Sunday Morning~ Lilongwe

March 26, 2017

Mlendo ndi mame~ Guests are like dew

Malawian Proverb

Hi Everyone,

It’s been a sad week. It started out with a sick boyfriend. That’s never a good Monday morning. It was nothing critical, and a few other people around here had similar symptoms, but it’s just not fun to be sick. Tuesday he was feeling a bit better when I dashed out early for my ride to Liwonde. Once he said he thought the worst was over, I plopped his tea down and ran. The driver came early and I had to scoop my fried egg into a plastic container to eat on the road. I finished dressing in the car, attaching my pins and epaulets as we bumped along.  We’ve had a tremendous amount of rain. We’ve had whole days and nights where the rain didn’t stop. That’s a bit unusual for these parts, but it is welcomed, and the crops are robust. Their thirst is well quenched.  The drive that morning was spectacular. The landscape is so beautiful if you can look past the trash on the side of the road. The mountains were ringed with low lying clouds and their peaks popped out the top. Sunlight shone through an opening here and there and the whole scene looked mystical, like something out of the Hobbit. I poured milky tea from my thermos, sipped, and enjoyed the views. I’ve stopped exclaiming about it since Malawians think it’s absurd to comment on natural beauty. It’s just always there. They giggle a bit if I say something but they don’t even look up. It doesn’t strike them as something remarkable.

Since we’d gotten such an early start we were in Liwonde in time to catch the end of the morning report. There was a lively discussion going on, but since I’d missed the beginning of it, I didn’t know what the trigger was. I heard someone say “We are killing these babies!” I thought, eww, something bad must have happened.

I decided to start the day in the postnatal ward before I was tired. I thought that might help my attitude.  It didn’t really.  The students were ready with patients to present to me. The first was a young woman who’d had a c-section the day before for “prolonged labor”. That term doesn’t really mean anything to me here as I find it to be quite subjective. I got the initial report that the baby was in the nursery because he needed oxygen and the mom was expressing breast milk for him. The mom smiled and made an effort to sit up as we discussed her situation. I asked if she’d held the baby and she said not yet. I told the student once we got her settled for the morning, we should go to the nursery to check on him and if possible bring him to his mother so she could nurse him. Or if he couldn’t be moved, we could bring her to the nursery. The mom told us she had slept well during the night and her mother-in-law was with the baby. This young mother was beautiful with long dreadlocks and no sign that she’d had a long ordeal the day before ending with major surgery. She moved amazingly well for someone twelve hours post op.  By the time we’d gotten through her history and examined her it was about 9:30. I thought we should go see what was happening with the babe. Twelve hours is a long time for a mother to be separated from her newborn and she hadn’t even seen him after the delivery.

The student and I went to the nursery to check. There was no nurse in there but several elderly women, guardians, sitting by the babies they were caring for. We asked where our baby was. One of the guardians told us he had died some hours earlier and was taken to be buried. We were confused. The guardians looked away from us and lowered their heads. We went out to the nurses station to find a nurse. None were there. One of the clinical officers asked us what was wrong and we told him. He tried to help find someone who had some information. We tried to find the patient’s guardian. We went outside where several were sitting waiting for morning rounds to be completed. The student called to the group and asked if one of them was with our patient. One sad older woman raised her hand. She was sitting on the cement walkway staring at a brick wall. She came to us and confirmed that the baby had died and the mother-in-law had taken the baby to be buried that morning. I was aghast. “Without telling his mother?!” I asked. She nodded her head. I looked at the student. She looked at me and said, “That isn’t right. She never saw her baby.” I was horrified. I can’t imagine that. Was this cultural? Why did no one tell her that her baby died before they took him away?  The clinical officer said, let’s check the morgue; he might be there. Being hopeful we’d find this child, I wasn’t prepared for what the morgue in the postnatal department looks like. He opened the door, which is just a room off the nursery, and looked in the wooden cubbies. Lots of wooden cubbies lined up on a table top. Although all these cubbies were empty, I still felt like fainting. How many of these cubbies do they need at any one time? Good lord. No baby there, so the medical officer concluded it must have been taken for burial. He looked around for a chart and found one. He flipped through it and confirmed that the baby died at six that morning. I asked, “Who will tell the mother? Do you know why he died? She shouldn’t be kept without knowing this any longer.”  He folded the chart and said, “I guess I will tell her.” So the student, guardian, clinical officer, and I went and surrounded this young mother. There was no private place to take her. The thirty beds were filled with other mothers in various stages of consciousness. Some were sitting up nursing their babies, some were lying still with eyes closed, some were staring into space. We formed a semicircle around her which gave some semblance of privacy. Everyone in there knew what we were telling her. I wondered if she would start wailing. She didn’t. I watched her face as the words I couldn’t understand started sinking in. It was like watching a house of cards collapsing. I put my hand on her shoulder. I watched her eyes. It was thirty five years ago on that day that Jake was born. I imagined myself sitting on my bed that day hearing this news about my baby.

