Sunday Morning ~  Blantyre

Zinapangana zinaulukira pamodzi ~ They agreed amongst one another and flew away together.

~ Malawian proverb

March 25, 2018

Hi Everyone,

I am reading a book called A Heart for the Work, Journeys through an African Medical School by Claire Wendland. She worked in Malawi as a medical student, then came back several years later as an anthropologist. In the prologue she reflects on what it must be like to be a medical student here without having experience in the land of a million resources. She writes: “Would they, like me, at one moment want to stay forever and the next count the days until they could leave, while feeling guilty for counting?”  I read that sentence many times. It’s a dichotomy I struggle with often.

Week three of clinical rotation is finished and the coming week will be a short one because of the Easter holiday, for which I want to get on my knees and thank God. I’ve had to leave the ward several times because I could not bear to watch what they were doing to women there. They clean open gaping wounds with “spirits” which is just plain alcohol. You know when you get a little alcohol on a razor cut when shaving, or on your finger when you’ve got a paper cut, and it hurts like hell? Well, they scrub out open abdominal wounds with this stuff and I swear it’s like being in Guantanamo. The protocol is to medicate them a half hour before but often the medication is “out of stock” and they just rip the bandage off and do this while the women cry and scream. It’s ghastly. I can’t teach this. I can’t tell the students this is how to clean a wound, so I found myself retreating down the corridor with my head hanging and feeling like a complete and utter failure. I met with the students every afternoon last week from three to five in our clean(ish) classroom, as far away from the ward as I could get, to discuss this and let them vent. They hate doing it too, but will be tested and graded on how well they perform this task. I was honest that I don’t believe this is the way to treat wounds but I know it is the protocol they must follow, but also that they have the capacity to change things when they graduate. It felt like a cop out. Here’s my colleague having a discussion about whether they should scrub in a circular motion or in a linear one and the students burst out laughing at the expression on my face. Horror. It’s one of those moments when I feel like I’ve got to get out of here.  Thursday afternoon we’ll be on the road to Mozambique and I hope to come back from that ten day break with an attitude adjustment.

On Friday the Tiyamike women came to discuss plans for the future and what to do with the money earned. I was totally stressed at work and had to be on campus for an 8 a.m. exam vetting meeting. I was clear I had to leave by nine to meet with these women and wanted the meeting to start on time. It was 8:40 by the time everyone arrived and I was irritated. I left shortly after nine even though it was not finished, only to get home and wait until almost ten for the women to arrive. I should have known. Then Eneless sent a message that she couldn’t come, but “good luck!” I then had a panic attack because if Peter, the other teacher didn’t come the whole thing would be a bust since the women don’t speak English and my Chichewa just isn’t that good. Fortunately, he came though and was able to translate, as I had a lot I wanted to say to them. As soon as everyone was seated under the mango tree I started by telling them how proud I was that they were so dedicated to the class and how impressed I was by how fast they learned a new skill. I told them I wanted them to have a discussion about how to move forward but wanted them to understand what everything cost. I laid out all the materials and told them what I paid for it all. I also explained how much time I spent searching the market in Limbe for the supplies. If they wanted to continue, it would now be their job to do that. I wanted to give them the skills to continue on their own. I shared some ideas I had for selling their creations in the salons and guest houses. I asked them to think of new ways to market their products (Don’t do it the same way as all the men). I asked if they wanted to continue as one group or form smaller groups closer to their homes. They all said they wanted to continue as one group but would meet in a more central location. They might search for a community space or church to use but wanted to avoid paying rent. (This all seemed incredibly well thought out.) They said they wanted to meet once a month at my house to show their goods and maybe get another lesson. All this was great. Then money talk got complicated.

