Monday 14th March 2011-Sunday 27th March 2011
It is totally crazy that since my last blog we have passed three important timeline markers; two months in Malawi, two months in Nchalo and I am one third through my time in Malawi. Please don’t get the wrong impression-I’m not wishing away my time but I am amazed at how quickly the time has passed! It’s the last week in March already, how did that happen?! I wish that I could say that because we are two months down the line, the temperature is gradually dropping-unfortunately not! This last week in particular has been a scorcher and every day has been about 40-45 degrees Celsius...all that can be done is to wait and see and hope that in time the temperatures will fall to a more manageable level. In the mean-time I am learning to accept that I have no control over the weather and I have become significantly more appreciative of being at the right temperature (mainly when in Blantyre).
Nadia, our Desk Officer from Coll, came out to visit and we went up to Blantyre to meet her and enjoy a St Patrick’s Day party. I don’t quite know where from, but all the azungu seemed to emerge that night and gather at Doogle’s youth hostel and it was a very good event. The whole weekend was great actually and it was strange to think that I am on my Gap Year and my desk officer has visited. As I say so often, the planning and preparation for this time away has been so long that I cannot believe that it’s over and I am actually living in Malawi!
The morning of the day that Nadia was due in Nchalo, we had an office meeting with Paul. It was another of those meetings where there were a lot of misunderstandings and repetition, but it was very interesting. We discovered more about what Paul saw as our role in FHECC; he was under the impression that we are in Nchalo to re-invent FHECC, find them funding and get them back on their feet (they were funded by Family Health International until 3 years ago and now they receive nothing). As you know, we feel that we have come to Malawi for a totally different reason-to use our skills and knowledge to help a part of a community- and it was an interesting conversation when we discovered the differences in understanding but it did make sense of a lot of confusion that had been around. We have been confused as to why we are still visiting quite so many villages and why FHECC are reluctant for us to focus on one CBCC, support group or village but it’s because Paul thought that for January, February and March we would get an idea of what the organisation is about before then deciding how to recreate it. When Nadia arrived, she agreed that we were not in Nchalo to spend 7 months at the internet cafe researching grant making organisations-we did that as part of fundraising! It did all work out in the end as now at least everybody knows where they stand and we have agreed with Paul what we are here to do. Hopefully this means that the project can move forwards and develop. Sophie and I have also had the idea of starting to train FHECC volunteers on how to deliver Home Based Care. Again, we felt that our visiting patients once will help them while we are here, but there will be no lasting effect when we leave in August, whereas if we train the volunteers, what we teach can be continued once we are gone. This also makes the project more concrete in structure. Nadia has been looking at potential new projects in Malawi and soon has to decide what existing projects will continue and which won’t. Because ours has taken so long to get off the ground we are unsure of what will happen, but if it does continue we will have helped to establish a really different and exciting project, and if it doesn’t then we will have been some of the few people in the world who have ever taken the opportunity to visit Nchalo and spend time getting to know the community. Either way, it’s pretty special!
Hospital work continues to be interesting and we have appointed ourselves new roles within the hospital-infection prevention monitors! We attended an Infection Prevention session run by the staff, for the staff and it s good that we now know that the staff are aware of what good and bad practice is and we can now pick up on mistakes, knowing that they have been made through carelessness rather than not knowing. I have seen an improvement since the session and have also been more confident in discussing the issue with the nurses as I feel less likely to be judged as the azungu who is here picking flaws seeing as we attended the same day of training and we have built up good friendships with them too.
The maternity ward has brought a few interesting cases this week; firstly there was an 18 year old mother who, due to her HIV medication, gave birth 7 weeks prematurely to a tiny, tiny baby. It was so small that its ears were not properly formed but I am happy to say that it was otherwise healthy and managed the knack of breastfeeding without any problems. The young age of the mother was not new, but this was the first time that I had heard of ARVs causing premature delivery. Through other work I have learned more problems that ARVs cause and being in Malawi is certainly still a learning experience. I doubt that that will change!
