Sunday Morning~ Blantyre

April 30, 2017

Hi Everyone,

Our Model Ward proposal has been accepted and I waited all week for a schedule and format instructions. I didn’t know if I should prepare an hour presentation or a ten minute presentation. The fact that the meeting starts in three days and I still haven’t received that information is causing me a tiny bit of anxiety. But, going with the good news that we would indeed present this idea to the Association of Malawian Midwives (AMAMI) I got busy first thing last Monday preparing a power point. (I can whittle it down if needed, but I’m hoping to have an hour.) We knew we couldn’t present anything to the national organization involving our hospital without first talking to key people there to let them know. It was declared bad form for them to hear our plans for them at a national meeting. I was not familiar with this etiquette, so on Tuesday I asked Ursula, our dean, how we should go about it? She asked me to print out some copies of the abstract and then follow her.

We paid a visit to the matron of the obstetrics department, and politely explained our idea. We told her this was just an idea and, of course, once we present it next week we will come back and form a committee to have everyone’s input about how we should proceed. She loved the idea and told us who we should speak to in the college of medicine. We would go nowhere without their support. So, next stop was the office of the head of the OB department, where we just happened to find the three people we needed all sitting down and chatting with each other. The head of the department, the assistant head of the department, and the representative to the ministry of health for the department. How utterly convenient. Ursula, whose late husband was a much loved obstetrician in this department, was warmly welcomed. I was as well and we were offered seats around their table. The usual greetings were exchanged. The room we occupied was so crowded with stuff it was difficult to move. There were three big desks with (I assume) administrative assistants shuffling papers and recording stuff in log books. In front of the desks were the soft low chairs we occupied around a small coffee table. Five of us sat there in a space the size of a refrigerator. Behind us were two bookshelves crammed with notebooks, textbooks, and brown envelopes. Beside one shelf was another small coffee table with an electric kettle, bags of sugar, powdered milk, and tea. It was cozy.

The head of OB is a big man and I have found him to be a little intimidating. I have watched him rip into medical students in a way that would have made me walk out the door and never come back. I was dreading this meeting, expecting this to be a hard sell to that guy. But Ursula grew up with him and they went to school together. He was as congenial as they come, and started in on a long soliloquy about how midwifery and medicine have to work together! He lamented the deplorable state of the department and waxed nostalgic about the old days when Queens was a place where women got good care. I was holding my breath afraid to believe he was actually stating the problem before we did! When he paused for a thought, Ursula said, “Well, this is exactly why we are here. We have a proposal…” and she went on to describe our idea and list the problems we thought it would address. She handed everyone a copy of the abstract. They read it and all told us they would be happy to work with us on this. They all agreed something has to change, that students (both medical and midwifery) are not having a good experience and women are suffering. They don’t want to give up on the institution but know it has gone down the tubes. We let them talk a lot. When Ursula finally had the floor, she took them through the system we wanted to initiate and when she got interrupted with one of their comments, she quietly and politely said, “Excuse me, before you speak, let me finish.” in a completely polite and non-threatening way. She was brilliant. I sat silently trying to learn from her as I watched a secretary squeeze between us to make tea at the little table, shuffling around in a strange way. When I could finally see her feet I could see it was because she was wearing nylon stockings and flip flops. It looked exceedingly uncomfortable. She shuffled along, barely making it between the chairs, and reached over our heads to place a tea cup in front of each of us. She wedged her way between chairs to place the tea bags, sugar, and milk on top of a pile of papers. Then she put the boiling kettle in the middle and said quietly, “Help yourself to tea.” Everything looked a little precarious, but nothing fell off. I took this as a good omen. No one moved toward the tea, so neither did I. I waited until there was a lull in the conversation, really thinking I had nothing to add to what Ursula said, but when Dr. Head of Department (I must learn his name) said, “The midwives in the old days were so much more independent! They knew exactly how to handle everything! Now, they are acting as assistants! They take no responsibility!” I did not point out that this was, in part, due to the medical school taking over everything, but did feel compelled to tell him that when I was here in the late seventies working as a public health nurse I was in awe of the midwives. They were the strongest most skilled practitioners I had ever seen. It was the Malawian midwives that initiated my desire to go back home and go to midwifery school. I told him that coming back here all these years later I am shocked at how their roles have changed. Ursula (who is my age) remembers those days and is equally frustrated with how their role has devolved. She sat smiling at me and nodding. When it was all agreed that we would work together on this, that they would “help in any way possible”, we were encouraged to have tea together. We poured, sugared, milked, and dribbled tea on (hopefully unimportant) papers. A plate of cooked sweet potatoes was uncovered and we all ate one of those. This whole thing took about two hours but we had every blessing that we needed. Ursula and I were so excited when we left there. We calmly walked out of the office and in a whisper Ursula said, “Wow. I thought that would be much harder.” We were down the hallway and around the corner before slapping the high fives and practically dancing all the way back to our offices. I considered that a very efficient and productive morning. And I didn’t need lunch. I was sitting at my desk, smiling when I had the little panicky thought of, “Oh. Now we have to DO this.” And I began the slow process of downloading articles on Maternal Mortality in East Africa. That took way longer than getting everyone’s support. That would have been the exact opposite at home.

