Guess who's back

Hi Guys!

I just wanted to let everyone know that I arrived back in the US safe & sound. My flights went without a hitch and my luggage actually made it all the way to Detroit in one piece!

I just want to send a final shout-out to my Real World Malawi 8:

Shant: A big thank you! I think all of us would agree that you were the glue that held our group together. You are one-of-a-kind and we were lucky to have you with us. Thank you for all of the delicious meals. You are a truly gifted cook.

Tom: Blue tooth box. "hey Tom...you awake...?" Thank you for making me laugh. You are hilarious and...pretty much good at everything! Thank you for starting the flip-cup-Malawi-Chapter, and thank you for introducing me to "Lucy, the Daughter of the Devil".

Kim: Our technical support. Thank you for agreeing to compile all of the pictures. Sorry I took so many. I cannot wait to get the DVD! I hope you are enjoying a large pot of coffee right now!

Emily: Our Chichewa translator. I admire your dedication to learning the language. Thank you for the deep talks, and for being "pretty much a big deal" with me :). Good luck on the rest of your travels and be safe.

Angela: Thank you for being such an awesome roommate. Thank for the girl talk and for understanding me. I don't know what I would have done without you on this trip. You are beautiful and I feel so lucky to have gotten to know you better on this trip.

Katie: Thank for for taking the hits for all of us, and for being such a good sport about it. You made our trip so much fun. You and I will go horseback riding with Angela (and without the boys) when you get back. And I am counting on you to keep me in line next year!

Sammie: "Go Big Or Go Home". I cannot tell you how glad I am that we have become friends. I would trust you with my life. I hope you know that you are going to be an amazing doctor. Thank you for keeping it real.

Everyone: Thank you for making this trip something that I will cherish forever. Thank you for tolerating my loud laugh...well, tolerating me being loud in general. Thank you for putting up with my mothering tendencies, and for helping me keep the "your mom" jokes alive! See you all at graduation!

Zicomo!

Niamh


All of us with Terrie:

Block II -- 8 2009

Block II - 8...I think that Shant came up with the name, and I like it. We were the second group of students in 2009 and there are 8 of us.

Here is our last picture together in Terrie's house as Block II - 8 :




Well, this morning is my last morning here on 24 Kufa Road, and I really cannot believe that the 6 weeks are over. Sorry for the lack of posts all week; I've been busy trying to soak up my last few days in Malawi and I just couldn't justify spending time sitting in front of the computer. The past 6 weeks seem to have flown by, and I am experiencing a wide range of emotions this morning. I had no idea what to expect on this trip, and looking back I know that I could never have imagined that this trip would be as amazing as it was. I loved my time here. I did not save any lives or cure AIDS, but I don't think that was what I was supposed to do here. Instead, I learned more about who I am and what I want to do with my life. I learned about 7 other individuals, that I did not know very well before this trip, but who I now really admire. I learned about people like Terrie, people that are so dedicated to life and medical research, people that I hope I can one day be half as motivated and hard working as. I learned about Malawians, sweet, honest, hard working Malawians. And I learned about people and a culture that are so different from what I am used to. People that get by on so little, and that taught me how I don't need so much. Over the past 6 weeks, both at the hospital and here at our home, I have witnessed joy and despair, hope and fear, laughter and misery, poverty and abundance. I miss my family and friends back in the US and around the world, and I am ready to get back to my old life, but I am not necessarily ready to leave. We have it so nice here, it is almost like we are living in a make-believe world. As students in a foreign country we have no real responsibilities, we can technically do as much or as little work in the hospital as we want, we live in a house where pretty much everything we need is at our fingertips and we get to enjoy the hot sun and beautiful scenery of Malawi. Who wouldn't love it here? It has been a true learning experience and a vacation all in one. It almost feels unfair that I got to round out my medical school career here and not everyone in my class got the same experience. I am ready to get back to having responsibility, and not feeling guilty for living such a comfortable life, but I know that I have to come back here someday.


Thank you all for reading this blog. It has been so much fun writing.

7 of us with Simoni:





Love you all!

Last week in Africa

Last night we enjoyed a delicious dinner prepared by none other than our resident chef, Shant. We then sat around looking at pictures and laughing about past memories.

Thursday night we went out to dinner with Fatima. We went to a really nice Indian restaurant and all got dishes to share. It was sad to say goodbye to her; we love her...and she basically wants to adopt us as her own...so we will miss her! I am sure we will stay in touch.

Tuesday night was so much fun. Like I said before, it was Angela's last night, so Simoni made pizza and salad and Shant, Katherine, Sammie & Katie made tortilla chips and guacamole and Shant made no-bake cookies...so we had a feast! Ang and I tried to help make the chips, but I think we spent more time taking pictures with our aprons on than actually helping. We had 6 of the friends that we have met over here over for dinner, and after dinner we sat around the couch playing guitar (Tom and Angela played), singing and talking. What a nice last night for Ang!

One thing that I forgot to write about thus far is health passports. Every patient has what is called a health passport. It is a little book that looks like an actual passport that has all of the patients health history in it. The poor patients that we see do not have a "primary care doctor" that has all of their medical records. Patients can not just call up their doctor to have their records transferred to the hospital. The idea of the passport is that since most patients live far from the hospital and may travel to many different doctors that will not be able to talk to each other they can just carry their medical records with them. When patients arrive at the hospital the doctor should be able to ask for the passport and from it learn all about the medical history of the patient. When a patient leaves the hospital the doctor writes the discharge summary in the book. The doctor will write the medications that the patient is being sent home on, and the diagnosis of the patient. The problem here is that there is a real stigma attached to a diagnosis of HIV. I never saw a patient fake or edit her/his passport, but the rumor is that patients with a HIV positive diagnosis will change their passport or steal someone else's passport so they are free of the dreaded diagnosis. The whole health passport idea is such an interesting concept. I always wonder if something like it would fly in the US, and while I think it would be cool, I suspect it would not work. Here I really have not seen patients drug seeking or going to the doctor when they are not really sick like I have seen in the US. I wonder if patients in the US would fake problems or change their book for attention. It also seems like not having the passport leaves some of the power of the medical world in the hands of the medical professionals, and keeps the general people at the mercy of the medical professionals. Right now, patients here go to the doctor when they are honestly sick...very sick. I wonder if this country was a little more well off if patients would go to the doctor with simpler problems and then possibly take advantage of their unlimited access to their health history. Just something I have been thinking about...

Well, I have to get going. I will do one more post this week. So sad that my time here is almost up.

Mumbo

We're back from the lake! We got back on Sunday night but we had no internet until yesterday afternoon. Last night we had "family" time and played Cranium so I did not have time to post. Angela leaves tomorrow. We are having her going away party tonight. We are having friends over and Simoni is making pizza (if he can find dough). I am going to miss her so much! She has been on of my roommates this whole trip, and for 2 of the weekends we have shared rooms just the two of us. She is such a good friend and great person. Today I'll go to the hospital, then when I get out I will go to Blantyre with her. The rest of us leave on Saturday. I cannot believe that our time here is almost up! It has been so much fun and such an amazing learning experience!

