Mwalira mvula, mwalira matope

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“Mwalira mvula, mwalira matope”

Since I last wrote, here in Malawi we’re in a New Year and a new season - the rainy season.

It’s the second month of the rains that will likely continue through until May. Malawi is looking beautiful. The countryside has changed so much so quickly and everything is lush and green. These are the rains that many have hoped for over the past several months as food has become increasingly scarce. Many villagers were using just the husks of the maize to make their staple Nsima, some were living off just the Okra that usually serves as a relish and others were going for days with nothing at all. There were deaths from starvation in some areas. As always though, anything that people did have was always shared. Villagers would be offering us their Okra and mothers could be seen sharing a single Mandazi (local donut). However, things are now getting better. The hard work that has been done by many people in their fields since November is beginning to pay off. Last year harvests were small due to poor weather conditions but so far this year things have been ideal with there being a regular abundance of sunshine in the mornings (and unfortunately sometimes unbearable heat) followed by the rains in the afternoon (and sometimes spectacular storms). Maize that was planted even as recently as last month has already reached head high. Green fields of tobacco, ground nuts, beans and pumpkins stretch out as far as the eye can see.

The Malawian proverb “Mwalira mvula, mwalira matope” translates literally into “You’ve cried for rain, you’ve cried for mud”. The rains that there has been so much hope for, that are making the country look beautiful and encouraging crops to grow are also bringing with them more suffering. Over the past few months the hospital wards have become full of patients with Malaria due to there being more and more mosquitoes every day. Conditions are also ideal for sanitation-related pathologies. The Cholera that has claimed so many lives in Zimbabwe has spread to Malawi. St Gabriel’s has prepared a quarantine shelter and has everything in place to ensure that, should the disease reach here, they will be able to identify all those diagnosed and treat and isolate them from others to avoid further spread.

Should a person become ill, as road conditions worsen it becomes more and more difficult for them to reach medical treatment. Some roads become completely impassable during the rainy season. One of our Clinical officers is ready to retire but won’t be doing so until March when his home village becomes accessible again. We haven’t had too many difficulties so far but we packed up early from one clinic as a storm started to blow in due to fear that we might otherwise not be able to get home. When I have days like yesterday where we spent 2 hours travelling 30 km to one of our outreach locations and arrived to find recently diagnosed people waiting for us and a CD4 test that they would have to otherwise walk such a distance for, it makes me realize some of the extent of the problems here - what patients have to go through to try and get treatment and some of the reasons why there are so many unnecessary deaths.

We have seen a lot of really sick people appear at our clinics, people who should have been treated a long time ago. We have found not just a few patients suffering from WHO stage 4 (advanced HIV/AIDs) opportunistic infections such as Kaposis Sarcoma and TB who have never visited a clinician never mind been tested for HIV. Apart from being attributed to difficulties reaching treatment there are other more surprising reasons such as one cultural belief where people that are sick think they must have wronged someone and been cursed and there’s nothing they can do about it.

Although I find myself seeing so many sad situations there are many rewarding times also. We are starting to see some of our patients attending St Gabriel’s ART clinics looking much healthier than when we met them. It doesn’t take long for the treatment to show it’s effects. We have also had many Health Center staff express their thanks to us for helping them provide more comprehensive care. Some don’t have clinicians themselves (just a nurse or a health surveillance assistant) and many don’t have the facilities to provide HIV or CD4 testing themselves. We have found that patients attending quite a few health centers are therefore just having their symptoms treated - e.g. recurring skin infections that are characteristic of stage 2 HIV infection are treated each time they appear but the patient is never tested for the disease. Now they can be tested and started on treatment if needed.

Many patients have also been very thankful. For a lot of people the nearest CD4 testing facility is in the capital, Lilongwe. However, even if they are able to make it there themselves they have to first wait for an appointment. We have seen quite a few patients who are very proactive and eager to know if they are eligible to start ARV treatment so that they can start ASAP. We have still only been running clinics for 3 months but with on-going community sensitization people are showing more and more interest and we are expanding all the time. We have 16 communities on the February schedule for monthly/bi-weekly/weekly clinics and we are actually receiving more requests for visits than are possible for us to fulfill. People seeing our truck in Lilongwe are asking for us to visit but due to the nature of the project we have to first concentrate on seeing patients whom we will be able to follow-up at St Gabriel’s.

Now that we are all comfortable with the day-to-day workflow of the project, we have new things to concentrate on including making sure we are reaching as many people as possible. This doesn’t just mean people in different locations but also that we work on approaches such as family centered testing (e.g. if we find a mother is positive, we do everything we can to get her children and husband tested). This will help ensure that everyone is getting the treatment that they deserve.

In my personal life, all is going well. Life in the house here is never boring as so many interesting people come and go. I am currently living with an American girl, Jennifer, who is doing an infectious disease fellowship at the University of Maryland, and a 70-something year old Dutch man, Dr Jacob, who first came here 40 years ago, and will be here for 3 months. Next week my good friend Todd from San Diego will be back for 3 months, this time doing some volunteering. I've also made some really good friends here at the hospital. My Chichewa is really coming along which helps a lot. I'm current reading Malawian folk takes which, if nothing else, make me laugh a lot. I now know why bats only come out at night (they are running away from all animals and all birds as there was once a war between the two and the bats kept changing sides depending on who was winning, saying it looked more like one than the other).

Today is my 30th birthday and my second birthday to be celebrated in Malawi so we just had a nice breakfast of banana pancakes (I am now feeling very extravagent) and we're having a party tonight. Some friends are coming over to help us with a bit of cooking this afternoon. We're having local food, which basically seems to involve a meat-fest. I won't be eating it.

I hope 2009 has started off well for everyone. Time is flying by!

Until next time,

Joanna.

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