October 30, 2016

Sunday morning~Blantyre

Hi Everyone,

Even though Blantyre is situated on a plateau at 3,500 feet, it gets hot before the rains come. It’s much hotter on the lakeshore and in the valleys––––about twelve degrees hotter, but it’s still hot here. Bearable, but hot, especially in the sun when there is no breeze. I don’t have a thermometer, but it’s in the high 90’s I’d say. The clouds are starting to form and yesterday afternoon we had our first rain.  It was a sweet, cooling relief.

My Monday afternoon class is from one until five. Four hours is a long class; then add the heat, the afternoon sun, and the west-facing windows, and it seemed like way more than that. I had had such high hopes. I had so much fun making the slides. I was so proud of myself and thought the class would get as much pleasure out of the colorful boxes filled with text as I did. The photos that accompanied the key concepts were so subtle, so poignant. Brilliant, actually. Well, that little mac bubble got burst rather quickly.

At one p.m. there was no power at the college so I couldn’t use the projector. That was a disappointment. I remember questioning the reliance on power point presentations when we were training in Washington. I wondered what would we do if there was no power for the power point? At the time I thought I’d plan everything so as not to have to rely on the electric company and the one hydroelectric plant situated on a river with diminishing water levels. But then I got sucked in. In the hours I was planning the lecture, it was entertaining to play with the slides. It also gave me an outline to go by and since this was my first time giving these lectures, I thought that would be helpful. I hate it when presenters just read their slides, but having the outline up there was something to look at and I could email it to everyone afterward. I tried to recall ever having looked at one that someone emailed me, and couldn’t remember ever doing so, but, I was always impressed by audience members that asked for it. They always made me feel a little lazy and unmotivated. I usually thought I was doing well to attend the lecture and pay attention to the majority of it. But maybe if this technology had been available during my college career I would have appreciated the profs notes. At least when I was cramming for tests. Anyway, I started with an exercise in writing practice, hoping the power would be on but the time we finished that. It wasn’t. So, on battery power, I looked at my own beautiful slides and started the lecture. It was painful to watch the faces of everyone. Sweat was dripping down their cheeks and after ten minutes, five of the twenty-one students were asleep. They weren’t even trying to hide it. Their heads were flat on their desks. The few that were trying to listen had to fight to keep their eyes open. One girl got up and paced around the back of the room, presumably to keep herself awake. I didn’t ask.

After fifteen minutes of this torture the generator, located just outside the sun-blazed window, went on. It was so loud I had to practically yell to be heard above the din, but at least I could show my slides. The reality of that experience wasn’t quite my fantasy of engaged eager students hanging on every my word, captivated by my creativity with background color and placement. By thirty minutes into the class, fifteen of the twenty-one heads were on their desks. The others’ eyes were glazed over. They looked like they were about to keel over. The ones in the front fought it the hardest, wiping their faces and jerking their heads up. It was about a million degrees in there. My blouse was soaked with sweat and my hair was wet. I told them to take a break and walk around outside for a bit. Three of them didn’t even wake up.

They took a ten minute break, threw water on their faces, and filed back into the classroom. They really are dedicated and were trying hard to make the best of this. I tried to tie it all in to the thermoregulation point I was making earlier, but I doubt any of them 1) heard the original point, or 2) remembered it. I reiterated briefly with the heat-stroke context to go with it, and I think I drove it home. It’s impossible to meet a higher need until the lower needs are met. You can’t learn if you are too hot to think about anything except being hot. Pretty good, huh?

I continued with the lecture, just trying to get through the material. I felt like I had to get through everything I prepared. It seemed a little like wasting food otherwise. I realized quickly that they weren’t going to be able to pay attention in that heat, and the remaining slides were mostly  examples of information already given, and I couldn’t stand watching them try to stay awake any longer. I shut the projector off and said, “We’re going to break into groups and do some role play.” I felt the whole room get happier. My original plan was to discuss case studies in the class but realized I would be painfully ripping the participation out of them, so I decided to break them into five groups and give each group one of Maslow’s five basic human needs. I told each group to think of an example of a person trying to meet this need and act it out, and one of them had to be a midwife helping them meet that particular need. I told them I would give them twenty minutes to plan it, then they had to act it out for the class. I congratulated myself for pulling that one out of my ass and looked at the time, praying this would kill an hour. I hoped the skits would be long. I thought maybe I should have given them more time to plan; we still had two and a half hours to get through.

It was such a relief to hear them talking to each other, heads all leaning in to the center of the group. I was amazed! I thought, “Wow! They are discussing it! They must have been paying more attention than I thought!” After about ten minutes, one of the girls came up to me and said her group had a question. I jumped up, so happy to be needed, and went to them and asked what their question was. They held up the paper with their need written on it. “We don’t know what this means.” they said. I started laughing and asked, “What took you so long to ask me?” They said they were trying to figure it out. So I explained it to them, and this time they were listening, and they dove into their task. Really, they were all so animated, I couldn’t wait to see what they came up with. I personally, don’t like doing role play so I would have hated this assignment; I never was drawn to acting. But here they do it all the time. And they are really good at it. Another ten minutes went by (I had decided to give them thirty to plan) when another group came to ask me what their need meant. Again, I laughed at the thought they were spending so long trying to figure it out before they asked. I explained it to them and said, “You don’t have much time now, ten minutes. Go!” Their’s was self-actualization, which, I thought was a little hard to grasp in the first place. I couldn’t wait to see what they came up with.

Well, I’ve got to tell you, they blew me out of the water. First of all, I love how uninhibited they are. Not self-conscious in the least. They got up and acted these things out as if they were really: the baby crying, or the woman who just had her leg amputated (which affected her self esteem), or the father who wanted to kill his albino baby to sell the bones, or the aspiring singer at a talent show. They were fabulous!! I was like, “Holy shit! They really got this!” I congratulated everyone then gave them another break, hoping to think of something to do with the remaining time. This is exhausting!

