Hi everyone,
Sorry that we haven't posted until now, internet access in rural Malawi is a bit patchy (unsurprisingly)! We've checked into a hostel in Cape Maclear for the weekend - you'll see why further down.
Rest assured that we're having an amazing time and we're both tanned and happy : ). We've written lots of blog posts over the past week, so have a look, they're all posted below!
More soon,
Danni
Saturday, 31 March 2012
Living Room Safari aka “I’m A Doctor, Get Me Out Of Here”
[Friday 30th March]
OK.
This is getting ridiculous. I kid you not, but we’ve just battled
[unsuccessfully] with a giant BAT [yes, a flying rat] in our living room. It’s
like a reality TV show where some sadistic producers release larger animals to
see how we contend. To save you having to watch this on ITV78 in a few month’s
time, I’ll just tell you.
On
Monday it was King giant cockroach – HUGE! We’ve started to get along now
though. Danni and I just think he’s a bit lonely and is looking for friends.
He’s freakin’ ugly, so I’m not surprised he hasn’t yet found any. We now live
in equilibrium. I don’t even scream like a girl [or a boy] any more when he
says hello of an evening.
On
Tuesday it was the Praying Mantis – HUGE!! OK, this one flies and looks deadly.
Now, I don’t <think> these creatures are dangerous but they’re bright
green and look weird so I naturally assume that even being within 10 metres
will cause certain death. Still not used to him.
On Wednesday
we met the mouse [read: RAT, but we’re trying to make ourselves feel better]
and his family. At least they don’t fly but my gosh do they scurry, and are big
and hairy and OBVIOUSLY full of rabies, hepatitis and malaria etc. I’ve kind of
got used to them, Danni hasn’t.
On
Thursday it was the giant spiders in my room – I think they’ve been there
before but with other worries on my mind [cockroaches, praying mantises and
rats] I hadn’t noticed. Thank GOD for mosquito nets. Bleurgh.
Tonight
[Friday], as I said - it’s the bat. We
were literally just talking of how many animals we’d met in our abode and we
see a bat above our heads. We duck [obvious, natural reaction to a flying rat]
and then worry about getting too close to the floor lest we meet the cockroaches
or floor rats. Sigh. We realize quickly that we can’t just coax it out the
door, so we do what any intelligent people do – we run into Danni’s bedroom and
barricade ourselves in. That’s where I’m sat now, writing this. Ugh.
We’re
going away for the weekend, but I fully expect a lion and a dragon to be sat on
the sofa when we get back.
Wish
us luck.
Cross your legs girls...
29th March 2012
This morning, Dan and I got a call at 7am to say that a
woman had gone into labour. Having struggled out of our mosquito nets and
thrown on some scrubs, we hurried over to the maternity unit, where the nurse
in charge filled us in. The presentation of the baby was ‘footling’, which is a
rare type of breech presentation where the baby’s foot is the first thing that
is going to come out. This is particularly dangerous situation for both mother
and baby. To put it into perspective, in the UK this would be an emergency,
requiring a specialist obstetrician and an urgent caesarean. By the time we
arrived, the nurses had already called an ambulance to take the woman to a
larger hospital, as Mkope doesn’t even have an operating theatre, much less an
obstetrician. The response over the phone was that neither ambulance was
available due to lack of fuel. We were on our own.
By we, of course, I mean the mother and the nurses. I
personally was hiding in the corner, with images of a traumatic labour,
forceps, horrible tearing and paediatric resuscitation dancing through my head.
Your average five-year-old child would probably have been of more use.
As the woman in labour reached full dilation and began to
push, my heart leapt into my mouth, and from the look on Dan’s face he was
feeling the same. As the first foot came out, I braced myself for 10 to 15
minutes of utter terrified panic. However, within five seconds, the woman had
somehow pushed out the entire bottom half of the baby. Before we knew it, a
pair of shoulders appeared, followed by a head, which promptly started crying.
