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!

one week down

Today is day 8 of our trip. I cannot believe how quickly the time is passing. Right now we are getting ready for a hike up Mt. Mulanje. We are leaving here at 9am, and will hike all day to a plateau and then camp out there tonight and then continue to hike on Sunday. We are all very excited and the hike is supposed to be beautiful. We will each carry a small day pack that will have water and a poncho, and then we will hire 4 porters to carry our dinner, sleeping bags, clothes and some extra stuff. It should be fun!

Well week one was a very interesting week at the hospital. It is still so amazing to me the variety of cases that we see in the wards. There is an ICU here, but there are no other special units. Yesterday we rounded on about 30 people in the womens ward, 2 of which had Brown-Séquard syndrome, something I had only read about before, two had heart failure, one had breast cancer, one had malignant melanoma (the melanoma was the size of half of the sole of her foot), several had TB and several had HIV related pneumonias and other diseases. The registrar that was rounding with us is from the London and she has been here for a month and said that in one month she has been amazed with the type of pathology that she has seen here. One Monday I will be going the the HIV clinic with her. Terrie told us this past week that the life expectancy here is 38 years old! That is primarily due to HIV, which I think is just shocking.
This past Thursday several of is watched as Terrie and her team did an autopsy on a 2 year old child that had just passed away due to complications from malaria. It was sad, but very interesting. I had never before seen an autopsy, and because this autopsy was being done for research purposes it was interesting to see the different things that they were specifically examining.
I will write more later

Poverty

Queen Elizabeth Hospital generally serves the poor people of the Blantyre. There are 2 internal medicine "paying" wards (that are not filled) and the rest of the internal medicine wards are nonpaying and very over crowded. People with money generally go to private hospitals in the area. I was talking to Terrie about the distribution of wealth in Malawi and she said that while the middle class has grown since she has been here, it is still very small and the largest class here is the poor.

Terrie said that the general attitude toward poor people is a lot different in Malawi than it is in US. According to Terrie, in Malawi it is generally considered a blessing to have money, and being poor is more the norm. Wealthy people do not look down their noses at poor people and being poor it is not considered the fault of the people. The attitude here is not that poor people do not work hard, or are lazy or do not deserve better, all opinions that you often hear voiced in the US. Walking down the street you can sense the feeling that wealthy people do not resent the poor and are not bothered by their presence. I find it remarkable.

Another interesting thing is the clothes that people wear here. I will write more about the clothes tomorrow, Terrie just got home and it is dinner time!

it's hot

It is hot here. I like hot weather, so this is a nice change from cold Michigan, but it is hot! Overnight it cools down, so first thing in the morning it is probably about 70 degrees, but by mid-morning it feels like it is 80-90 degrees and very humid. We leave the house at about 7:30 am, and by the time we have reached the hospital (about a 20 minute walk) we are pouring sweat. The first day I felt bad, because who wants to show up somewhere on their first day with their shirt drenched in sweat, but it didn't matter. We sweat all day. After morning report we round on patients and I can feel the beads of sweat dripping of my forehead. There is no air conditioning in the hospital and with over 60 people in one room it gets hot! I have never fainted in my life, but on both my first and 2nd day in the hospital there was more than one time that I thought I was going to pass out. There are so many bodies in one room, no where to sit, and no water. It has hit me about 2 times each day where I start really dripping sweat and then all I can think about its how I am either going to throw up or pass out. I try to take deep breaths and calm stay calm, because I would just feel like such a jerk, a healthy, well fed girl fainting in front of all of these very sick people that are in serious need of help. Most of the rest of the 8 of us have felt the same way, and I think it will get better because today I felt better!
What is really remarkable about the heat is that the Malawians don't seem to be bothered at all by the heat. Moreover, they don't seem like they are even hot. Malawians on the street walk around with many layers of clothes on. Many women walk the streets wearing long skirts, carrying a basket on their heads and their babies on their back, and they look cool as a cucumber. The patients in the hospital wear layers of clothes and wrap themselves up in several blankets. It makes me overheat just looking at them!
I will write more later about the clothes, food and much, much more!!
Gotta go!!