Tomorrow, May first, is a holiday here, Labor Day. I didn’t realize this until the middle of the week and am a little disappointed we didn’t plan to do something. George had his last week with medical students and was very busy with that, and I was all consumed with this presentation and we just didn’t get our shit together to make a plan. I had received a wedding invitation for a wedding on Saturday, but ended up not going. The invitation was slid under my office door addressed to “Linda and your friends”. I opened it and read the invitation and had no idea who was getting married. I did not recognize the names at all. I went though my student list to see if it was one of them. Nope. I asked around the department. One of the drivers? Nope. No one else knew who it was either. I thought it would be fun to go and see what its like, but George didn’t really want to go and neither did “my friends” and in the end I decided if I were going to go to a fundraising event (which is basically what wedding receptions are around here) I’d prefer it to be for someone I knew. I thought of going to the church, but that was at 7 a.m. and I had no idea where the church was, so missed out on that cultural experience. I’ll make more of an effort next time.

The medical students are on an academic schedule that is similar to ours at home. They are finished with classes now and have the next few months off and start again in mid-August. The nursing school has no such schedule. It continues all year since there are so many more students and clinical sites are hard to provide. So that means my schedule does not mesh at all with George’s. He had final exams this week, and by Thursday his cohort of psychiatrists from Europe were ready to party. We initially planned to go out to eat, but that’s always such a frig here with a big group and it’s hard to talk to each other. I suggested we meet at our house, have dinner, and have it be more of a relaxed evening. We had plenty of food for everyone and they all brought the wine. Well. I had been at the district hospital in Thyolo all day with a new group of students (a hospital I had never been to before) and though I was home in plenty of time to put things together for supper, I had not eaten all day. (I’m sure you can see where this is going). As we puttered around making a gorgeous salad from the garden, I had a pre-party gin and tonic. When everyone arrived and were munching on the little pizzas I’d made for appetizers, I had another, since they were all having one. Two gin and tonics? That’s not that much, right? As I put the finishing touches on the pumpkin risotto, they all gathered around the table and started pouring the wine. And really, that’s about the last I remember. I hear the food was good, though. Two of the women from UK had brought a little box of something and it was on the sideboard along with a card with a piece of chocolate attached. I have no recollection of this, but I guess after everyone left I brought that to bed to read the card and see what was in the box. And then I went to sleep, or more accurately, passed out. When I awoke at 6:45 a.m. with a splitting headache, I reached over and felt that George was not in the bed. Uh oh. Did I say something to make him mad? Good chance. Then I felt something under my back and couldn’t figure out what I was lying on. I reached my hand under there and pulled out the remains of a melted chocolate bunny that I didn’t remember taking out of the box. I just saw the melted chocolate on my hands and all over my back and screamed! Which hurt my head very badly. George, now finished with all the previous night’s dishes, came running down the hall with a cup of tea for me. I screamed, “What is this?!!” And showed him my hands. Totally nonplussed, he leaned over and sniffed and said, “Chocolate.” (Remember, he’s used to psyche wards.) And then he looked at my back and said, “Oh, I’ve got to get a picture of that.” He apparently remembered what was in the box. He was surprised to learn that I didn’t. He told me I didn’t act drunk at all, and no, he didn’t recall any mean things said to him by yours truly. Phew. But that was so weird. I don’t remember not remembering anything like that since college. And then, groaning, I had to get up and go to a neighboring town for an antenatal clinic with new students, in like five minutes. Friday was a hard day. I get queasy just thinking of it now. I made it through the clinic by not turning my head more than two degrees at a time, but it was touch and go there for awhile. In a cramped dark room with awful smells and nine students…let’s just say it’ll make the next clinic there seem like a breeze. This had something to do with not wanting to go to that wedding. I still had a headache on Saturday. Ugh.

Let’s see, what else? We’re thinking of buying a car. One of the reasons it’s hard to do anything spontaneous around here is because we have to plan so many extra hours for transportation. I hate to put one more car on the road here and we had thought we’d just rent cars when we needed them, but they are astronomically expensive to rent and by the time we rent one a few times we could have bought something second (or third or fourth) hand. I priced cars for the time Jordan will be here and just for ten days it will be almost a thousand dollars. Expats are always leaving and selling their cars which they bought from another expat who was leaving. So we’ll see. There are a bunch of cars, nice ones, sitting with grass growing up through them that were bought for some project with grant money. When the grant is finished the cars just sit there unused. We were wondering if we could fix up one of those and use it. It seems such a waste. On Friday I got a call from Stefan, George’s counterpart, and he said cheerily, “I’ve got the number for the guy who rents cars that you asked about last night.” I tried to recall a conversation I had about cars Thursday night. Nothing. Relieved to hear I was coherently talking about cars, I said, “Oh, great! Thanks!”

Yesterday we decided to have a low-key walk-around day. We bought a meat grinder. It’s one of those cast iron, heavy, clamp-to-the-counter numbers my mother used to use when my father decided it was cheaper to have her grind up the beef for hamburger. She bitched about it bitterly (“This stupid asinine thing!”), but I always thought it was pretty cool. A couple of weeks ago when George said wistfully, “Oh I wish there were a place we could buy some chorizo here.” I said, “We can make some!” which for some reason, made him slap his forehead and crack up laughing. So just to show him, I went down to the “Lord is my Savior” butchery and bought a chunk of pork and spent hours chopping it into mince to use for chorizo. The spices were no problem to find and it came out pretty good, not great, but pretty good. I have been obsessed with finding a meat grinder ever since and yesterday struck gold. I knew there had to be one around here somewhere. It was in a dusty corner of some Chinese shop in Old Town. I could smell it. It’s all cleaned up and after I finish writing this I am going down to my friends at the butchery to buy more pork to try it out. I’ll work on finding the casings later. For now I’ll make patties. When we were sipping tea yesterday morning talking about buying a car, George said, “Oh wait! I know! Let’s make a car! Scrap metal seems easy to find!”