We made a total of 104,500 Kwacha at the sale. We needed to decide what to do with the money. That conversation didn’t go as smoothly as the where-to-meet one did. Several of the women wanted to buy more supplies and open a bank account. There was long discussion about that but it two women didn’t agree. One thought the money should just be divided up equally among the group and that’s it; everyone goes off with 10,000 Kwacha. Lots of animated Chichewa was flying around, clearly in disagreement. They have a distinctive scolding tone when someone is behaving, in what they consider, to be inappropriate. One member was crunched up in a corner, pouting. She was being scolded. I asked Peter to tell me what was going on. He said there was disagreement and the discussion wasn’t moving toward resolution so there would be a vote. I said, “Ah, ok. That seems fair.” Then the vote happened and it was eight to one in favor of buying supplies and opening a bank account. I thought, Well then. There. That’s settled…But no. That’s not how this works. If everyone doesn’t agree then it’s not settled. Lots more discussion. Lots more. Lots more scolding. Exasperation. Angry words. I asked Peter to translate again as I watched the pouter turn further into herself.  Peter pointed to her and said, “This one does not agree to save some of the money. She wants her full share.” That got my back up a little. I said, “Really? Her full share? When the others want to buy supplies and put some in the bank?” I told Peter I’d like to say something and wanted him to translate.  One of the women had taken a tailoring course. I asked her to tell the group how much she paid for the course. She said it was 70,000 Kwacha for the year but they have shorter ones for 15,000 Kwacha. I looked at the women and said, “So she had to pay to learn a new skill, right? I have given you this class as a gift. I did not ask you to pay. I have paid the teachers and bought the supplies. It was my gift to you. I did not expect that we would make this much money, so now we have the chance to receive another gift. You can save some and create a business together so you can have an income. That will give you more money in the future than if you take it and spend it all now.”  Most of the women were nodding in agreement. Lots of affirmation murmuring. The pouter took her arms away from her face and nodded in agreement.  Peter turned to me and said, “Now she understands.”  So they figured out how much it would cost to buy more varnish, glue, twine, and other needed supplies like scissors. It came to 30,000 Kwacha. That would be enough for them to make a lot more jewelry. I suggested they put the same amount into a bank account and split what was left over for their transportation costs. That was all met with hearty agreement.  So they all took 5,000 Kwacha (about $6.50, and the equivalent of a week’s salary) for their personal use, they chose three women to go shopping for supplies, and two to go to the bank to open an account. We agreed to meet again on April 9th. Then one of the women asked if we could hold hands and pray. We formed a circle and held hands while she said a lengthy prayer of thanks. It was very moving for me. No matter what happens, this has been worth it.

I have to scramble to find someone to come talk to them about handling the business side of this. It is way more than I can handle right now. I asked our Peace Corps liaison if there were a traditional volunteer around who was working on forming women’s cooperatives. Waiting to hear back on that one.

In addition to all this, there was a half page story in the Malawi newspaper about the group and I heard there was a story on the television as well! I don’t have a TV so I am hoping there is a tape of it somewhere. The newspaper link is:   https://www.times.mw/women-get-art-skills/  and I’ll work on finding the video. Enelless just sent me a screen shot of my face on the television.

Next week from the coast of the Indian Ocean! Can. Not. Wait.

Love to all,

Linda

Sunday Morning ~ Blantyre

Citsiru cinaomba ng’oma ocenjera nabina ~ The fool beat the drum while the clever ones danced.

~ Malawian proverb

March 18, 2018

Hi Everyone,

I gave up alcohol for lent, forgetting that the first year students would be starting clinical and the women’s group would be having their graduation and jewelry sale during that time. I’m really proud of my ability to find the calming effects of lemongrass tea, sipped while ripping my hair out.  But we made it through the week without killing a patient (I think), and the graduation/ jewelry sale yesterday was a success. And it’s Sunday, which, doesn’t count toward lent so wine is on today’s menu.

We hadn’t really defined what “success” meant for our Saturday sale, but I based the description on the fact that it didn’t rain, people showed up, people bought stuff, the women were proud and happy, we got great feedback, and some offered us new ideas. That was plenty good for me. I’d had very low expectations for this project. If ten women learned a new skill, I figured it was worth the money I spent on supplies, artists’ stipends, and snacks. I was stressed about making certificates for the women. I couldn’t find anyone with a color copier, so made them from a template on my mac and printed them on yellow paper to look festive. They were a hit.  Friday was our final class and a reporter from the Malawi News station and newspaper came to do a story about the women. Eneless suggested we display everything for the video (and possible TV story). That added an hour of running around Friday, but it turned out to be good prep for Saturday; we got some display kinks worked out. I do love displaying things and the class found that very entertaining. They watched me with fascination. I love Malawian crafts but display is not their strong suit. Everything is usually piled up in a heap and you have to paw through it all. The reporter made some videos of the women making jewelry, did some interviews, and supposedly it will be in the paper sometime this week. About three minutes after the class ended, the sky opened and buckets of rain came pouring down. Buckets. I had just finished moving all the jewelry back inside and moments later we had a river running through our yard where the jewelry had been hanging moments earlier. That didn’t help my anxiety level on Saturday morning. I didn’t know if a hundred people or five were coming and wasn’t sure how we’d fit everything in the house if it rained. Our living room would be very crowded with fifteen people, standing. But even though Saturday’s clouds looked exactly like they did on Friday, Chimemwe told me, “Oh, no. It will not rain today.” I asked, “Are you sure? The clouds look like they did yesterday.” He laughed and said, “No. I am sure. It will not rain.” And so I believed him and set up everything outside. And he was right. It did not rain. He is always right.