I asked the student what her plan was for this patient now? She told me she would sit with her this morning for emotional support. Right answer. We’d talk later about the cultural implications of taking the baby away to be buried before his mother could hold him. I moved on to be with the next student.

This student was with a patient who sat upright, legs straight out in front of her, back bone completely erect, on a bed with no mattress. She sat on a web of metal bars. I asked where the mattress was? The student told me they had no more. I looked around and six women were sitting on these beds without mattresses. And this wasn’t a piece of plywood. This was a grid of metal bars. It looked like a torture chamber. The women had laid a chithenje over the bars and were lying on them like it was a posture-pedic. I am not kidding, Nelson Mandela’s cell on Robben Island looked more comfortable than this.

I greeted the woman and said to the student, “Ok, tell me her story.”  The student explained that she had been referred from a health center after a prolonged labor with bleeding. Her uterus had ruptured and the baby was already dead when she arrived. They did a hysterectomy. She’s anemic and receiving blood transfusions. She had a reaction to the first blood they give her, but the second one she had no reaction. It was her fourth baby.

As the story is coming from the student I stared at the bars she was sitting on. This woman is post op with a dead baby and no uterus, nearly bled to death, and is lying on a web of metal bars without complaining? We walked through the plan of care for the day while I held on to the bar at the end of the bed. I felt the fried egg churning in my stomach and moved to the bed where the next student was waiting for me. This bed had a mattress as the woman was only one day post op. They shift them around depending on status. It’s like the ones with the mattresses are the ICU.

During this time, a clinical officer was making rounds on the patients. He was alone, stopping at each bed, looking at the charts (which are just a few note pages tied together with a piece of gauze), examining the women with unnecessary roughness, and moving on without washing his hands. He did use a glove if he touched a wound, though, I’ll give him credit for that. I don’t know if his lack of hand washing was due to neglect or the fact that the hospital has no running water. It’s plumbed and the sinks are all there, but there hasn’t been water for several weeks. This hospital is situated mere meters from the largest river in the country. I have no idea why there is no water. It’s the rainy season for God’s sake. We make hand sanitizer for the students which is just a mix of “spirits” (alcohol) and glycerine, and I’ve got my own stash in my pocket, but it’s not as satisfying as soap and water and the regular staff doesn’t even bother with hand sanitizer.

While the third student was presenting his case to me I heard the clinical officer yelling something in Chichewa. I looked up as he grabbed a woman by the back of the neck and forced her head down between her legs, then brought her head back to the bed, then down to her knees again, over and over. She was naked and her arms and breasts were flying like a rag doll.  I said, “What the hell is he doing?!”  No one in the room said a word. When he finished with that exercise, he grabbed her arm and made her stand up. She wrapped a chithenje around herself, then he took her arm and made her walk fast down the length of the room and back again to her bed, where she climbed on and curled up in the fetal position. Her bed had a mattress. I went over to the clinical officer and asked, “What are you doing?”  He replied, “Physical therapy. I like them to be moving soon after surgery. It’s been two days for her and she hasn’t been moving.” and he moved on to the next woman. I put my hand on the shoulder of the curled up woman and said, “Pepani” (I’m sorry), and went back to my student. Before the student continued with his report I said, “Treating a woman like that is never ok.” He nodded and asked if he could borrow my pen.

Before going over to the antenatal ward, which seems like a picnic compared to postnatal, I stopped in labor and delivery to talk with Elizabeth about what I’d seen. She was busy demonstrating a breech delivery to the students there, so I kept going. When I found her much later I told her how upset I was with all that had happened that morning. She shook her head. I was hoping for some local wisdom or encouragement, but she had none. Just shook her head. While we were sitting and chatting, a woman in late stages of labor was lying on the floor, refusing to get onto a bed, writhing in pain. She was refusing to let anyone examine her, so a different clinical officer said she was going to take her to the operating theater. Elizabeth and I looked at each other. Elizabeth said, “That’s ridiculous! She can’t go to surgery without an exam! I’m going to talk to the patient.” So Elizabeth (not too sweetly) told this woman having her eighth baby, to get on to the bed for an exam. I don’t know what she said as she was speaking Chichewa really fast, but the woman obeyed, and Elizabeth checked her. She was fully dilated and pushing but the baby was not coming. I asked about a vacuum. Elizabeth said, “Let’s try it. We can’t let her go for surgery at this point.” Eighth baby! So a group of students (no nurse to be found) got the vacuum out and while Elizabeth put in an IV, I got the cap on, gently pulled, and easily delivered this baby over an intact perineum. I turned to the students and said, “See? No incision on her abdomen, and no lacerations on her perineum. There is no need to cut these women.” We left there soon after the placenta was delivered to make the trip home. It’s all so disjointed and slapdash. Five hours twice a week in this place is nothing.

So the scenery didn’t lift my spirits on the way home. I thought and thought about our role here, what happens to women all over the world, how tiny the steps to improve things, and then the huge backslide for women’s rights happening at home. The driver had the radio on to an English-speaking station and I heard something about the American ambassador, Peace Corps, and killed. I said, “What” What did they say?” But no one else in the car was listening.

