Language corner

I'm about to make a comparison between Malawi and the US, which is something that I had vowed not to do in this blog. Of course, travelling from one of the poorest countries in the world to one of the richest is going to be a culture shock, but the differences between the terrains, the lifestyles and the healthcare systems are obvious. An entire blog of 'when you stand in Times Square and think about the powercuts in Malindi...well...yeah...' would get really old, really fast.

There is something I hadn't thought about before though, and that's the differing attitudes to language. In Malawi, there are two 'official languages', English and Chichewa. On top of that, there are several tribal languages - the one we were most exposed to was Yao. As far as I could tell, the diversity of language was treated as part of the fabric of Malawian culture. It wasn't unusual at all to be mutilingual. Very small children were able to speak to us in basic English. Although we had a serious language barrier with a lot of our patients in the village, this seemed to usually be a marker of poor access to basic education. After a while, in fact, I think that everyone found it amusing that it was taking us so long to pick up Chichewa. As far as I could tell, the attitude was 'everyone has a different first language, so if we can all make ourselves understood in a few languages then everyone can communicate.' Of course, I'm over-romanticising it a bit - the necessity for speaking English, along with the coming together of tribal languages is rooted in a difficult colonial history - but it's still a skill and an attitude to language that I very much admire.

To me, this intermingling of different languages is equally apparent in New York City. It's fantastic to wander around and hear people speaking Spanish, Mandarin, Hindi, Polish - diversity is part of what makes this city amazing. Yet, I don't get the impression that there's as much of an imperative to learn other languages as there was in Malawi. For those of us who have English as a first language, we always use the age old excuse 'I know it's lazy, but everyone speaks English.' While that is largely true, I think it goes beyond that. I think, both here and in the UK, that we are far too attached to the idea of a language hierarchy, with English at the top. We're very lucky to have the global language of business as our first language, but but perhaps that's just not enough of an excuse any more.

I'm completely guilty of this too - I love languages, but I've been a bit lazy about learning them. I just think it's time for a bit of a cultural shift. I'd love to hear what you guys think.

Buenas noches amigos (I admit, I had to Google the spelling of that. I'm working on it.)

We'll turn Manhattan into a isle of joy...

New York City had a lot to live up to - I've been excited about coming here for the better part of two years. Somehow, however, everything has surpased my expectations. As you can probably tell from the lack of blog posting up until this point, Dan and I have really been getting the most out of the city. Ironically, the increased availability of electricity and internet access has coincided with a decrease in the amount of time that we have to update the blog, but rest assured - we're having an amazing time!

For the moment, I'm not going to detail everything that we've been doing in our spare time. I'll probably do a detailed description of the delicacy known as Korean fried chicken at some point, but I'm currently resisting the urge. Instead, I'd like to talk about medicine for a bit.

So that everyone is up to speed, I'm in New York doing a placement in paediatric (I still refuse to spell it the American way) endocrinology. If I'm honest, I was expecting to feel a bit smug about the UK way of doing things. Anyone who knows me and my 'liberal agenda' knows how attached I am to the NHS, and I am willing to admit that I came into this placement with a prejudiced view. I was semi expecting to claw my way to work through hoardes of people begging for health care while doctors inside the hospital feed grapes to rich people who are being carried around on sedan chairs.

Although there are significant problems with the US healthcare system (and several things that they do better than the UK), the similarities between the styles of medicine really took me by surprise. Here, in the UK and even in Malawi, the desire to make sick people healthy - as simple as it is - seems to run through at a very fundamental level. The methods are different, the obstacles are almost incomparable, but it appears to me that a lot of people across the world went into the medical profession for similar reasons.Whatever my observations about comparative healthcare and international health, the last five weeks really have cemented my respect for healthcare professionals, and I'm honoured to count myself among them.

In other news - I love people's reaction to my British accent. I know we're meant to find it annoying, but it's quite nice to be complimented on it as if it's some sort of skill. I think I've started milking it a bit, I may well start overdoing it if I'm not careful.

Pip, pip and cheerio chaps.

A sad goodbye

By our last day at Nkope, we felt as though we had been there forever. As we packed and went around the hospital taking endless amounts of photos, it was hard to believe that we were potentially seeing this place for the last time. In the afternoon, as we were saying a final goodbye to some of the kids in the village, we got a call from St Martin’s inviting us to spend an evening at the hospital before we left. This felt like a fitting end to our trip, as we hadn’t been able to see St Martin’s since our first day.