A second mother, in the ward, was in the second stage of labour and the midwife told me that because of the size of the fundus, they suspected that she was expecting twins. However, after palpating and listening for a foetal heart sound he decided that actually she wasn’t expecting twins, she was just obese! This is the first time I have encountered the concept while in Malawi. Sure, there are overweight people, but there are many more that are underweight. What really struck me was the difference in techniques between here and the UK. At home, and ultrasound would have been done very early on in the pregnancy and twins would have been confirmed or eliminated well before the day of delivery! Here, because the gestation age is measured according to fundal height, nobody was very sure of what to expect until she was delivering. Fundal height is a variable that is controlled by so many factors and isn’t a totally reliable measurement. Though the hospital has one brand new ultrasound machine, it is too expensive to run regularly and patients cannot afford to pay for its use either. St Montfort is a mission hospital, as opposed to a government hospital, so patients pay for treatment. The healthcare dilemmas that I come across are always really interesting for me and I have started to think about my Community Report for Project Trust-the problem is that there is so much I could include! I’ve accepted my place at Edinburgh to study medicine next year and I keep thinking about what a totally different experience it will be to learn about medicine in the UK in comparison to Malawi.
Of course, my blog would be incomplete without some food news...we have made some really good, cheese-less pizza to celebrate our 2 month anniversary. As we keep saying, flatbread has become one of our staples and has so many uses. Jen, you really will thank me! We cooked risotto for the family too...what a debacle! For every meal they usually have three or four insulated dishes on the table, each with something different in it, so when we set the table and there was one pot in the middle it was very different. Seeing as we measure the success of the meal on how much salt is added, this dish was a total disaster. Sophie and I were happy with the seasoning, but the family each had repeated servings of salt on their portions! We are in need of some new ideas of recipes to cook for them, so if anyone has ideas (that don’t include pork or alcohol) please let me know!
Finally, in the past fortnight we have officially sold all the furniture that we had so source for our house in Sekeni Village. Mphatso, the landlord, bought it from us and we are now fully untied from the rent agreement. This is a good weight off our shoulders and what’s even better is that we are now on holiday! Having worked for two months solid we are both tired but excited about going to climb Mount Mulanje for my birthday this week. We’re currently in Blantyre, enjoying cool weather and preparing, but I’ll let everyone know how it goes and hopefully have some good photos of the stunning views to upload at some point in the future. Malawi is a stunning country and we witnessed the most amazing lightning storm when coming down the Escarpment Road last weekend. The forks of lightning were illuminating the whole sky-it was just breathtaking and I cannot believe that I have this chance to spend time living in such an amazing part of the world.
All in all life is good and I am very excited about our impending holiday and spending my birthday in Africa! I hope that things are all well at home and I send lots of love to everyone,
Take care and keep in touch,
Catherine
xxx
Monday, 28 March 2011
Sunday, 13 March 2011
Nchalo...it now resembles a swamp!
Friday 4th March2011-Friday 11th March 2011
Another week in Nchalo, another week of new experiences…I hope that this won’t change anytime soon! The January rains have finally arrived, two months late (standard Malawian delays), and have reduced the dusty roads to mud. In Chichewa, the word for mud is the same as the word for rain (mvula) and there is an old proverb “Mukufuna mvula, mukufuna mvula.”-You want rain, you want mud. There is no chance of having one without the other as we have learned this week. We were caught in a particularly heavy downpour one afternoon. Between the FHECC office and the hospital we managed to get totally drenched, even with an umbrella, and we ended up splashing mud at each other, much to the amusement of all the hospital staff. Those azungu…a constant source of entertainment! The advantage of rain is that it significantly lowers the temperature and crops can grow. The disadvantages…roads to villages become impassable by Sherpa and my phone is too soggy to work! Luckily Ignatius has a spare one that I can use until I can find a new one. As a result of the weather, a lot of our village visits didn’t go ahead this week so we’ve been at the hospital a lot.
On Tuesday, Sophie went to maternity while I went to the paediatric ward. We noticed later that the 5 hours that we spent in different areas of the hospital is the longest that we have been apart in 8 weeks…wow. Paediatrics has been very interesting, but there are so many cases of severe malaria, especially in young children. The sad thing is that they rarely sleep under nets because they don’t have them, but if a parent takes their child to the Under 5s’ clinic, they can be given a free one. Unfortunately there is no scheme in place for children over the age of 5. There aren’t many other illnesses on the ward, so cannula insertion to set up IV quinine is the standard procedure. The nurses were all for me having a go, but if I am going to try cannulation, I will definitely not start on children! Firstly, their veins are nearly impossible to see and secondly, they are more resistant to needles and often two fully grown Malawian men are needed to restrain him or her. I have learned to set up the IV drip though and had a hand in helping with dressing the burns on the little girl that fell on the boiling water. I am happy to say that the wounds are healing much better and she has been discharged! I really hope that the wounds stay clean and continue to heal well in a dusty village environment.