Well we certainly picked the right trip to take on our last weekend! We had a blast all weekend! Friday started out great when our hired minibus showed up at Terrie's house. It was hot pink. Who can go wrong traveling across Malawi in a pink minibus?

Here is a picture I took of our sweet ride:



We arrived at Gecko Lodge on Friday at about 2pm. The drive took 6 hours and the roads here are not good, so we were all pretty exhausted once we checked into the lodge. Well, it was the perfect place to be exhausted. No one had any plans or expectations for us. We ate lunch, and then read and laid on the beach or in the hammocks until dinner. It was so relaxing. All you could hear was the peaceful sound of the waves crashing against the shore. In the evening was ate dinner and hung out at the bar. There was a party going on at a different lodge. Angela, Kim and Katherine (a girl that we have befriended here) went to the party, while the rest of us crashed early. The 8 of us stayed in one big dorm room that had 8 beds, and 3 fans. Katie and I somehow ended up no where near the fans that night, and we both woke up completely drenched in sweat! The bad thing is that since we know the symptoms associated with various diseases we were both convinced we had Malaria or TB due to the night sweats and feeling feverish! I think we are ok :)

Me, Katie and Kim at Gecko:



The next morning we said goodbye to Katherine and left for Mumbo Island! Angela and Tom kayaked 10 kilometers to the island! Pretty impressive!

Here they are:


The rest of us took the easy route.

Here we are on the boat over to Mumbo:


Even though we did take the easy option for getting to the island, it was not without adventure. The boat ride took 1 hour and half way to the island it started storming. It turns out, the "roof" of that boat doubles as a sieve in the rain! The 5 of us got drenched, and we were so worried about the two in the kayak. Luckily we all made it to the island in one piece.

Our paradise, Mumbo island:





Unfortunately, it did rain all day Saturday & Sunday, but that did not slow us down. We snorkeled, kayaked, read and played games. Shant, Angela and I played speed scrabble while Sammie and Tom became Boa champions (an African game like Mandala). Angela & I were roommates and, in our opinion, we had the best view of the lake from our room.


The 7 of us:


As our pink minibus rode into the sunset on Sunday evening I couldn't help but get nostalgic. The 7 of us bounced around phasing between laughing & joking to daydreaming & sleeping, all strangely content in this foreign country. I am going to miss my 7 roommates so much. I feel so blessed to have been able come on this trip. It is definitely an extra bonus to be here with such an amazing group! I am so lucky.

week 5

Wow! I cannot believe that we are coming to the end of week 5! 7 of us are leaving tomorrow morning for our weekend getaway. Emily is staying here. She will spend Saturday in a local village and then go to church on Sunday. I am a little jealous because I would love to see what church is like here, but I cannot complain, we have a great weekend in store for us. We are going to a place called Cape Maclear tomorrow morning and staying at Gecko Lodge tomorrow night. Supposedly there is a big party going on at Gecko Lodge this weekend with lots of local bands playing. We have been hearing about this party for the past 4 weeks, so it should be fun. On Saturday we are taking a boat across Lake Malawi to Mumbo Island where we will go snorkeling and kayaking! I have never been snorkeling or kayaking so I am sooo excited!

Week 5 was a good week. I spent my week with the girls on OB. One of the most notable things about the patients in general, regardless of if they are on the OB ward or the IM ward, is how passive they are. Doctors do not round everyday so sometimes patients are waiting for days to be evaluated by the doctor. Patients just lay in their bed, very quiet, waiting to be seen. If they need labs or an ultrasound and they cannot get the tests done that day, they wait. There may be nothing really wrong with them anymore and we are just waiting for a repeat chest x-ray to make sure they are ok, but the x-ray machine is broken, so they wait. I have never seen a patient complain, ask questions or demand attention. The patients can be throwing up, writhing in pain or nauseated, but they never complain. If the doctor notices that they are in pain they will ask the nurse to give them pain medication, but if the doctor does not see the patient nothing gets done. What is also amazing is that some of these patients have been sick at home for a long time. One woman is 25 years old and has been short of breath since she gave birth...6 years ago. Now it has gotten to the point that she cannot lay flat without feeling like she cannot breathe so she decided that she needed to go to the hospital. She looks so sad and painful, and she has been waiting all week to be seen by the doctor, but she has never gotten loud, demanding or simply asked for help.
Sammie is on pediatrics and she said that the babies here are also a lot quieter than they are back in the US. In terms of the babies she thinks it is because most of the time their mothers are right by their sides. Anytime a baby cries the mothers start breast feeding them and they stop crying. Women breast feed their babies all the time. On the medicine ward often the women that are sick have small babies with them. Literally, with them. One time a mom was asleep in a bed and her guardian was holding her baby and the baby started crying. The guardian walked over to the mom, reached in to her shirt while she slept and took out her breast and laid the baby next to the mom and attached the baby to the breast. The baby fell asleep and the mom continued to sleep! I was amazed! Often the sick women have small toddlers sleeping in the bed with them. Everywhere I go in the hospital there are women with children on their backs. In general babies are everywhere, and breasts are everywhere! Walking down the street a lady may have a basket on her head, be having a conversation with a friend and have a baby on her breast, all with perfect posture. The women are so calm, and quite resourceful. We have heard from several people that in most families the man is the decision maker and the head of the family. If a woman is counseled about birth control options she has to talk to her husband first before she makes any decision. The problem is that if her husband is not at the hospital with her, then she has to go home to talk to her husband, and if they live several miles from the hospital it may be days, possibly weeks before she makes it back to the hospital, and by then the need for birth control may be obsolete. It is all so different from what we are used to in the US.

I have one more week here, and I still have so much more to learn about the culture! I guess I'll have to come back! :)

Have a good weekend!

sista

Hello All!

Last night was a lot of fun! We looked great in our matching bandannas!

Here is 7 of us. Aren't we cute!?




Here is me and Katie:




Today Katie, Sammie, Kim and I went to a part of the market that sells paintings, jewelry and wood carvings. The artists there are so intense. They all surround you holding their work yelling "sista, sista, look here...look at my painting...sista, please, I have no money please buy my stuff". When you look at someone's work for a minute, and then start to walk away they start to guilt trip you saying "sista why won't you buy my stuff, please sista!" It is so overwhelming. After half an hour my head was spinning, and I had bought way more necklaces than I had intended! They really have a good business strategy!


This week I switched to OB/GYN, and I will spend my last 2 weeks with Emily, Kim and Katie on OB/GYN. I like OB so much that even after one day with the ladies on the ward I am so excited for these next 2 weeks! I am sure I am going to see and learn a lot, but I am sure it is going to be hard. Emily was telling me a story about a woman that came to the hospital that was 7 months pregnant that had been beaten and kicked in the stomach after she wouldn't give robbers 3,000 kwacha (about $21). Sadly the blows to the stomach killed the fetus. Emily said the lady was so sad. I cannot image how hard that must have been.

Well, we are having a guest over for dinner so I should go! Have a good day!

Happy St. Patrick's Day!

