Sunday Morning ~ The Way The Snake Moves

Sunday Morning ~ The Way The Snake Moves

Khote-khote wa njoka, utsata kumene kwaloza mutu. ~ Crooked is the way the snake moves, but you just follow where the head points.

~ Chewa proverb

February 18, 2024

Hi Everyone,

I’m in a bit of a fog this morning. After a lazy Saturday doing some painting and going for a walk with a friend, I followed up with a lazy evening. It was after nine when I felt like going to bed, a little late for me, and read until I was sleepy. I turned off the light and fell into a glorious deep sleep that lasted two hours before a buzzing around my ear woke me up. A mosquito had gotten into the net and I spent the next hour slapping myself in the head, half asleep, trying to kill it. The buzzing would stop and I’d think I’d succeeded, then just as I was fading into repose, again the buzzing would start. It was like something out of a Bugs Bunny cartoon. I was trying so hard  not to wake up entirely, knowing I’d have a hard time getting back to sleep, but I finally looked at the clock and at 12:35 a.m., defeated, turned on the light and got up. I stood on the bed chasing it around the net, slapping, missing, slapping, missing, until it landed on the wall side and I was able to squish it against the wall. Blood covered my hand. Dammit, I thought, if it had already sucked my blood why was it still buzzing me? Then I heard another one. I saw it and was not going to stop until I had eliminated that parasite-carrying pest as well. I chased it futilely and, now wide awake, decided to read with the light on until it landed on me again, which it did about ten minutes later. I waited until it was well situated on my thigh, got my left hand into a good position and nailed it. There, I thought. Peaceful sleep. But by then I was intrigued by my book and read for another hour, just to be sure I was alone under that net. Considering how many bites I had on my legs, I thought there had to be more mosquitos in there. But nothing. I turned off the light around three and started drifting off. I may have even achieved sleep when bzzzzzzz started again around my ears which led me to more slapping of my own head thinking the harder I slapped the more likely I was to be successful. I must have hit something because the buzzing stopped long enough for me to fall asleep only to be awoken by some kid of alarm nearby. I wasn’t worried that this property was being vandalized, it was a bit further off than that, but it went on and on and on. I eventually fell into a fitful sleep for a little while. When the sun came through my bedroom window I got up. This is all to say I’m tired today. 

We had no electricity all day yesterday, so the beef I defrosted did not get cooked. That is a priority today though it’s hot and I’m not very hungry. I have a list of things to get done but so far this draft is the sole achievement. This may be it until tomorrow after I have (please God) slept. 

The mosquito story, as annoying as it was, made me chuckle. Back in my Peace Corps days the head of the WHO in Malawi was a Korean doctor named Dr. Yun. During training he came to talk to those of us in health care and told funny story after funny story. When giving us some realistic advice about how much can be accomplished and how frustrating efforts can be, he described sleeping under a mosquito net. “Ah, the net is protecting you! You feel sure that little insect cannot get in. But does the mosquito give up? No! He keeps looking and looking over and over until he finds that one tiny hole to get in and bite you. We must be like the mosquito.” Then he laughed and laughed. It was impossible not to love him. I think of that every time I feel like giving up on something. The proverb reminded me of this, too. It’s a long and winding road, but if we keep the end in sight, we might eventually get there.

We had two “scouting” trips this week to Balaka and Chriadzulu. (This is for those of you who follow along on google maps.) This process would probably be accomplished with a phone call at home, but that is not culturally appropriate here. Scouting a clinical site involves meeting with administrators, the head nurses (matrons), and preceptors. We cannot arrive without snacks for the meeting, so to prevent another cancellation like last week, I offered to buy the snacks and get reimbursed later. A colleague and I went to the grocery store and filled two carts, one with drinks and one with packages of biscuits. I know it was my impatience that led me to offer this and I’m not sure how appropriate it was, but everyone was grateful we could continue on our business having secured the time, transport, and treats. The students start tomorrow and it would be very difficult to go after that. And clinical placements cannot proceed until this formality is accomplished. It’s a real cultural lesson. I was just a passive observer and didn’t need to be there, but I like being part of the team and I’d never been to Balaka. And while we were in the grocery store some guy fixed a dent in my front bumper for the equivalent of $1.50. Some aspects of life here are so easy. 

The scouting visit begins with the head matron’s office where she takes us on a tour. Then we go into a room where seats are arranged in a circle. Staff filters in. When all the seats are occupied, someone is asked to say a prayer. Then one of our faculty leads the discussion. She asks if they have had any problems with our students in the past? This goes on for awhile with what seemed like minor complaints. It’s good feedback. They talked about how hard it is for the students to find housing, and how they want us to come more often to supervise them. Very valid. The use of “gadgets” (meaning their phones) was a big issue. Both sites had a policy of confiscation if a student uses his or her phone during a clinical rotation. The phone is kept in the head matron’s office until the end of the rotation. (I thought this was a bit harsh). She described sobbing students pleading stories of family problems and urgent communication. But the staff has seen students post photos of patients on social media and they don’t budge on this rule. Then our administrator brought up student complaints. He explained how important it was for the staff to model good care. “Students learn from the nurses and midwives”, he said, “and if they are not dressed properly or give disrespectful care, what what, this is not acceptable.” I held my breath expecting an argument or defensiveness. None. Several of the staff admitted they could do a better job and they would take note. I exhaled. He ended his remarks by saying “Remember, these are the nurses and midwives who will be caring for us as we get older. We want them to have a good education.” Everyone nodded. It was remarkable. When the topic of liability came up he described a scenario to get everyone thinking: “Supposed a student repairs an episiotomy and closes the woman up entirely. If I am her husband and I cannot find the hole, who am I to blame? The student or the one who was not supervising them?” I was the only one who’s head snapped up in absolute shock, but the discussion continued as it he were talking about an ingrown toenail. Honestly, it’s amazingly productive. Then we went through the MOU line by line while someone passed out the drinks and biscuits. The discussion doesn’t move on until everyone is satisfied and agreement has been reached. This is a society where everyone has a say and others listen respectfully. 

I looked out the windows at the huge mountain behind the hospital, grateful for these lessons. 

Love to all,


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