As I write about this, it seems like the class went well and they did learn something, but for some reason when it was done I was despondent. I was so hot and drained and felt like I’m not good at this. I walked home, moping, and in a single gesture, entered the kitchen, opened the fridge, and grabbed a beer. If I could have opened it with my teeth I would have. It seemed a huge chore to reach for the opener. George was sitting in the living room, focused intently on something he was reading. I was not getting the attentive welcome I was hoping for, planning to launch into how awful the afternoon was. I opened the beer and went out to the porch.

He yelled, “How did it go?” without looking up from what he was doing.

“Hard”, was my reply.

“Can I get you a beer?”

“Got one.” I was already half way through it.

I hate feeling like I’m not doing a good job. I thought, maybe I’m not cut out for classroom teaching. I wondered how I would get through the whole year like this, wishing the class time away. I hate feeling like I’m boring people. I sometimes worry that this blog is boring, but then I think, well people don’t have to read it. They can stop. Or never start. But these students have to sit there like trapped rats. George got up and got himself a beer and came out to talk, but by then I didn’t feel like it. I was thinking perhaps the twelve hours of planning that lecture weren’t enough. I’d have to sit in that dark office on my butt for twenty hours to plan the next one. This is painful.

On Thursday I had to give a two hour lecture on the respiratory system. Now really, how can you make that fun? I didn’t have any real lungs to pass around the room to illustrate what a smoking and non-smoking lung looks like. I thought of my sixth grade class when our principal, Mr Gramolini, walked up and down the aisles with a normal lung in one hand and a smoker’s lung in the other. I tell you, it made an impression on me. I have never taken a puff of a cigarette in my life. But I started thinking, where the heck did he get the lungs? Were they in plastic bags? I think so. I’d never even thought of that before. What was it, 1967? We didn’t have any creative teaching aids back then. Anyway, the Thursday class was from ten to noon and the sun wasn’t coming in the windows. It was still hot, but not unbearable. They had just come from their tea break and were attentive and engaged. No one fell asleep. I started with another writing practice, but this time I told them everyone had to read aloud what they wrote. Previously I’d told them reading aloud was optional, but I noticed that not all of them were writing, so Thursday I made it mandatory. I figured that would be a way to improve participation. I gave them one minute to describe my canvas bag. They were a little confused by the assignment. I told them, “You are going to have to write in a medical record and describe things you see. It helps a lot if you practice this. Just write and describe what you see. No wrong answers.”  It’s not quite flowing yet, but I’m not giving up on this one. And I do think it’s helping to loosen them up a bit. When I toss out questions now, several of them speak up and respond. It’s such a relief. After the writing practice, I started on the respiratory system and ten minutes into it I asked, “Ok, what are some things that can change a person’s respiratory rate?” The answers started coming from different corners of the room, “Exercise”, “Illness”, “Anxiety,” and I was feeling like, yes! we are opening up here! Getting it! Then one girl raised her hand timidly and when I acknowledged her she said quietly, “Sex.” I thought, “Hmm. Ok. I can go with that.” So I said, “Yes, sex is exercise. And involves some excitement and excitement can be like anxiety, it can raise your respiratory rate.” There were a few giggles. A girl in front raised her hand. I said, “Yes? You have another?” and she said, “I think she meant male or female.”

So, yeah. I couldn’t believe they were only giggling and not laughing hysterically. Very polite, these Malawians.

Off to church. Only a couple of miles to walk to mass today.

Love to all,

Linda

Sunday Morning~Blantyre

October 23, 2016

Hi Everyone!

Well, it’s into the evening now, past my bedtime and I’m just getting back to this.  It’s been a long day.

The college has several vehicles to transport us to the various clinical sites and there are drivers to go along with the vehicles. A couple of weeks ago, one of the drivers, named Mark, asked me what church I go to. Everyone asks that here. Church is very important to them.  I told him I was Catholic and he lit up. He is too! Wonderful! He asked if I would like to go to his church sometime. I said, “Sure. We’ll figure out a Sunday to come.” Well, we didn’t have much going on this weekend, so I send him a text yesterday saying we’d join him for mass today and asked for directions to his church. I told him we’d ride our bikes and meet him there. He told us it was seven kilometers down the Chicwawa Road, and he would meet us at the Chadzunda Trading Center. Great. No problem. We figured, what’s 7K? About four miles? Maybe a little less? We’d leave in plenty of time and get there early. We gave ourselves forty-five minutes, which should have been ample. We set off, and rode and rode and rode, downhill a long way. I will say the scenery was beautiful, but I was getting worried about getting home. I know Chicwawa is at sea level and was hoping we weren’t descending 3,500 feet. When an hour had past, Mark called my cell to see where we were. I gave him the landmarks we were passing and asked how much further? He said, “Just keep coming.” About fifteen minutes later, we finally rode into the village of Chadzunda and Mark was there waiting for us. We were pretty well drenched with sweat, a bad sign early in the morning having just gone about fifteen miles downhill.  We locked our bikes at a local store and Mark led us into the village to the church. This was another fifteen minutes or so. We never would have found this church on our own. My original thought was to meet him at the church, but I soon saw why he told us he’d meet us at the trading center. We’d still be wandering around dirt paths looking for it.

We could hear the choir from a hundred yards away. They were fabulous. It was a St Vincent De Paul mission church and, let me tell you, it was simple. The choir wore “poor people’s clothes” and the church was a basic brick structure with a tin roof. It was packed to the gills with people, all on low wooden benches with no backs. We knelt on the cement floor. After the long ride and the longish walk in the sun, we were a little overheated. Then we spent three hours inside what was basically a large brick oven. I could feel the sweat dripping down my back, down my cheeks, into my ears. I don’t think I sweat that much when I ran the marathon. The mass was in Chichewa, and it was really lovely. The singing and swaying were spectacular. This is an award winning choir and they have a CD, which we bought when mass ended hours later.