The poinsettias are in bloom. I had no idea that so many of the trees (yes trees) surrounding us were poinsettias. They are spectacular. It’s one after the other of blooming beauties around here, competing with each other for attention. We’ve got two in our yard and four more I can see from my window in others’ yards. I wonder why they are associated with Christmas? It’s not when they bloom here! Anyway, another feast for the eyes. And now that the maize is harvested and we can see the ground again, it’s a diversion from the trash that didn’t disappear during the growing season. So much trash. Awful.

So I need to go arrange transportation to the meeting this week in Lilongwe, finish up the presentation, and make some sausage. The meeting is from Wednesday the 3rd until Friday the 5th. The acceptance email said they will let us know by Tuesday the 2nd what the format will be. No rush. I think our proposals for our national organization at home are due like a year before the meeting. I can’t wait to see what this will be like.

Love to all,

Linda

April 23, 2017

Hi Everyone,

When I was in college, I remember calculating how much tuition we were paying per minute when the professor was late. I recall there was some unwritten rule that if they were ten minutes late, we students didn’t have to wait any longer and could leave. I don’t think we ever did, though there weren’t that many times the prof was more than ten minutes late, but often it was more than five. Here, students wait entire days. They will sit in their seats for the endurance of the class whether the lecturer shows up or not. It’s stunning to me. They’ll read or be on their phones or laptops if they have them, but they stay in the room. More often than not, it’s at least a half hour wait for the lecturer, but in the case of the first week we were supposed to be teaching obstetrical nursing, we didn’t show up at all for the first three days, after receiving an incorrect schedule. The students sat and waited.

On the Wednesday before Easter, we received notice that there would be a three day faculty meeting in Lilongwe starting on the following Tuesday at nine a.m. I thought this was rather short notice for a trip that would involve the better part of a week, but others thought it was a luxurious amount of time to plan. The only reason we got such advanced notice was the four day Easter holiday about to commence. The bus was to leave the Blantyre campus on Monday (a national holiday) at 1 p.m. and return to Blantyre on Thursday night after the end of the meeting on Thursday. That would pretty much kill the entire week of scheduled classes. I asked, “Uh, what do we do about the classes scheduled for next week?” Oh, no problem, the students will just do independent study for that time. No one got in a flap about it, and since I was finishing my course responsibilities in an eight hour lecture marathon the following day, I didn’t either. At least I could give the students a heads up that no one was showing up the next week. I explained to my colleagues that I would be on Mt Mulanje on Monday and wouldn’t get home in time for the bus, so I decided to take a commercial bus on Tuesday morning and arrive a little late for the meeting, knowing it would not start on time. The bus gets to Lilongwe at eleven and I was sure, arriving two hours late, I’d still catch the opening prayer. As it turns out, a couple of other faculty were going by car on Tuesday morning, so could fetch me at 6 a.m. an hour before the bus leaves. That gave me twelve hours to get the Mulanje dirt off me, bandage a few scrapes from our slippery descent, repack for the week of meetings, and get a few hours of sleep. Packing in a rush always means I take too many clothes because I can’t decide what I’ll need, so I just throw it all in. After all, a car was coming to get me; I wouldn’t have to walk with it to the bus station.

I got to the Lilongwe campus at eleven sharp and looked for the midwifery department meeting. The nine a.m. meeting hadn’t started yet. It began after lunch at one. (I’m so glad I didn’t rush to get home to catch that bus on Monday.) On Wednesday, the full faculty meeting was to start at nine and I got there a little early just to show my enthusiasm. I looked into the large lecture hall and it was strewn with half-erected tables. There was not a soul around aside from the maintenance people setting up the tables. I walked around the campus looking for another faculty member and couldn’t find one. Obviously there was a memo I hadn’t received. The house I was staying at had no internet, so I figured there was an email out there for me somewhere. Eventually I found another lecturer from Lilongwe who also was looking for a sign of a meeting. She invited me to her office saying, “We’ll wait thirty minutes and go back and see if there is someone there.” At her office she found the email saying the meeting was postponed until ten. That was at 9:25. At ten we walked back across campus to the meeting venue to find a few people sitting at the largely empty tables. Greetings abounded as people straggled in. At eleven it was decided to have tea and then start the meeting. Not having eaten breakfast, I was ok with that. At 11:15 the meeting started in earnest and didn’t stop for hours and hours. It was supposed to be over at three, but at 3:30 we were only on number seven on the agenda of twenty-seven items. The passing hours did not deter the vigorous discussion after every item. The “brief” remarks, “just quickly” would go on and on and on. (Note to self: Never attend a meeting again without knitting.) At 5:15 p.m., with rain pouring down, it was decided to table the remaining twenty-one agenda items until the next full faculty meeting, with the understanding that this was the first one since 2014. Not one of the fifty attendees had a problem with that.

Now, I will say, that I enjoy these meetings. It’s interesting to see how they are run. They are certainly not efficient by our standards and expats usually go bonkers with the slack adherence to the clock, but I love how everyone gets a chance to speak their mind and put forth their ideas and concerns. Everyone listens respectfully. They refer to each other as “Madam Chairperson” or “Madam Assistant Chairperson”. It’s so polite. Each person is thanked for their remarks and congratulated on bringing issues to light. Will anything come out of it? Who knows. But not much comes out of meetings at home either with the rigid adherence to schedules and respect for time. I’m not saying one is better than the other, but these meetings seem more festive and fun. There’s food and tea and greetings and laughter. There’s camaraderie and problem solving, it’s just not the same style. I like it. However, it does help to plan for the long time delays and bring other stuff to do.

