Sunday Morning ~ Mangochi, Majete, Maternity

Sunday Morning ~ Mangochi, Majete, and Maternity

Madzi atupa ndi a m’njira. ~ The waters become plentiful because of all the side rivers. 

~ Chewa proverb

June 16, 2024

Hi Everyone,

The vice president of Malawi died in a plane crash last Monday. He was on his way to the funeral of a lawyer who was found dead in his hotel room a week before. People are upset and a bit worried as the vice president was well liked and thought of as a hope for the future of this country. I’m not in on most of the conversations in Chichewa amongst my colleagues, but I know they are disturbed. I heard elsewhere there was some question of foul play. I guess that’s inevitable. To my knowledge there has been no official report, but it was a small plane and the weather was bad. They were unable to land in the northern city of Mzuzu so turned around and crashed on their way back to Lilongwe in the Chikangawa forest. It was nearly twenty-four hours before the plane was located and none of the ten people on board were found alive. This is also raising questions as there was a village nearby and the crash happened mid-morning. The “forest” has been devastatingly deforested to the point where there are hardly any trees left, so there are questions about why it took so long to find them. The VP’s funeral is tomorrow and it’s been declared a national holiday. So our Monday workshop will be held on Tuesday. It never ceases to amaze me how things get shifted last minute and happen anyway. So, day off on Monday. 

I spent an overnight in Mangochi this past week, supervising the students there. I went with my colleague Esthnath; she has one group and I have another. The protocol is to request university transport for the travel but Mangochi is a good three hour drive and there has been a problem with petrol supply. So what often happens is transport is booked then canceled and we are sitting in our uniforms with our overnight bag packed and wait all day to go nowhere. I offered to drive my own car and not have the uncertainty of going or not, and that’s what we did the last two weeks. That meant we left on time at 8 a.m. got there before noon, and spent the whole afternoon and following morning with students. We stayed the night in a local lodge, which is safe and convenient, but I wouldn’t put it on the itinerary if you are planning to visit. The sheets were clean and there was a mosquito net, my two requirements, so it was ok. There was no hot water, spotty electricity, and it’s a bit loud from the bars, but it cost ten bucks a night and that includes breakfast so I’m not expecting the Ritz. Breakfast was two slices of white bread, a hard boiled egg, and fried potatoes. I’m fine with that. Tea was included, but there was no milk, with which, I am not fine. I can not drink my tea without milk. So, I gave the security guard some money and he ran to the market and bought me two packets of dried milk and was back within five minutes. Problem solved. He’d also washed my car during the night, so I tipped him for that, too. 

These poor students, it is astonishing what they endure. They are first year students and we have just finished their didactic, which is fourteen weeks of lectures with a few days in the skills lab learning the basics. Remember there are 258 of them. Then they get split up and sent all over the southern region to do their clinical rotation, which, is supposed to be the basics, like vital signs, bed making, and emptying catheter bags. Remember, they are just out of secondary school. Because of the distance of their clinical sites, we don’t get to spend much time with them there. It’s a big problem. So, when we arrived at the hospital we found them not only doing the basics, but hanging blood, starting IVs, giving meds, changing horrible wound dressings–––all with hardly any supplies. It’s overwhelming. I’d done a pep talk for them before they left emphasizing all the things they do know how to do, like be nice to people, ask them their stories, show up on time, have a clean uniform (a challenge when you see their living conditions, I don’t know how they manage), carry a pen and paper, have your stethoscope, etc. There’s a Malawian proverb, You don’t go to the field without a hoe, that I said in English not Chichewa but they laughed anyway. And then they arrive on site and are thrown into high skills situations almost immediately. I mean, I’d been a nurse for a few years before I started an IV, the “IV team” did that, and these kids are doing it on their first day!  Anyway, they were both traumatized and beaming with pride when we arrived, and very grateful for the support. That was satisfying. But when only popping in to the site for these short periods I don’t have time to get adjusted to the conditions and it’s so stressful. I’m continually murmuring to myself, “Oh My God. Oh My God.” Seriously ill women: strokes, lethal infections, septic abortions, late stage gynecological cancers, gangrenous limbs, all crammed into an overcrowded ward, side by side with maybe twelve inches between beds. At least none were on the floor, but I’m sure that could change. So we teach what we can with what they have, like no bandages to dress a wound so they just cover it with cotton roll; all the sterile technique we taught is pretty much moot. And handwashing? One needs water for that, though I did see that some of the sinks were working. No soap, though. I handed the bathroom soap I took from the lodge to the student leader and told her to share with her friends. 

Esthnath and I drove back to Blantyre talking about how frustrating this is and how it’s more evidence we need this teaching ward! I got home and soaked in a bath feeling guilty about my cushy life, then  joined a zoom call with Deb and Chris (the architects) to plan for the workshop on Tuesday. That, plus two glasses of wine, helped my spirits. 

Lest I spend the weekend wallowing in despair, I joined the Wildlife Association’s annual Majete walk and camping trip. It was fabulous. I mean the extremes I experience here are really remarkable. This event is organized by the competent leader of this organization and all I have to do is show up and pay the fee. It’s glorious. We drove down into the Shire Valley to the game park late afternoon Friday and camped in the park campground. Then early Saturday morning, we met the rangers who would accompany us on a ten kilometer walk/hike along the river to a designated campsite where we spent the night. It was so exciting! This is in the park where I’ve been in vehicles looking for animals (the big five are here!) but this was on foot, with an armed ranger in the front and armed ranger in the back. I’m told they know what they are doing and know how to keep us safe without having to kill anything. So I trusted them. We had a security briefing before setting out, which included the instruction: “Do not run. The only thing that runs here is food.” And off we went, twelve in the group. It was gorgeous. The drives through the park are gorgeous but doing it on foot was really special. The Shire River is a magnificent natural wonder teeming with hippos, crocodiles, and birdlife. There were many birders in the group and we had plenty of rest periods while they identified and documented various species. Hippos lined up in the water to watch us pass and we were assured they would not get out of the water and charge us. They are most dangerous when they are on land during the night looking for food. The rangers were always listening and watching and it was an honor to be part of the group. 

We reached the site for camping where a pit latrine with grass enclosure had been dug. There were also two grass enclosures for bucket showers. Luxury! We all chose a spot and pitched our tents, then relaxed and chatted. There was even a small tributary we visited without crocodiles where we could get wet or float a bit. It was too shallow for swimming, not that I would have swum, but it was nice to dunk and get washed off. Then the rangers built a fire and everyone cooked their supper on it while we chatted some more. I was in my tent early, read a bit, then slept soundly with occasional wakings from hyena howls. Others said they heard lions, but I must have slept though that. In the morning I watched the sunrise from my tent, boiled water for my tea on the fire the rangers had built, and we packed up like little nomads and hiked back to the park entrance. It was fabulous.

I realized when I got back and connected that it was Father’s Day, so Happy Father’s Day to all the good dads out there. We are looking at designing a maternity ward able to accommodate the fathers. It’s a relatively new concept to have fathers present at birth here. As Deb pointed out in her presentation about privacy and the proximity of beds, women want to have their husbands at their birth but they don’t want their neighbors husband at their birth. We’ve got some work to do. 

Love to all,

Linda


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