Niamh

Mourning

When Terrie gave us our first tour of the hospital she made a special note to tell us that when a patient dies in the hospital Malawian tradition is for a large group of family and friends to roll that body on a bed through the halls of the hospital. She told us that if we see a large group if people walking down the halls the polite thing to do is to stop walking and stand off to the side until they pass. Literally an hour after she explained this to us she was giving us a tour of the hospital and we heard this amazing sound and saw a large group walking toward us. The leader of the group seemed to be a nurse wheeling the body, and behind her was a HUGE group of people. One person in the group would sing a line of a song and then the rest of the people would echo that line. The song they were singing seemed to be in Chichewa (the language spoken here), so we didn't understand what they were saying, but it didn't matter it, it sounded so beautiful. It was so powerful that it brought tears to most of our eyes. Standing there, watching and listening you could almost feel the spirit of the body passing by. Terrie said that someone usually dies everyday, so I am sure that we will see this ceremony often. There is so much more to write about, but I don't have time now. We are about to take off to the hospital!

Have a good day

Niamh

the hospital

Yesterday was our first day on the wards. Most of us had to be there at 8am. Angela and Tom had to get there at 7:30 for surgery. It definitely seems like it is going to be an amazing place to work in for the next 6 weeks, and quite different from American hospitals that we are all used to. First of all, there are people everywhere. The families of the patients stay at the hospital with the patients. The families are in charge of bringing food/drinks, linen/blankets & clothes for the patients while they are being treated. The family members sit outside the hospital all day and wash clothes or start a small fire to cook food for the patients. While in the hospital, mothers are allowed to stay with their sick children 24 hours/day. Other family members stay in a boarding house next to the hospital at night.
The hospital is a large one story building with lots of hallways and many wards. Shant and I are on internal medicine. We arrived at 8:00 for morning report which began by having a 3rd year medical student and a 5th year medical student both giving a case report. After they each presented their attendings grilled the students very hard about their presentation. A British student turned around and whispered to us that it is like this every morning, and the attendings are really hard on the students. After morning report we got a tour of the hospital. There is a mens ward, a female ward, an admissions ward and a TB ward. Pediatrics, surgery & OB have their own areas of the hospital. Shant and I then met up with an intern (intern means the same thing as American intern, but here the internshp lasts 18 months instead of just 12) and started rounding with her. All the patients that she had to see were in the mens ward which is basically one large room that is PACKED full of patients. If you can imagine a room with a central passage way and then 3 rows, & each row has beds right next to each other...literally touching each other. Shant guessed there are probably 60 male patients in that big room. Some are hooked up to IVs, at least one had a chest tude in, and all are very sick. We were told that 15-20% of the population of Blantyre is HIV positive, and 80-90% of the hospital pateints in the internal medicine ward are HIV positive. The intern that we were with had a list of about 28 patients that she was responsible for seeing and taking care of. She is probably in her 20s, and she is very smart and nice and caring with the patients. She talked to Shant and I in English and explained that with several of the patients she knew what the optimal medication would be to treat them, but at this hospital certain medications are just not available, so they have to opt for 2nd best. We saw about 14 patients with this intern in about 2 hours. There are no charts hanging on the walls here, rather each patient handed the intern a stack of papers that the doctors have been using each day to write notes in. Labs are often days old, and certain labs are just not practical here because they take days to return. One of the patients that we saw had an extremely low blood count, and wa sin despirate need of a blood transfusion, but blood is hard to come by here in Malawi. I could go into a detailed story on each patient that we saw and the unbelievable circumstances that they are all in, but I don't have time now. It is pretty unbelievable though. The hospital is full of very sick patients.
Everybody else had good days too. Sammie was struck by the number of malnutritioned children on the pediatric units. Tom saw some unbelievable orthopedic surgery cases and Angela was amazed by the less than sterile technique of the upper and lower GI scopes. I will go into details later. It is now time for breakfast. I will write all about the yummy food we have been eating later. For example, 2 days ago Shant made eggs, with avacado & tomatoe, and yesterday we had toast, with avacado and tomatoe. Today we will have friut salad that Simoni made for us.

Miss you all!!