The most exciting medical new of the week comes from Sophie who, in the maternity ward, helped to deliver a baby. All week at the ward the nurses have been teaching her and today (because nothing was happening at paediatrics) I went to maternity and watched her clamp and cut the umbilical cord, give an injection and deliver the placenta! It was great to watch and she went about the whole procedure with so much confidence and it was so smoothly done. The patient’s records officially say that the baby girl was delivered by Sophie-how amazing is that? What an amazing opportunity for her!
We’ve been at the ante-natal clinics too and my news is that I am now able to use a blood pressure cuff and stethoscope to measure blood pressure! We were sitting, having weighed everyone, waiting for another nurse to come and measure the BPs when Sophie said “Do you want to just have a go at doing their BPs?” Before I knew it I had really sore ears from having used a really old stethoscope to measure 30 women’s blood pressures! I feel like we are now even more useful because we weigh, register and take blood pressure, so it is definite progress, both for the clinic and my personal skills too!
In other FHECC news: we are going to start teaching one morning a week at a Community Based Child-Care Centre (a bit like pre-school) in a small village called Dzilonzo. We introduced ourselves this week and set up a timetable-they have never had one before-and have come up with a list of topics that we will try and teach. The struggle will be teaching the children to learn. Up until now they just repeat what the teacher says; she says “silence” and they all shout “silence” and then sit quietly for a while; they can sing the alphabet song but they don’t know what the letters are. We’re going to try and teach the alphabet, letter by letter, maybe some animals and basic personal hygiene too e.g. hand washing. We’ve also established our role with the youth groups. We’ve been uncertain for a while about what we will actually be doing with them, but we had a meeting with one of the local groups this week and our role is an advisory one. We suggested activities that they could do and new methods of teaching about HIV in the community. They want to apply for funding for their community pre-school, so we have given them a plan of action to try and increase the chances of success. All in all, despite the rain, it has been another week where our role in Nchalo and the neighbouring villages has become clearer, so we’re happy!
Again, we cooked a meal for everybody in the family. We have now made them Toad in the Hole with onion gravy, chocolate cake and, of course, pancakes, for Pancake Day! They all went down quite well we think, especially because not a single person added salt to our Toad in the Hole meal-quite an achievement in Malawi. We have now tried maize porridge, phala, which all the children eat. It is a bit like sweet nsima, only the consistency of custard. It’s not too bad, but a little goes a long way for us! We were handed a bowl each but we asked to share. We only ate about a quarter of the bowl and the village chief had the rest, after having had a huge bowl herself. I think we’ll stick to muesli in the mornings from mow on!
Having visited Blantyre immigration last weekend we are now allowed in the country for a further 30 days. We spent the night and met with some of the other PT volunteers. We had some great food, from several outlets, and a good party at the youth hostel, featuring a drummer who turned his bike into a drum kit! It was the first chance that we have had to dance at a reasonable temperature and we were pleased to feel cool in Blantyre while others said they were hot-we must be adapting to the Nchalo heat. Success! This weekend we have been chilling our after a busy few weeks and the next few weekends are looking packed too; next weekend we’ll meet up with everyone in Blantyre as Nadia, our Desk Officer from Coll will be visiting. We’ve also arranged to climb Mount Mulanje for my birthday with some other volunteers, so that will be Sophie’s and my first holiday since coming to Nchalo. I’m really excited about spending my birthday in Malawi! So, to have down time this weekend we’ve swum with Prudence and Nema, watched a film with all three girls and eaten fresh coconut! After uploading this blog, we’re going to go to the Sports’ Club and watch the England Vs Scotland Six Nations’ match…come on Scotland!
Post has been amazing this week too, so please keep it coming; we love going to the hospital administrator and them handing us a big pile of letters between us. I hope that all my letters have been making it to the UK, or Namibia, and that everybody is well. I can’t believe that we are now a quarter of the way through our time in Malawi. Each week flies by, but at the same time I can never remember what I did yesterday-each day is so long, full-on and packed with new experiences, but I like it that way!
All in all, a good week and hopefully there's another one to come. Thank you so much for all the encouraging messages and support-I love receiving them and they do mean a lot. I trust that everyone is well and look forward to hearing the news from home.
Take care and keep in touch,
Love
Catherine
xxx
Another week in Nchalo, another week of new experiences…I hope that this won’t change anytime soon! The January rains have finally arrived, two months late (standard Malawian delays), and have reduced the dusty roads to mud. In Chichewa, the word for mud is the same as the word for rain (mvula) and there is an old proverb “Mukufuna mvula, mukufuna mvula.”-You want rain, you want mud. There is no chance of having one without the other as we have learned this week. We were caught in a particularly heavy downpour one afternoon. Between the FHECC office and the hospital we managed to get totally drenched, even with an umbrella, and we ended up splashing mud at each other, much to the amusement of all the hospital staff. Those azungu…a constant source of entertainment! The advantage of rain is that it significantly lowers the temperature and crops can grow. The disadvantages…roads to villages become impassable by Sherpa and my phone is too soggy to work! Luckily Ignatius has a spare one that I can use until I can find a new one. As a result of the weather, a lot of our village visits didn’t go ahead this week so we’ve been at the hospital a lot.