I was able to get the abstract finished for the Midwifery meeting to be held in Lilongwe on May 3rd. We will be presenting our idea of the model midwifery ward. Since the abstract wasn’t due until two weeks before the meeting, I’m going to go out on a limb here and say they weren’t being overly selective as I got word the next day it had been accepted. It was fortuitous to have all the faculty cornered at that campus in various states of waiting for meetings to start, as it gave me plenty of time to incorporate all their input, get the initials after their names correct, and get it sent in on time. Now we have two weeks to put the presentation together. The midwives from the Karolinska Institute in Stockholm are excited about it and will also be involved. I’m starting to feel a tinge of optimism that we’ll pull this off. The graduate program here is salivating over all the data we’ll be able to collect on maternal morbidity and mortality (officially at 459/100,000 but we all know it’s much higher than that), and neonatal outcomes. I’m even thinking of ways we can get midwifery programs at home to be involved in a student exchange here. Why not go for broke? We presented it as a randomized controlled trial to look at outcomes. That way it won’t have the air of let us show you how to do it right and therefore might ruffle fewer feathers. This was the idea of the Swedish midwives and I think it’s brilliant. They actually created this type of ward in their setting in Stockholm and it was so successful, and the outcomes were so good that, guess what? They closed it. The doctors thought it was unfair that some women should have a better experience than others, so in order to be fair to everyone, they closed the midwifery-run ward with the better satisfaction surveys and outcomes. I was incredulous! I said, “You are kidding me! Everyone at home thinks Sweden is utopia!” Helena looked at me, rolled her eyes, and said with a tinge of embarrassment, “Yes, we know you do.” It’s funny, part of me had that misery-loves-company feeling of relief you get when you find out that marriage you thought was perfect really isn’t, and part of me had this overwhelming feeling of disappointment like when you find out the celebrity you loved and admired is really hooked on cocaine and beats her kids. Seriously? Even Sweden’s midwives have to struggle to be allowed to give good care? WTF?

On Thursday, the department meetings were to start at nine. I got there fifteen minutes early to connect to the internet and send off the finished abstract. When that was done, no one was able to say at exactly what time the meeting would start. The bus back to Blantyre was supposed to leave at two when the meetings were scheduled to finish, but by ten thirty when the meeting finally started, I knew I wasn’t going home that day. It ended at five, only three hours late. After our last night-time-bus-trip-close-call, I decided to spend an extra night if it meant I’d arrive at my destination during daylight hours. I only had office work to do on Friday anyway and I could do that on the bus. That gave me Thursday evening to brainstorm with Kristina (the other midwife from Sweden) about ways to make this midwifery ward a reality. Chatting over gin and tonics and pizza, it beat clinging to the seat in front of me praying we avoid a head-on collision with headlight-less cars on pitch black roads .

I caught the seven a.m. bus back to Blantyre on Friday, arriving home to find George had washed the entire pile of muddy clothes I left on the floor when we got off the mountain Monday. Very sweet. That was a nice homecoming gift. And then I learned that the doctor I quit my job in Maine over, got arrested for wife battering! (I’m sorry for her, but it is satisfying to have the truth come out after our complaints went unaddressed for so many years.) And it looks like a few more treasonous politicians are running for cover, so maybe the tide is starting to turn. Hope springs eternal.

I just got back from church which was still clothed in miles of gold and white satin, draped everywhere. I’m a little bummed that I missed the holy week celebrations but considering the regular mass is almost two hours long I’m sure Easter was a mass-a-thon. The enormous satin (actually cheap polyester) canopy gave a hint of the elaborate spectacle it must have been. Today we had a visiting priest who gave a sermon not subtly directed at married couples. “Ok so you may not like each other’s behavior! No one is perfect! You have to try to understand each other!” It sounded a little like he was fed up counseling married couples and wants them to shut the hell up and get on with life. At the end of mass there was a procession where the youth group (about fifty of them) dance down the center aisle with what looks like the contents of the food pantry donation box. They carried a bag of laundry soap, brooms, toilet paper, a live chicken, dozens of eggs, a crate of bottled water, plastic bags, a cabbage, and other assorted items all presented to the priest who blessed them before the youth danced off to the side of the altar and back up the side aisle out the door. Not sure what that was all about. Maybe donations to the priests. The music was good though and I thought it was entertaining. George has had enough of a ritual he was not brought up with and now spends his Sunday mornings doing his own thing. It’s fine. I wasn’t expecting him to convert. I actually enjoy being there on my own. I don’t have to worry about what he’s thinking.

This week I will have two days in the clinical setting with new groups of students and then will try to corral people to work on this presentation. I have a suspicion I will be doing most of that myself, which, hopefully won’t be an indicator of the whole project, but we’ll see. I’m getting excited about Jordan’s impending visit. A few weeks and I’ll take a week off to show him around. Can’t wait to share this!

I’m picking more and more from the garden––ripe peppers this week and the cucumbers have blossoms! I need to make a spray for the tomatoes as the vicious little whiteflies are invading, but I found a recipe for homemade insecticide so will give that a try. Or Chimwemwe will. I love having a gardener. Love it. I asked him how I could get at the guavas too high to reach and he said, “You want guavas? No problem! I will climb!” and he was up in the tree, twenty feet over my head in three seconds. “How many do you want?” he called down, as if I were placing an order in a grocery store. He brought down ten and asked if that were enough for now? I love him.