Somehow, this woman had managed to give birth to a breech baby with almost no
assistance, within the space of about 40 seconds. We were stunned, relieved,
and incredibly impressed.
Want to know the particularly incredible thing? This was
done with NO PAIN RELIEF. No epidural, no pethidine, no gas and air. While
doing her basic observations, I rubbed her shoulder and said ‘well done’, which
felt about as appropriate as giving a thumbs up to someone who had just climbed
Everest with no oxygen. Particularly as she didn’t seem to speak much English.
Marvelling at the miracle that we had just seen, Dan and I nipped out for a
quick drink of water. Within about 15
minutes, the woman who had just given birth walked out of the labour room and
into the post natal ward, fully dressed and carrying her suitcase.
Before the end of the morning we had also seen another woman
deliver. This woman had come to the hospital saying that she was in labour, and
had once again calmly walked onto the ward. Within minutes she was on the floor
delivering the baby, as she didn’t have time to get to the bed. She had walked
in and spoken to the nurses while literally in the process of giving birth.
Labour and birth are almost unrecognisable here. This is in
no way diminishing the achievement of anyone who has given birth in the UK –
having seen the process I absolutely take my hat off to all of you. It’s just hard to do anything but gape in awe
at women who sit through hours of contractions without anything more that
rubbing their backs and moving around a bit. According to Clara, the
aforementioned (amazing) head nurse, only about 20% of the women who deliver at
Mkope scream. I witnessed her definition of ‘screaming’ this morning. Trust me,
I made more of a fuss about the mosquito bites. When it comes right down to it,
I’m just so impressed with the strength and courage of everyone involved today.
Every member of staff and every mother seemed like part of a wonderful team
that had banded together to ensure that mother and baby were safe and well,
regardless of the difficulties that they encountered.
Also, seriously, no pain relief.
Mothers of Mkope, have a standing ovation.
Danni
PUBLIC HEALTH CAMPAIGNS & CONFIDENTIALITY
[Thursday 29th March]
This is going to be a bit of a mixed-bag blog post, but over the past few days there are a few things that have struck me about working here.
The Malawi Ministry of Health clearly knows what its priorities for public health spending are: Malaria treatment, Anti-retroviral drugs for the treatment of HIV and Maternal Health. Whilst a lot about healthcare here is disorganized, haphazard and a bit of a mystery [seriously, today I saw the clinical attendant in clinic prescribe amoxicillin for “cellulitis” which was almost certainly just a mosquito bite], the three areas I mentioned at the beginning of this paragraph are astonishingly good.
Malaria treatment is provided free of charge to everybody who pitches up at the clinic. The Ministry of Health has provided the hospital with “Rapid Detection Tests” [RDT] for Malaria, which take 30 seconds to give a result and free LA [The first-line anti-malarial treatment] is then available in well-designed, easy to understand packets. A disease that is potentially deadly has been reduced to the level of annoyance of the common cold [and a few hours waiting at a clinic to get some treatment]. Amazing.
As I’m sure you’re all aware, HIV is a huge problem in Sub-Saharan Africa with nearly 1 in 3 people in Malawi being infected. Whilst HIV [and the subsequent development of AIDS] was almost a death sentence 20 years ago, anti-retroviral drugs have turned this disease into a chronic condition. Not only do these drugs stop people from dying, but they also [almost] stop people from being able to infect others as they reduce the amount of virus in the blood to almost nothing. This is a fantastic public health campaign. Each patient is given free anti-retrovirals in clinic. Lots of details for monitoring their condition are taken on official WHO forms at each clinic session. It was nice to see that unlike in the UK, there was no stigma attached to having HIV. Again, amazing!