On Tuesday, Sophie went to maternity while I went to the paediatric ward. We noticed later that the 5 hours that we spent in different areas of the hospital is the longest that we have been apart in 8 weeks…wow. Paediatrics has been very interesting, but there are so many cases of severe malaria, especially in young children. The sad thing is that they rarely sleep under nets because they don’t have them, but if a parent takes their child to the Under 5s’ clinic, they can be given a free one. Unfortunately there is no scheme in place for children over the age of 5. There aren’t many other illnesses on the ward, so cannula insertion to set up IV quinine is the standard procedure. The nurses were all for me having a go, but if I am going to try cannulation, I will definitely not start on children! Firstly, their veins are nearly impossible to see and secondly, they are more resistant to needles and often two fully grown Malawian men are needed to restrain him or her. I have learned to set up the IV drip though and had a hand in helping with dressing the burns on the little girl that fell on the boiling water. I am happy to say that the wounds are healing much better and she has been discharged! I really hope that the wounds stay clean and continue to heal well in a dusty village environment.
The most exciting medical new of the week comes from Sophie who, in the maternity ward, helped to deliver a baby. All week at the ward the nurses have been teaching her and today (because nothing was happening at paediatrics) I went to maternity and watched her clamp and cut the umbilical cord, give an injection and deliver the placenta! It was great to watch and she went about the whole procedure with so much confidence and it was so smoothly done. The patient’s records officially say that the baby girl was delivered by Sophie-how amazing is that? What an amazing opportunity for her!
We’ve been at the ante-natal clinics too and my news is that I am now able to use a blood pressure cuff and stethoscope to measure blood pressure! We were sitting, having weighed everyone, waiting for another nurse to come and measure the BPs when Sophie said “Do you want to just have a go at doing their BPs?” Before I knew it I had really sore ears from having used a really old stethoscope to measure 30 women’s blood pressures! I feel like we are now even more useful because we weigh, register and take blood pressure, so it is definite progress, both for the clinic and my personal skills too!
In other FHECC news: we are going to start teaching one morning a week at a Community Based Child-Care Centre (a bit like pre-school) in a small village called Dzilonzo. We introduced ourselves this week and set up a timetable-they have never had one before-and have come up with a list of topics that we will try and teach. The struggle will be teaching the children to learn. Up until now they just repeat what the teacher says; she says “silence” and they all shout “silence” and then sit quietly for a while; they can sing the alphabet song but they don’t know what the letters are. We’re going to try and teach the alphabet, letter by letter, maybe some animals and basic personal hygiene too e.g. hand washing. We’ve also established our role with the youth groups. We’ve been uncertain for a while about what we will actually be doing with them, but we had a meeting with one of the local groups this week and our role is an advisory one. We suggested activities that they could do and new methods of teaching about HIV in the community. They want to apply for funding for their community pre-school, so we have given them a plan of action to try and increase the chances of success. All in all, despite the rain, it has been another week where our role in Nchalo and the neighbouring villages has become clearer, so we’re happy!
Again, we cooked a meal for everybody in the family. We have now made them Toad in the Hole with onion gravy, chocolate cake and, of course, pancakes, for Pancake Day! They all went down quite well we think, especially because not a single person added salt to our Toad in the Hole meal-quite an achievement in Malawi. We have now tried maize porridge, phala, which all the children eat. It is a bit like sweet nsima, only the consistency of custard. It’s not too bad, but a little goes a long way for us! We were handed a bowl each but we asked to share. We only ate about a quarter of the bowl and the village chief had the rest, after having had a huge bowl herself. I think we’ll stick to muesli in the mornings from mow on!
