When the pedicurist gasps: arriving to MPHATSO

After five hours of walking today, my blisters have run out of space, and now are developing blisters of their own. I have travelled to an organization called Mphatso- initially developed by a single Australian woman 9 years ago, Mphatso is now the largest children’s organization in the area. Through Mphatso and its generous donors, 9 pre-schools have been built and fully supported while previously there were none, select and qualified school children are sponsored to continue their primary and secondary education, a widespread malnutrition feeding program has been developed and sustained, and every Wednesday, up to 100 local children are entertained for porridge and play time. The organization is currently run by an Australian couple, Mark and Lena, who reside there with their two children. One’s pre-conceived notion of a ruggedly handsome man and a beautiful, fearless woman, are only augmented by their tall sun-kissed blond teens, who have traded in sleepovers and high school dances, for composting toilets and communal living. Aside from their standard Australian Akubra, Lena and Mark wear many hats, and in the past week have been summoned to care for both a midnight breech home delivery and a child with a poisoness (or non-poisoness dependent on the witness) snake bite.
Here, on Wednesdays as well, the couple holds a lakeside clinic. Our job will to be evaluate any sick children or locals that arrive. As I look up, a silent line has formed of mothers with babies on their backs, children, and even the village chief. Again I am struck with the faith they have in us, and panic as I realize just how insufficient my skills are. A mother brings in a small child covered with circular sores with dark black centers. Can a child have Kaposi sarcoma? Can leishmaniasis look like this even if it does not match the exemplar photo in my tropical medicine book? A farmer arrives with pain and weakness in his forearm. After a lifetime of repetitive slashing and hoeing, it appears that his tendon might have ruptured. Surgery is not an option. We immobilize, prescribe rest, dole out ibuprofen, and hope for the best. He wants to know, how can he work without strength and mobility in his arm? Good question. Next is a fifteen year old boy. He lives and breathes soccer. He dreams of playing professionally, and is said to be one the best goal keepers in the area. He has dislocated his middle finger on his right hand. It has been two weeks, and fibrous scar tissue is developing around the misaligned joint. He complains of continued pain with any impact, and is only seeking help because his coach has banned him from playing. It is too late to re-align, and we must tell him that it is possible that he will never play goal keeper again. At least not as well. His face remains expressionless, but his eyes betray him, as I see his dreams evaporate, replacing hope with dull resignation. We teach him how to buddy tape, provide him ibuprofen for before and after practice, and excuse him from the bench, because the line is continuing. Lena hands us a cold bottle of coke, and as I look at her family, I know for a fact that angels reside on earth.

OBSERVATION

One can not walk down the path without being greeted by the local villagers, children and elders alike. You will most definitely exchange a five part greeting, dependent only on the time of day. Following, you will be asked, in order, where you are going, where you are coming from, and your name. While a nuisance initially, because a 30 minute journey is expanded two-fold, I do find comfort with the knowledge that if I were to be lost, and entire village will know where I am, and where I should be.

When the milk runs dry and the honey sours: Chintechi Hospital

When asked at interviews about my most challenging experience, I will no longer struggle for an answer that doesn't include surviving my mothers cooking...Today was my first day at Chintechi Rural Hospital. Run by nurses and a medical officer, it is the largest clinic within an hours drive. While void of a doctor, the medical officer is trained to deal with anything that walks through, or is carried through, the doors. One can imagine the outcomes in a country with tragically limited resources, ridden with communicable disease, poisoness reptiles, and fast vehicles on narrow unmanned roads.
The hospital is made up of two female wards, a labor and delivery ward, one men's ward, a pediatric ward, and an operating theater for the occasional rotating surgeon. Each ward is lined with cots and non-absorbent mattresses on dirt floors. Medications are extremely limited, and glucometers, urinalysis, or xrays are not available. When supplies allow, the lab can check for malaria, HIV and hemoglobin levels. My duty will be to round with Rose, and Australian nurse volunteering for 6 months, and the medical officer, to assess the patients, write medication and lab orders and re-evalute discharge plans.
I feel desperately inadequate for this position, and to the best of my ability squelched back fear and anxiety as we started in the women’s ward. How do you tell a woman with a hip fracture, that because she can not afford surgery, she will never walk again? Progressing to the pediatric ward, my heart stopped. Grouped 3 to a bed, each mother patiently waited with her child. The children here are sicker than any I have seen in my life. Some halfheartedly attempt to breastfeed. The rest lay listless, to weak to cry, with eyes that reflect a short life of sorrow and starvation. The first child was a 2 yr old, inhabiting the body of and reflecting the physical milestones of a 6 month old. While she could sit, she could not walk or speak. Her skin struggled to stretch over her protruding ribs and swollen abdomen. With sores lining her mouth, this child was fighting a loosing battle with malnutrition and AIDS. She no longer ate and had stopped producing wet diapers. Her eyes were dull and her spirit was dying. Her body followed 24 hours later. And it continued like this, on and on. I was hit with waves of nausea, frequently stepping out because the gravity of the illness in these children rendered me useless. What do you do when the milk runs dry and the honey sours?

