Sunday Morning~ Blantyre

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,