The women all came an hour early, dressed to the nines, carrying containers of food they’d made. I asked Peter (one of the artists) and Chimemwe to make a sign for the corner directing people to our house. They asked me what to write. I said, “Just write ‘jewelry sale’ with an arrow pointing down the road” and off they went with the paper and markers. A few minutes later they came to me and asked, “Is this okay?” and I looked at the colorful sign that said, “JUWEL SALE” and was about to tell them to make another one with the correct spelling, but stopped myself and said, “Sure. That’s fine.”  The Malawians won’t care and the mzungus will laugh. It was fine. It was supposed to start at ten, but it was 10:30 before we were even ready and later before people started showing up. Our friend Daisy, who runs the cultural center here, arrived around eleven and said, “Sorry I didn’t make it in time for the ceremony.” I told her we hadn’t even done it yet, it was all a little loose. I think when people started buying stuff we didn’t want to interrupt them! Daisy told me one of her favorite words was the Greek, “Kairos” which means, the opportune moment. It’s my new favorite word. Finally at one point, Eneless came to me and said she thought we should do the ceremony. I really wanted her to be running the show, but we hadn’t even discussed what we’d do or how we’d do it, or who would say what. That was poor planning. It could have been more polished. Glad the TV crew wasn’t there. So we exchanged some phrases: Should I talk? Or you talk? You talk. Ok, will you translate? Yes, I’ll translate. After every sentence, or should I just talk? Just talk.  (This took place while everyone was quietly watching us.) I had planned to organize my thoughts and prepare something, but got caught up in set up and running around and didn’t so I am a little disappointed I wasn’t more eloquent. Half the people couldn’t understand me anyway, but I felt like my little speech was weak. Giving out the certificates was fun, however (they do love certificates around here). Endless called their names and they came forward for a photo with their “mother”. Some people from an organization for single mothers were here and want to emulate what we did. They were taking notes. Daisy bought a bunch of stuff to put in the gift shop at the cultural center. Others bought stuff to bring home for gifts. It was really quite satisfying. Exhausting, but satisfying.

Now that I’ve had a night’s sleep and regrouped, I have some thoughts I want to share with the women. I could have done some of it yesterday, and wish I had, but they are all coming back this Friday to discuss what we’ll do with money earned from the sale and what the future of the group should be.  We made about $130, which, is a lot of money in these parts. We got a few special orders and need to figure out how that money will get distributed. One of the biggest challenges, as I’ve mentioned before, is finding a market for their stuff. After guests left yesterday we had our celebration sodas and samosas, everyone packed up, cleaned up the displays, and the women left to walk home. I then walked to a local salon to get a six dollar pedicure, one of my guilty indulgences. For an hour and a half my feet get all the love they desire. It’s heaven. As I walked home, admiring my adorable pink toes, I thought the salons might be a good place for the women to sell their stuff. There are loads of hair places and a surprising number that do manicures and pedicures. On Friday I am going to discuss this with them. I am extremely pleased with all the women have accomplished in eight weeks but I don’t want to take this on as another job. Rather, I want them to find markets for their stuff and learn how to budget for materials and expenses.  I’ve been supplying all their needs so far (thus the mother title), and want to be careful they don’t expect a gravy train with no end to the line. One option is to use what we made at the sale to buy more supplies and distribute it all equally. We’ll see how the discussion goes. The advice from today’s proverb is to give people credit for what they are capable of doing. I think I’ll practice saying it in Chichewa and wow them with it on Friday. Damn, I wish I’d done it for the speech yesterday.