Naughty Knees and Naked Boobies: City girl meets Malawi

Malawi Post One
Week One, Monday:

For a girl who is terrified of insects, frightened of the dark, and who has a healthy distrust of venomous snakes and man-eating crocodiles, coming to Malawi is akin to exposure therapy extreme enough to make even the most sadistic psychotherapist cringe. For the record, it is not ALL types of bugs that send me into full blown panic, mainly spiders, cockroaches, grasshoppers, locusts, large ants, and any insect that flies with erratic and unpredictable motions. Loaded with 6 cans of bug spray, malaria prophylaxis, 2 massive suitcases filled with medical supplies, knives of various sizes, emergency power bars and iodine tablets, I felt armed and ready! Of course that was only until the plane touched down in Ethiopia, at which point realized that I was in a continent where I did not know a soul, did not speak the language, and had been foolishly tricked by AT&Ts promises of international phone reception. My first night passed uneventfully, in that I was lucky enough to be picked up by Dr. Kim, the head of the (only) nursing school in the capital city Lilongwe, in an ambulance, which disposed of its hopefully not-so-sick patients in honor of my arrival. I would stay one night with a local volunteer doctor and and his wife, and the next morning start my bus ride to a rural village up north, forgotten on most maps.
In addition to my aforementioned obstacles, I am also plagued by severe motion sickness, which is very unfortunately aggravated by oppressive heat and pungent smells. Further complicating the journey, in which I am attempting to lug over 150lbs of luggage, there will be a complete absence of bathrooms stops. While many of my fearless friends offered foley insertion, or adult diapers in come cases, I figured having a bag of urine attached to my leg would only add to the unwanted weight I would have to carry. So based on further suggestions, I was now bravely equipped with a "you go girl," female, compact able, reusable, urinal, of a feminine lavender color, whose package boasts utilization during camping trips, while canoeing and at concerts!! So those of you accompanying me to my next Backstreet Boys performance- watch out- I plan on zealously chugging down rum and cokes (joking mom, orange juice) no longer constrained by the nuisance of bathroom lines!
Because buses here are overcrowded, with no discernible schedules, I arrived to the central bus station at 630 AM, only to sit in the baking vehicle for two and a half hours before it was decided that they were full enough to depart. With no organized waste management in the country, I was surrounded by a pool of discarded plastics, rotting foods, decaying animal carcases, and feasting flies. As the smells wafted in, I was already off to a bad start, and might be the first person alive to become motion sick in a completely stationary vehicle. A woman with a young child on her back, chose to sit next to me. While the child was a little angel sleeping, the minute she awoke, all hell broke loose. Like other mothers on board, the woman pulls out a breast in attempts to appease the child (although showing knees are forbidden), and yanks and pulls for a few minutes before she looses interest. Tired of her kicks and wails, this mother thought it would be most suitable to lay this child across both of our laps for the remainder of the journey, and give her a whole mango, which she preceded to consume with voracity. Having also a fear of sticky children, my mind was attempting to reconcile the mothers plan of cleaning her mango-laden offspring. Luckily for me, she chose to let her child remain covered in pulp and juice, now the new epicenter for all the flies in the area. Now, covered in mango, flies, and coca-cola that the mother had ingeniously spilled across both my shirt and pants, my already-peaked anxiety level (so I thought) was only augmented by the now sputtering engine. As I gazed out the window for distraction, I noted that vendors selling samosas and eggs have been replaced by lush green foliage dotted with bursts of color as women dressed in blues, yellows and purples, walked along the side of the tarmac with jugs of water balanced on their heads, and sleeping babies on their backs. Now if only my lap child would do the same...
As we pull off the road in one of our many stops, on a particularly desolate part of the road, the engine succumbs to heat and exhaustion, and refuses to restart. Four hours into the journey, just as I breathed a sigh of relief at the halfway mark, all one hundred of us, plus luggage, are forced to disembark in the midday sun. Efforts to repair the engine dissolve into workers napping in the shade of the engine block. The promised 20 minutes turns into two hours, and as sweat pours off of me, I revisit my four-sips-an-hour rule, and decide that passing out form heat stroke, tropes having to use the go-girl, but barely...Digging through my luggage I withdrew my mom-approved sun safety items, and sitting on a pile of suitcases with my Fendi sunglasses and wide-brimmed floppy hat, I am sure I was a site to be seen.
As promised, a replacement bus did arrive. However, it was already filled with people, without a seat to spare. As people with sacks of rice and chickens balanced on backs and heads, crowded to climb into the bus, I succumb to the realization that me, my wide hat, and my obscene amount of luggage, would never fit. Amazingly, 45 min later, all of us refuges had been successfully crammed into the now heavily weighed-down bus. Laps are piled with briefcases, small animals and children. Packed so tightly in the isle, I have no ability or reason to hold on. As famous Nigerian author Chinua Achebe is fond of saying when describing crowded market places, "if one were to throw a grain of rice in the air, it would never touch the ground."
I arrived at sun-down, and much to my relief, found one of the employees, Dan, waiting for me at the police roadblock, as he had been, for the past four hours. Together, with my luggage, we trudged the 2.5km over dirt, rocks and sand (and environment on which I would later be hilariously and painfully learning how to ride a bike), to my final destination. Never had my arms been more numbly tired, never had I been more thoroughly exhausted, never had I been happier to have a group of people call out my name, sequester my load, and hand me a cold beer.