Happy St. Patrick's Day! We bought fabric that has a cool green design on it and last night I cut the fabric into bandannas (the only thing all of of us would agree to wear!) and tonight the 8 of us are going to go out to a local bar/restaurant sporting our team bandannas! We are very excited ( and obviously huge nerds!) :) I am sure I'll get some good pictures!

So one thing that I have been meaning to write about is what goes on on the streets here after dark. The only real house rule here is that we cannot walk around outside after dark. There is a restaurant down the street that we can walk to as a group after dark, but that is the only exception, and even then the guard gets nervous when we walk there in the dark. The odd thing is that this is not just Terrie's rule. At the hospital one day one of the locals told me I should not stay too late because it was important that I not be out on the street after dark. When the 6 of came back from the safari and we were waiting for our ride to pick us up from the bus station we had no more minutes left on our cellphone. We asked one of the locals how far it was to the nearest place to top up the phone, and she said oh no, just use my phone, and had her ride wait while we used her phone. Then she left but the guard for the bus station (a man whose job it is to walk around the station all night) told us that he would stay with us until our ride came and that is was really not a good idea for us to walk anywhere in the dark. It seemed extra spooky coming from him seeing that his job means that he is out after dark. It certainly made us all nervous and the 6 of us more or less huddled together under the one spotlight outside the locked, isolated bus station waiting for our ride. What was strange was that the streets around us were abandoned. Not a car or person was in sight, and yet the guard made it crystal clear not to leave. There are no street lights anywhere, so away from the station it would have been pitch black. Scary to think what must go on to make everyone so concerned about the dark. We talked to Terrie last night about her thoughts on why going out at night is so bad, and she said that she is not positive, but one theory is the what she called the "mob mentality". What this means is that during the day there are generally people everywhere so if someone steals something from the market all of the people around will start chasing the thief. She told us that one time she was at work and she saw someone that she didn't know putting a lap top in his bag. She tried to confront him, but he started to run. She was feeling daring at the time so she started chasing the man shouting "thief" in Chichewa. People started joining her and soon she had a whole group of locals were helping her chase down the perpetrator. The man took the laptop out of his bag and threw it in a nearby field. Terrie followed the laptop, and the crowd followed the thief. Later the group caught the man and dragged him back to Terrie shouting "kerosene" in Chichewa! Terrie couldn't believe them! Rather than pour kerosene over him, she compromised with the crowd and called the police and had the man arrested. Terrie said that the prison's are pretty terrible too, so I'm not sure how much of a compromise it was to send him to jail!
I think Terrie is right about the mob mentality idea. I also think there is a good deal of corruption in the legal system so if you were alone and got robbed you would have to pull some strings to get help. I asked a local if there was a short cut home from the market. He said that there was, but he didn't recommend me taking it because it is through an isolated field. He said that he knew a white guy that took the short cut once and got mugged. I think I'll stick to the long route!

Well, I have to head in to the hospital!
Have a good day!

Zomba

Hello All! We arrived back to Blantyre safely yesterday morning after a weekend filled with many wild adventures! On Friday morning Katie, Kim, Sammie and I left for Dedza at about 8am (we were scheduled to leave at 7am...but weren't surprised at all when the car didn't show up until 8...Malawi time seems to be a little slower than the pace that we are used to!). The drive to Dedza was beautiful. Rolling hills and green countryside...makes me feel guilty for falling asleep for some of the drive! It took us 3 hours to get to Dedza, and when we arrived we were all ready for coffee! Luckily, the pottery place that we were visiting is known for its great coffee shop. The 4 of us ate a delicious lunch, shopped for pottery and relaxed for most of the afternoon.





We had rented a car and driver for the entire day, so the driver waited for us while we shopped and soon after 3 we got back on the road for Zomba. We were expecting the drive to Zomba to take 1-2 hours but really it took 3. On the way to Dedza the driver had been a very good driver and we all felt safe, so it took some of the girls by surprise when he all of a sudden seemed to be driving a little recklessly. I was not worried until our car hit a biker! We didn't knock the biker off his bike (actually it was remarkable, the biker didn't even swerve!) but our rear-view mirror hit him. It made all of us jump and pay more attention to our drivers driving. It appeared to us that his driving got exponentially worse as it got darker! We concluded that he had night blindness...not a quality you look for in a driver! Added to the fact that our driver couldn't see, was the fact that none of us knew exactly where we were going (including our driver), and the fact that once night falls here it is pitch black. The road to the plateau was a steep, windy road along the side of the mountain, and I actually found it comical at times because the car would almost stall out as the road got steeper, and all I could think about was 4 girls pushing a car up a mountain in the middle of the night! Eventually we made it to the top of the plateau and we were so happy to join the rest of our group. We stayed in a guest house on the top of the plateau that is owned by Mr. Umi. It was a furnished 3 bedroom house with 2 double beds in each room. Plenty of room for all of us. Mr. Umi offered to cook us dinner, but we have Shant...so we did not need Mr. Umi's help with dinner! Mr. Umi was also our tour guide for the next day.

On Saturday morning we set out with Mr. Umi soon after 9 to see the plateau. First, we stopped at the Mulunguzi Dam. This dam supplies most of the water to Zomba and surrounding villages. At the dam we hiked down a rocky slope to get to the door to an underground tunnel. Mr. Umi's friend opened up the pressure locked doors and we all walked through the tunnel that was 47 meters under the water's surface! It was very cool!

Inside the tunnel:





After the dam we continued on our hike up the plateau. We hiked for about 5 more hours. It was a good hike and at times we were all huffing and puffing. The remarkable thing is that as we were climbing up the mountain we kept getting passed by Malawians, mainly women and children, climbing down the mountain barefoot and carrying what looked like their weight in firewood on their head! They are not allowed to cut down trees that are not damaged so they have to hike to the top of the plateau where a fire went through a couple years ago to collect this wood to heat their homes. Mr. Umi said that they make this trek once a week. The men were at the top of the plateau collecting the wood, and the women and children were carrying the wood home. The ground was quite slippery and there was a steep incline, and we were all focused on not wiping out, I have no idea how they managed the decent and looked so graceful doing so.





We got to the first lookout called Queen’s View. Here we stopped for lunch. The fog cleared for just a minute to give us a peak at the village below. Then we continued on to Emperor’s View, where Kim unfortunately got attacked by elephant ants! The story goes that these ants are so ruthless and relentless that they will actually drive an elephant to kill himself! They will climb inside an elephants ear and irritate him so much that he bangs his head against a tree (in an effort to get the ants out) so hard that he knocks himself unconscious! The ants then eat the elephant! Who knew ants could be so powerful? Kim was fine after she jumped around a bit and took off her shoes and socks!

The next stop was our favorite part of the day...Williams Falls! We were all so hot and sweaty from the walk that we were dying to get in the water. Even though the water was freezing we all changed into our suits and splashed around under the water fall. It was so refreshing!







After our dip in the water we headed back to the house, where we relaxed for the rest of the day.