Having visited Blantyre immigration last weekend we are now allowed in the country for a further 30 days. We spent the night and met with some of the other PT volunteers. We had some great food, from several outlets, and a good party at the youth hostel, featuring a drummer who turned his bike into a drum kit! It was the first chance that we have had to dance at a reasonable temperature and we were pleased to feel cool in Blantyre while others said they were hot-we must be adapting to the Nchalo heat. Success! This weekend we have been chilling our after a busy few weeks and the next few weekends are looking packed too; next weekend we’ll meet up with everyone in Blantyre as Nadia, our Desk Officer from Coll will be visiting. We’ve also arranged to climb Mount Mulanje for my birthday with some other volunteers, so that will be Sophie’s and my first holiday since coming to Nchalo. I’m really excited about spending my birthday in Malawi! So, to have down time this weekend we’ve swum with Prudence and Nema, watched a film with all three girls and eaten fresh coconut! After uploading this blog, we’re going to go to the Sports’ Club and watch the England Vs Scotland Six Nations’ match…come on Scotland!
Post has been amazing this week too, so please keep it coming; we love going to the hospital administrator and them handing us a big pile of letters between us. I hope that all my letters have been making it to the UK, or Namibia, and that everybody is well. I can’t believe that we are now a quarter of the way through our time in Malawi. Each week flies by, but at the same time I can never remember what I did yesterday-each day is so long, full-on and packed with new experiences, but I like it that way!
All in all, a good week and hopefully there's another one to come. Thank you so much for all the encouraging messages and support-I love receiving them and they do mean a lot. I trust that everyone is well and look forward to hearing the news from home.
Take care and keep in touch,
Love
Catherine
xxx
Thursday, 3 March 2011
One Month in the Hottest Part of the Warm Heart of Africa!
19th February - 3rd March 2011
Sophie and I were really amazed to look at our diaries this week, on Thursday, and to realise that we have been in Nchalo for a whole month! Remembering back to those first few days in the area, we wondered where on earth we would be one month on, how we would be coping and how life would be going. The answer to all of that is; it’s all pretty good actually!
Progress has been made regarding the FHECC project! We had a meeting one afternoon (we were supposed to visit a village but there was a mix up, so we’ll go next week) with Paul and Never. It was a two hour meeting full of misunderstandings and miscommunication, but in the end, both sides have compromised and we have a successful outcome! Sophie and I wanted to have a weekly timetable that would always be the same so that each week we would visit the same village and build a relationship with the community. Paul disagreed-he thought that was unfair and villages would feel let out. We felt that it was unrealistic for us to include all 60 villages in the FHECC catchment area, and then I asked “What do you want us to do? What do you hope to achieve by our being here?” Now, this is a question that we should have asked a long time ago! We had never actually asked and so we had assumed that they wanted our skills and a direct input into specific projects or youth groups. In actual fact, what they want is our advice I think. We have set up a timetable where we have a few fixed items per week (antenatal clinics and hospital work) and then there are days or afternoons that will change every week where we will visit different communities and see what programmes are in place, listen to their situation and offer guidance on how to move forwards (whether this is a Home Based Care patient, youth group or a preschool). We feel a lot more comfortable in knowing what is being asked of us and are really looking forward to starting to offer our advice. It’s not what we expected, but as Mum reminded me, that’s part of the Malawian experience-too true!
Work this has been very enjoyable and, as always, very educational for both of us. We spent two days in the Maternity ward and as a result, I have held even more new born babies born to remarkably young girls. Every day there are 17 or 18 year old girls in the labour ward, giving birth, and I can’t help but try to imagine myself in their position. I really cannot imagine being married and having my first or second child by the age I am now. It’s one of the differences in culture between home and Malawi which constantly amazes me, probably because of the similarity in ages, and I will probably get used to it in time, but right now, every time a teenager is in the ward I try to put myself in their shoes.
One specific case stood out for me this week; a woman in her early 20s came in with contractions. Now, gestation age is measured by fundal height here, and it was indicating a gestation age of just 20 weeks. The lady was very malnourished and unfortunately the baby had died, hence the contractions at 20 weeks. What struck me was that she had attended 3 antenatal sessions at a clinic and her weight had been noted each time and each time it was clear that she was very malnourished. I wondered why nothing had been done to help her, or whether advice had been given to her to increase her body weight and improve her health, both for herself and for her baby. I guess that she probably was advised to increase her food intake and encouraged to gain weight, but it is more than possible that she lacked the funding to get food or coal to cook, or perhaps she had no support at home. There are plenty of comparable cases, but this was the first unsuccessful pregnancy that I have encountered, so it specifically stood out for me.
We spent some time watching stitches from c-section scars being removed. The midwife was all for me having a go, but I assured him that I would watch for now, but in the future I would love to. What an opportunity, it’s something that would never be offered to me in PRI, and we have been surrounded by similar offers to undertake clinical procedures. We would love to, in time, but for now it is important that we learn how the staff go about the procedures and we observe techniques first! Nevertheless, learning has taken place this week and we can now both take blood pressure using a stethoscope and BP cuff! (Assuming the surroundings are relatively quiet!). Once we practise a bit more and are more confident in our abilities, this will come in handy at the antenatal clinics.