In the other part of my life, I will be so glad when Good Friday comes. That means this clinical rotation will be over, we’ll be on the road to Mozambique for a ten day vacation on the Indian Ocean and I will no longer be living in fear of someone I am responsible for irreversibly harming a woman. I found students drawing up incorrect medications, holding the syringes by the needles, and documenting incorrect vital signs. It’s impossible to watch all of them all the time and they are being told to do things they haven’t learned yet. It is a miracle to me that anyone walks out of that hospital alive. I feel so guilty that I want this rotation to be over. I know this stuff will still be happening, but I don’t want to see it. I feel like a personal failure for being relieved when it’s time to leave. I did, however, see some students being very kind and tender to patients when they didn’t know I was watching. That got me through one morning.

One of the reasons I find such pleasure in this women’s art class is it’s such a contrast to the suffering I see so many women endure. It’s joyful to see women chatting with each other, laughing, and making something creative and beautiful. I am praying they pay it forward. Baby steps.

Love to all,

Linda

Sunday Morning ~ Dedza

March 11, 2018

Mvumbi ku ana, akulu nadya nthanga.~ Heavy rains for the children, the adults eat pumpkins.

~ Malawian Proverb

Hi Everyone,

I’m sitting on the porch of the pottery lodge looking out over Dedza Mountain. It’s been a long week. I’ve been frazzled and irritable. We were supposed to get away last weekend but because of our friend’s traumatic robbery, stayed home to be with them. This weekend wasn’t looking good either, even though we’d long ago planned to spend it hiking to the ancient rock art with good friends. When we started out on Friday afternoon, two hours later than we’d planned, we nearly got into a collision at the rotary leaving the city. Tired, hungry, and depressed (did I already say frazzled?) I lit into George for not looking more carefully at who had the right of way. He retorted with “I was MILES from that car!”, which, as our friend Peter said last evening when we recounted the story, was like waving a red flag in front of a bull. It seemed like we were going to be fighting the whole time and shouldn’t even drive the three hours to Dedza. George asked, “Do you even want to go?” dodging more Blantyre traffic. I thought saying home would be worse, but wasn’t speaking to him so didn’t say anything. By the time we’d driven another hour it seemed too late to turn around.  Yesterday we took a long beautiful, therapeutic hike up the mountain. We were a third of the way down when it started pouring. The rain made for a slow descent and there wasn’t time (or inclination) to go to the rock art. We came back here drenched and tired but sporting good moods. We showered and wrapped ourselves in blankets and settled in with tea then wine, board games and good conversation. Glad we came.

This time of year has George winding down and me getting overwhelmed. The nursing school’s schedule is so unbalanced. It’s crazy. This week my first year students started on the wards. It is their first clinical experience and they are supposed to be checking vital signs and making beds and transferring patients to x-ray; stuff like that. Basic skills. After six hours on the wards I find them giving medications, starting IVs, one was giving blood! I was flipping out! They have no idea what they are doing, but are too intimidated to tell whomever told them to perform that task that they don’t know how to do it! I spent my week running around saying “These are not mannequins! They are human beings! You can’t poke her with this needle (you are now touching with your non sterile gloves) ten times!” The women don’t say a word. They let anyone with a uniform or white coat do whatever they want. It makes me crazy. I’ve been on the verge of tears all week. Well, Thursday and Friday I was in tears. I get so upset trying to be with ten students spread out over an acre, doing mediocre bedside teaching and feeling like I am doing a terrible job. I go back to my office occasionally to collect my wits. On Thursday, I had a splitting headache and was sitting at my desk with my head in my hands wondering why they put the generator on when the power was working. I looked out the window and didn’t see the generator. Then I thought, hmm, that’s getting louder; it sounds like a train. The I felt the floor moving and then the walls, and knew, it was a real live earthquake.  Having worked in Haiti after the earthquake there and seeing those buildings in ruins, I ran outside as fast as I could. Others were doing the same thing. A few moments after I got outside it started subsiding but there was no way to know that would happen when it started. These brick buildings are supposed to be the worst to be in if there is an earthquake. They just crumble. The epicenter was in the very south of the country, ninety miles from Blantyre. We found out a very short time later that it was a 5.6 (earthquaketrack.com lets you know minute by minute where there is an earthquake in the world and how big it is). Amazing. We heard there was damage near the epicenter but have been without internet and haven’t seen photos or even heard any more about it. Very scary though.

