a fishbowl sometimes and I sheepishly pass the collection plate along.
None of this matters when the eight students in the front of the church start to sing, though. There is something about church music and acapella and the richness of their voices that absolutely shatters me. Oh. So this is what church has that my little Oswald chambers devotional does not. One of the guys really gets into it, closes his eyes, and does an involuntary wiggle with his shoulders that makes the congregation erupt into giggles.
The pastor preaches about marriage and earthly families. We read about Hannah and Samuel. A bible story I haven’t revisited in a long time (though let’s be real I haven’t revisited most of them since first reading). Elkanah had two wives but he favored Hannah.
All throughout the sermon, a bell clangs annoyingly at improper intervals. The village kids get their hands on it and go to town.
I whisper ask Mandy if it’s rude to take a video of the singers. She’s unsure but I do it anyway. They are so good I want them to go on the Malawian version of Americas got talent or American idol if such a thing exists.

The next several hours are spent in silence. It’s the sabbath of my youth, except now there’s internet. And I read Imperfect birds and drink tea and listen to the rooster crow like it’s sunrise when it’s not.

Friday

Tags

africa, hiv, malawi, travel

The sun sets earlier here.
By six pm the sunset was already overtaken by the inky blue night and by eight Matt and Amandas had fallen asleep on the couch, lulled by the white noise of a crackling fire.

My first actual day here and it was good. The only reason I managed to wake up on time was because my body still doesn’t know what time zone it’s in.
We went to worship at 7 and we sang some hymns in Chichewa and someone read from Ezekiel. There’s a book I haven’t heard about in a while.
They introduced me in front of the staff and I never know quite what to say about my situation. I usually tell the truth, just not the whole truth.
I met dr. Hayton who I admit I was a little intimidated by just based on what I had heard about him being a typical surgeon. I found him to be a humble yet confident leader and I’m glad he’s here. He took me on the tour of the hospital and the grounds and talked with me about the importance of sustainability in global health and the mission field in general. The exterior of the hospital is beautiful. All red brick and open arches lining the breezeways.
I end up in rounds with dr. Kemwendo and Stella, one of the clinical officer students. The prevalence of HIV and tb are immediately apparent as one in every four women we round on are sero reactive. Every pulmonary complaint is suspicious for tb. Later we talk about how the rate is something like 16%, but in the district we are in it’s more like 38%. I can’t wrap my head around that number; it’s so high I’m skeptical. Amanda from Canada tells me we don’t make the patients with tb wear masks because it stigmatizes them.
My brain runs like wheels spinning in sludge as I try to drudge up the facts I learned on flash cards and study sheets and promptly pushed aside when I decided to go into psychiatry. The first patient is a man with ascites tho. Or rather abdominal distention. He says he’s proud of his notoriety as the town drunk. I do hear the Malawi rum is bomb. Make a mental note to pick some up before I leave.
Rounds are finished by 1030 and I twiddle my thumbs while Stella writes notes. I wish I knew more. I wish I could be more useful. Matt is a fourth year surgery resident and he functions like an attending here. Providing much needed coverage for the surgeons esp on weekends.

On my way home I miss a turn and get a little lost.

I think that it’s been a good day and then a text from Francine reminds me that my whole family is at my uncles funeral and I’m devastated I’m not there.

Here

Tags

africa, malamulo, malawi, missions, travel

It’s Thursday already. Somehow. I left on a Tuesday and suddenly it’s Thursday and I’m in Ethiopia waiting to my board my last plane

Having a bit of an out of body experience as I wait in line for the security checkpoint. There were 15 infants and several kids on board my 12 hr flight from Washington DC to addis Adaba and counting my red eye inTo DC I think I slept a total of three hours these past 24. Feeling acutely alone now, as I hope that I’m waiting in the right line and make my flight in time. I start paying attention to the overhead announcements, and ask an airport employee as he walks by if I’m in the right line. He points me to a shorter line and I’m whisked into security where they confiscate my reflex hammer for being too pointy. It was probably pointless for me to bring it anyway. The last couple days before leaving were spent scrounging up my medical equipment after almost a year of disuse. Let’s hope I still remember how to do a physical!

