Malawi Week 5 (Week 6 in Africa)

Africa
March 20th 2012

Published: March 20th 2012

Quotes of the Week: “Hello and goodbye.” German man at the Malawi Church this weekendThe quote of the week says it best.... “Hello and goodbye Malawi”. I have been on the continent of Africa for six weeks and Malawi for five of those six and it has taken every bit of those six weeks for me to feel acclimated to my surroundings…to feel like I have a sense of the people…to feel like “yeah, I could come here again”. It feels like I am only just starting to know this place and it is already time to say goodbye.The summary…I will begin this with the end, the weekend. This past weekend was bittersweet as it ushered in the announcement of my match results and rounded out our last weekend of experiences in Malawi. First things first, if you have not already heard, I matched at the Detroit Medical Center in Medicine & Pediatrics! It was my top choice, so it was quite an exciting moment for me. I would have been happy at any of the places that I ranked, but this choice is special because it puts me in the heart of my hometown again for the first time in more than a decade. (I can’t believe I’ve been alive long enough to say that.) (Pausing to let you take it in if this is new news to you :o)Our group thought it fit to spend our final weekend in and around Blantyre. Not only are we all pretty exhausted from the frequent travel, but we had not spent so much as a Friday night in Blantyre yet. On Friday and Saturday we collectively visited local restaurant and bar establishments, bought crafts from the local markets, cooked dishes for each other and prepped for our impending departures. Four of my colleagues went to the tea estates Saturday morning while two others and I visited the curious (craft market), my favorite local Indian restaurant Veggie Delight and the fabric store, Lambats. Oh boy did I spend too much at the fabric store and the craft market… Saturday evening we reconvened and had a pleasant dinner at La Hostaria, an Italian restaurant in Blantyre. Apparently the Italians have a thing for Malawi because Italian food (including Gelato) is a little too easy to find here. In any case, the food was good, but not nearly as good as the food from La Casa Rosa last weekend. A few went out to celebrate St. Patrick’s Day with many of the expats and Azungu visitors in Blantyre, Malawi. The rest of us stayed behind and went to bed at our usual lame bed time. What can I say…I really like my sleep, especially when the rooster crows so early in the morning! Feeling especially rested and very happy about the weekend, I rolled out of bed at my usual 5:30 am on Sunday morning made homemade cinnamon rolls from a batch of bread that I prepped the day before. (It’s a really easy and delicious bread recipe if anyone is interested…only 5 ingredients). I almost let them burn because I fell back to sleep while they were in the oven! Only a few people were awake to share them with me, but the rest of the house eventually woke up and gratefully enjoyed the Sunday morning treat. I usually only work out Monday –Friday, but I took advantage of the extra time to get in a little exercise before joining Anna for church. It’s not as random as it sounds…Anna’s husband is a United Methodist pastor and is friends with a United Methodist Missionary who was visiting Malawi a few weeks ago. Anna happened to not be going on the excursion that weekend, so she visited their friend at her Malawian congregation. Since we were in town this weekend, she wanted to go back and I gladly joined her. Now here is my challenge…how do I tell you all about my 2.5 hours with this lovely congregation most efficiently as possible without leaving out the fragile details of this awesome experience? I apologize in advance because I will not be able to fully convey the depth of the experience here. It was the first time I was able to be in the company of Malawians outside of the medical setting and the first time I was able to share in a very important aspect of their livelihood instead of observing from the outside. The church was housed in a small, old, single roomed building behind a larger Baptist church and school. Anna and I arrived at the tail end of the Sunday school services. The young children were sitting under a tree outside with their teacher while the adults had arranged chairs in a circle inside the building. Anna and I joined the circle inside and I don’t know if it was because of our presence or if it was their normal practice, but everything was stated in both English and Chichewa. The lesson concluded with a prayer in Chichewa and we all helped to rearrange the plastic outdoor style chairs into rows on either side of an assumed isle. The church superintendent asked us to sit next to her in the front and share her song book (everyone carries their own paper song book). Not all of the hymns were in the book, but all that were there were written and sung in Chichewa. I could pick out a word here are there, but