I got home and received several messages from a fellow volunteer in Blantyre asking if I was going to the service in Lilongwe for the volunteer killed on Monday. A Peace Corps volunteer who’d been working here for a year in the northern part of the country was killed Monday in a car accident. She was 25 years old.

The incidence of deaths among Peace Corps volunteers is similar to the population at large. Most of of the fatalities are from car accidents and not snake bites. The logistics are difficult though, when faced with calling her family and arranging for her body to be flown home. It’s a Peace Corps director’s worst nightmare. I came up to Lilongwe on Thursday as the memorial was early Friday morning. Volunteers came from all over the country, even those of us who didn’t know her, to be together as a family and support the staff who were terribly distraught.  Thursday evening the director had a gathering at her house where everyone could visit and grieve and be together. Friday morning a vehicle picked us all up at the hotel and took us to the ambassadors residence where the service was held. They did such a beautiful tribute. The language teachers, the office staff, volunteers from her group who were very close to her, the doctor from the hospital where she worked, her host family, all gathered under a tent and began to sing “Let There Be Peace On Earth.”  I sat with Towela, who works with our group of volunteers and a woman we’ve become close to. She said it’s been a hard week. They have taken shifts to sit with the body, never leaving her alone. It’s a Malawian custom. Several people spoke. There was a letter from her family. Her friends made a video. We sang “Amazing Grace” as we filed out of the tent, each dropping a rose in front of her photograph.  I thought, we are all guests here and we are all like dew. We evaporate very quickly if we are in the sun, and linger a little longer if conditions are right.

There is a car going back to Blantyre this afternoon, so I avoided a bus trip and will catch a ride with them. staying the extra night in the empty house of a volunteer who decided to end her service early. I spent yesterday reading and trying to nurse another head cold. I’ve been sick here more than I have in the past twenty years! Others told me they’ve had the same thing, so I’ll lay low, sip on limey tea, read, and shore up for the week ahead. I took a walk with Amber yesterday afternoon, she’s a nurse with our group and I was lamenting how ineffective I feel most of the time. She said, “Linda, don’t you think it’s incredibly arrogant to think you can change things in one year when so many people have been trying for decades?”  She’s right. We are guests here and we are like dew. We evaporate quickly.

Love to all,

Linda

Sunday Morning~ Blantyre

March 19, 2017

Hi Everyone,

It’s a rainy day. The rainy season is winding down so it doesn’t rain every day now, but today is a socked-in, grey, constant-rain, kind of day. I made it to mass and back before it started and now I can just hunker in and enjoy it. I’ve no place to go, got a goat leg simmering on the stove, and bread rising. I’m feeling rather domestic and cozy. This kind of rain doesn’t usually cause a power outage, but I shouldn’t speak too soon.

The first year students have finished their final exams and have the next two weeks off for holiday. I erroneously thought I had two weeks off as well, but that’s not how this nursing school works. None of the classes have vacation at the same time, so my fourth year students still have clinical and I’m still going out to Liwonde for the foreseeable future. The first year students will start their second term when they get back in two weeks. I will supposedly be teaching something, but still don’t know what that will be. I’ve asked around a few times, “Am I supposed to be teaching something second term?” but the response has always been, “We will meet soon to discuss that.”  The meeting should be this week (I hope) and then I can start preparing. The midwifery faculty is so overwhelmed with all their responsibilities it seems they are just doing what has to be done on each particular day. Planning ahead isn’t popular. I’m learning to roll with it. I wish I could roll a little better with the clinical rotations, but I still come home from there feeling traumatized. I wish I could run the wards myself and have everyone do it MY WAY. I can see why women are afraid to come to the hospital. We have got to do a better job.

The mornings I go to Liwonde the driver picks me up at my house a little after 6:30. We drive to collect Elizabeth, another faculty member, and then hit the road for the two hour journey. That part of the day is rather nice. The car is comfy and I can gather up my stamina. We have students in labor and delivery, high risk ante-natal, and high risk postpartum. At this site Elizabeth stays with the students in labor and delivery and I go to the other two wards. Antenatal is not traumatic for me. The health education is fun. They sing and dance a little and the students do a good job of it. The women have very low expectations, so any attention they get seems like a perk. The women get seen in a consultation room, which is just a bare room, but there is a window and a exam table, a bench and two chairs. The walls are painted institution green, but they are clean. I share the bench with the patient and the students sit on the chairs. There is no blood pressure cuff, so I bring mine along when I go. It drives me crazy that there is no functioning cuff there since blood pressure is just a little important for the high risk mothers, most of whom are there for high blood pressure. It’s ridiculous. Anyway, the room provides privacy and the students do a fair bit of one-on-one teaching. I like it there. It’s hot (Liwonde is 3,500 feet lower than Blantyre) but not terribly unpleasant. Smell isn’t bad.