Just to quickly mention maternal health. Maternal mortality [the number of women who die around childbirth] should be zero. In the UK, There are usually less than 10 maternal deaths per year and each one is the subject of a huge inquiry. Sadly, this is not the case in the developing world, where it’s much more commonplace. The Health Ministry fully funds the maternity unit here at Mkope. Whilst the conditions are very, very [!!] different compared to the UK, the work here is amazing. Women here have 5 antenatal clinic appointments during their pregnancy and each time is an opportunity for some education. Women sit in groups and are taught the importance of lots of different aspects of their pregnancy and symptoms to look out for that could suggest a serious illness at each clinic appointment. We heard about a new campaign by the Ministry of Health encouraging women to keep having sex with their husbands all the way through pregnancy and then afterwards to stop their husbands finding sex elsewhere, thus containing the spread of HIV. It was an amazingly candid campaign, and whilst I imagine many feminists would hate it – I was impressed at the honesty.
A final word about confidentiality – one of the first things I learnt about in medical school. It is all-important for doctors in the UK to ensure that what our patients tell us is kept between doctor and patient. This health clinic doesn’t quite stick to the stringent confidentiality codes that we do. Several patients are often invited into the clinic room at the same time, a woman gave birth on the floor of the maternity room today [having 10 seconds early walked in carrying her own suitcase] with the door wide open and people watching. Best of all was this afternoon when the village priest was in the consulting room printing off some “proof of baptism” certificates [the clinic room has the only printer in the village] whilst patients were sharing intimate details of their sex lives. Awkward.
This is going to be a bit of a mixed-bag blog post, but over the past few days there are a few things that have struck me about working here.
The Malawi Ministry of Health clearly knows what its priorities for public health spending are: Malaria treatment, Anti-retroviral drugs for the treatment of HIV and Maternal Health. Whilst a lot about healthcare here is disorganized, haphazard and a bit of a mystery [seriously, today I saw the clinical attendant in clinic prescribe amoxicillin for “cellulitis” which was almost certainly just a mosquito bite], the three areas I mentioned at the beginning of this paragraph are astonishingly good.
Malaria treatment is provided free of charge to everybody who pitches up at the clinic. The Ministry of Health has provided the hospital with “Rapid Detection Tests” [RDT] for Malaria, which take 30 seconds to give a result and free LA [The first-line anti-malarial treatment] is then available in well-designed, easy to understand packets. A disease that is potentially deadly has been reduced to the level of annoyance of the common cold [and a few hours waiting at a clinic to get some treatment]. Amazing.
As I’m sure you’re all aware, HIV is a huge problem in Sub-Saharan Africa with nearly 1 in 3 people in Malawi being infected. Whilst HIV [and the subsequent development of AIDS] was almost a death sentence 20 years ago, anti-retroviral drugs have turned this disease into a chronic condition. Not only do these drugs stop people from dying, but they also [almost] stop people from being able to infect others as they reduce the amount of virus in the blood to almost nothing. This is a fantastic public health campaign. Each patient is given free anti-retrovirals in clinic. Lots of details for monitoring their condition are taken on official WHO forms at each clinic session. It was nice to see that unlike in the UK, there was no stigma attached to having HIV. Again, amazing!
Just to quickly mention maternal health. Maternal mortality [the number of women who die around childbirth] should be zero. In the UK, There are usually less than 10 maternal deaths per year and each one is the subject of a huge inquiry. Sadly, this is not the case in the developing world, where it’s much more commonplace. The Health Ministry fully funds the maternity unit here at Mkope. Whilst the conditions are very, very [!!] different compared to the UK, the work here is amazing. Women here have 5 antenatal clinic appointments during their pregnancy and each time is an opportunity for some education. Women sit in groups and are taught the importance of lots of different aspects of their pregnancy and symptoms to look out for that could suggest a serious illness at each clinic appointment. We heard about a new campaign by the Ministry of Health encouraging women to keep having sex with their husbands all the way through pregnancy and then afterwards to stop their husbands finding sex elsewhere, thus containing the spread of HIV. It was an amazingly candid campaign, and whilst I imagine many feminists would hate it – I was impressed at the honesty.