Mark asked if we would come to his house for lunch and we accepted. Again, he lit up. I was so hot I didn’t have much of an appetite, but I didn’t want to refuse his invitation. He was born and raised in this village and he was so proud. He had lived for years in Blantyre to be close to work, but when his father died three years ago, he moved back to the village to protect the family land.  We walked from the church to collect our bikes, then walked with him to his house, about a mile away. The property was beautiful and he has built a nice house at the top of a hill, nice breeze blowing through the open windows. We sat and chatted with him and his brother for maybe an hour, when two young women came in with plates of food. They put them on the table in the next room. I was glad when they finally brought the food, as it was getting late and we had that long ride uphill to get home.  George, with a big smile on his face, said,”Oh, great! I’m looking forward to some nsima!” Everyone in the room looked at him in horror. Mark said with alarm, “You want nsima?” and realizing his mistake, George said, “Oh, No! No! Whatever you have will be fine!” I piped in, “We will eat whatever you have brought!” but Mark got up and said something to the young women and they gathered up all the plates of food and left. Then we sat there for another half hour waiting for them to make the nsima that George so enthusiastically said he wanted. I glared at him. He said, “Why can’t I keep my mouth shut?” I said, “That’s what I keep trying to figure out.” Ok, he was trying to be nice. Malawians always eat nsima, but they apparently didn’t think we did, so they had made potatoes for us. When the women came back a while later, they handed us each a plate heaped with potatoes, beef and nsima and salad. My plate alone could have fed four people. There was no way I could have eaten all that. I said grace as asked, and we dove into the food. I ate about a fifth of what was on my plate, but George shoveled every last morsel down his gullet. I watched him and said to myself, “He is going to explode.”  He said he was going to eat it all if it killed him.

Mark tried to talk us into waiting until later in the day when it might be cooler, but we had guests coming for dinner and we didn’t know how long it would take us to get home, so we set off around two for the long haul home. It was bloody hot. And grueling. We had to stop twice to buy more water to drink. I probably drank three liters of water and didn’t have to pee once. So we left for church at 8:30 this morning and returned home at 4 p.m. Like the puritans.

Ok, I finally started doing the job I came here to do.  On Tuesday morning, after the Monday Mother’s Day holiday, I showed up at the college and tried to find someone and see what was happening. It was the first day of classes and as far as I knew, I was supposed to be teaching something. I’d heard that the upperclassmen (second, third, and fourth year students) had been delayed a few weeks and weren’t starting until November first. I didn’t know what this meant for me and the first year students, I was supposed to be teaching.

As I was walking to the IT department to see about connecting to the internet, Lily, the dean, called to me from her office window. Thrilled to have a purpose, I ran to her door.  She and the other dean were revising the schedule and wanted to know which classes I was willing to teach. “Aren’t classes supposed to start today?” I asked.  Lily answered, “Yes, we will be going there shortly. I told the students we will start a bit late today.” It was 8 o’clock and the class was supposed to start at 7:30. Lily and Ursula needed to know if I could teach the class on Wednesday morning, from 7:30 until noon. I assumed since it was less than twenty four hours away, the expectation would be a bit low. “Sure,” I said. I’d already looked over the module and the first one looked pretty basic, about nursing and midwifery values. I figured I could wing it. I went with Lily to observe her teach the first class, which, was just an introduction to the module on Fundamentals of Midwifery. It was supposed to be a two hour class; we were starting a half hour late but she fit it all in to the allotted time. These twenty-one students are the ones I’ll be with all year. This is great. It’ll take me that long to learn all their names. As they went around the room introducing themselves and telling us where they were from and which secondary school they went to, I could understand about none of it. They speak incredibly softly and I still struggle with the accent. I really don’t know how I did this in French. I’m hoping they will open up a little as we get to know each other.

At 9:30 I went to my office to plan for the next day. It was then that I realized that four hours is a long time!! I figured I could fill it, but I was getting tired just thinking about having to be in front of a class that long and trying to keep it interesting. It was actually four and a half hours, but they get a half hour tea break. I was starting to think I shouldn’t have been so cocky. I was depending on a certain level of discussion to kill the time and wasn’t sure what I’d do if no one said anything. My empathy for my college professors was going way up. Like what if I see someone falling asleep? What do I do then? Let them sleep? I imagined a lively discussion and hoped I could will it into reality.  I started googling group activities. I thought maybe I could pepper the four hours with some of that. I had already thought I’d start off with a writing exercise like we do in my women’s group at home. That’ll kill some time and is a bit of an icebreaker. I could throw a few more of those in there, or maybe end with one.

Then I started trying to make power point slides. I have no experience with this, but everyone here does it and I need to get comfortable with it. I put my outline on there and they were the most dull things imaginable, but I didn’t have time to play around and make them pretty.  I was kinda proud of myself when I figured out how to put a border around the text. Good enough for the first day, I thought.

Wednesday I was up at 3 a.m., wide awake, obsessing about filling a four hour time slot, and trying to think of anecdotal stories to tell to relate to each of the values I was outlining.  That was useless. I decided to make a good breakfast, and we had power so I went at it. When he got up, George asked if I was anxious about teaching the class. “No! Why did you even ask that?” I sniped, a little more snippy than I intended. He said, “Well, you are banging things around the kitchen. I just thought you might be anxious.”  Ok. So I was a little anxious.

It went pretty well, I thought, but I had no idea what to do with myself during the group activity work. It’s a little awkward. I need to plan some activities for myself. Tomorrow is my next class. I’m teaching Maslow’s Hierarchy of human needs. I had two whole days to play around with the keynote program (mac’s version of power point) and I am getting addicted. I had to google how to use it and found a 50 minute youtube video! My children are being replaced! I could not believe how much fun I was having making those slides. And I learned way more about Maslow than I ever did when I studied him in school. Really, I’ve decided the best way to learn something is to have to teach it.