After a couple of hours there I brace myself and go to the postnatal ward. I hate going over there. It is so depressing. There are thirty beds all in one room with no privacy curtains. I can never find a staff person; the students are usually there alone except for the clinical officer who has a woman writhing in pain from his repeated vaginal examinations open for everyone to see, blood everywhere, and the patient screaming. It is horrific. Most of these women are post operative, having had c-sections they may or may not have needed. Their babies are lying next to them, an inch from the edge of the bed and there are no safety bars. I must say though, I have never seen, or heard of, a baby falling off the bed. They’re so bundled up in zithenje and blankets it probably wouldn’t hurt them if they did. I have to dig into the bundle to actually find the baby.

There are no IV poles, so the IV bags are lying on the bed and the blood backs up into the bag so it looks like muddy water being infused. It makes me gag. The urinary catheters are revolting as they stay in for days so the woman doesn’t have to get up to go to the toilet. There are no catheter bags so they use the empty IV bags to collect the urine and these hardly ever get emptied so they overflow and smell and I feel like I can almost see the bacteria. How these poor women survive, I do not know. I want to cry the whole time I am in there.

The students try; they really do. But they don’t have the confidence to speak up to the clinical officers. When I walked in there on Monday and saw this horrific exam going on, I asked the students what he was doing? They said they didn’t know. I walked up beside him and asked, “What is the problem here?” He held up his bloody (non-sterile) glove, which I had watch him jam into her vagina three times, and said, “She’s bleeding.” He had his other hand mashing her uterus which was the part of the exam that was making her scream.

“When did she deliver?” I asked.

“Two days ago, by cesarean.” he replied.

I cringed at how rough he was with the hand on her uterus and said, “Oh, well, at two days that bleeding should still be normal then, right?”

He looked at his hand, put it back in her vagina again, took it out and said, “Well, but it smells bad.”

I said, “Well then maybe she needs an antibiotic.” and left off the last part of that sentence “not a rape”. He wasn’t upset with me, he actually looked like he was happy I came to consult with him. The chilling thought went through my head that he actually didn’t know what to do so just stood there putting his hand in and out of her vagina while all the other patients and their guardians looked on. It is so disturbing. I covered her up while he wrote an order for an antibiotic. I told the students to take the catheter out. That was probably infected, too. I covered the woman with her chitheje, patted her shoulder and said, “Pepani” (I’m sorry) and moved on to the next patient with another student.

In the afternoon we had the students present case studies, one from antenatal and one from postnatal. Well, if I wasn’t depressed already, these stories sure finished me off. The first one was a woman at 27 weeks gestation with eclampsia. She reported that she had a seizure at home, got on a minibus and came to the hospital. Her blood pressure was high and she was advised to terminate the pregnancy. At 27 weeks the baby wouldn’t have survived here, there isn’t a high risk nursery at that hospital and even if the baby got shipped to Zomba where there was one, the chances were very low for survival. But if she did not deliver, chances are she would die if she was already seizing at 27 weeks. She refused to deliver this early and tried to go home. She said if she was going to die she’d rather be at home. She was 19 years old.They gave her some antihypertensive medication and she went home. No one knew if she was still alive. We spent some time discussing how that case could have been handled better. I thought of what I was doing when I was 19.

The postnatal case was a woman who had a postpartum hemorrhage and needed a blood transfusion. As the students were giving us her history I couldn’t help from gasping at regular intervals. This woman, 20 years old, lived in a village and went to her local health center with a complaint of back pain in late pregnancy. She was told to go to the district hospital, but it was 6 p.m. and getting dark and she had no transportation. So she went to spend the night in the room allocated for women waiting to deliver and slept on the floor there. At 3 in the morning she delivered her baby on the floor, picked up the baby, still attached to the placenta (which was still inside her) and went over to the delivery room to get help. The midwife there told her she had been instructed to go to the district hospital so this was not their problem. They would not take care of her. So. She waited until daylight and the minibuses were running, got on one, rode to Liwonde (an hour away), with the baby tied to her abdomen and THE PLACENTA STILL INSIDE HER!  When she got to the hospital and they delivered the placenta, she had a major hemorrhage and needed a blood transfusion. Somehow she and the baby lived. Fortunately for me, Elizabeth exploded so I didn’t have to. She cried, “We don’t even treat women like human beings! You students have got to be the ones to change this! I want to know the name of that midwife who sent that woman away!” I will say, the list of “what should have been done differently” was pretty easy to make in this case. God help them, please.

It takes me awhile to recover from days like that. I start spiraling into a hopelessness. I don’t know what I should be doing, but keep plodding along. I gave up alcohol for lent so wasn’t sure if the mint tea would calm me down enough. George listens while I recount the stories. He shakes his head. I feel a little better just saying it out loud.  He tells me to go lie down and brings me mint tea with lime. It does help.

We went back there on Thursday and while walking to the antenatal ward I fell into step with a woman walking in the same direction. She asked where I was from and when I said “America” I braced myself for a comment about the presidency, which is pretty much standard these days. Instead, she said, “You Americans are always helping people. You are such good people.” And I thought, that was a nice little gift to brighten my morning. Everyone doesn’t hate us yet.