A final word about confidentiality – one of the first things I learnt about in medical school. It is all-important for doctors in the UK to ensure that what our patients tell us is kept between doctor and patient. This health clinic doesn’t quite stick to the stringent confidentiality codes that we do. Several patients are often invited into the clinic room at the same time, a woman gave birth on the floor of the maternity room today [having 10 seconds early walked in carrying her own suitcase] with the door wide open and people watching. Best of all was this afternoon when the village priest was in the consulting room printing off some “proof of baptism” certificates [the clinic room has the only printer in the village] whilst patients were sharing intimate details of their sex lives. Awkward.
A feminist interlude...
26th March 2012
As anyone who has met me will
know, I’m really interested in womens’ health. It was great, therefore, to
spend my first day in the hospital in the maternity unit. Off the top of my
head, I’m not sure of the maternal mortality rate here, but in countries as
poor as Malawi it is usually staggering. The government are clearly trying to
address this; the maternity unit at Mkope is government funded (unlike the rest
of the hospital), and newborns get free treatment for the first week of life.
As far as I can tell, Mkope has taken this funding and run with it, something
which really seems to make a difference to maternal health. Every pregnant
woman is seen 5 times during her pregnancy and given iron supplements, malaria
prophylaxis and a free mosquito net. There is also a massive push for maternal
education, both through public health campaigns and antenatal classes. I was able
to watch one of the midwives give a class on the signs of certain dangerous
conditions in pregnancy, something which is particularly important at a
hospital in such a rural area. The whole thing was very different to the way
things work in the UK. As the entire thing was in Chichewa, I didn’t follow
everything, but it seemed much more didactic – in the UK, the paternalistic
approach isn’t seen as appropriate any more. Personally, I found the ‘if your
ankles are really swollen, come to the hospital’ approach quite effective. The public health posters are quite similar
in style. One that I particularly liked said ‘a good husband takes his wife to
the hospital before the 4th month of her pregnancy’, which I thought
was a really important message, pretty much regardless of delivery.
The department, of course, has to
deal with unbelievable shortages – women sometimes deliver on mattresses on the
floor, due to lack of space. Despite this, several women that I saw in the
antenatal clinic were invited to stay as inpatients because they were near term
and lived far away. My admiration for the entire department was cemented on
hearing that a woman who had presented with eclampsia (intractable seizures
related to pregnancy) had been successfully treated and gave birth to a healthy
baby girl.
Update on the mosquito bites –
Dan now has two, which I’m sad to say makes me feel slightly better. As much as
I don’t want either of us to get malaria, I was starting to feel as though this
was some sort of plot by the makers of Anthisan to make me start buying it by
the litre.
Danni
MY FIRST DAY AT WORK – MKOPE MEDICAL CENTRE
[Monday 26th March]
I was already awake when my alarm went off at 6.30am this morning. My mind was racing all day yesterday worrying about work. Today would be the first day that I’ve seen and treated patients since becoming a “doctor”.
We arrived at 7.20 and decided to sit under the massive “Oral Rehydration Treatment” tree [picture to follow, or to be found on facebook – it is an epic tree], that provided some shade from the already intense sun. Petre, the clinical assistant, met us and showed us round. I was staying in the outpatients department for the day, whilst Danni went off to Maternity.
I was overwhelmed at first watching Petre work, at how he managed to make clinical diagnoses based on a few sentences of history and a scant examination. By the afternoon I realized that his diagnoses actually fell into two categories – “Malaria” and “Infection in the place where the presenting symptom has developed”. Such fun! The only investigations we could order were: Haemaglobin, Malaria test [RDT] and urinalysis – so when I got to diagnose patients by myself, I really was using my own clinical acumen. Well, either that or just copying Petre by saying every patient with a fever had Malaria. I have to say, it did feel weird prescribing drugs all by myself. Now, I know this may seem unethical to some of you [given that I may have passed finals, but I haven’t graduated yet], but really were it not for me then none of my patients would have got their drugs.