It’s late and I have to get to bed. This is totally unedited and probably crap, but I can’t go back through it now. I’ll post it while we have power and then get to bed and do better next week.

Love to all,

Linda

October 16, 2016

Liwonde

Hi Everyone,

The town of Liwonde is a hundred kilometers from Blantyre and fourteen from the game reserve by the same name. This is the place we decided to spend the Mother’s Day weekend. Mother’s Day is on October 15th, a national holiday in recognition of mothers. This year it falls on a Saturday, so we get a long weekend out of it. There is a chitenje specially printed for this occasion every year, though I haven’t seen the 2016 version yet. When I see one I’ll get it as a memento. Though I’ve limited myself to buying one a week, I may splurge this week; Zithenje (the plural) are my weakness.

I’m writing at a table in the observation tower of the safari camp where we’re staying. There is a thatched roof over my head, the sun at my back, and a savannah stretched out in front of me reaching toward the Shire River. There’s a warm breeze swirling at about the low setting on a large fan. Every once in awhile it picks up to high for a few seconds, a little startling, then back to low where it can stay forever. Friday evening we saw elephants from here, but now, in the heat of the morning, it’s mostly birds darting in and out of the trees dotting the flat landscape. An occasional impala or bush buck wanders by. I can’t tell you how much I love this. Having just gotten back from an early morning game drive, we’ve ordered our lunch of steak and rice to be ready at noon and we have a couple of free hours to write. There is no internet here, so this won’t get posted until tomorrow, but I’m not stressing about it. Stress does not fit into this scene.

There were four of us on the game drive in an ancient, open Toyota Land Rover with a canvas roof supported by a bamboo frame. Our driver and guide, Paul, a quiet, knowledgable, capable companion, drove us through herds of elephant. I mean, drove through them! There are 2,500 elephants in this park now. Up until July, there were 3,000, but specialists from South Africa came and relocated 500 of them because they were starting to overpopulate. Paul explained that they used helicopters to herd them into an open field, then anesthetized them with darts, lifted them with a winch onto a truck, and before they woke nine hours later, transported them to a game park in Nkhotakhota, north of here. Amazing. I’ve believed for a long time that ecotourism is the only thing that will save this country and I want to support it wholeheartedly. We plan to come back as often as we can.

Yesterday morning we took a boat ride down the Shire which flows through the park. This park is 30 kilometers long and fifteen wide, formerly private property, it was taken over by the forestry department, then in 1975 it became a national park, though I don’t recall even hearing about it when I lived here in ’79. The animals that were reintroduced have flourished and it is gorgeous. We lost count of how many hippos we saw. Hundreds of them were gathered in groups sticking their great noses out of the water, their little beady eyes watching us. Scattered around them were solitary fishermen in dugout canoes casting fishing lines. It’s illegal for them to be fishing in the park; if they get caught they’d get a large fine or 25 years of hard labor in prison. We must have seen fifty men and young boys taking their chances. Our guide told us about thirty a year get eaten by hippos or crocodiles. Man oh man, that is some risk to take. Desperate times, I guess. No amount of money could have persuaded me to get in one of those canoes. We were in a twenty-two foot motor boat, and I was a little nervous in that. We could see huge crocs sunning themselves on shore, though, our guide told us they were average size. He said they get up to six meters long and two meters wide. They looked well fed. We saw a floating dead hippo and there had to be twenty crocodiles surrounding it, their foreheads and eyes visible as they circled the corpse. Incredible bird life, hundreds of different species, were swirling around us. The Baobab trees on the banks of the river seemed to me like tall, fat aunts stretching out their arms. The smaller branches on the huge limbs were like fingers. I felt like they were saying, “Oh come here so I can hug you!”  Other giant Baobabs looked like tall lovers entwined in an embrace. George patted my leg and said, “I see why you love it here.”

I came here from Lilongwe on Friday and met up with George in the town of Liwonde. I got to Lilongwe on Tuesday where I participated in what everyone knows as the O.S.C.E.’s (pronounced “awhskees”). Until I got there, I hadn’t really understood what they were, just knew they were exams the fourth year students are required to pass before graduating. I thought it was a written test, but those occur after what they call “a week of peace”; a “study week” in our parlance. O.S.C.E. stands for Objective Simulated Clinical Exam. All 260 of the graduating midwifery students must individually undergo a ten minute simulation of four different scenarios. Do the math here; this takes some time. In the huge cafeteria of the Lilongwe campus of Kamuzu College of Nursing, twenty stations were set up divided by curtains. On one side, the ten stations house one obstetrical catastrophe, and the ten on the other side house a different one. There is fairly elaborate set-up involved in this, since the simulators can really “bleed”. Day one is two scenarios, and day two there are two different ones. The 260 students are sequestered in a large lecture hall and twenty by twenty, come in to the testing area. Each sits in a chair by one of the twenty curtained areas and awaits the bell. The bell is the start of a ten minute period where they have to read a scenario and take steps to manage it. During that time the examiners, of which I was one, check off the skills that must be demonstrated to evaluate whether this person is a safe practitioner. After they finish the first scenario, they switch sides and go to the other ten minute simulation, so by the time scores are tallied, each group of twenty students takes about a half hour and there were thirteen groups. It’s tiring. On day two there are two more scenarios set up, making four testing sites in all. When they’ve finished their test for the day, the students can leave, and are forbidden to have contact with the yet untested students to prevent “leakage”. They guard these tests like the shroud of Turin.