Till next week…

Love to all,

Linda

Sunday Morning~ Easter on Mulanje

April 16, 2017

Hi Everyone,

It was two years ago today that George and I met on the train platform in Berkeley, California. In a way it feels like we’ve been together forever, but saying that seems to take away from our past lives and doesn’t seem right, but we’re making up for lost time. We’re celebrating our anniversary and Easter with friends on the top of Mt Mulanje, in the same hut where we celebrated my 60th birthday in September. It was hot and dry then and the landscape was desert. Now it’s lush and green and wildflowers are in bloom everywhere. The rains are ordinarily finished by now but we had a downpour when we got to the first hut on Friday and steady rain yesterday when we got here to Chinzama Hut, where the sign on the door says “YOU ARE ALL MOST WELCOME”. But there is no space between the ALL and MOST. We’ve been so lucky to have made it to shelter before it started raining and so far all our clothes have stayed dry. I was hoping to have a little Easter sunrise service this morning, but we are in a thick cloud and can barely see off the porch of this hut. It looks more like the coast of Maine out there than Sub Saharan Africa. We slept way later than usual on our thin vinyl mattress on the floor of this cedar refuge. The hiking across the plateau, supper by the fire, wine, and whiskey may have contributed to the long slumber. We slept eleven hours. We tried to stay up last night to play cards but it was so hard to see in the dim candlelight we packed it in by eight and got up at seven. George has a fire going and the water is heating for tea. We’ll leave after breakfast and head back to Tuchila Hut and stay there tonight, hopefully just the four of us. When we got there Friday, thinking we’d have the place to ourselves, we found five adults and nine children occupying the place and using all the blankets and most of the mattresses. We claimed a side room which fortunately fit the four of us with our packs, and we made the best of it for the night but it was a little noisy and less than serene. Trying to cook on the small fireplace all sharing the same pots and plates was a challenge. Then around seven p.m. two young women showed up having hiked the last hour in the dark, unable to make it to the hut they were heading for and we had to make room for them too. It was cramped. We left early yesterday morning for the three and a half hour hike to this place and we have it all to ourselves. Very nice. Nothing against camping with nine kids and a dog, but been there done that.

We are blissfully disconnected from the outside world and part of me doesn’t want to hear what’s going on. I just want to plan new adventures and talk about past ones. This is the first time up Mulanje for our friends, Peter and Caroline, even though they have lived here longer than us. When we met them in October we were talking about the mountain and they said they had been wanting to climb it, but were waiting to find people their own age to go with. (Most of our expat colleagues are thirty or more years our juniors, and make us feel very unfit when engaging in a strenuous activity.) So with the four day weekend for Easter and the rains (we thought) behind us, we decided this was the time. Caroline got cold feet after a huge deluge of rain last week in Blantyre. Sheets of rain flooded the roads everywhere and she panicked at the thought of climbing a steep mountain in that. It took a little cajoling, and I’m not sure what I said that convinced her it would be okay, but we were back on after a little cheerleading. Peter said, “I knew you’d convince her. I didn’t even try.” So I was praying we wouldn’t get swept off the trail in a deluge after assuring her, with absolutely nothing to base it on, we wouldn’t. So far so good. We hired the same guide we used last time and took three porters for our gear. I’m telling you, I never want to hike again without a porter. It’s not that we couldn’t have made it up here with our packs, but it would have been so much less fun. And we’d be in pain. And we wouldn’t have carried the four liters of wine. When we arrived at the hut, the packs were already here, firewood stacked next to the fireplace, and a kettle of water was ready to boil for tea. The big basin was full of water from the nearby stream, and at four thirty the caretaker came to tell us our warm bucket baths were ready. Life doesn’t get better than this. And it’s nice to be able to do this with another couple, our generation, with similar interests. Peter is a gastroenterologist working at Queens and teaching at the college of medicine. They are originally from Zimbabwe but have lived in UK for many years. After he retired from the Health Service in UK they decided to come back to Africa to work for a while and have been in Malawi a little over two years. They have a nice big comfortable car, so getting to the base of the mountain was pure luxury compared to last time on the minibus. We really are going a bit soft but it feels so grown up.

I’m in charge of breakfast, so I’ll get my raisin bread on the fire. I’m baking it in a rather thin pot so it’ll be tricky to keep it from burning. Not like my nice cast iron. They are so impressed with my cooking I hate to have a flop here, so I must pay attention. The porters managed to get the dozen eggs I brought up here intact, not even a crack (they are so worth their $6/ day) so I’m making a basil and cheese omelet to go with the raisin bread. And sausage, just because it’s Easter.

This will be late as I’ll post it when we get down off the mountain tomorrow.

Much love to everyone. Now more than ever. Happy Easter.

Linda

Sunday Morning~ Blantyre

April 9, 2017

Hi Everyone,

While waiting for the kettle to boil for tea this morning, I turned off the outside light and looked to see if the night guard was around. He’s been leaving early and not waiting for the day guard to arrive. I happened to be looking at our gate that leads to a footpath and saw a hand reach in to see if the lock was secure. To open the gate from the footpath, you have to reach in a little hole cut into the sheet metal, turn the padlock so the keyhole is pointed up, reach your hand into the square opening, insert the key, and fiddle with it until it opens. It’s a little annoying. To open it from the inside is a little easier as you can use one hand to hold the lock and one to use the key without the sheet metal digging into your wrist. But even that is a nuisance. I hate being locked in here like this. I appreciate when the guard is right there and does it for me, but often Chimwemwe is gardening, so I do it myself. I’ve often wondered why we need that padlock? There are already multiple locks on the doors of the house and we don’t leave anything outside. But this morning when I caught the glimpse of a hand coming through the opening in the sheet metal, grabbing the lock, turning it to see if it was indeed locked, which it was, then dropping it and walking on, I wondered if it was a thief checking to see if entry would be easy. Finding the gate locked I guess he decided it would be too much hassle to climb over the brick wall and deal with the razor wire on top. Hmm, I’m not sure what was going on, but I guess it’s a good idea to keep it locked.