On Sunday morning it was pouring rain, Mr. Umi arranged to have a "taxi" take us down the mountain. When our ride arrived we all laughed! Our taxi was a pick-up truck with 2 benches in the bed of the truck and tarp over the top of the bed of the truck. It reminded me for all the world of the type of truck that you see on tv that gets pulled over and when they look in the back it is filled with refugees. The tarp was there to keep the rain out, but the holes in the tarp did a nice job of letting lots of cold rain in! Poor Emily pretty much got a shower in the truck. This truck took us down the same windy road that we came up on Friday night, so again we feared for our lives as we got jostled around the back of a truck. It was funny!


We took a standard greyhound type bus back to Blantyre, and that ride was nice, and fairly uneventful except for the fact that the bus was over crowded so some people had to stand, and one the people standing was a lady holding a baby that (we think) had pooped his pants, and the baby was right next to Tom's head the entire 2 hour bus ride!

Last night the 8 of us went to a nice Italian restuarant with Terrie. The food was delicious! Terrie also presented Shant with an apron that she had the tailor make for him. A nice thank you for all of Shant's hard work last week, since he made us dinner 4 nights last week. Simoni is back today so Shant will get a break.

Have a good day!

week 4 in review

Week 4 seemed to fly by. I cannot believe today is Thursday of our 4th week here! Tomorrow Sammie, Katie, Kim and I are renting a car and a driver and going to Dedza (a place that makes pottery) for the day. The drive there is supposed to be really pretty and there is a restaurant there that past groups have raved about...so we are excited! In the evening we are meeting Tom, Shant, Angela and Emily at Zomba Plateau, where the 8 of us will spend the weekend hiking. It should be fun.

Today on my walk home from the hospital a man came up behind me and said "excuse me madam? Chicken?", I turned around a saw 8 live chickens hanging by their feet on the handle bars of his bike! They weren't even putting up a fight! Animals in general are thought of very differently here compared to the US. People here cannot fathom the idea of having a pet in your home with you that you love and treat like a family member like we may in the US. Here animals are looked at as food. Oh, I forgot to tell a funny story in one of my previous blogs. When we got in the minibus on our way back from Mvuu we couldn't help but notice the overwhelming smell of fish. We didn't think much of it until halfway home I call of a sudden heard a thud near the passenger side rear view mirror and noticed what seemed to be bird feathers flopping around near the window. I assumed that we had hit the bird, and it was now somehow stuck. Once we arrived home we discovered that our driver must have gone fishing before he picked us up, and rather than take up room in the bus, he strapped the fish to the rear view mirror, where they must have caught the eye of a hungry bird! I thought the whole situation was funny! Some of my roommates were less than impressed!

Ok, so let me talk about more differences between the hospital here and in the US. On the topic of animals, occasionally I have seen chickens and roosters walking in the halls of the hospital. The hospital is all one story, with doors in the hallways that open up to large areas where the guardians hang out all day. I am assuming that those chickens that I have seen walking the halls belong to one of the guardians and will be a patient's dinner later that day.

On the topic of food, everyday all of the doctors and medical staff get a lunch break from noon to 2. At this time the patient's guardians all come on to the floor, and it is an absolute mad house in the ward, so even if you don't want a two hour lunch break you have to get out of the ward if you want to be able to hear yourself think. As I explained in an earlier blog the guardian is a family member or friend that stays with the patient for their entire hospitalization. Since the only food that the hospital supplies the patient's with is a bag of milk, it is the guardian's responsibility to feed the patient. It is really sad when a patient does not have guardian, but all the patients are so nice to each other that they usually share their food. For one whole week, Shant bought food for one of his patients everyday because he felt so bad for this poor guy that had no family. Guardians also bathe the patients (wipe them down with a wash cloth), change and wash their clothes and the bed linen, and often have to walk back home to pick up old medical records or x-rays that are at the patient's house. Since the hospital is all on one floor the guardians often hang out near the window that is closest to the patient that they are with. What is really funny, is when the doctor has a question about a patient that the patient cannot answer, the doctor will stick his/her head out the window and talk to the guardian, or will call out the name of the guardian and the other guardians will help the doctor find who he/she is looking for. If a lady patient has a small baby, the guardian may hold the baby for a while and then pass the baby through the window to the patient so that she can breast feed.

When we get a new patient both here and in the US the doctors usually ask the patient questions about their "social history". In the US we may ask are you married, do you smoke, do you drink alcohol, do you use any other drugs, and that is typically the extent of the questioning. Here, when getting a social history the doctors ask if the patient is married, if their spouse is HIV positive, how many children do they have, have any of their children died, where do they live, how did they get to the hospital, do they have running water and what is their roof made out of? All of this information is actually quite valuable when considering what may be wrong with the patient.

There is so much more to write about, but I will save it for another day. Last night was a lot of fun. The Carlsberg tour was ok, but there were about 30 other people taking the tour with us, so it was hard to hear everything that the guard was saying, but the 8 of us know how to have a good time, so we had a blast. By the way, it is gorgeous here today, 75 degrees and sunny! We are off to walk to the town to pick up food for tonight's dinner.

Have a good weekend!

Niamh

Death

Simoni Paulo is our housekeeper. He is in his 50s and has worked for Terrie for nearly 20 years. Every day he cleans the house, does our laundry, buys our groceries and cooks our dinner. He is a terrific cook and will make us whatever we want. Over the years he has learned how to make many "western" dishes, like delicious lasagna, peanut butter cookies and pizza! He has made us beef stew, curried lentils, veggie chili, orange chicken, fish and chips and ratatouille to name a few. He laughed at me for not knowing how to make salad dressing, and told me he would teach me how to make his fantastic vinaigrette. Simoni is sweet and gentle and as honest as they come. This week Simoni is not here. Simoni called Terrie on Sunday night to let her know that his wife had just died.

About a week after we got here, Simoni's wife was taken to the hospital. It was hard to figure out what exactly was wrong with her, as Simoni would say things like belly pain, and "water on her back", but would never go into details. She had had a hysterectomy 2 years ago and had some complications from that, but men do not usually talk much about "female problems", so Terrie could never quite figure out what the complications were. A neighbor told Terrie that Simoni's wife had never been the same since that surgery. There was also mention of possible TB. She got a little better our 3rd week, then worse, then she passed away. Simoni was beside himself with grief.

The funeral for Simoni's wife was yesterday. Terrie suggested that 1-2 of us should go, and so Kim and Katie went. I would have loved to go, but I had responsibilities at the hospital. Talking to the girls it seems like the funeral was incredible.

Funerals here are very unique. The main employer for the family (typically the person/company that the man works for) is responsible for paying the funeral of the employee, his/her spouse and their children. The person is returned to the village where they were born/raised to be buried. The employer hires a lorry (large flatbed truck) to transport family and friends to the village, pays for the casket, and helps pay for the food to feed the people at the funeral. The Blantyre Malaria Project has a fund for funerals and paid for all of this for Simoni.

Kim and Katie traveled almost 3 hours to the foot of Mount Mulanje to a small village outside of Phalombe where Simoni and his wife originally came from and much of her family did still lives. It is expected that the entire village attends; in this case more than 500 people. If a person is not in attendance, they are talked about behind their back and possibly implicated in the death!