I don’t know what we were expecting when we got to the hospital, but we were genuinely speechless when we arrived to a massive outdoor farewell party. As well as all of the people who had become friends with during our stay, several nurses, administrative assistants and other members of staff had come to wish us well. It was unbelievable. There were several speeches throughout the evening, including a rather unprepared double hander from us. We were also able to formally present the hospital with all of the things that we had brought from the UK – largely an assortment of needles, syringes and gloves, as well as books, toiletries and a laptop. The money that everyone so kindly donated through the Come and Sing Haydn’s Paukenmesse was spent on theatre equipment, which the hospital really appreciated. Unfortunately the equipment hadn’t arrived by the time that we left, but St Martin’s should be receiving a large batch of theatre blankets, aprons and sterile shoes at some point during the week.

 As we drove away from St Martin’s the next morning, both Dan and I were quite emotional. Our time at St Martin’s gave us an incredible insight into a world that we otherwise wouldn’t have been able to imagine, and (more importantly) we made some amazing friends that we’ll never forget. We’re planning to keep sending basic equipment to the hospital at least twice a year, and we’re really hoping to go back in the not too distant future.

Thank you St Martin’s – it’s been amazing.

A jumble of thoughts from the warm heart of Africa...

11^th April 2012

As we’re coming to the end of our placement at St Martin’s hospital, I thought I would give you all a rundown of the things that have happened over the last couple of weeks.

The absolutely wonderful thing is that Dan and I have had a baby named after us! Little Danielle (probably not spelled that way – no one here has worked out how to spell my name yet) was born about a week ago, and was my first delivery at Nkope. Although things were nowhere near as eventful as they were during Dan’s first delivery, we clearly made an impression, as the mother came to our house a couple of days ago to let us know that she has named her daughter after us. I can’t describe how honoured I feel. There are a lot of downsides to working in the medical profession, but moments like this make it all worth it.

We’ve been experiencing frequent power cuts over the past few days, which Dan referred to in one of his last posts. This has led to long periods of quiet introspection, mainly because Dan and I have had to rely on each other’s conversational skill for entertainment (seriously, it’s been a stretch :D). Before we got here, I knew how lucky I was in comparison to most of the world’s population, but the last three weeks have really brought it home. A good example is the reaction of both Dan and myself to the food here. Although it is yummy (genuinely, there is a type of dumpling that has just become addictive), both of us completely took for granted the level of variety available in the UK. In comparison to the rest of the village I imagine that we’re eating really well, but the sight of Cadbury’s in Blantyre actually rendered us speechless for a moment.

 What has amazed me is the way that people in the village just get on with things. For instance, the fact that electricity here is so unreliable means that almost everyone gets up before sunrise to make the most of the daylight, and that there isn’t a siesta culture despite the oppressive heat in the middle of the day. Although everyone is (understandably) angry about the fuel crisis, there seems to have been a general acceptance of the fact that getting in and out of Nkope is difficult. I imagine that once I’m back in the UK I’ll be back to complaining about 8am ward rounds and getting cross when the local supermarket runs out of cinema sweet Butterkist, but I hope that my perspective has changed a bit. Either way, I definitely intend to stay in close contact with St Martin’s, and I hope to return in the near future.

One of the things that I will miss (along with the dumplings, the sound of Lake Malawi, and the odd, safe sensation of sleeping under a mosquito net) is the wonderfully friendly nature of a lot of the people that we have met here. They definitely call Malawi ‘the warm heart of Africa’ for a reason. It feels like everyone in the village has really tried to make us feel welcome, and we really have made some lovely friends.

Danni 

The day that Danni nearly crushed a duckling and other short stories

Friday March 13^th

Leaving Nkope was a pretty sad affair. We were given very little notice, and so we didn’t manage to say goodbye properly to everyone that we wanted to. Clara, the amazing midwife wasn’t in but we left gifts for her with her house-keeper [who didn’t speak a word of English] and some of the kids who we would play with were just nowhere to be seen. James, our legendary cook and his beautiful young son Ishmael, were coming with us to Malindi [where St Martin’s Hospital is based]. Driving through the village for the last time was poignant.  We drove past the market where we would go every day to buy food or essentials [such as deep friend doughnuts, or kilos of kidney beans] and lots of people waved us off.

