This is Malawi

Cocopina, sweet tea, TV bars, specials, smells (the 'different' sweat smell in the hospital, the smell of shake-shake, the smell of roadside food - chips, donuts, fish - the smell of fresh produce - tomatoes, avocadoes, bananas, pineapple (unfortunately no mangos yet), the music (Lucius Banda has been blaring out of the local 'cinema'), the loud noises of insects at night and of birds in the morning,ladies with babies on their backs, men sitting under trees, crop fields (the maize has now been harvested but the cassava is growing) & red dust, absolutely everywhere. My friends who are reading this whom I met last time I was here - you all know - this is Malawi. You will be pleased to know that, as far as the food and drink goes, I have already managed to have everything I just mentioned and I've not even been here a week! It feels like I've been here forever.

All is well. I found the first couple of days a bit difficult as my luggage was lost. My bags were stuck in Heathrow terminal 5 and I became the talk of the 'town' when I bought two shops out of one dollar Celtel phone credit vouchers so that I could call and get it back. However, I am settled in now. I am living in a 'guest house' in the St Gabriel's hospital grounds. I feel truly spoilt. We have hot showers and, wait for it, wireless!!! Ok, maybe not all the time, but to have it all is quite amazing I think! My housemates will vary during my time here but I am currently living with 6 Danish girls (trainee nurses and midwives) and 1 german guy (a medical student in his final year at university). They are all great and we are managing to entertain ourselves without a T.V. just fine. We have also stocked up on plenty of food. We actually had no choice in the matter as the market stall guys managed to convince us that we couldn't just buy a few tomatoes - we had to buy a whole, nicely stacked pyramid (it would upset the aesthetics of his stall if we didn't I guess), we couldn't just buy a few potatoes - we had to buy a bucket, we couldn't just buy a banana or two - we had to buy a whole branch....you get the idea!

I have also been settling into work. It seems so normal being in St Gabriel's hospital as it reminds me very much of Monkey Bay hospital except it's about double the size and a little bit nicer. It even has a 'private wing'. For less than 20 dollars a night you can get your own room. You might have guessed already - we were told that most of the time it has quite a few rooms to spare. The first morning myself and my colleague Artem (who is here for a week) attended the morning staff report, where everyone gives updates on the patients in the wards. It was all in English and really quite interesting. Patients and their symptoms and test results were discussed, along with possible diagnoses. When hospital director Dr Kiromera turned on one guy and asked him what he would diagnose for one particular case it reminded me of the t.v. show House except that Dr Kiromera had a little smile on his face and seems like an absolutely lovely man. They also talked about an HIV positive patient who agreed to take her medicine for a co-infection that she had but would not agree to taking ARVs. She said that she would pray for her HIV to get better instead. The lady has apparently been moving from hospital to hospital and not getting better. Dr Kiromera says that she will have to pray harder. He did also suggest that maybe someone could go and talk to her church leader and maybe that would help unless of course it was the church leader that was telling her to pray.

Earlier in the week, I spent the majority of my time in the lab with Artem. He is doing research and development work during his time here but he is also very kindly training me up! I am trying to get as much knowledge from him as possible before he leaves next week! I already feel much more comfortable with the instrument that we will be using for the testing in the field.

Today was a very productive day. I am suddenly really quite busy, everyone I've talked to is very enthusiastic about the project (one person even wants me to ride around on the back of a clinical assistant's motorbike while he promotes it over a megaphone) and we are almost ready to get the project 'on the road' (bad joke). All of the staff at the health centers that we will be working with are also apparently very enthusiastic. The main question being asked is "why does the project only have to last 18 months? Why can't it continue?" Myself and the St Gabriel's hospital staff who will be working on this project had our first group meeting. I will be spending much of my time over the next 18 months with -

- Hospital director Dr Kiromera.
- Hospital matron Hilda. Hilda has worked at the hospital, and with outreach, for over 20 years.
- ART clinician Aubrey Kuzala. Aubrey just started at St. Gabriel's today.
- HIV/AIDs nurse counselor Mary Kaludzu.
- lab technicians & phlebotomists Alfred Ndawnhiz and Isaac Thengolose (lab technician & phlebotomist). Alfred is a Will Smith look-alike.

Amongst other things we talked through the project in general, progress so far, any problems that we might experience e.g. accounting for African time, ensuring patient confidentiality at outreach clinics (using different rooms in peoples' houses if necessary), lack of patients whenever there is a community event (community is a priority in Malawi so if there is for example a funeral on then no matter how sick a person is, they can wait until the next day) etc. etc. We also discussed the Malawian guidelines that bactrim be distributed as a prophylaxis to any symptomatic person with a CD4 count below 500 and condom distribution - when condoms are available they will be given to HIV positive patients but not to those testing negative. We then went together to the lab for a bit of training.

In the afternoon, our World Bank contact appeared - a man by the name of Alfred Chirwa. He had come to review project progress so far. There's a lot of paperwork to be sorted out before we can receive the first part of our funding.

All in all it's been a really great first week. Everyone is really nice, equally enthusiastic and positive and I think we're going to get on great. We're going to be a good team! Oh - if any of you ever have any questions about the medical/science things I talk about then just let me know. I don't want to go into it all in great detail here (there would be way too much to say) but I can answer any of your questions if you're interested!

That's about it for now. Sorry I don't have more photos yet. I guess I have only been here 5 days though! I seem to have plenty to talk about already!

Hope everyone is well and I'll be in touch again soon.

Joanna x

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