Friday morning before I ran out to the hospital, I checked my email and saw one from the doctor I worked with at the Women’s Center in Bar Harbor. She was one of the five of us who started the Women’s Health Center in 1993.  We’re heading off to hike to the ten thousand year old rock art, so I am not going to have time to write about that email right now, but it is both disturbing and encouraging. Women have had it. We’ve been living in abusive workplaces for so long we saw it as normal. The shift taking place is frightening and exciting, a little like that earthquake. I want to be careful about how I tell this story and need to think about it. Ten thousand years ago pigmy bushmen ground red rocks into powder, mixed it with animal blood, and painted designs on the cave walls where they lived. I’m trying to picture that civilization where life was in such a balance that everyone’s contribution had to be valued equally. Women were responsible for the majority of the food collected. They were very much equal to men. Ten thousand years ago. I need to think about which way the pendulum is swinging.

Love to all,

Linda

Sunday Morning ~  Blantyre

Musamaumirire mtunda wopanda madzi.~ Do not keep on staying in an area without water.

~ Chewa Proverb

March 4, 2018

Hi Everyone,

If there is no progress, change your plans. Not to be confused with ‘’give up”, this is the attitude we had going into this week’s meeting about the model ward. If we can’t get it going at QECH we’ll change our plan and do it in a different location. I am starting to feel like my time here is very short. What have I got left, four months? A little less? And a few of those weeks I’ll be away. It’s nothing. This week I had to shift my mental image to what might realistically be accomplished by the time I go and I know there isn’t going to be a functioning model ward by then. That said, Thursday’s meeting was very encouraging. My colleague, Alice, said, “I think we are at the base of a very high mountain. It will take some time to reach the top.”  My feeling was more like I was swimming and suddenly found myself way over my head. Not like I’m going to drown, because I’m still swimming, but want to be aware of how deep it is, where I am, and how far from shore.

We were supposed to go away this weekend. It’s a holiday weekend, Martyrs Day, so Monday is free. We had booked a place at the lake called The Blue Zebra, a luxury lodge with a rainy season/resident special rate and thought we’d tick another one off our list. But at 2:30 Friday morning we were awoken by our guards yelling for George. I was dead asleep and thought he was having a nightmare and trying to get out of bed. He yelled to me, “Something’s happened! They are calling me!” I was having a hard time waking up, confused, not scared, even though the likelihood was that someone was breaking in. Then I saw headlights and George came running back into the bedroom and said, “The Scots have been robbed!” By this time I was trying to get some clothes on and went out into the living room where our friends from UK (George’s colleagues) were standing with the police. One of them, dear Ruth, was leaning on an umbrella for support.  I said, “Let me make some tea.” (I learned something from all those Call the Midwife episodes. Everything British is treated with tea: robberies, illness, death, you name it.) But they didn’t want any. They’d already had tea. The robbery was over an hour old and they’d been sitting with the police at their house going over everything. They’d come to us to get a phone as all theirs had been stolen.  Their house is next to the one we used to live in. We’d been forced to move from there as Peace Corps deemed it not secure enough. Well, there you go. There is no wall around those houses. They are owned by the College of Medicine and there have been plans for a wall, but you know how that goes. The two night guards had been tied up, (they never yelled or screamed) the six robbers broke a window in the porch door and used a crowbar to pry it open. (George maintains that since we had a padlock on the inside grate they wouldn’t have gotten in if we’d still lived there.)  George gave them his phone and they left to go finish giving a police report. They didn’t want us to go with them, apologizing all over the place for disturbing us. We didn’t get back to sleep. We stayed up and talked for a long time and didn’t feel right going away for the weekend. We planned to walk over there as soon as it was light to see what they needed and what we should do.

George went over first while I baked some cinnamon rolls to take over. I figured comfort food would be good, sweet and buttery. The other team members were there when I arrived and we did a little debriefing. Ruth, who is the sweetest woman on the planet, said, “Oh, now see? If this hadn’t happened we wouldn’t be eating these delicious cinnamon rolls!” Nothing like looking on the bright side.  Lost wallet, laptop, phone, and sense of security, but hey, she got a cinnamon roll out of it. What a wonderful world this would be if everyone were like her.