Arriving at the hospital was so strange. 3 weeks ago we’d been horrified at how basic and crumbling the place was, but with rural village health centre eyes it looked almost modern now! We were thrown a really love leaving party that Danni will talk more about in her blog post, and we had some interesting discussions that really hit home just how different our lives were.

• “In England, do you have villages?” Why yes, yes we do. “So people live in huts made of mud with thatch straw roofing then?” Dear lord, no. To us, rural means surrounded by greenery and not too near a city. There are still tarmac roads, often a train station, constant electricity, usually broadband internet, landline phones, plumbing and usually a village GP. Peoples mouths gaped open in disbelief.

• “So, there are no power cuts?” Well, occasionally one house will lose it’s power due to a fuse problem and once in a blue moon a street will go dark for 20 minutes, and it will make headline news in the local paper. In general, we take electricity for granted – it never cuts out.
• “Here in Africa, many people present to hospital late because they trust traditional healers much more. A child died this morning because they turned up to hospital when it was too late. Do you have spiritual, traditional healers in the UK?” Err….not really. Most people trust doctors and will see a doctor in the first instance. One of the many reasons our health outcomes are so good.
• “So do you ever have shortages of gloves in hospitals?” Oh my gosh, we are SO lucky in the UK. Women at Nkope health centre over the weekend had to give birth without midwives being able to perform vaginal exams because they had so few gloves that they just had to guess how dilated the woman was. Any woman in obstructed labour would have died.
• “So, do houses look like this in the UK?” Well….no. <cue me showing a picture of my house, which is exceptional even by UK standards but it’s the only pictures I had> “Wow. You live in heaven! And there are really only 4 people sharing that entire kitchen? You have more than one bathroom in your house?! You own your own car?”.

I’d felt pretty embarrassed after I’d shown them the pictures, but it really hit me just how far away from home I was.

We then danced the night away, woke up early to catch a minibus [read: rusty sardine can stuffed with too many people] to Lilongwe, the capital – another experience that Danni will fill you in about.

I’m sure you’re wondering why the title of this blog post is “The day that Danni nearly crushed a duckling…”, and now that I’ve grabbed your attention for long enough, I’ll tell you. In our little compound in the village lived a family of ducks. Their ducklings were freakin’ adorable and so we tried [and often failed] to pick them up and stroke them. Danni finally managed just before we left but the little ducky didn’t seem too happy. She tried to put it down, and as she did so she dropped the heavy [!!] bag from her shoulder and missed the little fluffball by several centimetres. That would not have been a nice way to end our village experience. Thankfully the duck was fine to live another day.

Thanks for staying tuned – I’m quite enjoying the blogging lark!

Much love,

Dan

Angry Birds – A Universal Language

Wednesday April 11^th

This is a slightly more light-hearted blog post.

Some of the local kids [including our cook’s son, Ishmael] found my iPhone. It’s a testament to how easy they are to use that within 3 minutes they were sat round playing Angry Birds – and LOVING it. They don’t speak a word of English, as none of them have started school yet. It’s a brilliant testament to the user interface of Apple products that even young children in rural Malawi who have never touched, let alone seen, a computer before can work out how to play games on one of their products in 3 minutes.

Not the most insightful post perhaps, but it’s been fascinating to watch.

Dan

P.S. For those of you who’ve never heard of Angry Birds – shame on you!!

My last day at the Health Centre

Wednesday April 11th

I can’t believe that time has passed so quickly! It’s the morning of our last day.

I have mixed emotions. Whilst I could never live like this for an extended period of time, I will miss it. Listening to the waves of Lake Malawi crash onto the beach 15 feet from our house, being able to leave our door unlocked during the day and having people stop by all the time to say hello. It’s nice.

Life is very hard for people living in rural Africa. They work long hours in awful conditions with little to no chance of being able to leave their village. I’m so glad that I’ve gained some insight into this. It’s easy to read about it in articles [or blog posts!!], but to experience it is something very different. If you ever get the opportunity, you should take it!

I have huge amounts of admiration for all the hospital staff, working in appalling conditions to provide pretty darn good medical care to their patients. I’ve learnt a lot about professionalism and that many [most] of the things I complain about are like the colour of the icing on top of the cake, whereas here in Malawi they don’t even have enough flour to bake at all. [OK, weird analogy – it sounded better in my head].