We’ve been to paediatrics and seen a 2 year old girl with burns all over the front and back of her torso. She fell onto a pan of boiling water and with baulas being the normal mode of cooking here, it is too common an injury. There were quite a few burns victims and because there isn’t a separate burns unit, infection is easily caught, so the children have to stay in even longer as they become more ill. I’m looking forwards to returning to the paed ward and getting involved in dressings and getting to know the children there, but also seeing how the staff deal with the different cases.
For the first time at the NRU, we were involved in the Under 5s clinic. This was quite a manic morning. We arrived at about 7.30 and there were already tens of women and their babies or toddlers at the centre. We were quickly roped into weighing the children using a hook weighing scale and the children were dangled form the hook in chitenges. It was quite scary when you had wriggling babies trying to escape the chitenge that was suspending them 4 feet off the ground! We took it in turns, one of us getting the chitenge onto the hook and reading off the weight, while the other wrote the weight in the chart in the health passport. There were women everywhere and we were totally surrounded by so many noises and everybody wanted to know how their child was doing. I was pleased to see that so many women were interested in the health of their children because, until now, it has appeared that having children is a duty rather than a choice or opportunity in Malawian culture. In the labour ward I am yet to come across a smiling mother or an encouraging relative or friend, which is very odd. What is also strange about the labour ward is the pain aspect. In all the work experience that I have done, if a patient is in pain the clinician will try to reduce that instantly and make the patient comfortable and also combat the source of the pain. So, it is very odd for me to be in a maternity ward where it is normal for women to be in pain and they are supposed to be in pain, so nothing is done to reduce it. It is just so different to anything I have come across before, but then so is the Malawian experience!
Village visits have also become a semi-regular part of our project. I say semi-regular because about half the time they are postponed due to communication breakdown, transport issues, or the village is closed because there is a funeral. I really enjoyed the visit to Besta village, where we went to the homes of Home Based Care patients. Never acted as translator and would tell us the patient and guardian’s side of the story, then we would ask questions about the symptoms of their illness and give our advice. It was also important for us the make sure that the patient was receiving adequate care from the guardian, but also that the guardian themselves had enough time and support to care for the patient. We came across one patient who looked elderly and complained of pain in her arms and legs which had begun 3 years ago. She had been on ART (Anti-Retroviral Treatment) for 3 years, so we put the two together and said that it was a side effect of the medication-ART has many side effects. After asking a few more questions we changed our diagnosis and decided that we thought she had osteo-arthritis. Because Malawians don’t have a high life expectancy, arthritis is virtually unheard of (Several times people have asked what kind of nurse Mum is and it has taken a while to explain. The concept of an old people’s home is also totally alien!) and it was strange to be giving advice to a lady living in poverty in central Africa which was (hopefully) similar to that which Mum gives out to her patients who also have osteo-arthritis. The experience was great and I cannot wait to be involved in more HBC-we feel that we can really bring something to the patients and make a valid contribution, so it’s a positive experience both ways!
We have also learned a lot more about the sugar estate from Ignatius. He took us on a tour of it and it is enormous! Within the estate, there are 7 villages, the factory and plant, masses of sugar cane and schools, clinics and the sports club. We have been to the pool a couple of times and made friends with a young South African lady who is new to the estate too. We joined her at the bar one night and met a lot of South African expats and there’s also a Scot! He came out for 3 months, 12 years ago, and is still here…We will definitely be coming home in August for university, the thought of the October heat is too much to bear!
We’re gradually getting used to moulding to an African family’s way of life. It’s challenging as there are always people everywhere but it is good in that we are able to learn a lot from them too. We went to Blantyre to one of Ignatius’s churches and then had lunch at his “brother’s” (very close friend) house. It is perfectly normal to refer to close friends as relatives here, so that’s causing a little confusion! We cooked for the family again and we think that they enjoyed it…we did fajitas and Monica (who is very picky with food) thoroughly enjoyed it, so we count that as a success! We have also been developing our friendships with the locals, and Edwin (the surgeon/doctor) asked us if we would be his “Pennipols”. After a lot of laughter and confusion we realised that he wants us to be pen-pals, and we have agreed, though we now refer to “pen-pals” as “Pennipols”, just for the comedy.