The girls said that one by one Simoni's wife's relatives stood up to speak about her life. The whole service was in Chichewa (so the girls could not understand it), and there was lots of singing (the girls were told that the singing was to drown out the wailing of the mourners.) Before the service concluded, a man recited the donation list. This was a list of who donated to the family and how much they donated. Most people would donate food or send money if they weren’t able to attend. Most of the donations were 20 Kwacha, about 14 cents.

Overall, Kim and Katie said that the day was very powerful, and Simoni was very happy to see the students from Terrie's house represented at the funeral. I am so glad that they went.

Everyday we are faced with unbelievable poverty and desperation. Death is a common part of life here. Almost everyday that I have been here I have seen or heard the mourners singing in the the hallways. Yesterday in the woman's ward 2 women died. I couldn't help but get tears in my eyes when I heard that they were dead...and I mean literally "heard" that they were dead. The description that the medical student gave me last week about "hearing the guardians wail and that signals to the medical staff that something is wrong" is all too accurate. It was around 11am yesterday when I saw a guardian throwing her body on the floor and crying and wailing. She was so loud it was hard for me not to stare. All the rest of the medical staff went about their business like nothing was wrong. The guardian started chanting and wailing. In the US it would probably look like this woman was acting. It was unbelievable, and hard for me to watch, but very appropriate and expected for here. The other patient's in the ward were very quite and respectful as this patient's guardian mourned over her death. Then a friend took the guardian's arm while the nurses wrapped the body in sheets, and led the guardian and the body out of the ward. The mourning procession then started. As I walked through the hospital halls yesterday evening I say another group of mourners lead by a very small body wrapped in sheets on a stretcher. 114 infants die for every 1,000 live births, so babies die all the time, but who can ever get used to seeing that small body on the stretcher? I take care of only women here in the hospital and most of them are my age and have HIV...and have HIV positive babies. It is sad.

Everyday I come home to a comfortable house where we have a gardener, a cook and housekeeper, and guards. In the house we have 3 computers, internet, and a movie projector. It is hard to wrap my head around the fact that my world and the world of these desperate patients coexist side-by-side. It seems wrong, and I feel like I can't do anything to change it.


Sorry for being such a downer today. You can see why we try to do fun stuff at night and on the weekends. Later today we are going on a tour of the Carlsberg beer factory here in Malawi...rumor is that they give away free samples!

On a lighter note, our house favorite Chechewa word so far is Poopsya - it means Danger!


Love you all!

Niamh

Mvuu

Hello All! I apologize for my delay in posting this blog. I spent Monday in the HIV clinic, and then helped Shant in the kitchen yesterday evening, so I was totally exhausted last night.
We had a blast this past weekend at Mvuu Lodge (Mvuu means Hippo!!)! I was so happy because all 8 of us were able to go, so e had some nice bonding time together!

We arrived back from Mvuu Lodge on Sunday evening, to a note from Terrie asking us to help her clean up the house and prepare food because we were having 18 people over for dinner. Soon after her call we also discovered that we had no water. It was funny because I think, as our minibus neared Blantyre we were each visualizing an evening of hot showers and lying around reading and sleeping, and instead we had to switch gears and start tidying up the house. It was quite inpressive, we all pictched in and prepared a lovely spread for the guests, and survived without water until the next morning. Terrie said that there is no rhyme or reason to when or why the water stopps running, it just gets shut off every once in a while for several days at a time. Most of Blantyre was without water for the entire weekend, some for the whole week.

Our trip began on Sat morning. We were up early and ready to go at 7am. To get there, we rented a mini bus and a driver. Mini buses are the main mode of public transport around here. They are basically a large van that seats 9 people plus a driver and a passenger who typically finds passengers by yelling out the window at people walking by. Ours was not yelling out the window because we hired him specifically to drive just us. The minibuses are known for being cheap, and driving fast and recklessly. I never felt unsafe, but some of my roommates were less than pleased! I must have a higher tolerance for danger ;)

Finally, after a few screams, laughs, white knuckles and possibly even prayers, we arrived at Liwonde. From there we took a boat up the Shire River to Mvuu Lodge. The boat ride was about 45 minutes long and perfect! Mountains lined the river and there were hippos everywhere. Emily said that the Shire River is home to the highest density of hippos in the world!



Sneaky hippo:




Here is a photo of the boat ride to the Mvuu Lodge:




After the boat ride we pulled into the dock at Mvuu Lodge. The first place we were escorted to was the dining room. This was in a large hut that was perched on stilts about a story above the ground. From the dining room we had a perfect view of the river and we immediately spotted a crocodile. After lunch, we were shown to our rooms. There were two people in each room. The rooms were beautiful. Every cabin overlooked the river with its own balcony, and we even had outdoor showers!

Angela and I shared a room at the lodge. Here it is:





Saturday afternoon we set off for our first safari drive. We saw lots of impalas and warthogs. Apparently warthogs eat on their knees because their necks are too short for them to reach some of the really tasty bits of grass!



We also saw more kudu, a few elephants and water bucks. There is a sanctuary within the park where zebras and rhinos are being bred then will be reintroduced. We did see four zebras outside the sanctuary. A few years ago, 3 zebras escaped...and now thee are 4!! I guess they know how to survive in the wild!!


Here is a photo of the 8 of us:




A pretty tree:







Sunday was awesome. In the morning, we got up early to go for a walking tour in the park. We didn’t go very far but it was cool to see all the trees, flowers, and tracks in the sand close-up. None of the animals came very close but we did see impalas and water buck.

Waterbuck:




Then after lunch, we embarked on a water safari. The first thing we did was explore the small river that flowed in front of our cabins.

Krikey! It's a croc!



We saw tons of hippos, and lots of birds including the Fish eagle which is the national bird of Malawi & King Fishers.


King fishers:






Then our guide somehow spotted some elephants several miles away. We took off towards them. It was incredible. There were at least 50 elephants including a bunch of young ones. It was crazy to get so close to them. Most of them just hung out and watched us. They were eating and washing. About a hundred yards up river we saw one elephant get into the river almost completely. Our boat just hung out there for a while and watched the elephants and got some amazing pictures.





Me getting closer to the elephants!


Momma & baby:



I have to go now, but overall, it was an amazing weekend. The lodge was beautiful The river and the elephants were unbelievable.

love you!!

Week 3 in Review

Week 3 was a good but short week. Since we were gone until Tuesday, I was only in the hospital 3 days this week. We will leave tomorrow (Saturday) morning for Mvuu camp in Liwonde National Park which is in the south of Malawi. We will just spend one night at Mvuu, and hopefully we will see a lot of the Malawi wildlife! It is nice that we are able to get away every weekend, because the pain and suffering that we see each day in the hospital can be very hard and emotionally taxing.

Ok, so I think I will use this week in review blog to highlight more of the differences between this hospital and the hospitals in the US since there are so many and I notice more and more everyday!