Mid-morning we performed a ward round through the male, female and paediatric wards. It was here that I could truly appreciate how under-resourced and poor this centre was. We met a woman who had been having an asthma attack for 2 days. The centre could only afford enough salbutamol for 4 puffs twice a day. There were no prednisolone tablets, no aminophylline, no nothing. I suggested that perhaps the patient may have a secondary pneumothorax and got a blank look back – the nearest place to get a chest x-ray was 50km away. In England, she’d be back to full health by now, having been fully investigated and treated for free. I love the NHS.
Nurses came in and out of our clinic all afternoon complaining of a lack of syringes [there were 2 left at 4.30pm on Monday], IV fluids [there were none] and staff shortages.
Again – I know this all probably sounds like I’m working and living in hell, but I can assure you that I’m not. For all the drawbacks, the health centre provides good quality healthcare where it can [lots of public health campaigns happen here, and it is fantastic to see!]. After work, myself and Danni walked through the village, and amassed about 50 kids following us! That was fun!
I’m quite tired now, so I’m going to stop typing and I’ll hopefully update later in the week, or maybe write something about the public health campaigns that I just mentioned?
I was already awake when my alarm went off at 6.30am this morning. My mind was racing all day yesterday worrying about work. Today would be the first day that I’ve seen and treated patients since becoming a “doctor”.
We arrived at 7.20 and decided to sit under the massive “Oral Rehydration Treatment” tree [picture to follow, or to be found on facebook – it is an epic tree], that provided some shade from the already intense sun. Petre, the clinical assistant, met us and showed us round. I was staying in the outpatients department for the day, whilst Danni went off to Maternity.
I was overwhelmed at first watching Petre work, at how he managed to make clinical diagnoses based on a few sentences of history and a scant examination. By the afternoon I realized that his diagnoses actually fell into two categories – “Malaria” and “Infection in the place where the presenting symptom has developed”. Such fun! The only investigations we could order were: Haemaglobin, Malaria test [RDT] and urinalysis – so when I got to diagnose patients by myself, I really was using my own clinical acumen. Well, either that or just copying Petre by saying every patient with a fever had Malaria. I have to say, it did feel weird prescribing drugs all by myself. Now, I know this may seem unethical to some of you [given that I may have passed finals, but I haven’t graduated yet], but really were it not for me then none of my patients would have got their drugs.
Mid-morning we performed a ward round through the male, female and paediatric wards. It was here that I could truly appreciate how under-resourced and poor this centre was. We met a woman who had been having an asthma attack for 2 days. The centre could only afford enough salbutamol for 4 puffs twice a day. There were no prednisolone tablets, no aminophylline, no nothing. I suggested that perhaps the patient may have a secondary pneumothorax and got a blank look back – the nearest place to get a chest x-ray was 50km away. In England, she’d be back to full health by now, having been fully investigated and treated for free. I love the NHS.
Nurses came in and out of our clinic all afternoon complaining of a lack of syringes [there were 2 left at 4.30pm on Monday], IV fluids [there were none] and staff shortages.
Again – I know this all probably sounds like I’m working and living in hell, but I can assure you that I’m not. For all the drawbacks, the health centre provides good quality healthcare where it can [lots of public health campaigns happen here, and it is fantastic to see!]. After work, myself and Danni walked through the village, and amassed about 50 kids following us! That was fun!
I’m quite tired now, so I’m going to stop typing and I’ll hopefully update later in the week, or maybe write something about the public health campaigns that I just mentioned?
Lots of Love, as always!
Dan
OUR HUMBLE [AHERM!!] ABODE
[Sunday 25th March]
So. It’s not exactly the Ritz.
On the plus side – there are walls, there are distinct rooms, it has windows. Also, it’s right by the hospital AND right on the shores of Lake Malawi. OK, this kind of sounds idyllic, right? WRONG! :P
[I’ve been sat here for 10 minutes trying to find more positives – I think that’s about it].