It’s an intimidating experience for students. One student performs in front of three faculty members and they know their grade (and future) depends on it. My heart went out to them. I felt a little PTSD from my student-days. The afternoon students seemed more nervous and less focused and I wondered if it was because they were holed up all day waiting their turn. I asked if they’d been fed lunch. I was assured they had. As each student entered the testing site, we, the faculty, introduced ourselves and asked their name which was then written on the top of the scoring paper. I had a hard time with that part. The students speak incredibly softly and their names are not easy for me to understand or spell. They were wearing name tags, but they were small and there was little light so I had to stand, walk over to the student, and angle their tag upward to be able to see it. They wanted to be polite, but didn’t want to waste the time they could be reading their scenario. I did hear some great names, though: Happy, Love, Memory (that’s a common name for a child born after it’s older sibling has died), Miracle, and three named Linda (which means “goal” or “aim” in Chichewa). Those were the easy ones. The last names are hard to decipher when spoken (or mumbled) in a heavy accent: Nkhata, Chindzitzi, Mpunda, and much longer ones I had to copy off my colleague’s paper.

I could see the tension in their faces. The first scenario was a postpartum hemorrhage in a woman having her fifth baby. The steps they got marked on were: calling for help, explaining to the mother that she was bleeding and emergency measures needed to be taken, massaging the uterus, giving a shot of oxytocin, getting an IV going with more oxytocin, observing for amount of bleeding, checking to see if the placenta was completely removed, and once the bleeding had stopped and the woman was stable, they were supposed to initiate breastfeeding with the little doll sitting next to the mother, explaining that this would help the uterus to contract. The simulator is worn by one of the faculty and there is red fluid draining out of a “vagina” into a bucket on the floor. The wearer can control the bleeding by a lever inside the simulator. She can also make the “uterus” flaccid or firm so she can tell if the student actually knows what they are feeling. It’s really quite remarkable. These didn’t exist in my day. The students had to know the correct dose of oxytocin for each route given, and these they usually had down pat. It was the simple things they usually forgot, like checking vital signs or putting the baby to breast.  I could see them wracking their brains trying to remember, knowing they forgot something. I had to restrain myself from poking the baby or making a little “waa” sound to remind them. One student examined the placenta on top of the doll and didn’t even notice. Alice said, “Oh! My baby!” to let her know the doll was there, but the student just moved the “ placenta” and continued with her examination of it, and when she declared the placenta complete and fine (one point), I could see on her face the “What am I forgetting?” look, but never thought of the baby. I could relate. I remember being so worried about memorizing lab values and medication dosages, I’d often forget simple things like keeping the patient warm, asking her name, or taking vital signs.

There were three of us mzungus, as part of the faculty, two from the Lilongwe campus and me from Blantyre. The students in our scenarios were forced to speak English so we could understand and I felt like they should have gotten extra credit for that. I could see the look of disappointment on their faces when we’d say, “English please.” It’s another layer of concentration when they are already nervous, and I felt like I should apologize to them. Alice said, “No! It’s fine! Many of them will go to other countries to practice anyway and they must be able to do this in English!” She is very kind to me. But I swear the students said, “Oh shit” to themselves, or however you say that in Chichewa. I was wiped out at the end of Thursday when we finished the last group. The bus to Blantyre was leaving around four to take our faculty back, but I’m not allowed to be on the road at night, and sunset is six, so I stayed another night and came to Liwonde from there on Friday. I was glad of that. The roads are dangerous enough during the day; at night, they are death traps: narrow rutted roads, pitch dark, no streetlights, and two way traffic, some with faulty headlights or no taillights. You really have to have a death wish to drive at night here.

George had taken a minibus to Liwonde from Blantyre and beat me by an hour. He wandered around the little bustling town and I found him at the “Cash and Carry” grocery store. There, a driver from the camp picked us up and drove us the fourteen kilometers to the park. It’s a rustic camp, but sweet. We are staying in a “luxury” tent, which is just a tent up on a platform, but has a double bed and a screened sitting area. There is an “honesty bar” were we can take drinks from the fridge or mix one from the bar and mark it on a sheet with our names on it. The dining area is a cement platform under a thatched roof with five picnic tables. For meals we go over to the open kitchen area and write what we want and what time we’d like it served, and they prepare it on a big outdoor charcoal stove and serve it to us at our requested time. It’s great, and the food is good. Not fabulous, but good and filling and, like I said, we want to support places like this. They have guards at night to shine lights if the elephants get too close to the camp. This provokes them to move away. I could hear the guards all night long walking around stomping their feet. They almost make more noise than the elephants who come incredibly close to the tents. The guards and “scouts” know what they are doing though, and I feel safe here.

Late yesterday afternoon we took a walk along the road bordering the park. As we watched the classic sunset, the perfect red globe sinking quickly into the horizon, the Baobabs in silhouette, the orange glow on everything, George remarked that he wished he had a better camera to capture it. I told him I probably have a hundred photographs of African sunsets and they never quite capture the feeling it gives me. I need to feel the dust on my feet, need to be a little thirsty or sweaty, need to have companionship or solitude, need to have life be so simple that this few minutes of the day is as captivating as an opera. A monkey chatters, a fish eagle squawks, more birdsong I can’t identify surrounds us and I say, “That. That’s what makes it so rich. We hear that while watching this.” And I took a photo with my phone, and we walked toward the honesty bar, and talked about how good a shower would feel, and how lucky we were, and how we want to take our friends here when they visit.