I rode my bike out to Joseph’s school to pay for the second term. I can finally find the place and rather like going there now.  When I handed the money to the principal, he thanked me and said, “God will truly bless you for this.” I remind myself to let go of expectations about what Joseph will become in life. It’s good enough now that he’ll finish his form three. I’m trying to stay in the present.  The next day I bumped into Catherine on the road to the nursing school. She still guards our old empty house. I told her I went to pay for Joseph’s second term and she hugged me and said, “Thank you God my mummy!” She wasn’t implying that I was God, I think she was trying to convey the same message as the principal. She told me Joseph would come and see me on Friday, which he did. He was much more pleasant than he had been in our prior interactions. He was smiling and gracious and thanked me for paying for school. Then he said he needed more notebooks and pens, and some clothes for church. I told him I would get those things and bring them to his mother. Then he pointed to my bike and said he would like that as well. (His English is way better than his mothers) I told him, sorry. I’m keeping my bike and when I leave it goes back to Peace Corps. It’s not really my bike, I’m just borrowing it from them. He smiled and said, “Ok. Thank you!” No hard feelings. No whining. Just thought he’d ask. At times like that George and I just say to each other, “If you don’t ask for honey, you’ll only eat wax.” That proverb gets used on a daily basis around here.

Love to all,

Linda

Sunday Morning~ Blantyre

March 12, 2017

Liwiro la mumchenga nkuyambira limodzi~ When racing in the sand, we must begin together.

Malawian Proverb

Hi Everyone,

I think I’ve told you this before, but when I was here in 1979 there were five million people in the country. Birth control was illegal; we couldn’t even mention it in public.  Sometimes men would ask me how I could “stay with Robinson every night and yet have no baby?” I didn’t know how to answer. Magic? Barren? One of the many blessings of having gotten pregnant while we lived here then was the speculation about “taking special mankwala (medicine) to prevent a baby” was eradicated. Finally, I was accepted as a real woman.

Back then, the President-For-Life made the rules and we never quite understood the rationale for banning contraception. We wondered if he thought his enemies might invade if they thought the population was limited? Since nearly half the children died before their fifth birthday, people thought they needed to have many children because they could only count on half of them surviving. Women had no say and no choice. The ban on birth control lifted with the AIDS crisis and the novel idea of democracy, but that wasn’t until the country couldn’t produce enough food to feed itself. The population is now nearly 17 million and many are hungry.

The roles here are still very traditional. It’s not as drastic as it was, but at church the men still sit on one side, the women the other. Some men come with their wives for prenatal care but I never see one in the delivery room. Never. They aren’t even in the waiting area. They just don’t come to the hospital at all. It’s always a female relative that accompanies a woman for childbirth. I see an occasional man with a child on his back in a chithenje, that’s new. Some men cook a little. More boys go to school than girls, but about twenty percent of the medical students are now female, so things are slowly changing. Glaciers now move way faster than progress toward gender equality around here.

When I was a young public health nurse up north, the majority of my time was spent working at what we called “under five clinics”. These were weekly clinics where we’d immunize kids, weigh them, and assess them for malnutrition and health problems. Adjacent to this was the antenatal clinic where the pregnant women would get care. It would take a couple of hours for the women and kids to arrive, having walked miles, and once a large crowd had gathered the health talk would begin.  The topics for these ranged from hygiene to nutrition and they always started with a song. The songs seemed to be well known as they all joined in robustly, usually one lead singer in the group chanting out a line and the other hundred women joining in the chorus.  I loved to listen to these songs; everyone sang so passionately. The health workers would be dancing and clapping and the women would be ululating and it all seemed so festive and joyous. It was like they were being reborn or singing for joy and then I’d find out the lyrics were things like, “It’s ok to eat eggs when you are pregnant. Eggs are good for you. There is nothing bad about eggs for the baby.” or “We only feed our child with a cup and spoon.” and it would just crack me up.