My final piece of good news is that I received a parcel, as did Sophie! (Thanks, Claire!) We love when letters arrive and love reading emails reminding us of home life and keeping in touch with everyone and their news. Everyone says that nothing is changing at home, but that is comforting to know, seeing as everything always changes here! All in all, things have been going relatively well and we are very proud to have survived a month in Nchalo. We didn’t think it was possible when we first arrived, but I think that it proves that if something seems totally unachievable, it may not be!
Missing everybody at home lots, but not enough to bring me home before August (especially now that our project appears to be making progress). I can’t believe that it is now March and I am living in Malawi. The reality still hasn’t sunk in and I’m nearly 7 weeks in! I wonder if it will ever seem real…
Please keep letters and emails coming, I really enjoy reading them,
Take care and love to all,
Catherine
xxx
Sophie and I were really amazed to look at our diaries this week, on Thursday, and to realise that we have been in Nchalo for a whole month! Remembering back to those first few days in the area, we wondered where on earth we would be one month on, how we would be coping and how life would be going. The answer to all of that is; it’s all pretty good actually!
Progress has been made regarding the FHECC project! We had a meeting one afternoon (we were supposed to visit a village but there was a mix up, so we’ll go next week) with Paul and Never. It was a two hour meeting full of misunderstandings and miscommunication, but in the end, both sides have compromised and we have a successful outcome! Sophie and I wanted to have a weekly timetable that would always be the same so that each week we would visit the same village and build a relationship with the community. Paul disagreed-he thought that was unfair and villages would feel let out. We felt that it was unrealistic for us to include all 60 villages in the FHECC catchment area, and then I asked “What do you want us to do? What do you hope to achieve by our being here?” Now, this is a question that we should have asked a long time ago! We had never actually asked and so we had assumed that they wanted our skills and a direct input into specific projects or youth groups. In actual fact, what they want is our advice I think. We have set up a timetable where we have a few fixed items per week (antenatal clinics and hospital work) and then there are days or afternoons that will change every week where we will visit different communities and see what programmes are in place, listen to their situation and offer guidance on how to move forwards (whether this is a Home Based Care patient, youth group or a preschool). We feel a lot more comfortable in knowing what is being asked of us and are really looking forward to starting to offer our advice. It’s not what we expected, but as Mum reminded me, that’s part of the Malawian experience-too true!
Work this has been very enjoyable and, as always, very educational for both of us. We spent two days in the Maternity ward and as a result, I have held even more new born babies born to remarkably young girls. Every day there are 17 or 18 year old girls in the labour ward, giving birth, and I can’t help but try to imagine myself in their position. I really cannot imagine being married and having my first or second child by the age I am now. It’s one of the differences in culture between home and Malawi which constantly amazes me, probably because of the similarity in ages, and I will probably get used to it in time, but right now, every time a teenager is in the ward I try to put myself in their shoes.
One specific case stood out for me this week; a woman in her early 20s came in with contractions. Now, gestation age is measured by fundal height here, and it was indicating a gestation age of just 20 weeks. The lady was very malnourished and unfortunately the baby had died, hence the contractions at 20 weeks. What struck me was that she had attended 3 antenatal sessions at a clinic and her weight had been noted each time and each time it was clear that she was very malnourished. I wondered why nothing had been done to help her, or whether advice had been given to her to increase her body weight and improve her health, both for herself and for her baby. I guess that she probably was advised to increase her food intake and encouraged to gain weight, but it is more than possible that she lacked the funding to get food or coal to cook, or perhaps she had no support at home. There are plenty of comparable cases, but this was the first unsuccessful pregnancy that I have encountered, so it specifically stood out for me.
We spent some time watching stitches from c-section scars being removed. The midwife was all for me having a go, but I assured him that I would watch for now, but in the future I would love to. What an opportunity, it’s something that would never be offered to me in PRI, and we have been surrounded by similar offers to undertake clinical procedures. We would love to, in time, but for now it is important that we learn how the staff go about the procedures and we observe techniques first! Nevertheless, learning has taken place this week and we can now both take blood pressure using a stethoscope and BP cuff! (Assuming the surroundings are relatively quiet!). Once we practise a bit more and are more confident in our abilities, this will come in handy at the antenatal clinics.
We’ve been to paediatrics and seen a 2 year old girl with burns all over the front and back of her torso. She fell onto a pan of boiling water and with baulas being the normal mode of cooking here, it is too common an injury. There were quite a few burns victims and because there isn’t a separate burns unit, infection is easily caught, so the children have to stay in even longer as they become more ill. I’m looking forwards to returning to the paed ward and getting involved in dressings and getting to know the children there, but also seeing how the staff deal with the different cases.