Love to all,

Linda

October 9, 2016

Blantyre

zina ukaona kamba anga mwala (a tortoise looks like a stone) ~ Malawian proverb

Hi Everyone,

I love these proverbs. There are hundreds of them. I’m trying to learn a new one every week. I originally thought I would learn one a day; there are certainly enough of them to last the year, however I’m finding one a week is ambitious enough. Malawians fling these proverbs around all the time, weaving them seamlessly into casual conversation. I find it quite amusing. This one, of course, means things aren’t always as they seem or you can’t judge a book by it’s cover. Since books were introduced here long after this was relevant, they used local materials for their proverbs. I found this one in the dictionary when I looked up kamba.  Monday, I was walking back from the local market with two bags over my shoulders and a man fell into step beside me asking me where I had come from, commenting that the bags looked very heavy. They weren’t really, and I asked him if he wasn’t used to seeing mzungus carrying bags? He laughed. He asked which market I’d come from and I pointed, not knowing the market had a name. He said, “Ah, Kamba Market. It means tortoise.” I couldn’t understand his accent when he said “tortoise” and I had to ask him to repeat it several times. He finally said, “ Tortoise, the animal that pulls it’s head in and looks like a stone.” By the time I got home I had already forgotten the word kamba so looked up tortoise in the dictionary and found that proverb. In case I run in to him again I want to be able to recall the word and I thought it’d be very catchy if I tossed out the proverb as well. That’ll make him laugh. They get so impressed if you even say one word in Chichewa, it’s  fun to use it. They crack up. On an outreach trip this week the driver said in English to the guy in the front seat “It’s getting very hot” and from the back seat I said, “Nditu, nditu.” Which means, “sure sure”; they say that all the time. The whole car started laughing as if I spouted off an entire speech in Chichewa. “Oh! We’ll have to be careful what we say! She can understand us!” Which, I might add, is a good motivator for getting better at the language. What are they saying about me anyway?

Tuesday morning Catharine was at the kitchen window calling my name before six o’clock. I was still in bed, peacefully sipping on my tea, chatting with George. I decided not to answer her right away because I didn’t feel like getting up yet. She often sees me in the kitchen at that hour, so she probably figured I was up, but it often feels like an invasion, which, by our standards, it is, but not by theirs. There is absolutely no privacy around here. None. Every once in awhile, I just want her to leave me alone in the morning. So I got up a half hour later and she was pacing outside the kitchen window looking in, waiting for me. She said, “Linda! Joseph ali ku nyumba!” Or something close to that. Telling me Joesph was at the house. My house? Her house? He didn’t go to school? What? I opened the door. Joseph was sitting there in his school uniform looking at the ground. I said, “Good morning, Joseph. Why are you not at school?” He pointed to his feet. He was wearing flip flops. “I need shoes” he said. Ignoring that comment for a minute, I asked, “You are attending school, right?” And he said, “Yes. But they told me I can’t come without shoes.” This irritated me. The day I went with him and we walked up one mountain and down another, he did that in flip flops, and so did I! On the long list of requirements, it said nothing about shoes, just the school uniform, which, I’d paid for. I figured he didn’t get this mandate that morning, because he didn’t go to the school, get turned away, and get all the way over to our house before six. And, I had just paid Catharine for cleaning on Friday and I gave her some extra, which, she was very happy about. She was on her way to bail her brother out of jail. That may not be completely accurate. There was something about brother and jail and not being back until Monday so I figured she was paying something for him. People get locked up all the time for not paying some fine or other when they have no means to pay. And I was in a generous mood. On Monday, however, she showed up with a new wig and cell phone and I wondered about her financial decisions. And now, on Tuesday Joseph is here asking for money for shoes? No. Didn’t sit well with me. I said to Joseph, “I paid your mother on Friday, and I gave her extra. She can give you some of that money to buy shoes if you need them. I paid your school fees and paid for your uniform. You can find a way to get some shoes. I will go to the school next week to talk to the headmaster about how you are doing.”  Catharine was anxiously waiting for him to translate what I said. Neither seemed upset. They both said, “Ohh, ok.” and he left. Then I felt guilty all day but when I got home and saw the wig and cell phone again, I thought, screw that, she could get some shoes. We didn’t agree to adopt Joesph. Shoes cost nothing at the market.

This morning Catharine was at the window at six but didn’t call me. I was getting tea, already up and writing when I saw her. I said good morning to her and she asked me to open the door. I got the key and opened it and the sweetest little girl was standing with her. “My youngest”, she proudly told me. I gushed over her, she came to me for a hug, and then Catharine pushed her in the house. I said, “What are you doing?” She said, “She wants to see Linda.” Oh my God, does this woman have boundary issues?! I said, “Catharine, I am working, and George is sick, and I am going to church. She can’t stay here.” Again, her reply was, “Oh. ok.” and she and the child (I think her name is Katarina) went off to sit at the end of the driveway. On the way Catharine picked a few guava off the tree by the porch and gave them to her to eat. This is so awkward. I really don’t want to adopt more kids.

Yesterday we walked to the big market in downtown Blantyre a few miles away. We shopped and walked back and it was really hot and we were in the sun the whole way. George didn’t feel well when we got home and we figured it was the heat and dehydration. But later in the day he got a high fever and was really washed out. We were supposed to have dinner with visiting psychiatrists from Scotland, but he didn’t feel he’d be able to make it through dinner. When he backed out of that I knew he really didn’t feel well. He got in bed and I went out to the dinner. He’s better this morning but I’m glad this didn’t happen up on Mulanje. He never would have gotten down. I was about to rule out malaria when he started feeling better this morning. Not sure what it is, but it seems to be passing. He just drank a sprite and ate a scone with jam, so I think he’ll survive it. It’s the first mystery illness for the year. Colds and diarrhea don’t worry me but mystery fevers are unsettling.

This week I will be going to Lilongwe for a few days to proctor exams for the fourth year midwifery students who just finished their community midwifery rotation. We have two campuses, one here and one in Lilongwe and students from both campuses must take the exams together. They take exams very seriously around here. I’ll be there Tuesday until Friday and am not quite sure what I’m supposed to do but am told I can learn in five minutes. All I know is I’m supposed to be there in uniform. So I’ll show up appropriately attired and await instructions.