On the female ward that I am on there are typically about 78 patients (the "ward" is one large room), and for those 78 patients there are about 4 nurses! Needless to say the job of the nurses is way different here than it is in the US. Here the job of the nurse is mainly to give the patients their medications, to return lab results (which is really funny, because the nurse will just walk through the ward calling out patient's names until the patient responds! Apparently, HIPPA/patient privacy laws have not made their way to Queen Elizabeth's hospital yet!), and hand out food (a 500 ml BAG of milk-twice a day) to the patients. The medical students and interns put in catheters and chest tubes, do all of the blood draws, lumbar punctures (almost everyone that comes in to the ward gets a lumbar puncture...partly because most of the patients are that sick, but also because LPs are a cheap and a relatively easy way to find out what may be causing the decreased consciousness/infection/reason for sepsis...), biopsy lymph nodes, drain bellies that are full of fluid...the list of jobs that the medical students here do (often with no supervision) goes on and on. So different than in the US!
Labs here take forever to get back. A urine analysis takes a few days to return from the lab, and I've never actually seen anyone order a urine culture because that takes weeks. A patient's blood count may be from blood taken 2-3 days ago...so often a patient will be severely anemic and sitting in the ward for days, with no blood transfusion...oh and blood transfusions are few and far between. The other day a 3rd year medical student looked at a patients labs and commented that everything looked normal...when the registrar looked at the labs, she said...while a hemoglobin of 10 may be considered normal in Africa, if you go the US or the UK just remember that we would never look at 10 and think normal! I thought that was pretty funny! One day there was a patient here that had a hemoglobin of 2 and he sat like that for days until they finally got blood from the blood bank. In general, Malawians do not donate blood, so there is a serious blood shortage here.
If a patient needs to have a chest x-ray, the doctor writes an order and the next day the nurse will walk around the ward and tell the patient to walk down to x-ray on their our (or their guardian will help them walk if they are too sick), where he or she will wait in a long line until it is their turn for the x-ray. The chest x-ray will be taken, and then the hard copy of the x-ray will be given to the patient to carry back to the ward. Radiologists do not read the chest x-rays. Instead the attending/resident on service will read the chest x-ray. If it is a particularly tricky x-ray and the attending is not sure what to make of it, the attending will bring it to morning report or the interesting cases noon lecture and all of the medicine attendings will talk about the x-ray and hypothesize on what they think is going on in the x-ray. They may spend 15-20 minutes talking about one x-ray! Then, when the patient is discharged from the hospital the patient is given back the hard copy of the x-ray and it is the patient's responsibility to hold on to the x-ray and bring it back to the hospital the next time they are sick!
Echos on the medicine ward are done on Thursdays. So if someone comes on to the ward on Monday with suspected heart failure or heart valve dysfunction they have to wait until Thursday to have an echo of their heart.

The craziest thing happened to Shant yesterday. We generally all go to lunch at noon, so yesterday I went over to Shant's ward a little before noon to wait for him. He was just finishing up his last note when a woman came up to him and said "something is not right with my husband", Shant looked over at the husband and thought...oh my god, that man looks dead. That man had just been transferred (carried) from a floor bed (literally a bed on the floor) to a real bed because he was too "sick" to be on the floor. Shant went over and touched his hand and it was cold. The brother of the dead man started wailing and crying. The nurse that had just transferred the patient asked Shant what was the matter and he said, I think this man was transferred to this ward dead. Shant tried to listen to the heart, but their was no beat. He tried to look in the patient's eyes but they had rolled back in the patient's head. It was so shocking and sad because while Shant was trying to evaluate the patient his brother was screaming and crying.
Later I asked a medical student what do they normally do if a patient's heart stops beating, or they cannot breath, and the student looked at my very perplexed, and then answered, "well, usually we will hear the guardians start crying and that signals to us that something is wrong." I said, "In the US we do chest compressions, or what is called CPR", and he had no idea what I was talking about. He said, "a doctor has to make sure that that patient is actually dead, but why at that point would we try to bring them back to life?"...it was a very interesting conversation!

By the way, the dress I had made for me by the tailor is finally ready, and it is so cute! It took several alterations, but I cannot wait to wear it when I get home to the US (it is too short to wear here since it is cut above my knees and showing knee is a no-no). And, for all of those that have been wondering, the Malaria prophylaxis is going well so far. I take Malarone daily. The first week here was a little hard on all of our GI tracts, so I cannot blame the Malarone, and I have been fine since then. The tap water here is good and safe to drink.


Well, I should go. I will write again on Monday!

more pictures!

here are more photos for your viewing enjoyment!!

love you all!

more safari talk

We saw all of the following animals while on the safari (and lots of baby animals):
(All of these animals were less than 20 yards away from our truck and most were even closer than that! Our guide, Gondwa, said that as long as we all stayed in the truck, the animals didn’t think of us as humans but rather as a single creature, so they didn't feel threatened)

1. Tons of elephants (and a very small baby elephant that was less than 1 year old!) (so cute!)
2. Tons of Zebras (and baby zebras)
3. Giraffes (and cute baby giraffes)
4. Tons of Impalas (with baby impalas)
5. Hippos
6. Cape Buffalo
7. Warthogs (and Jack the warthog...read previous blog)
8. Bush Bucks
9. Velmet monkeys
10. Baboons (and adorable baby baboons)
11. Puku
12. Water bucks
13. Land moniter lizard (Our guide had only seen one before in his 6 years as a guide)
14. Spotted hyena
15. Elephant shrew
16. Scrub hare
17. Genet
18. Black stork
19. Saddle beaked stork
20. Crocodile
21. Bee-eating birds
22. Cameleon (Kim, Katie and Shant all held it)
23. Water buffalo
24. Tree squirrel
25. King fisher
26. Gray Heron
27. Yellow billed stork
28. Porcupine
29. Kudu
30. Water monitor lizard

I did not realize how much I liked zebras until I saw them in the wild. They are truly beautiful, exotic creatures. Probably my favorite! I liked the hippos too. They are huge, but since they can swim underwater you don't even know they are there until all of a sudden they come up for a breath. Very cool! Unfortunately, there were no rhinos at this park. They have all been illegally poached. Gondwa said that if you catch a rhino and sell its parts you are rich for life, so they are a hot commodity...poor rhinos.
One of the most remarkable parts of the whole safari was how well the animals lived together. In one part of the park there would be baboons playing right next to impalas and zebras. I guess I wasn't expecting there to be such harmony between the animals.

Here are some of my safari pictures. I will post all of my pictures on facebook when I return (uploading photos here is painfully slow)












This last one is the view from our cabin! SO beautiful!

Elephants and zebras and monkeys, oh my!

Hello All! We arrived back from our trip to the safari in Zambia last night. Oh my, we had so much fun! It was unbelievable, and I fear that this blog entry will not do it justice, but I will try to describe it as best I can (it will take 2 entries).