for the most part I didn’t know what we were singing. Still, the melody of everyone’s voices as they sang filled my heart and I could feel the hymns without knowing what they meant. One song, though, was very obvious to Anna and I based on the melody alone… ”The Old Rugged Cross”. Now that was cool. The guests, including Anna and I, were invited to the front to introduce ourselves to the church and receive their prayers and greetings. The entire congregation lined up and shook our hands one by one…and this is where I got my inspiration for the quote of the week. I introduced myself and said that this Sunday was my first Sunday and probably last Sunday for quite a while. One after another people welcomed us and the sole white member of the congregation, a German whose name I cannot remember, said to me “well, hello and goodbye.” I got a good chuckle out of that one. A bit later, the Sunday school children came to the front and shared their Sunday school lesson about the importance of obeying your parents and sang us a song. There was lots of singing, giving thanks and the scriptural readings prior the message. The message was delivered in English by a guest minister (another Malawian) and translated to Chichewa by the local pastor and they both did a fine job! His lesson about what it means to be Christian left me both thoughtful and humbled. After church was over, we gave offering and heard announcements. Then the pastor and his wife lead the congregation to form a line outside of the church, which is apparently customary. One after another, each member (men, women and children alike) shook the hands with each person in line before also joining the end of line until we all formed a large circle outside of the church building. Announcements about after church meetings were reiterated and everyone was dismissed. This Sunday was easily one of my most memorable experiences yet.The wards…A bit of the novelty of the hospital has has worn off, so the experiences in the wards are not as sticky as they once were. Still, there were many interesting things to learn and experience in the neonatal unit this past week. There are three different sections to the ward, the intensive care unit for the very sick newborns, the stable newborns and the “kangaroo ward”. The Kangaroo ward is for premature babies. They do not have enough warmers to keep all of the healthy premature babies in while they are observed for weight gain and well being. So the kangaroo unit is where the babies and their mother stay for 3 or more days. When the babies are not being fed or examined, they are wrapped to their mother’s chest using sarong style fabric. I spent most of my time in the intensive care unit and in the step-down unit. So many babies are born prematurely or small for gestational age that the healthy weight babies look unusually large. Unfortunately, I saw much more of neonatal pathology than I’ve seen in all of medical school: a baby with Turner’s Syndrome; a case of Beckwith-Wiedemann Syndrome (Dr. Hans-Rudolf Wiedemann coined the syndrome to describe the combination of congenital abdominal wall defects such as hernia or omphalacele, large tongue - macroglossia, and large body – gigantism); a mild case of bilateral cleft palate in an albino neonate with hydrocephaly and intestinal atresia, a relatively healthy baby with a unilateral complete cleft palate, a baby with gastroschisis having his abdominal contents protected and suspended inside an empty saline bag using an IV pole, gauze and surgical tape. Those were the neonates that stood out the most, but every last one of them was precious. The ward had a different vibe from the others I had been in. There were more staff and the residents moved about at a very fast pace. For one, they did not have to talk to mom or a guardian as is usually the case with newborns as the whole history is already known. Also, the rooms are kept very very very warm, so you can only tolerate it for so long before you need to step outside to cool off (and mind you, it’s also hot outside). The majority of the babies fair well and need very little intervention, while for others there are a very limited and predefined set of actions you can take. Finally, there are many many newborns to be seen and 3 to 4 residents to see them all. It’s not too bad, but they do seem to move very efficiently through the ward. That concludes this week. Next week will be short as I will need to take a couple of days to prepare for departure and to take care of paperwork for graduation and residency before I leave. I will therefore split my time between the research ward, the nursery and the neurology clinic.A couple of final note… New British term: Bung. “I bunged the bike into the back of the car." A funny quote from Elizabeth "Nothing like paying your rent in two dollar bills." (The largest Malawian bill is the 500 Kwatcha, which is worth about $2.00 on the black market.)Cheers!

Malawi Week 5 (Week 6 in Africa)

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