Ugh, what a week. Twenty hours of lecturing in a week is a lot. If you just look at the number hours, it seems like half time. But considering it was my first time teaching this, the prep took up just as much time. It actually should have been more prep for me to be properly prepared. I did more winging it than I should have and it showed during the genetics unit. My exhausted evening idea of downloading some simple Genetics 101 video from youtube bombed when the internet was so slow nothing would download. In my exhausted state I figured it would work in the morning. (Being exhausted is a little like being drunk, some ideas seem really good at the time.) I tried at 5 a.m. but it didn’t work, and an hour later I was like, Ok, I’m screwed. I had to admit part way through the lecture that I really didn’t understand parts of the material myself. I vaguely remembered having to memorize some of this stuff in nursing school and as I recall, I didn’t do too well on that test. I should not have been teaching genetics. The parts of genetic counseling I do know, I was able to relate fairly well, but it all seemed pie in the sky anyway. If they had frigging water to wash their hands with I’d be happy. No one in my lifetime here is going to have an amniocentesis. But albinism is fairly common and being able to describe how it is inherited could actually have some impact. I focused on stuff like that to distract from the fact that I still have to look up the definition of chromatid. Anyway, I’ve got this afternoon to gear up for another similar week, then two more days the following week and my section will be done. My remaining lectures are topics I’m up on, so I think I’m over the steepest hill.

On Tuesday I had no lecture so went out to Machinga Hospital in Liwonde to supervise the fourth year students. Hours of lecturing made a clinical day seem easy. Elizabeth was in Lilongwe at a meeting so it was my first solo out there. It started in labor and delivery where four students were caring for four of the twelve laboring women. There are only six beds, so half were rolling around on the floor. The ones that could move. I greeted the students and asked what was going on? One, told me he was taking care of a woman having her seventh baby. I said, “OK, great. Present her to me.” This was a little after 9 in the morning and they start at 7:30. He had to go get her chart to read it and tell me her details. That annoyed me. She’d been in labor all night and he’d been there for an hour and a half. He should have been able to tell me something about her without searching for it in the chart, like, how dilated is she? Any complications? Basic stuff. Her age, maybe? HIV status? I’m not asking for her genotype, but some basics should be on the tip of his tongue! C’mon! I looked at this woman, who was skin and bones, writhing in pain, chanting and moaning. She had an IV in her hand about to come out from her thrashing around. The little tape that was used to secure it was flapping in the breeze. The IV bag was hooked on the little lever on the louver window. I thought that was good. It wasn’t lying on the bed. She had a urinary catheter in, but no bag was attached, so urine, along with amniotic fluid, was leaking all over the black plastic and she was lying in a pool of this mixture. She rolled away from me and I could see she was also lying in shit. I asked, “She’s been here all night and not delivered? Seventh baby? Really?” As he’s looking at the medical record he tells me she is going for a c-section. Whoa, what? Six vaginal births and now a c-section, why? He didn’t know, but says he can see in the chart she’s been fully dilated since six a.m. and she hasn’t delivered. He said, “It says in the chart the head is still high.” But since she hadn’t been checked since then, we didn’t really know where the head was now, did we? I pulled a glove out of my pocket and examined her. The head was about to crown. I said, “Get ready for the delivery, the head’s right here.” He put the chart down and looked disappointed that now we had to do the delivery. Let’s just say his energy was low. (To be fair, he was probably hungry. The students often don’t have time to go get water to wash, cook their breakfast, then walk the half hour to get to the hospital for 7:30. Their lives are hard.) But I was not going to let this woman go to surgery when I could practically see the head. I told him to explain to her the head was close and she would deliver soon. He translated this and then her reply to me. “She’s saying she’s too tired to push. It won’t come out. She wants a c-section.” I asked, “And do you think that’s a good idea with the head right here?” He looked at me silently, apparently searching for the answer I was looking for. I said, “Ok, I am going to answer that for you. No! It’s not a good idea! She doesn’t need surgery! Let’s help her to push!” He then tells me she has TB, so has no energy. (Ok, that’s why she’s so skinny.) I said, “So unnecessary surgery would be even worse for her, right?” He reluctantly nodded, apparently deducing from my tone that I was looking for agreement.