On Friday at 4:00pm the 6 of us boarded the bus for the 4 hour journey to Lilongwe, the capital of Malawi. The fun definitely began on the bus! For some reason for over half of the bus ride the bus driver played Christian rock music-videos on the bus TVs. The dancing and clothes in the videos was opening credits of Cosby Show style, and it wouldn't have been nearly as funny if they hadn't played the same 4 songs over and over again for 2 hours. I think all 6 of us now know how to say Jesus loves me in Chichwea. Still not sure why they played that music. We came up with 2 theories. One, the bus company may be owned by a Christian organization, or 2, we were being brain washed.
The odd and ironic thing is that while music about how God loves us shook the bus, we all looked out our windows and saw nothing but poverty and despair, almost creating a strange combination of both hope and hopelessness. As the sun set on the towns between Blantyre and Lilongwe we saw groups of people huddled around fires, huts with one light bulb lit in them, and the day laborers walking home with several pounds of fruit or wood on their heads.
The travel agent that we booked our trip through had told us that when we arrived in Lilongwe a cab would pick us up and take us to the hostel that we were staying in for the night. There are very few street lights anywhere in Malawi, and Terrie has made it abundantly clear over and over again that we should never be walking around anywhere here after dark. Unfortunately, our cab driver was not at the bus station when we arrived and it was very dark and none of us know good enough Chichwea to ask questions. I have felt very safe this entire trip until that moment. Standing at an unlit bus-stop in Lilongwe I felt very vulnerable and uncomfortable. We all had money and passports on us and we had no idea where we were. Luckily some kind people helped us and we made it to the hostel in one piece (minus Shant's Nalgene bottle, not sure what happened to that, but it is going in the list of "Stuff Shant will lose on this trip!). Once at the lodge we relaxed and enjoyed some good quality time together.
The next morning, it was up at 6am (sleep is the one thing we all missed this weekend) to get ready for our trip to Zambia. We met up with 2 girls from Holland, and the 8 of us piled into a truck/bus that drove us 6 hours across the border to the safari. It was a ride to remember. I thought the roads in Malawi were bad, but they are nothing in comparison to the roads in Zambia! I am so thankful that I don't get car sick! We had heard that the road we would be taking was a glorified goat-trail, and that is no exaggeration! Our driver explained that there is some corruption in the Zambian road business, so money to repair potholes (mini lakes) often gets "lost". About 4 of the 6 hours were spent being jostled around the back of the truck! Most of the time Katie and I couldn't stop laughing because it seemed like some sort of mean joke/punishment.
We arrived at the park at 4ish on Saturday. As we drove into the park we spotted an elephant off in the distance and we were all giddy with delight! We were so happy to finally be there! Our guide for the trip gave us a quick tour of where we would be staying for the next 3 nights. Shant and Tom shared a cabin, the 2 Dutch girls shared a cabin, and the 3 other girls and I shared a cabin. The cabins were clean, and had a shower, hot water and ceiling fans! We felt like we were living in luxury! 400 meters from our cabin was a beautiful river with chairs set out for us to relax in. While we waited for our dinner our guide explained that we would be doing a 4 hour morning and evening drive through the safari on both Sunday and Monday. He also explained that since the park was not fenced in it was quite possible that we may see baboons, monkeys, hippos and any other animals wandering around outside our cabins, so we needed to be careful. Baboons were nothing to worry about, but hippos can be dangerous. As he talked we could see baboons and monkeys swinging from the trees behind him! It was unreal! Down at the river we all took several photos of the hippos bathing, but we were warned that the river was full of crocodiles, so swimming in it was off limits.
The next morning we were up at 4:30 to get ready for our morning ride. Breakfast was at 5:30, and we hit the road at 6am. One of the many nice things about this safari company was that they prepared all of our meals for us, and they were all very tasty. Our safari tour guide was very friendly and so knowledgeable; we were blessed to have him as our guide. I guess the training to become a safari guide is quite extensive and intense. They have to learn a lot of details about all of the animals, trees, and grasses. He answered all of our questions with great ease and I learned so much on this trip!
All of the animals that we saw on this trip were beautiful and breath-taking. We saw large groups of agile impalas, exotic zebras and enormous elephants. We saw baby monkeys nursing and baboons giving each other piggy-back rides. We stopped the jeep one time because a giraffe was walking across the dirt road in front of us. We came a foot away from a hippo, and we saw an impala standing extremely still while it looked straight into the eyes of a crocodile. We met Jack-the-warthog who was raised in the nearby village because his mother was killed when he was a baby. He recognized our guide’s scent and actually tried to jump up into our jeep! We slowed down as hungry hyena crossed our path, and we all stared in amazement as an angry elephant fanned out it's ears at us in an attempt to protect it's baby. We heard a lion roar, and saw the lion's foot-prints, but the trees were too thick and green for us to actually see the lion.
Kim has a complete list of all of the animals that we saw on this trip, and I will get it from her for my next blog. I will also post a handful of the over 100 photos that I took this weekend in my next blog.
About 2 hours into each 4 hour excursion our driver would find a pretty place for us to get out of the jeep and walk around and have tea & biscuits. We were constantly surrounded by beauty. We all had so much fun on this trip and there were so many funny things that happened to us, that I know I will remember this weekend forever!
On both Sunday and Monday we had the afternoons to relax. Most of the time we laid out (the weather was perfect all weekend), read by the river, took pictures of the baboons playing outside our cabins, or napped. It was so relaxing!
Yesterday, we begrudgingly left the camp at 7am. None of us were ready to return to reality! We spent 10 hours in buses yesterday and we were all exhausted when we finally arrived home.
Overall, the safari was way more fun than I thought possible! I am so lucky to have gotten to spend the weekend with such great people! Our personalities work so well together. The 6 of us got along so well the entire trip, so it was nothing but laughs all weekend. I hope that you all get the chance to one day go to a safari! I am so happy that I have had the opportunity to see such beauty.

(In other news, Emily, one of the 8 of us, got engaged this weekend! She was the one that didn't come with us. Instead she spent the weekend on Lake Malawi with her now-fiancé!)

week 2 in review

I know it seems a bit early for me to be writing my week 2 review, but we are leaving town tomorrow and we won't be back until Tuesday. Sammie, Katie, Tom, Shant, Kim and I are going to a safari in Zambia, Emily and her boyfriend are spending a romantic weekend together at lake Malawi, and Angela is staying here and spending time with Katherine (a girl from Michigan that is doing research here in Malawi). I am so excited to go to the safari!!

Week 2 was a good week. There is so much to write about! I still can't get over just how differently things are done in the hospital here compared to the US. I will use this blog entry to highlight some of the differences.

First of all, the sense of urgency that is sometimes felt in the American hospitals is not present here at all. The girls on the OB unit, said that the other day there was a lady in labor and while she was pushing the doctors could not pick up fetal heart tones, (and they don't use fetal scalp electrodes or IUPCs) no body seemed concerned. The c-section room was occupied and so they just told the woman to keep pushing. In the US there certainly would have been a lot more concern and fast moving to get that baby out!
Today when I was in the ward I spent some time with two 3rd year medical students. They have a lot more autonomy compared to students in the US. Most of the time the registrars or consultants round on the wards twice a week. For the rest of the week the students & interns round on the patients that they are assigned to and unless it is a real emergency (I'm not sure what would constitute a real emergency, since a blood pressure of 80/40 did not worry the students) they will not talk to their supervisor until the Tuesday or Friday when we do group rounds. Today one of the patients, who is HIV positive and has a very low CD4 count, was shaking and sweating, and probably septic, and the student decided that he should take some blood so that he could make sure that he would know by tomorrow if this patient has an infection! So different from how that situation would be handled in the US!
On Monday I spent the morning in the HIV clinic. The clinic was jam packed! I mean wall to wall filled with people! The registrar was telling me that some people will be carried into the HIV clinic by family members and by the time that they arrive in the clinic they are nearly dead. While waiting their turn in the waiting room they will die. Unbelievable. Patients are also found dead waiting in the "Emergency room" waiting room.