Next Monday is a national holiday, Mother’s Day, so we have a three day weekend. We are going to one of the game reserves about two hours from here and will stay at the bush camp. I’ll go directly from Lilongwe and meet George there Friday afternoon. It’ll be a nice little mini vacation before I start classes on Tuesday…or Wednesday…or Thursday. I’m still not exactly sure about that since the academic calendar STILL isn’t out yet. I have been assigned a course to teach but don’t know when it starts, or what days it’s on, or how much time I have for the lectures. Loving the flexibility lessons here. In the meantime, George has been exceedingly busy since his classes are just finishing up. This past week my major job was to take care of him so he could take care of his students. It made me feel a little bit useful. I also started planning our trip to South Africa in December. We do know we both have Christmas and New Year week off, so we’re going to fly to Johannesburg and rent a car and do a loop through Cape Town where his niece and sister live. I had never looked in depth at traveling in South Africa, but now that I’m reading about it, I’m getting very excited. Nothing like having an adventure within an adventure!

Ok, time to go check on the patient…

Love to all,

Linda

PS. We’ve heard snippets of news from home and I am continually amazed that it can keep getting worse. Where on earth is rock bottom? I’ve got to check out where we can go to watch election results and then a place to watch the inauguration. That’ll be a job for the week. We’ve voted and the ballots arrived in the states. That’s a relief. I can’t wait to see what voter turnout is like.

October 2, 2016

Strangers come with a sharp knife~ Malawian Proverb

Hi Everyone,

Life has gotten so much better since orientation is over. I’m settling in at the college and learning my way around. I’m getting more familiar with faculty roles and expectations. It’s so much more comfortable not being in the way, feeling like a useless ornament.

I spent three days this week in rural areas supervising fourth-year midwifery students at their community-midwifery rotation sites. I can’t begin to express how much more fun this is than my four weeks of orientation. I’m in such a good mood I’m not even going to complain about the unflattering uniform I’m required to wear. I went to five different sites with three different faculty and saw the students in action and I am impressed. These students are graduating in a few weeks, are in their last rotation of their four year baccalaureate program, and are quite skilled in maternity care. The midwives in the rural areas are isolated. Some have only a medical assistant with them, so emergency resources aren’t readily available. They can transfer women to a district hospital if she needs surgery, but transport is usually a problem. I’ve seen reports of babies or mothers dying because the ambulance at the hospital had no petrol. The community-midwifery rotation is for experience in very low resource settings, because once they graduate, students don’t have a choice about where they work. The government will assign them a site where there is an opening, so getting rural experience is part of the program. Once a week a faculty member visits each of the ten sites to supervise and advise them.

We found the students sparkling in their white uniforms. Some of these places were miles down dusty dirt roads. I have no idea how they keep those uniforms so white, but there they’d be, working in the antenatal clinic or teaching in the postpartum ward or waiting for someone to deliver in the labor room, clad in a snow-white uniform. This impresses me, since I can’t seem to keep anything white for longer than ten minutes. In the first site it seemed like the students showed up and the staff took the month off. They were running the show with hardly a complaint. I was with Esnath, and when the morning work was finished, we sat with the students for a little conference. They are required to identify a problem at their community site and make a plan to address it. They told us the biggest complaint women had was the staff at the health center wasn’t always available and the maids are doing the deliveries.  Also, the men in the village are not consenting to their wives getting contraception. There has been a boatload of resources poured into population control here and there is a family-planning program at every health center. When I was here in the 1970’s, contraception was illegal. We couldn’t even mention it. The country then had five million people and though there were hushed requests for contraception, there was a public policy against providing it. Now? It is everywhere. There are vasectomy clinics, condoms, and every method of female contraception known to exist. Everyone has access to it. The population is now almost eighteen million and it is very clear that this country can not feed itself. Population control is front and center. The only barriers are cultural.

Esnath asked the students what ideas they had to address these problems. They told us they had organized a meeting with the village health committee and were going there to talk with them about it. They asked if our vehicle could give them a lift? So off we went together, through maize fields and narrow walking paths in our nice SUV to the village headman, who turned out to be a woman. Some of the tribes in Malawi are matriarchal. We greeted her respectfully and sat on the porch of her mud brick house to wait for the committee to gather. That took about 45 minutes, during which time I spent daydreaming in the nice breeze. Everyone else, including the village head woman, were looking at their phones. I kid you not. The incongruity was mind boggling.

The committee consisted of twelve people, a mix of men and women, young and old. Some women had babies on their backs and some of the men appeared to be late teens. The elders were there as well. The students blew me away. We started with a prayer, and then they each got up and spoke at length about the problems and wanted to hear from the committee about possible solutions. I just loved it. Everyone had a chance to speak; everyone was respectful to each other, even when the topic of men’s resistance to contraception came up and it got a little testy. This was all in Chichewa, so I wasn’t contributing anything, but at one point Esnath spoke up about population control. She was good. I am in awe of their oratory skills. She pointed to me and told them I am from America and my state is bigger than Malawi and has only one million people! Think of that! One million people in a country bigger than this! (I didn’t correct her that it was a state not a country; she was making a point) She said, “Look at the fields ready to plant! What if the rains don’t come? What if we have a drought like last year? The trees are disappearing! We must think of the future! If we have only two children then we can afford to send them to school! Otherwise the children sit all day in the dust and have no chance of a good future!”  She hammered the climate change in a few more pegs and appealed to the men to consider this. She did this all respectfully, but with incredible passion. She is the picture of grace, and to see her use her skills and knowledge like this was a sight to behold. I had to restrain myself from cheering. A plan was formulated to have the village health committee meet with the health center committee to discuss the problems and find some solutions. It’s not like this was going to be solved overnight, but it was great to watch community organization at it’s purist. Cultural changes take time but I see the course accelerating.