The fourth year students have begun their high-risk rotations and the group I am with are at a district hospital in Liwonde, two hours away.  I went out this week and spent a day with the ones in the high-risk antenatal ward. Most of the women who are there waiting for labor have either high blood pressure or a previous c-section scar. Those women are at risk for a uterine rupture if they labor too long so they go to the hospital and sit until labor starts. That eliminates having to either walk or find transport for the long journey. Some women are waiting there for months. The ward is one big room with no beds. The women lie on the floor all day. They have each other to talk to, but many seem bored and depressed. Tuesday I arrived in time to see the health talk and I was happy to see the students do a song with the women as well.  It was like the old days, one woman sang out a line and the others rebounded, though it didn’t seem as joyful as I remember. The students had planned a talk on nutrition, so I assumed the song was about that, too. Kulela ine kulela. Ana onsewa ndi khale  olela ine kulela. I asked what the lyrics meant and the students told me it was a song about contraception. The words were translated as “I’m raising children, I’m raising children. All these children–– should I be the one raising these children?”  This sounded more like a protest song than a health education one to me, but I guess, whatever works.  During the health interviews I was impressed that most women had a few years between their pregnancies, so I guess I’m not going to tell them what to sing about. Many of them had lost a child, either in childbirth or from malaria. Many were young. All of them had left their families to lie around on the cement floor for four or more weeks in order to have some kind of trained care during their labor and deliveries. I wondered how everyone got along without them at home. The maize is way over my head now so most of the hard field work is done, but still, it must be strange to leave home for so long. What choices they have to make. And then I thought, maybe this is a rest and relief for them, who knows? I’d love to be able to really communicate with them and just hang out among them for a few days. My Chichewa is coming along, but it’ll never be to the point where I can really communicate with someone from the village. And even if I could, our worlds are so different I might as well be from outer space. I tried to encourage the students to do that––spend time in there just hanging out and talking with them. Get their stories if even it’s just to have someone listen to her.

I felt like I found my groove again that day. I was able to give some feedback, made suggestions about how to elicit more information during the interview, discussed ways to date the pregnancy without an ultrasound or last menstrual period, and felt a little useful. When the students discussed contraception, many women said they wanted a method they could hide from their husbands. Often it’s the men who don’t want to limit their number of children. I understood the song a little better.

Days like that are good for me. I get along well with the students. Other days I feel like a privileged waste, wondering what good I’m doing. I look at the huge difference between the male and female lives here. They are all hard, but the women just have such a steep climb and most don’t even know there is a summit. It’s just slog uphill everyday of their lives. And the unfairness of our own society’s treatment of women makes me wonder who are we to talk? And this pathetic farce of a government we now have at home has no more integrity than any we feel so free to criticize. At the rate we’re going we could regress to the days when birth control will be illegal at home for God’s sake.  And then I think I am so much more privileged than the men are here. And white men are more privileged than me. It’s all so unfair. Yeah yeah yeah, you work hard and get ahead, but so much is just luck. What color is your skin? Like you’ve got bloody control over that.

I made it back from Liwonde in time to get to my Chichewa lesson. I was pretty tired and my brain was still pondering the unfairness of white privilege and then he gave us the proverb and I thought, damn! Yes! There is such poetic wisdom in this culture! Jameson explained that if anyone gets a head start when you are racing in the sand, the other will never catch up. It’s not a fair race. Everyone must start together if you are running in the sand. And I thought, that’s right. Will women here ever get a head start? Because everyone is running in the sand.

Love to all,

Linda

Sunday Morning~ Blantyre

March 5, 2017

Madzi saiwala khwawa ~ Water doesn’t forget the valley

Malawian Proverb

Hi Everyone,

I’m feeling much better this week, thank God for antibiotics. I’ve been thinking that if we can make antibiotics from moldy cheese we can surely make make a democracy from this shit show of the last year. I can tell I’m feeling better when the optimism starts peeking through. My headache is minimal and I’m getting my energy back. The creepy rash is gone. We are settled into the new house with art on the walls and clothes put away. My first year students finished their clinical rotation, and even though I feel like I should have done more with them and I worry about their future, it seems they all came out of that part ok, and hopefully the patients did too. The coming week is called their “week of peace” (reading week) and the following week is final exams. Those exams have been vetted ad nauseam and this week should be much less stressful (for me anyway). I will have to travel for two days out to a district hospital in Machinga to supervise fourth year students, but after the last four weeks, that’ll be cake.

The avocados we salvaged from the tree at the old house have been pickled or frozen and when George went back yesterday to pick a few more, he found the entire tree had been stripped, so I’m glad we took what we could when we left. There were thousands of avocados on it. It’s astounding how many each tree produces. So the guards who are still there guarding empty houses have had their fill, hopefully. They are practically giving avocados away at the market. There are millions of them around now. I’m limiting myself to one a day. I never thought it would be possible to get sick of avocado, but I said about lobster before I moved to Maine: How can you get sick of lobster? Well, you can.

I’m sitting at my new desk looking south out on our front garden. Our day guard, Chimwemwe, is a full time gardener and I am embarrassed to say, I am getting used to this very quickly. Last week I thought we may have a bit of a territory issue; after all, I’m used to caring for my own garden. Well, let me tell you, I’m going soft. The grass is perfectly manicured as every day he does a little section with a machete, and then takes a big panga knife and carefully edges all the garden beds. The brick walls surrounding the property have flowering shrubs planted along them, hiding the wall almost completely. I know this will change in the dry season and the wall will be visible, but now it is lush and blooming and soft with greens and purples, oranges and reds. It’s pretty darn nice. There is one tall palm tree in the center with hanging baskets full of geraniums attached to the trunk. Just outside, under the window in front of me, tall plants, which I can’t name, are thick, with calla lilies interspersed and a healthy pink rose bush covered in blossoms. There is a bed filled with cosmos, calla lilies, and some tall purple flower I can’t identify. There’s a bird bath in the center with constant avian activity. And this is just the part of the yard I can see from this window. Around the other side is a blossom-covered bougainvillea hanging on the wall like it’s thinking of what to do today. It’s a beautiful little oasis on our side of the wall. The dirt road on the other side dead ends so there isn’t much motor vehicle traffic and the pedestrians are fairly quiet. For a city neighborhood, it’s lovely.