Hand washing between patients or even throughout the day really is not done. And supposedly hospital acquired infections are rare.
There are 4 ICU beds in the public hospital for all of Southern Malawi
The CT scanner is broken this week. There are 4 x-ray machines, but they don't all always work...

Oh, there is so much more to tell, but I have to get ready for dinner. We met a lady here names Fatima that spent 7 years living in Colorado. She is taking us out to dinner tonight.

Love you all!

Niamh

money

I have a bit of time today, so here are some pictures that I took this morning on our way to the hospital.


Currency in Malawi is in Kwacha. The current exchange rate is 1.00 US dollar = 170 Kwacha. The money is mostly paper money, and they have bills that are 500 Kwacha, 200 K, 100 K, 50 K, and 20 K. As you can imagine, when we convert 100 US dollars we walk out of the bank with a huge wad of cash. For Americans the exchange rate works in our favor, and for the most part we find things really cheap here. For example, one beer is 50 Kwacha...translation...one beer is .37 US cents...translation...we drink a lot of beer here. I bought 400 yards of fabric for 700 Kwacha = 5 US dollars. There is a woodcarver that comes to Terrie's house and sells his products. He will make anything from salad bowls, to wine goblets, to lamps and much much more. His prices are amazing for our standards (800 K for a nice lamp) and he will also take running shoes as payment. The amount he accepts for the shoes varies on how worn the shoes are. He said that he then gives the shoes to his family and people that work at his wood carving plant. There are some things that are very expensive, and not really worth buying. Cheese can be anywhere from 600 K to 1600 K, so we really don't eat cheese.
What is really interesting is that medical school for one year is 25,000 Kwacha! That translates into 178.85 US dollars a year! And, the government will give out loans to help people pay for medical school...and the loans don't have to be re-paid! But, it is really all relative. Interns in the hospital make 70,000 K a year, which is about 500 US dollars. While interns in the US generally make a little over 40,000 US dollars.
In general, doctors don't make near the amount that they can possibly make in the US. Doctors are respected here, but becoming a doctor is not considered the same great accomplishment as it is in the western world. The really "good" jobs are those that are business-related. Here, students go from secondary school (high school) to medical school. According to Terrie getting in is more to do with grades in high school and luck than it is to do with social class/ economic standing. Grades because they have certain cutoffs that they have to score above in order to be considered for medical school, and luck because once everyone has applied the candidates names are more or less put into a hat and then picked randomly. Then the names of the next years medical school class are announced on the radio for everyone to hear! So different from the way we do it in the US! No interviews and letters of recommendation needed! The way the system is set up, means that getting into medical school should be an equal opportunity for all. The problem is that many of the children from very poor families do not go to high school, instead they will do a few years of elementary school (maybe) and that is it. Such a different system!

Have a good day!

Clothes

Everyday one of us will see a Malawian wearing a t-shirt that is just hilarious. The other day Kim saw a pregnant lady wearing in a t-shirt that read "beer is what gets me up in the afternoon", another day Shant saw a very thin man wearing an XXXL t-shirt that said "wide-load". We all saw a man wearing a sorority t-shirt. The list of funny shirts goes on and on. I talked to Terrie about where the Malawians get these clothes and why they wear them, and she said that she is not totally sure, but she is reading a book about fashion and clothing in Malawi. Terrie has heard that the clothing industry is really suffering here because clothes that are imported in are cheaper. What is interesting is that in the market there are tons and tons of random worn clothes plied on top of each other. My theory is that when we in the US donate clothes to a "charity" they sell our clothes to organizations here that then sell them to people to sell here. I know it sounds like a conspiracy theory, but it is strange. Where do they get these worn clothes with American logos on them? Terrie thinks that the book she is reading will further explain where the street vendors get the clothes. Terrie believes that the people here cannot read what is on the t-shirts, and they just buy what they can afford. Most women still wear African style long skirts/wraps that are made from fabric that is sold on the streets here (I am not sure where the fabric comes from). The middle class people wear very western style clothes.
Terrie has a tailor that comes to the house to make her clothes, table cloths, purses and whatever she wants. We can buy fabric and ask him to make whatever we want. He is making me a dress right now! I cannot wait to see it!
Let me know if you want anything made!!
Love you all!

Mt. Mulanje

All 8 of us made it up and down Mt. Mulanje! It was a difficult climb. Two of Terrie's English friends, and one of their friends made the climb with us. They picked us up at around 9:30 on Saturday, and we got to the beginning of the hike a little after noon and began hiking right away. About 10 minutes into the climb we were huffing and puffing. The climb took us about 4 hours, and we stopped about 1/2 way to eat the sandwiches that we had brought. Terrie's British friends were experienced hikers, but they were very nice and one of them lead the pack and the other one stayed in the back with the slower hikers. It was very hot and humid during the climb, and there were time during the hike that sweat was pouring off my head and it was difficult to catch my breath, but we made it to the plateau before dark and it was wonderful. Once we got there, we walked to the "pool" and cooled off. All 11 of us stayed in the same cabin once we got to the top. We cooked our dinner over the fire and then most of us slept on the cabin porch that night. It was so peaceful to wake up to total silence and beautiful clear skies. On Sunday morning Shant, Emily, Angela and Tom went with one of Terrie's friend (Terry) on another climb, and Sammy, Katie and I went with Suzanne to find a different pool. It felt so nice to get in the water and splash around even though it was ice cold. We left the plateau where we were staying at around 1:00 and got to the bottom at 4. I thought coming down was easier except that our toes kept hitting the front of our shoes on the really steep parts (which seemed like it was most of the time). One of the amazing things about the hike was that the porters that were carrying our bags literally ran up and down the mountain with very little difficulty. Here is a picture of most of us (Kim had gone on ahead) on the way down, and a picture of the porters carrying our bags. I'm not sure if you can appreciate from the pictures how tired we are and how heavy the bags are that the porters are carrying. One of the porters was even wearing sandals! They are certainly in great shape!

At the bottom of the climb a large group of small children waved at us and said hi. We had been told that they loved "sweeties", and since Kim got to the bottom of the mountain before we did she opened up our bag of marshmallows and handed them out. She said that they all waited patiently for their marshmallow and then stared at them, unsure what they were! Kim showed them they could eat them, and they were all so happy. About 2 hours later when the rest of us made it to the bottom most of the kids were still clutching onto their marshmallows! It was very sweet!

Well, I have to go get ready for another day! Tonight we are having an Oscar party with some of Terrie's friends. None of us are allowed to look up who won what and we will all vote tonight who we think should win. Then we will watch the Oscars. This party is a tradition here, they have been doing it for many years. Have a good day!