I hate to use clichés about “life-changing experiences”, because I know that ultimately my cushy life won’t change. Even as a student on no income, I am rich beyond everyone in this village’s wildest dreams and that won’t change. People here will still be the poorest people on this planet, and I will still be one of the richest. What I hope will change is my ability to help. Danni and I want to send twice yearly shipments of basic equipment [gloves, syringes etc.] to the health centre [please make sure we do it!], and I want to get more involved with development charities. To my friends back in the UK, prepare to hear a lot more about poverty and how you can help.

Today will mainly involve taking more pictures of the village and the health centre to show you guys, giving out presents and also saying goodbye. Tomorrow we present the equipment that we have bought and then on Friday we go back to Lilongwe, the capital of Malawi, to prepare for our flight to Cape Town and to buy lots [an unnecessarily stupid amount] of touristy wooden carvings and paintings as presents for people.

My humble thoughts about Development

Tuesday April 10^th

My trip to Malawi is the third trip that I’ve made to Sub-Saharan Africa, and one of several more to the rest of the developing world. Since my first trip to Ghana in 2007, I’ve thought a lot about “International Development”, what the main problems are and how I would tackle them if I were ever fortunate enough to be in a position to do so. I’m obviously no expert, but here are my views:

Roads and Electricity. I believe that the poorer regions of Africa will fail to fully develop until it gets a handle on these two factors. They affect everything.

Every single village and every single person should be easily accessible with good quality, tarmac roads. Many rural villages in different parts of Africa are only accessible via dirt roads, which are susceptible to weather conditions and are often in such a poor state that motorized vehicles can’t gain access. This means no ambulances if people are sick. No exporting vegetables or other resources, to make money for the village. No importing building materials, people or money. A single tarmac road leading to every village in Africa would allow greater access to healthcare, to schools, to towns and to transport. If I were to give money to a development charity it would be one that is determined to lay tarmac roads to villages everywhere.

How can anybody function properly when electricity can cut out at any moment? Everywhere that I’ve been in Africa has had issues with electricity being scant. I’m not an electrician and I do not have a mechanical brain so I cannot understand why this happens but it needs to stop. Imagine if a surgeon was half way through your operation and the power cut out. No lights, no anaesthetic machine, no nothing. You’re dead. Speaking of dead, the president of Malawi died last week. His body had to be flown to South Africa as not a single hospital in Malawi was capable of keeping his body refridgerated. Sad.

We live in a digital age, and with digital technology comes an increased requirement for electricity. If city office workers, internet café owners, supermarkets, health centres etc. can’t run properly because of a lack of electricity – it costs millions of pounds to the economy.

Having had to experience poor roads and numerous electricity cuts, my personal opinion is that if these 2 factors were sorted out, everything else would follow. People would have more of an incentive to keep to time, healthcare outcomes would improve massively, vehicles would be better maintained [and might actually become safe], tourism would flourish and the economy would make these countries so much richer, giving them the freedom to develop.

I’m sure many of you have more sophisticated views than mine. I’d be interested to hear what you think?

Much love,

Dan

The times, they are a changing...

7^th April 2012

We’re currently in Blantyre, having a little city break (of sorts) in the economic and cultural capital of Malawi. As you can imagine, the journey from Nkope was far from easy. We had to get up at 5am on Friday to make sure that we reached Blantyre at anything resembling reasonable o’ clock. While we were waiting for transport from Nkope to Mangochi, we discovered that we weren’t the only ones who had had an unsettled night’s sleep. Everyone had been up listening to the radio, because the news had come through during the wee hours that the president had suffered a cardiac arrest and had been flown from the hospital in Lilongwe to one in South Africa. We later found out that he had died.

I don’t know anyone has been following this in other parts of the world, but the strange thing is that any of you watching the news would have known about the president’s death before a large proportion of the Malawian population. Those of us with access to the international news sources found out fairly quickly, but it wasn’t declared on the local news until yesterday (for reasons that I still don’t fully understand). The political situation here is already a bit delicate. Speaking to people over the last few days, it has become clear that there has been a lot of dissatisfaction with the government, largely due to the destabilisation of the kwacha, which has put the Malawian economy in a precarious position. Among other things this has caused massive fuel crises for the past few months, and people are now queuing for hours at petrol stations. It will be interesting to see what happens with the cabinet over the next few days. Neither Dan nor I have been in a country where the head of state has died before, so it’s a bit strange. Being in a tourist bubble in Blantyre means that not too much has been affected for us. That said, the Easter weekend when the president dies is not a weekend to try sightseeing. A lot of places have been closed, for one reason or another. 