No one encourages women here to push. It’s just easier to take them to surgery. That gets them out of the labor ward, and someone else can have the bed. It is completely preposterous. I get that it takes a lot of energy to encourage someone to push when they don’t want to. It can be exhausting. It is much easier when there is a supportive team around and you can feed off each other’s energy. But when no one wants to do the cheering with you, ugh, it’s hard. And I’m not supposed to be taking over; I’m supposed to be teaching the students to do it. That’s another energy-sapping layer. So here we go… “What do you think might give her some energy?” Sugar. “Ok, great! Let’s get her some sugar! Where’s the guardian? Can they bring her something?” Translation. No. They aren’t here. Ugh. What other idea? He said, “I can put some glucose in the IV.” Ok, that would be even quicker but I didn’t think they’d have any. He went off to find some. In the meantime, I tried to clean her up a little, smiled at her, tried to communicate that the baby was coming; she would have it in her arms soon. She shook her head and turned away from me like she hated me for preventing that c-section that could end all this (and maybe her life). The student returned with some glucose and injected it in the IV. While we waited for that to get to her brain it was time for a pep talk! None of this was coming from him. He was pretty much just acting like a translator. I could tell he was trying to figure out what I wanted and none of this was familiar to him. Fortunately, another student came over to help with some enthusiasm. He was great. He must have eaten breakfast. He helped get her in a good position and was talking to her in an encouraging way. She responded. I poked student number one and said, “See! Like that!” So then we had a little student competition going and the energy improved dramatically. I said, “Here’s the deal. This baby is coming out vaginally. Period. We can either do this all day, or help her to push and have it out in 20 minutes.” The students looked at me blankly. I said, “Translate that to her.” God knows what they said, but she did muster some energy. I took her hand to make her feel the baby’s head. “Mwana mutu”, I said. (Baby, head) It was just at this point that the clinical officer came to take her to surgery. They were talking about her like we weren’t even there, fortunately in English so I could say in a sweet happy voice, “Oh, she’s going to deliver. Look! Here’s the head!” (which, admittedly was taking forever to come out) Without attitude, the clinical officer looked relieved and said, “Good job. Thank you.” like they didn’t want another patient either, and walked away. It was another half hour of cheerleading before that head finally emerged, as I suspected, in a less than optimal position. And he was big! I was shocked that a woman as thin as she was could produce a baby weighing over seven pounds. She was ecstatic. Her grimace was replaced with a huge toothy smile. I did a happy dance and a bunch of I-told-you-sos. She told the student that I should name the baby. That always seems a big responsibility and I never know which name to pick on short notice like that. I always feel like there has to be some significance to it. If it was a girl, I would have said “Hannah” as I was thinking about Hannah Shaw that day, the third anniversary of her death. But it was a boy and I didn’t want to use Hannah for a boy. Though the mom would have been fine with it, I thought of Johnny Cash singing A Boy Named Sue and couldn’t do it. So I said, “Well, she (the mom) is 37, born the year my son was born in Malawi and his name is Matthew. Does she like that?” Big smile. Ok, yes, this baby is now Matthew. So I thought that was rather sweet (though when I emailed this story to said son he told me he finds my writing “selfish and pandering”, though his girlfriend and ex-girlfriends “eat this shit up.” I do hope the new little Matthew doesn’t turn into an asshole like his namesake). I wrapped the baby in a chitheje and took him over to show the clinical officer where the molding was on his head. I said, “See? His head was asynclitic; that’s why it took a little longer.” He nodded, bored.

From there I went to see the three students in the antenatal clinic. One had been pregnant herself and I learned when I arrived that she’d delivered four days before. I asked the other students if they were with her for the delivery? No, they weren’t. The delivery happened during the night and they didn’t go. It’s too hard to go anywhere in the dark. I thought that was poor form, but I didn’t say that. I just acted surprised that they didn’t want to be with their friend when she delivered. (It’s too early in their career to be this apathetic!) While we were standing there talking, I saw the recently-delivered student walking toward us through the hospital grounds. The others exclaimed, “Here comes Linda!” (Her name is Linda, too. She’s the only one whose name I keep straight.) She walked toward us looking like a young bride in a strapless chiffon dress with a black bolero. She had a smile from ear to ear. I thought, wow! What a transformation. I had never seen her smile before. She must be feeling a lot better. Her friends all greeted her and then she came to me and handed me a note. I opened it and read:

To: Dr. Chodzaza and Linda Robinson

From: Linda _________

I write to inform you that I have delivered my baby on Friday the 31st of March and am requesting to have two more days of sick leave. I can return on Thursday, April 6th. I will make up the lost time during the April holiday week.

I looked at her, beaming in front of me in what looked like someone’s old prom dress. I said, “Let me get this straight. You delivered your baby four days ago and you only want two more days off?” She nodded. I said, wouldn’t you prefer to have a whole week? She nodded. I said, “I think it’s fine if you take off the whole week and rest. Don’t worry about coming back here on Thursday.” She thanked me profusely. I mean really. Some days it is so easy to please people.

Touring the campus on Thursday were two midwives from Sweden who have an exchange program going with the nursing school here. We met for breakfast and talked for hours about the state of midwifery in our countries and Malawi. I told them about my clinical experiences here and the idea we have for a faculty practice. They lit up and exclaimed that they would love to be involved in that! If we could incorporate a couple of other university exchange programs and collect some good data, this really might fly! One is the head of the midwifery department in Stockholm and had some great ideas. It was another booster shot for me and I’ll get the abstract to her for input before I submit it this week. Woo hoo! Fingers crossed.

Next Sunday is Easter and we will be on top of Mt Mulanje, a different kind of cathedral. I won’t get anything posted until at least Monday. I’ve been so bloody inactive I’m sure I won’t be able to walk after the hike but should manage to type a short account. The fourth year students have this week off but the first and second years don’t. I have no idea who designed this academic calendar. It makes no sense to me at all.

Ok, off to make more powerpoint. I’m getting pretty quick at that.

Love to all,

Linda

Sunday Morning~ Blantyre

April 2, 2017

Hi Everyone,

Last September I was searching for ways to be helpful to the faculty. I felt like I wasn’t very busy and should have been doing more. One of the midwives told me to take advantage of the quiet time because our program is overloaded and there will be a time this year when I’ll wish there was nothing to do. Well, those days are here.

Second term has started and the course I’m co-teaching, that we thought was supposed to start tomorrow, actually started last Monday. We haven’t even written the curriculum yet. A week ago I still didn’t know what I was supposed to be teaching this term. I have four hours of lecture tomorrow starting at 7:30 a.m. at a campus thirty minutes away. I haven’t even started putting together a presentation.The students were sitting in class waiting for us last Monday, the day their term started, and we didn’t show up. The first year students start tomorrow, but for some reason, the second year students started last week. This was news even to Ursula, who is the dean of our program. Can I wing it tomorrow for four hours? I guess have to break my rule of not working on the weekend and spend this evening making a power point.