On Wednesday, I went to a different site with a different faculty member named Martha. Whoa man, she was tough. She has a take-no-prisoners attitude and I have a bit to learn from her. A few of the students were sitting around looking at their phones when we arrived. That did not go over well. Most of the staff were doing the same thing, which is probably why the students think it’s ok, but when they all gathered for our meeting, she came down hard. “There were women waiting to be seen! I don’t care that you were not assigned to the antenatal! If you had nothing to do you could have helped here! You could spend time with these women! You will be graduating soon! You have to learn to crack your heads and think of ways to make the health center better!” The students all murmured things like, “Sorry madam. We understand.” There wasn’t a lot of blaming going on, which frankly, impressed me. It was noted that there was no blood pressure cuff in the maternity center. I was aghast. “None? Not one?” The students all shook their heads. They told us that no women get their blood pressures checked. I immediately started thinking that I have two of them. Maybe I should bring one out there. But Martha, didn’t miss a beat. “Ok, so you have no blood pressure cuff. What are you going to do about it? Where can you find one? Is it fine to let women go without checking their blood pressure? No! So what will you do? I have asked if there is one at the OPD (Out Patient Department) and one is there! You could go there early to borrow it! Think! Crack your heads!” One of the students started speaking in Chichewa and Martha stopped him, “Linda does not speak Chichewa, please speak in English.” Man, I wouldn’t mess with her if I were them. But she wasn’t inappropriate or a hard ass. She complimented them and was kind, just tough. She has high standards and she told me, “We won’t be helping them if we accept this. We need to show them they can do better and make this health system better!” She asked them what problems they identified in the community. They said, “The distance from the village to the health center is very far and women can’t walk at night in labor, many deliver on the way. Also, the villagers are worried that so many women are having c-sections now.” I sat and listened to this with my mouth agape. First of all, I was so impressed with how professionally these students present these things. Next, I was thrilled that someone else is recognizing that all these c-sections are not necessary!!! Some are, but not 34%!!  Come ON! If a woman gets transferred to the referral hospital, which is Queens, her chance of having that baby by c-section is very high. The volume at Queens is so high that there isn’t anyone to properly observe and monitor women, so the solution is just to get the baby out by surgery, (plus the medical students and interns need their numbers). The sequelae from that (infection, hemorrhage, hysterectomy, death) doesn’t seem to be taken into account. The important thing is the baby got out. Then it seems they get thrown away. But I was thinking at least someone else is complaining about it!! But if the villagers are scared to go to the health center for fear of having surgery, then they will stay home and have the baby unattended, which, is not ideal either. So this needs to be addressed. One student suggested that the village might pool their money and buy a bike to transport the women in labor, someone else said they might look for an NGO to donate a vehicle, one student (who I loved) said they could do some health education about coming to the health center earlier in labor. They had organized a meeting with the village health committee for Friday. They said they were a little nervous about bringing suggestions to them because, strangers come with a sharp knife. The students know that the villagers don’t want to be told what to do. Martha said, “Do you go to the village and say, ‘We are from KCN and we know what to do!’ No! You do not say that! You ask them what they want; what they think a solution could be, and there is discussion. The solutions must come from them!”

She could take that show on the NGO road.

On Thursday I was with Alice. The students we visited that day identified a different problem. The youth in their area were complaining that they can’t go to the health center for contraception because everyone will see them and there is no privacy. I wanted to ask where on earth they go to have sex without everyone seeing them, but didn’t. The students at this place were fantastic. They said that 68% of the deliveries were teenage mothers but only 11% of the women at the family planning clinic were teens. I was thinking, these students get better and better! They organized a youth group to discuss some solutions. Everyone goes to the health center in the morning and it’s usually empty in the afternoon, so they asked the midwife at the health center to have a “Youth Friendly” afternoon clinic once a month that would be only for teens. We went to the village with them to meet with the youth group, the young midwife from the health center in tow. The youth gathered in a circle and we started with a prayer. The students spoke about  their concerns and the solution they came up with. They pointed to the midwife and said, “See? She is also a youth!” then the midwife got up and spoke at length about how they would work to make sure the “Youth Friendly” afternoon was confidential and they could feel safe. Applause! Cheering! I was so proud of these kids. Just blown away.

I couldn’t stop gushing about it on the way back to Blantyre. Alice said, “It’s so nice to hear you talk so much! We didn’t think you were going to say anything!” I told her I was just observing at the meeting last week to see how everything worked. I’m really not very shy. She said, “Oh, that’s good. We were a little worried you wouldn’t talk.” I assured her, that’s not a problem once I get warmed up.

The Peace Corps Director, Carrie Hessler-Radelet is here visiting Malawi. She’s the big director, the one at the very top, the presidential appointee. It’s a big deal. This year marks the 20th anniversary of the Peace Corps Response program and Malawi is on the celebration route. She arrived in Blantyre yesterday and we had a program set for her at the hospital so she could see how Maternal/Child Health is working here. I had arranged for two of the midwifery students to teach a class to expectant mothers for her and entourage to observe, and the students hit it out of the park. They were fabulous. Esnath and I did a demo of teaching at the bedside and again, the students were just great. They explained everything they were doing, showed the utmost respect and skill, and I was overflowing with gratitude to them. They were going over the importance of exclusive breastfeeding with the mother and her baby, and Carrie commented on what a beautiful baby it was and what a miracle babies are. Isabel, the student, said, “Oh, yes, and this baby’s name is Miracle!” and she held up the little health passport to show her the name. Ah! laughing and cheering all around! We couldn’t have staged that any better.

When we were done there (several hours later) a Peace Corps vehicle picked us up and we were treated to dinner together at a nice restaurant downtown. It was a really pleasant evening and there was great relief that the afternoon and come off so well. Carrie was a Peace Corps volunteer in Western Samoa in the early 80’s, and though my time in Samoa wasn’t as a Peace Corps volunteer, we had a bit to talk about. I do love this organization.

It’s getting hotter and the day ahead has the prospect of being a lazy one. I might even set the hammock up under the avocado tree for a nap.

Quickly now, while we have power!

Love to all,

Linda