One of the interesting things has been the reflection on the quality of healthcare in Malawi. Apparently it’s quite unusual for the president to ever be treated in Lilongwe (which is the capital city) and the reason that the president’s body was flown to Cape Town was due to a lack of electricity. Although we’re used to conditions like that in Nkope (the maternity unit was repeatedly lit with candles this week) we were sad to discover that things aren’t necessarily that much better at the hospitals in the big urban centres.

In better news, part of the reason that we came to Blantyre was to start sorting out the purchase of supplies for the hospital with the money raised via the ‘Come and Sing Haydn’s Paukenmesse’. We’ll be presenting the equipment to the hospital on Thursday, and we’ll let you all know how it goes!

Hope everyone is having a great Easter weekend,

Danni 

Disability Digest

4^th April 2012

Any OUSU people reading this won’t be surprised that, having covered womens’ health, I’m moving on to disability. It’ll be the Malawi welfare state next.

I was curious about the attitudes to disability here from the moment we landed – as well as the obvious worries about accessibility issues from a personal point of view, I was thinking about the inevitable crossover between medical care and the spectrum of impairment. I’m happy to admit that the way that disability is treated here is completely different from what I was expecting.

Let’s start with accessibility. Trick question – which hospital is more wheelchair accessible; the world class John Radcliffe Hospital, Oxford, or St Martin’s Hospital in rural Malindi?  OK, ok, to be fair to the JR, I assume that St Martin’s Hospital is all on one floor due to lack of resources, rather than through concern for those of us who can’t manage the stairs. That said, I was very surprised by the amount of ramps at both St Martin’s and Nkope and all of the stairs are both wide and shallow, meaning that a wheelchair bound person could probably get around without too many problems. Again, I’m not sure that this is deliberate, but it is quite refreshing. From my point of view, however, the massive downside is that every hard surface is made of smooth concrete. In wet weather (it’s currently rainy season) this makes the whole place an absolute death trap. Oh well, you can’t have everything.

In terms of the attitudes to disability, my first experience was, of course, how people reacted to me. For anyone who doesn’t know, I often use a walking stick, particularly at work. Having already asked one of the nurses about the prevalence of female doctors in Malawi (there aren’t many), I was fairly certain that I would be the first disabled doctor that many people here had encountered, and I’m pretty sure that they don’t watch House. To be honest, people seem to find it about as strange as they do in the UK. The big difference is that everyone is quite direct about it. As Dan mentioned previously, the idea of privacy isn’t such a big thing around here, which means that no one hesitates in asking me why I use a stick. I have to say, I much prefer this approach. It makes things a lot quicker, just for one thing.

Something that I’m still not entirely sure about is the management of mental illness around here. I thought that we might come across an obstetric patient who suffered from psychosis or post-natal depression, or that there may be mental illness in some of the HIV patients, for instance, but so far we haven’t encountered this. It may well be that these sort of illnesses manifest themselves differently due to the cultural differences, or that I’m missing things due to the language barrier. I’m not sure. What we have seen, however, is the management of a patient with a learning disability. A woman came to antenatal clinic, 16 weeks pregnant. She had been complaining of symptoms of pregnancy and movements in her abdomen, but she wasn’t able to understand the fact that she was pregnant. The nurses clearly had a protocol for managing this sort of thing; they had insisted on her being brought by a guardian, who helped explain the whole process to the patient. Dan and I were impressed that the nurses took the time during the busy clinic to make sure that the woman was receiving the required antenatal care, despite the difficulty of the situation. However, the issue of consent loomed in both of our minds – how had a woman with an impairment significant enough to render her incapable of understanding the concept of pregnancy become pregnant in the first place? Concerned, we asked one of the nurses, who explained that she was married. It would appear that the issue of capacity is not one that is necessarily considered around here, and both of us were very uncomfortable with the whole situation. That said, we are relieved that the patient in question appears to be receiving a lot of social and medical support, and hopefully the situation will be managed appropriately.

Danni