It’s the insects that get to me the most. I fully understood, expected and remembered that the physical infrastructure can be poor in Africa [especially rural Africa] and so the fact that some windows are a bit broken, that some doors don’t fit into their frames and that there are constant power cuts don’t phase me. The fact that I just had to stop writing this blog post because a cockroach the size of my foot just tried to crawl ONTO my foot, does. BLEURGH!
Danni went to bed with 3 cockroaches and a lizard, and I had none. Sigh. I’m also only marginally offended that the mosquitos don’t seem to like my blood/skin. Danni’s 34 [at the last count, in 24 hours] bites are staring at my like war wounds that I wasn’t cool enough to get. [Just kidding, apparently they itch like hell and they don’t look too pretty – so YAY!].
If I could find an internet connection fast enough, I would upload some pictures. For now though – stop complaining about a bit of mould on the wall [aherm, my house in oxford] and do NOT complain about not having an en-suite bathroom [although I currently do have one here, I wouldn’t wish it on any of you].
I’m having a seriously amazing time here, in spite of [because of] all this. Our first day at work is tomorrow. We’ve been sent to a Satellite clinic for a week [MKOPE MEDICAL CENTRE]. We are the only doctors there [and really, we are only doctors in the MOST literal of ways – we passed some exams]. A lot of women give birth here, but there are no operating theatre facilities [nor any forceps or ventouse] so if a woman needs a C-section we have to send her by ambulance to Mangochi. The only problem is that the only ambulance has no fuel. :-/ It should be interesting.
lots of love to everyone at home.
So. It’s not exactly the Ritz.
On the plus side – there are walls, there are distinct rooms, it has windows. Also, it’s right by the hospital AND right on the shores of Lake Malawi. OK, this kind of sounds idyllic, right? WRONG! :P
[I’ve been sat here for 10 minutes trying to find more positives – I think that’s about it].
It’s the insects that get to me the most. I fully understood, expected and remembered that the physical infrastructure can be poor in Africa [especially rural Africa] and so the fact that some windows are a bit broken, that some doors don’t fit into their frames and that there are constant power cuts don’t phase me. The fact that I just had to stop writing this blog post because a cockroach the size of my foot just tried to crawl ONTO my foot, does. BLEURGH!
Danni went to bed with 3 cockroaches and a lizard, and I had none. Sigh. I’m also only marginally offended that the mosquitos don’t seem to like my blood/skin. Danni’s 34 [at the last count, in 24 hours] bites are staring at my like war wounds that I wasn’t cool enough to get. [Just kidding, apparently they itch like hell and they don’t look too pretty – so YAY!].
If I could find an internet connection fast enough, I would upload some pictures. For now though – stop complaining about a bit of mould on the wall [aherm, my house in oxford] and do NOT complain about not having an en-suite bathroom [although I currently do have one here, I wouldn’t wish it on any of you].
I’m having a seriously amazing time here, in spite of [because of] all this. Our first day at work is tomorrow. We’ve been sent to a Satellite clinic for a week [MKOPE MEDICAL CENTRE]. We are the only doctors there [and really, we are only doctors in the MOST literal of ways – we passed some exams]. A lot of women give birth here, but there are no operating theatre facilities [nor any forceps or ventouse] so if a woman needs a C-section we have to send her by ambulance to Mangochi. The only problem is that the only ambulance has no fuel. :-/ It should be interesting.
lots of love to everyone at home.
The things we take for granted...
25th March 2012
Since we got here yesterday, the
phrase we keep repeating is ‘things are so different back home’. It sounds
obvious, given that we’re in rural Malawi, but it’s staggeringly true –
particularly when it comes to the hospital itself. While we were having dinner
last night, we got chatting to one of the hospital administrators about how
everything works. Apparently, patients tend to present here fairly late in
their illness, because they are often put off by the cost. Mission hospitals in
Malawi receive no government funding; apart from the staff wages, everything
has to be funded using donations or money received from the patients, who are
charged a small fee for the consultations and then pay for their own
investigations and medications. Despite this, it would appear that going to one
of the government funded hospitals is a false economy. Although these hospitals
have no consultation fee, there is a hierarchy meaning that ‘more important’
patients (those who know the right people) are the only ones who get proper
medical treatment, with the rest often receiving inadequate or inappropriate
care. These patients eventually end up coming to the mission hospitals anyway,
at which point their conditions are usually worse, and therefore more difficult
to treat.