On the ride to Lilongwe last weekend, I talked a lot about the frustrations I have with how women are treated here. Two of my colleagues were in the vehicle heading to meetings and I’d  hitched a ride with them. It ended up being a good brainstorming session. I started venting about the treatment of women and how hard it is to teach theory and the principles of good care  and then send students to the clinical setting where they hardly get any supervision and see women being treated terribly. I asked how are they supposed to learn to be advocates for women? It’s crushing me.

They both listened and shared my frustrations. Ursula, our dean, said she has a dream of having a faculty practice at Queens Hospital where the practice is run by midwives and we mentor students so they can see what real midwifery care should be. I jumped all over that. It would be fantastic! We wouldn’t have to be driving all over the country to supervise them and we could create an environment of respectful care! I asked how we could do that; what would it take to make it a reality?  Well, they said, we’d need money to start. They both laughed and said, “That’s where you would have to help. We’d need you to find a donor.”  I told them I’m not friends with Madonna, so don’t get any ideas. Just because she’s American doesn’t mean I know her. (Madonna has adopted kids from Malawi and she has donated money to build a big state-of-the-art children’s hospital here. It’s impressive to say the least, even in it’s half-done state.) But then I said, “But, yeah! Where does she think those kids start anyway?!” That got a laugh and a glimmer of hope. But I told them even if I could finagle an introduction to her when she comes next, money is the easiest thing about this. How would we sustain it? Who would pay the salaries? I don’t believe in projects that rely on continual funding from another source. It would have to be self-sustaining. We painted a broad picture in big strokes of what it might be like and then my mind started wandering and I had a huge fantasy of having a unit set up right near campus where we ran the show. We would only call for medical consult when we identified the need. No more medical rounds at 9 a.m. and 3 p.m. where a posse of med students and residents surround a woman’s bed, discusses her case as if she were a mannequin, take turns examining her without consent, make a plan, instruct whatever underling they see in a white uniform to carry out their order, toss the chart back on the bed, and turn to the next victim. I’m thinking they won’t be too eager to give up that power. I told my colleagues, the money is the easy part. Getting the medical school to stay away until we call them is going to be the problem. I told them if I had an opportunity to float the idea with someone from the embassy or with Peace Corps I would.

On Sunday I got a ride back to Blantyre with staff from Peace Corps and SEED Global Health. I brought up the idea of a faculty practice and discussed an actual path forward with it.  Our in-country SEED representative told me there was a scientific conference for midwives on May 3rd to 5th in Malawi and that I should try to attend and bring this up. When I opened my email Monday morning, there was a call for abstracts to present at this same meeting. I thought that was downright prophetic. I ran with it to my colleagues and said, “We should submit our idea! Let’s write it up and present it at this meeting!”  The theme is ‘Midwives protecting the lives of mothers in the workplace!’ This could get some momentum!” Elizabeth said, “Yes! Let’s bang our heads together!”  Ok, so let’s see…..we’ve got an idea, we’ve got enthusiasm, we’ve got a need, we’ve got some of the resources. What don’t we have? Right now, I’m feeling like it’s clout, but I didn’t want to sound like a Debbie Downer. I asked Ursula what kind of a fight we could expect from the medical school? She acknowledged it would take some finessing. She is well connected though, and if there’s one thing they do here it’s meetings, so we’d have to have some meetings with key people. I need to get some statistics. I need to stay focused on the steps without jumping right to the final product. I can’t let myself get too disappointed if it doesn’t go smoothly. I’ve got to protect myself there. I’m so excited at the thought we might be able to actually do something to improve women’s lives that I’m letting my heart run away with it. It’s like falling in love. It all sounds so good at the beginning. When it’s all theoretical the happy-ever-after seems assured. But then, you know, reality sets in and it all goes to hell and you look like an idiot for even believing it could work in the first place. And then I think are we really going to be able to create this model ward? Really? When we can’t even let the faculty know the schedule for the beginning of second term? But, if we can be aware of all those things, then maybe, maybe we can come out with something that works. Maybe we can create a model ward that gets replicated all over the country! Maybe it will be so popular that we’ll have to expand! Maybe, if we show we have better outcomes people will see the light and it will become a standard of care! Oh wait, we’ve already done that at home. We’ve already shown the better outcomes. That’s right. And the well-fed white men in dark suits still sit around the table deciding how women’s lives should be regulated. Fuckers.

Walking home from church this morning I saw a man lying half on the road with his head on the sidewalk. He didn’t look injured but wasn’t moving. I crossed the road and looked closer to see if he was breathing.  Another woman slowed her pace to look at him. Two young men came over and moved his legs so he was lying completely on the sidewalk. They looked up at me and said, “He’s drunk.”  I asked if they thought he was alive? “Yes, he’s alive. He’s drunk.” The man moved his head ever so slightly, and the other two men kept walking. The woman kept walking. Then I kept walking. I was shocked at how little emotion I felt. I had no desire to help him. I was glad for the other people around, but really felt no compassion at all. I thought, it’s the first of the month. Pay day was Friday. They’re probably right. He probably drank most of his pay. I wondered if there was a woman at home with kids who were hungry. I crossed the bridge over the river littered with plastic bags. I walked up the hill and home.

It’s gotten late and I’ve got to get something together for tomorrow.  Friends came over so we could discuss our plan for hiking Mt Mulanje over Easter weekend. We needed to coordinate the food and supplies and we put together a Huevose Rancheros for lunch which was actually quite good. We had a great time for a few hours planning our trek, but now I’m regretting the gin and tonic and bottle of wine that went along with the merriment.

I need to make some tea and start writing some notes so I don’t look like an idiot tomorrow.  I’ll let you know how it goes. Safe Motherhood Initiative and Respectful Women Care. I’m sure I can rant about that for four hours.

Love to all,

Linda