They are all ok. They moved out of that house and are settled into a lodge. We had them to dinner last night and they’ve done a good job of processing it all. They are all psychiatrists so are used to dealing with trauma, but still. It all could have been a lot worse.  We don’t feel unsafe in our house (we didn’t in the other one either) as it has a brick wall around it with razor wire, not that a wall would keep a Malawian out; they can climb a wall like it was flat, and even the razor wire is only a slight deterrent. It just buys some time. But we have panic buttons in all the rooms and the guards have one too. There is a lot of speculation that the robbery was an inside job; that the guards were in on it, that’s why they didn’t yell. Who knows. At home they could have been armed with assault weapons. The U.S. is still a scarier place to be. It’s interesting how things can change so quickly. I went to bed Thursday all happy about how the model ward meeting went, feeling optimistic about the future, and looking forward to our romantic weekend in the executive bungalow on the water. It’s probably the reason I was sleeping so soundly. Instead we are having a peaceful weekend at home, grateful for the friends we’ve made and glad they are safe and resilient.

The meeting had been a raging success. By that I mean this model ward is really going to happen. The reality of the effort it will take, however, is sobering. But, considering it will be a shift in the entire system, it’s understandable it won’t happen overnight. I remind myself it took ten years for us to get a new building for the Women’s Health Center in Bar Harbor. Ten years after everyone agreed that a larger space was needed. So, again, no one should be pointing fingers at the pace of progress around here. I’m still amazed we can get everyone in the same room to meet for a few hours in the middle of the week. That alone seems like a success to me.

Attendees showed up for the 8:30 a.m. meeting at 9:15. I had cleared my schedule this time, knowing it would take longer than expected, so I wasn’t stressed about this. While waiting we strategized about the agenda. We had agreed that Ursula would facilitate even though I had written the agenda and sent out the invitations. I agreed to take notes and write up minutes. I was thrilled that Alice, a colleague who had been a bit skeptical of the extra work this would entail, agreed to come as well. I had bought tea, milk, and sugar and baked a banana cake. When everyone arrived, the meeting began with a prayer, then Ursula asked me to give a history of the proposal and an overview of how it stood presently. We had invited all the head nurses (they are called sisters-in-charge here), the head of all the matrons (equivalent to the VP of nursing/midwifery), the head of the OB department who was at the last meeting, and the head of OB at the College of Medicine. The two doctors came in saying they only had a few minutes to spare as they had other meetings to attend, then both stayed for two hours.

The consensus is that this is a brilliant idea but questions remain about how to create the space and staff it. All of this we were aware of already. The College of Medicine doctor pointed out that they are required to do some staffing at the hospital and there is some resentment that the nursing faculty don’t do that. Ursula, who is my heroine, is mind bogglingly good at diplomacy. She calmly waited until the speaker was finished and replied with,”That is true but is a bit unfair. The College of Medicine is only 26 years old. When it was created there were no obstetricians in the country and QECH relied on them as consultants. Your infrastructure was created that way, ours wasn’t. We are trying to emulate that but we don’t have a system to do so. That is what we are trying to do with this project.”  Everyone saw her point. I nearly wept. I have so much to learn from her. We’re making progress, have another meeting scheduled, and have tasks assigned to be completed before then. We’ve got the major players on board and the plan to move forward was made together. This feels very big and grown up, and also slightly over my head. Part of me wants to stay here and see this through, another part wants to go home and work on getting services to rural women in Maine. I don’t know.

My first year students start their first clinical experience on Tuesday and need to be there at 7:30 a.m. in uniform ready to go. We have been practicing skills with them this past week. Anytime the students are in the skills lab, uniforms are required so they’ve been wearing them all week. Thursday they asked if they could wear street clothes. I was going to be reviewing documentation with them in the classroom, so said, “Sure. Fine with me.”  After my morning meeting I got to class and gave them some scenarios to write up as if they were documenting in someone’s medical record. Then we began reviewing what they had written. About an hour into class, the students looked out the window and someone said something in Chichewa and half of the students got up and ran out. Mass exodus. I was stunned. I asked the others, “Where are they going? What happened?” One girl answered, “It is going to rain madam. We have washed our uniforms and they are drying outside.”

I love these kids.

Love to all,

Linda