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