For the first time at the NRU, we were involved in the Under 5s clinic. This was quite a manic morning. We arrived at about 7.30 and there were already tens of women and their babies or toddlers at the centre. We were quickly roped into weighing the children using a hook weighing scale and the children were dangled form the hook in chitenges. It was quite scary when you had wriggling babies trying to escape the chitenge that was suspending them 4 feet off the ground! We took it in turns, one of us getting the chitenge onto the hook and reading off the weight, while the other wrote the weight in the chart in the health passport. There were women everywhere and we were totally surrounded by so many noises and everybody wanted to know how their child was doing. I was pleased to see that so many women were interested in the health of their children because, until now, it has appeared that having children is a duty rather than a choice or opportunity in Malawian culture. In the labour ward I am yet to come across a smiling mother or an encouraging relative or friend, which is very odd. What is also strange about the labour ward is the pain aspect. In all the work experience that I have done, if a patient is in pain the clinician will try to reduce that instantly and make the patient comfortable and also combat the source of the pain. So, it is very odd for me to be in a maternity ward where it is normal for women to be in pain and they are supposed to be in pain, so nothing is done to reduce it. It is just so different to anything I have come across before, but then so is the Malawian experience!
Village visits have also become a semi-regular part of our project. I say semi-regular because about half the time they are postponed due to communication breakdown, transport issues, or the village is closed because there is a funeral. I really enjoyed the visit to Besta village, where we went to the homes of Home Based Care patients. Never acted as translator and would tell us the patient and guardian’s side of the story, then we would ask questions about the symptoms of their illness and give our advice. It was also important for us the make sure that the patient was receiving adequate care from the guardian, but also that the guardian themselves had enough time and support to care for the patient. We came across one patient who looked elderly and complained of pain in her arms and legs which had begun 3 years ago. She had been on ART (Anti-Retroviral Treatment) for 3 years, so we put the two together and said that it was a side effect of the medication-ART has many side effects. After asking a few more questions we changed our diagnosis and decided that we thought she had osteo-arthritis. Because Malawians don’t have a high life expectancy, arthritis is virtually unheard of (Several times people have asked what kind of nurse Mum is and it has taken a while to explain. The concept of an old people’s home is also totally alien!) and it was strange to be giving advice to a lady living in poverty in central Africa which was (hopefully) similar to that which Mum gives out to her patients who also have osteo-arthritis. The experience was great and I cannot wait to be involved in more HBC-we feel that we can really bring something to the patients and make a valid contribution, so it’s a positive experience both ways!
We have also learned a lot more about the sugar estate from Ignatius. He took us on a tour of it and it is enormous! Within the estate, there are 7 villages, the factory and plant, masses of sugar cane and schools, clinics and the sports club. We have been to the pool a couple of times and made friends with a young South African lady who is new to the estate too. We joined her at the bar one night and met a lot of South African expats and there’s also a Scot! He came out for 3 months, 12 years ago, and is still here…We will definitely be coming home in August for university, the thought of the October heat is too much to bear!
We’re gradually getting used to moulding to an African family’s way of life. It’s challenging as there are always people everywhere but it is good in that we are able to learn a lot from them too. We went to Blantyre to one of Ignatius’s churches and then had lunch at his “brother’s” (very close friend) house. It is perfectly normal to refer to close friends as relatives here, so that’s causing a little confusion! We cooked for the family again and we think that they enjoyed it…we did fajitas and Monica (who is very picky with food) thoroughly enjoyed it, so we count that as a success! We have also been developing our friendships with the locals, and Edwin (the surgeon/doctor) asked us if we would be his “Pennipols”. After a lot of laughter and confusion we realised that he wants us to be pen-pals, and we have agreed, though we now refer to “pen-pals” as “Pennipols”, just for the comedy.
My final piece of good news is that I received a parcel, as did Sophie! (Thanks, Claire!) We love when letters arrive and love reading emails reminding us of home life and keeping in touch with everyone and their news. Everyone says that nothing is changing at home, but that is comforting to know, seeing as everything always changes here! All in all, things have been going relatively well and we are very proud to have survived a month in Nchalo. We didn’t think it was possible when we first arrived, but I think that it proves that if something seems totally unachievable, it may not be!
Missing everybody at home lots, but not enough to bring me home before August (especially now that our project appears to be making progress). I can’t believe that it is now March and I am living in Malawi. The reality still hasn’t sunk in and I’m nearly 7 weeks in! I wonder if it will ever seem real…
Please keep letters and emails coming, I really enjoy reading them,
Take care and love to all,
Catherine
xxx
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