I’ve stopped looking at our kitchen as tiny, and now consider it efficient. One hardly has to take a step between stove and sink and we’ve tucked all the essentials into the small space and we are managing just fine.

We are getting all the keys sorted and that is becoming more manageable. The key situation stresses me out. There are so many locks here! My office is located in a cove along with three others. The outside door has a big iron gate with two padlocks (two keys). Once that is opened and swung out of the way, there is another door to unlock (another key). Once inside there, there is a small hallway with two offices on each side. The office I share with Elizabeth, one of our cadre of SEED Global Health volunteers, has another locked door. These are all big keys. At home, our driveway has a gate with a padlock that sticks (one frustrating key), the front door is a big heavy wooden number with a heavy lock (one key), inside that is an iron gate with a padlock (another key). The back door in the kitchen has the same rig, big iron gate with padlock, and outside wooden door with heavy lock. Then inside, all the individual rooms have locks and keys (we just leave those in the doors), all the closets have locks and keys dangling from them, and some of the drawers have locks and keys, too! I don’t think Sing Sing has this many locks. Oh! Plus, Peace Corps gives us these big blue metal trunks with padlocks for our “valuables”. Since I carry my laptop with me most places and my grandmother’s ring is on my finger, I don’t have anything to put in the blue trunk. I store medical supplies in there.

Friday here was Martyrs Day, a public holiday. It’s the first three day weekend we’ve stayed home; we felt like we needed to get settled and catch up on menial things. We had been trying to explore a bit on the long weekends but we have both been busy and gone long days and it’s been nice to nest a bit. This isn’t a bad place to hang out, actually. Martyrs Day honors those who died fighting colonialism. Back in the day, when we were traditional Peace Corps here, it was a very solemn day. There was no public activity at all and we were warned not to walk anywhere or look like we were enjoying ourselves. Our first Martyrs Day in 1979 we were still in training, young, and cooped up all day. I’m not sure whose idea it was but we decided to go into the basement and have a dinner party where no one could hear us. To this day I think that is the drunkest I have ever been. We went around the table making toasts (several times) and I can’t remember what we were drinking but it wasn’t all beer. We were in Salima and not far from the lake, where we rode our bikes the next day and sat up to our necks in the water waiting for the hangovers to resolve. This year it seemed like business as usual. Stores were open, pedestrians chatting, no big deal. But we did get a day off.

George was away for an overnight this week out to a remote village on the Mozambique border. There was a report of mass hysteria in that village and a request went out for a psychiatric evaluation. So he and a couple of his colleagues went. It was too far for a day trip so they spent the night in a local hotel. George is still recovering from accommodation induced PTSD.

I had never heard of the phenomenon of mass hysteria, but apparently it’s a thing among young girls, often in boarding schools, and happens world-wide. The girls, approximate ages six to sixteen have little fits and fall down (not hurting themselves) and revive a few minutes later. It’s very disruptive in school, as one can imagine. There is worry about evil spirits and witchcraft and the whole thing freaks people out. I actually, would have loved to have seen it. George was incredibly amused by the experience (the hotel being the traumatic part). They met up with a medical officer from the nearest district hospital and took their ambulance to this village. When they arrived they had a meeting with the village headman and families. During the meeting, several girls got up and fell over, their eyes fluttering, laid on the ground for a few minutes, got up, then acted normally. George said the little girls were the cutest; they’d only stay on the ground a few seconds before getting up, a bit proud of themselves. The medical team did an evaluation and spoke to some of the girls privately who denied there was any stress or unhappiness in their lives. There was then a lot of explaining to the villagers that this was not possession by evil spirits and the cure was to stop paying attention to it. If a girl had fits she should stay home and away from other girls. The mothers complained that in the village it is impossible to isolate children; they see each other at the borehole, etc. So the suggestion was made that they be sent to relatives in Mozambique. Once the village was reassured that it wasn’t demonic possession and the girls were physically healthy, the entourage departed. As they were driving away, five girls collapsed on the road and the ambulance drove around them and continued on their way. The photos are pretty good. I personally wonder if being possessed by demons is a protection against rape. If all you have to do is gently fall on the ground for a few minutes every once in awhile it seems a clever strategy, but what do I know? I wasn’t even there. I would have liked to talk to the girls myself, though. I’m thinking this might be a good project for my fourth year midwifery students. They have to do a community health project, so I’ll keep it in mind.

I received an obituary today from Amanda whose mother, Janet, was a good friend. Janet died on the last day of January with Amanda by her side. I’m feeling sad and guilty for not being there.

