Malawi Week 1 Summary

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First of all, I apologize for the slow responses. Internet is
painfully slow and I have limited access to it. So to keep my sanity
I am going to just send one big update each week. I will still make
quick posts to facebook as often as possible. Also, because of the
slooooooow internet, uploading photos “ain’t gonna” happen. But I
will be sure do take care of that as sooooon as I get back to the
states.
Now, onto the juicy stuff.

Quote of the week:
Me “Something just bit me”
Hired Driver for our trip to the Cape “Must have been a
mosquito…welcome to Malawi” (followed by a hearty chuckle)

Elizabeth and I arrived in Blantyre, Malawi on Monday night last week.
Getting here was an adventure to say the least. But it was well
worth it for all of the stories we have to tell. Our gracious host in
Blantyre is Dr. Terrie Taylor, a malaria research, MSU COM professor
and physician. She spends 6 months a year in Malawi and has done so
for the last 25 years. There are a total of 6 medical students on
rotation here from MSU including me and Elizabeth. Liz and I are
working in the Peds department, while the others are scattered among
Internal Medicine, OBGYN and surgery. I get to hear stories about
the other rotations, but for the most part I can only tell you what
peds is like here.

About the Malawi Medical Students:
The students here attend the University of Malawi College of Medicine.
Their institution follows the British educations system; therefore
the vast majority go to medical school directly from high school.
Medical school is 5 years, followed by internship, then residency.
Overall, the process is about the same amount of time if you went
straight through the American system take a year or two because they
seem to spend more time in residency. They have different terms for
residents (registrars) and attending (consultants) too, which are
other legacies of the British influence here. (As a side note, they
also drive on the left side of the road, drink a fair amount of tea,
and for those proficient in English, they use British pronunciation
and phrases). The students are very well dressed, but some are more
casual than others (jeans and tennis shoes). I was most surprised to
see a student wearing flip flops on the hospital wards. The 3rd year
students seem pretty shy, but residents I have met are great teachers.
There are also other medical students and residents here from the US,
Europe and other parts of Africa. So it’s a very international staff.

About the hospital, Queen Elizabeth Hospital:
The hospital is surprisingly large (not by American standards, by
African Standards). All of the buildings in the hospital are 1 story
high and they are not all created at the same time, so it essentially
a sprawling maze. I kind of feel like a hamster because there are
numerous window covered hallways connecting all of the parts. There
is an Emergency Department (known here as Accident and Emergency,
A&E), Opthomology department, Surgery, OBGYN, Clinics and probably
some other things I’m forgetting. Pediatrics (spelled Paediatrics
here) has 9 subunits!
- Peds A&E
- Peds Special Care Ward (kids > 6 mo with acute or chronic conditions
requiring close watch)
- Peds Nursery (like the Special Care Ward, but - Medical Bay (for kids with chronic conditions, but stable)
- Moyo Ward (for kids with nutrition problems)
- Oncology Ward (the only ward for peds cancer treatment in all of Malawi)
- Chatinkha Nursery (Neonatology…for the little babies that are stable)
- Malaria Research Ward (for treating cerebral (brain) malaria…very
common here…comes from the mosquitoes)
- Peds Surgery

There are 700 plus pediatric patients in the hospital on any given
day, which is a lot! That could easily be the size of a US children’s
hospital, except here they are pretty understaffed and under
resourced. Still, it s surprising what they do have access to and
what they are able to do with the means available. Companies (GE
donated a MRI machine) make equipment donations and the US and UK
funds a lot of the hospital. They have research affiliations with the
University of Liverpool, MSU and John’s Hopkins…pretty cool.

Whew, that’s a lot. I don’t want to bore you with all of the
technical details, so enough of that.

Observations from my first week in the Peds Nursery:
- IV fluids hang from a few poles, but most are elevated anyway the
nurse (known as sisters) or doctor can figure out…on a shelf above the
bed or from a lever on the window.
- They do have suction or collection contains for nasogastric suction
(when you put a tube in the nose and it goes to the stomach to drain
stomach contents)…so the tubing drains to a rubber glove which is
secured with surgical tape
- Patient records…what are patient records? The only records we have
the hospital are the paper records from their current visit and these
are sheets of paper attached to each other using string, tape, and/or
staples. The string is actually gauze that has been twisted into a
“string”. They are left in the bed or on the shelves if they are
above the bed
- Each patient does carry around a little yellow paper book with their
health profile called the “Malawi Health Passport”.
- The nursery cribs are hard to explain, but they are not cribs like
you would think. They are basically shallow rectangular boxes made of
wood with a thin pad lining the bottom. Mothers bring their own
sheets, blankets and wash and dry them in the courtyard
- The nursery is very cramped, in the High Dependency Unit there is
barely space for two people between the cribs lining the two walls.
There are about 11 cribs with a wooden bench at the food for mom or
caretaker who stay by the child’s side the whole time. They nurse
there, change diapers there and eat their own food there.
- Things are not exactly that sterile and a child with TB is a baby
arms length from a child with bronchiolitis.
- It is better to walk your labs over yourself…it’s faster.
- There is no A/C of course, so all of the windows are open. If it’s
hot…if try to stand by the window as much as possible. If you are
lucky there is a fan in the room.
- Diapers are the size of the babies…made of cloth like home or towels.
- The Nurses wear the old school nurse outfits (the white dress with
the little hats)
- From my friend in the OBGYN rotations
o One baby warmer for the whole ogbyn ward
o Women with money/insurance are in a separate section than the women
who cannot pay and there is definitely a difference in the quality of
care
o No epidurals here…and very little screaming or yelling….but should
you scream, you will be told to be quite because you are disturbing
others
Common ailments among kids: stroke (oddly enough), epilepsy, malaria
(in the raining season December to March), HIV and the various
illnesses associated with HIV (e.g. TB and malnutrition), and
Bronchiolitis/Pneumonia.

About the City, the people and the Landscape:
It is the raining season, so it is vibrant and green. There are so
many different kinds of trees and they all look magnificent.
Mountains abound. In Blantyre there are paved roads all over, but no
sidewalks and some roads are better than others….makes Detroit
potholes look silly. Walking is tricky because you walk on the dirt
paths that are sometimes smooth and sometimes treacherous. Blantyre
is pretty large actually with houses speckled throughout the
mountainsides. We live in the more wealthy part of the center of
town, so the homes are large and made of cement/bricks with nice
roofs. Most people live in small brick or cement homes with thatch or
tin roofs. The people are very friendly and women can be seen
carrying everything on their head from suitcases to buckets of produce
to 2 liters of water. Lots of cars in the city, but more bikes in the
towns and villages. Coke is king here along with Fanta (and not just
in orange). Insema (overcooked grits basically) is a staple food item
and it taste pretty good with beans and greens.
Okay…I think that’s enough for one update. I hope you get to read it all!

Cheers!
Angela

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