An hour later, after a pit stop in Lilongwe, we are in Blantyre. Danika kept telling me how green it was here but from the plane all I see is brown. I’m tired and i want to go home and i laugh to myself because i haven’t even arrived yet (I also fear ate a burger at 9am in DC since I didn’t know when I would eat red meat before I got back). I have a mild heart attack when someone checks my passport before we reach customs and asks for my yellow fever card. What yellow fever card? Omg did I forget to get a vaccination? Could they kick me out of the country for this? I’m trying to think of a lie/excuse if this is the case. Kicking myself for being typical grace and hoping this is a country specific thing (which it is). I forget that I don’t look like a typical American (read: white) when I’m abroad. People assume I’m Chinese or other prevalent Asian flavor.
I think of all the mission stories I’ve heard in my time: there is a problem, a prayer is said, and a quick resolution follows. Praise God.
I pray nervously, pass through customs without trouble, and find my bags quickly. It occurs to me then that my baggage not getting lost in the four stop shuffle is a miracle in itself.
I never really considered this a mission trip in the sense that I was going to be evangelizing. Let’s be real, a month long service trip is mostly self serving, hardly long enough to be truly useful to an organization. But I know the money I’m paying will be useful even if I am not.
I have another secret freak out when I’m gather my bags and leave the small terminal. I assumed there would be people to meet me from the hospital but I never confirmed with them before I left. Again typical grace.
There are a few men holding signs right outside the airport but I don’t see my name. I stand off to the side and try to look occupied. A tall man approaches me and asks if I need a taxi. Someone is meeting me here, I tell him. He asks if I’ve made contact with them. I lie and say yes. A few minutes later a pretty girl with braids and hipster glasses approaches me and tentatively calls my name. She introduces herself as Temidayo, my Malawian “handler”, as Wilson would call her, and I can’t bring myself to tell her then that I had pictured her as a middle aged balding African man while we were exchanging emails. I also meet Dr. Fekadu, a new surgeon at the hospital, who looks like he stepped out of a jhumpa Lahiri novel turned movie (he turns out to be Ethiopian).
They help me with my bags and we get into the van and start the 1.5 hour long journey to the hospital. Our drivers name is Mr. America and he navigates the road and swerves around pedestrians and bicyclists well. There’s a heavy British influence here due to the history and I’m reminded of that as Mr. America heads the wrong way into a round a bout.

Malawi seems familiar somehow.
I had no idea what to expect coming to Africa and my only point of reference had been Haiti. The buildings seem sturdier here and the atmosphere less hectic than port au prince. Maybe it’s the signs of poverty in the relative wildness that is common to most developing countries. We pass women balancing large baskets on their head. A small market with produce laid out in neat piles on blankets. A few cows grazing by the side of the road. A herd of goats not too far later.
I should mention that it’s raining and the windows to the van don’t quite close all the way. Luckily I’m wearing the only long shirt I brought and a scarf I packed in my carryon. Temidayo tells me this is currently their winter. My suitcase full of warm weather clothing seems foolish now. I’m glad I kept a jacket in there.
We leave the city and the landscape transforms into fields and fields of the greenest leaves. I have mixed feelings about the tea plantations making mostly white non-Malawians richer but damn the view is breath taking. The tea plantations are interrupted by occasional groves of slender trees with branches clustered at their tops like cotton candy. Planted by the estates, per dr. Fekadu, so the workers could have some shade.

We reach the guest house, and meet the two Amandas, the other students doing a rotation here. They tell me the wifi has been spotty at best, but I still check obsessively. Someone brings in firewood and the Amandas start a fire. We talk and I meet Matt, the surgery resident doing his rotation here also. I resist the temptation to nap, but finally turn in at 8pm. I tuck in my mosquito net under the mattress and fall asleep while setting my alarms.