When we got back from Malawi in 1981 we lived in western Massachusetts in a crummy rental with no insulation. The pipes froze regularly. The rent was cheap; we’d heard our house was hard to rent because of a tragedy that happened there. My then husband was a student and I was making $6.12 an hour as a visiting nurse in the slums of Holyoke. Matt was a year old and I was pregnant with Jake. Janet and Bob lived next door in a dilapidated farmhouse and Janet was pregnant, too. Amanda was born three months before Jake and during our four years as neighbors that family became the most important people in our lives. I’m not sure we would have survived those years without them. Our house was freezing. We couldn’t afford to fill the oil tank so heated with a wood stove too small for the drafty place. We had to put Matt to bed with a hot water bottle to keep him warm. We used to go over to Janet and Bob’s to warm up; their wood stove was bigger than ours.They certainly weren’t rich, but shared whatever they had. I asked Janet once if she knew anything about what happened at our house. She said she’d tell us if we ever moved away. Janet was incredibly talented and well read. She chain smoked without apology. She taught me to do upholstery. She was my compass. She and Bob made us laugh. Our kids grew up together. When I noticed a sprinkle of freckles on Jake’s nose I grabbed him and ran to Janet’s. “Hey! Check this out!” I said, and pointed to his nose. She smiled, and gasped as if it were the stigmata. That’s the kind of friend she was. God, I loved her. When I went into labor with Zack I walk next door to tell Janet, who hugged me, took a puff of her cigarette and told me she loved me and knew I’d do fine. I felt like I couldn’t go off to the hospital without her blessing.

The farmhouse they lived in was a wreck but the yard was spectacular. There were huge beds of iris and every June Janet would have an iris luncheon. Another friend and I were invited and the kids ran naked in the yard while we sipped champagne and ate spanakopita in our sundresses and hats at an elegantly dressed table surrounded by irises. Every once in awhile we’d check to see no kid was face down in the plastic wading pool.

Four years later we were moving to Cleveland for me to go to graduate school. We were happy to leave that house but knew leaving our friends would be hard. We were sure the friendship would last, but it’s different when you don’t live next door anymore. We could not have asked for better neighbors. We didn’t think we’d ever be as lucky again. As we loaded the truck together we pretended it was just another project they were helping us with. Saying goodbye was pushed out of our consciousness. Our thoughts were consumed with whether the beds would fit in the truck, and if we’d be be able to get the crayon marks off the wall to get our security deposit back. (We didn’t) When we slammed the U-haul door down, finished, we stood in the driveway and said, “Well? What happened here?” Janet said, “Blew her head off with a shotgun.” We asked, “Where?” She said, “Your bedroom. It took forever to clean the ceiling.” We said, “Okaay then. Thank you for not telling us that till now.” Then as we were forced to hug and say good-bye with a resolute smile, little Amanda who was four, said, “Wait! I don’t want them to go!” And Janet and I looked at each other and started bawling. Totally ignoring Amanda we fell into each other’s arms and mourned the loss of a relationship that we knew could not be the same again. We’d always be friends, we knew that, but it’s different when you don’t live steps away anymore. We’d been able to run to each other when Amanda burned her hand or Zack fell off the table. We were always there for each other when life was pretty hard and that was going to change.

Our Chichewa proverb for this week was about water remembering the valley. Our teacher asked what we thought it meant. I volunteered that it had something to do with water always running downhill? Is that it? No, that wasn’t it. A few others gave suggestions, also inaccurate. Then he explained that when you meet an old friend, someone you haven’t seen for a long time, but someone you knew very well, when you meet again it’s as if you were together just yesterday. That’s what this means. When we meet someone we haven’t seen for a long time, this is what we say, madzi saiwala khwawa, water does not forget the valley.

I thought of Janet when he said that. We didn’t see each other a lot after we moved. Once a year for a few years, then every few years. I took all the kids out to visit them when my twins were four weeks old. Janet and I piled all six kids (the twins in car seats) into the back of Bob’s pickup truck and drove two miles to the lake to take them swimming. (Thank God I had kids when I did. I’m sure they would be taken away from me in this day and age.) Janet, Bob and Amanda came to Maine a few times, each visit with more years in between. It didn’t matter, the water doesn’t forget the valley. The last time they visited together as a family we had stomach pains from laughing. We vowed to visit more regularly. As they walked to their car and we stood there waving goodbye, Janet turned and came back to me and said, “Linda, I have a confession to make.” I was startled. I said, “What?” She said, “I was secretly hoping you’d be fat. I’m sorry.” And, her confession made, her sin absolved by our fits of laughter, she gracefully walked to the car and waved goodbye. That was years ago.

Amanda got in touch with me last year to tell me Janet was not well. I made it out to visit once before we came to Malawi. I knew then I might not see her again, but I guess I didn’t want to believe that. I wish I’d been with her in the last weeks. I wish I’d given her the same blessing she gave me when I went off to have Zack. I feel like little Amanda saying, “Wait! I don’t want you to go!” But she’s gone. And I wasn’t there to say goodbye.

Love to all,

Linda