a bit overwhelming

5 of us walked down to the city center of Blantyre today. It was an adventure, and a wee bit overwhelming. I have never before been the minority, but we are definitely the minority here. Everywhere we go people stare at us. I can't wait til we know more of the language so we don't seem like such outsiders. The city center is hard to describe. There are people EVERYWHERE! I mean EVERYWHERE! There are billions of little huts set up everywhere in the city. Huts on top of huts. People in the huts are selling everything, from DVDs to clothes to shoes to candy to fruit and everything in between. Everything is very cheap (at least cheap by our standards). Today we bought a dozen tomatoes, 6 mangos, 6 cucumbers and 5 sticks of sugar cane all for under 3 American dollars! It is sad. We could shop around to get cheaper prices, but really I don't care...I would rather make one lady happy selling me a dozen tomatoes for 30 cents than I would shopping around trying to get a dozen for 20 cents. What is so remarkable to me is that the venders are selling such random things that you would think that they set up their huts to target people that are vacationing in the area, but we are the only "outsiders". This is what they do everyday. They try to get our attention buy shouting random prices at us, but they don't care if we stop by their hut or not. They do this everyday, & they are just trying to make a living. The most random thing that someone tried to sell us was live chickens. A man can up to us holding 4 live chickens by their feet and he waved them in our faces. It was quite funny because Kim was with us and she is a vegan, and I am sure the idea of having a live chicken waved in her face was less than pleasant! Poor Kim!
This afternoon we sat around and talked about what we have found to be the most remarkable parts of the trip we have noticed so far. Kim noted that the beggars are very persistent. A poor begging child followed us for 10 minutes begging for money. It made me sad. I so wanted to give him money, but we had to keep walking because there were so many kids around us that we would have had a crowd of childen begging if we had started giving out money.
I hope I can take lots of photos because this really is a different world!
Terrie is taking us over to the hospital later and then out to dinner. We are going to go play cards now while we wait for her to come home. Terrie works very hard here. Rumor is that she often works from 8 am til 9pm.

Talk to you soon!

Niamh

24 Kufa Road

I was the first one of the 8 of us to wake up this morning. I love mornings, and I am also so excited to be here that I could not sleep anymore. It gets bright here at about 5:00. I think it was the sunlight and the birds that woke me up. There were many different birds singing outside our window. Once I woke up, I got out of bed and left the room so as not to wake my roommates. Terrie (Dr Taylor, she wants us to call her Terrie) had already left for the day. She left a note saying that she had to run some errands but that she would be back at noon to check on us. She is a wonderful woman and she is so caring. She is like a mother and a friend, and I know that we will all learn so much from her.
Our address here in Blantyre is 24 Kufa Road. Terrie has been renting this house since the mid 90's. The house is a one story 3 bedroom house. Terrie has one room and her own bathroom, and the 8 of us share the other 2 rooms (4 in each) and the other bathroom. I am rooming with Kim, Angela and Tom. The house is a stone house, and actually stays pretty cool during the day, even though it is pretty hot outside. Yesterday it seemed to be in the 90's when we were walking around outside. The house is surrounded by a beautiful yard/garden. In the back yard there is an avacado and papaya tree. There are a lot of other plants that I have no idea what they are. The front of the house has a big green gate, that is always closed. There is a guard whose job it is is to stand by the gate all day and let us in and out.
The internet here is really slow, so I may have to leave uploading photos until I get back. Shant just made breakfast for us all (Simoni, the cook, is not here on the weekends), so I have to go! We are exploring downtown Blantyre today, so I will write later and give you the details!

Niamh

We arrived!

Hello Everyone! Our group arrived in Blantyre, Malawi at about 1:00pm today (Saturday). It is beautiful, hot and very green here! Shant, Katie, Sammie and I flew from Detroit to JFK to Johannesburg together. We stayed the night in johannesburg in a nice B and B, and then left jo-burg this morning at 10:20. All in all everything has gone without a hitch... almost...unfortunately our bags never left JFK! The may arrive tomorrow...or Wednesday..keeping our fingers crossed...but not to worry, everyone is willing to share with us until our stuff arrives! I will write more later...we are going to go explore the area!!

Love you all

Niamh

Africa here I come!

Hello everyone! I leave today for my 6 week trip to Malawi. I am going to be in Blantyre, Malawi doing an internal medicine rotation at the Queen Elizabeth Central Hospital. There will be 8 MSU medical students at QECH and we will all be living together in Dr. Terrie Taylor’s home in Blantyre for the 6 weeks. Dr. Taylor spends 6 months a year in Africa doing malaria research and the other 6 months back in the US lecturing at MSU.

I am finally all packed and ready to go. I have 2 big bags and backpack. I am sure I am over the luggage weight limit, but at this point there isn’t much I can do about that! I just took my 1st dose of Malarone (my malaria prophylaxis), and I hope it doesn’t make me sick. My flight from Detroit to JFK leaves today at 1:30, and then it’s JFK to South Africa! That flight is almost 18 hours long. I just bought a new camera so I am hoping to use the time on the flight to figure out how to use it! My friend Shant & I will spend Friday in Johannesburg and then fly to Malawi on Saturday. There is a group of 8 students that will be just finishing their 6 week rotation when we arrive. I am hoping that we will see some of them before they take off so that they can tell us all about their amazing trip!

I will try to write as often as possible and keep you all updated on my life in Blantyre! I really have no idea what to expect, but I cannot wait to get there! Wish me luck!

Niamh