This afternoon we had our
hospital orientation, which nothing could have prepared us for. Our tour of the
operating theatre involved the loosest usage of the word ‘sterile’ that I’ve
ever heard. As someone who has watched a surgeon change completely because
someone brushed his elbow, the broken windows and piles of equipment came as a
bit of a shock. Given the conditions, however, they do try very hard to prevent
infection. Everything is autoclaved and packaged before it is used, which in a
hospital without a washing machine is quite an impressive feat. The nursing
shortages were also obvious, with a single nurse covering both male and female
wards. Tests that we take for granted, such as liver function tests, can’t be
performed here – sputum cultures are the only test for TB, as chest X-rays
aren’t available. Despite the shortages, however, the level of care is still
very high. Women having their first baby are automatically kept in for at least
two days, and an entire ward is dedicated to DOT (direct observed therapy) of
patients who have TB which involves them taking their medication under
supervision for two weeks. It’s a cliché, but the next three weeks are
definitely going to be a life changing experience.
In other news, the mosquito
repellent that I was so careful to buy in the UK is slightly less effective
than water. I’ve switched to the stuff that everyone here swears by. We’re
staying in accommodation which definitely has its downsides (more on that
later) but the massive upside is that it is right on the banks of Lake Malawi,
which is absolutely stunning. Every single person that we have met so far has
gone out of their way to make us feel welcome, especially all of the people at
the hospital. I’ve already fallen in love with this place.
Danni
THIS IS AFRICA
[Saturday 24th March]
On Friday night [23/3] we took off for Africa from the lovely, almost-sterile surroundings of Heathrow Terminal 4. We were complaining that the book shop wasn’t adequately stocked [what sort of airport doesn’t have 3 different varieties of Malawi Guidebook?!] and that Gordon Ramsay only has a restaurant in Terminal 5. Sigh [or as I would say on twitter so ironically, #firstworldproblems].
Whilst the flight was uneventful and pleasant – it was quite difficult to sleep. We arrived at Jomo Kenyatta [Nairobi – our stop over] airport at 6am, and it was already a hive of activity. Rows of duty free shops all selling the same things lined the under-decorated corridor that was suspiciously humid [given the mild temperature outside].
After a few hours, we met our connection to Lilonge [the capital of Malawi]. The airport was one of the smallest I’ve ever seen. There were no gates as ours was the only plane expected for several hours. Once passing through arrivals [and yes, of course we were last 2 people through, not having mastered the art of pushing in] our suitcases were waiting for us, looking slightly less pristine than they had when we said goodbye to them at sterile Heathrow.
Our representative from the Hospital said that he would be waiting for us outside customs holding up our names. We see nobody with our names [unless he mistook Dan & Danielle for “Mohammed Hussein”, who did have somebody waiting for him]. Luckily we’d prepared for just such a situation – we had his phone number. He was stuck in a meeting in Lilongwe and would be there very, very soon. Sure. “I will be there in 5 minutes” turned into an hour, and then another. Time seemed to pass very slowly, as we weren’t quite used to “Africa time”, yet.
Eventually we were picked up in a car that would have been condemned as “ancient, rusty and dangerous” in the UK [and that’s being polite]. It barely had seats, let along seatbelts. I made an off-the-cuff remark to Danni about how amusing it is that if we’d died, our travel insurance wouldn’t pay out as we weren’t wearing seat belts. After airing my thoughts, I didn’t find them quite as funny. That was one of the first journeys I’ve ever taken in my life without a seatbelt. As you’ve probably guessed, we didn’t die on that journey as I’m sat here writing this blog post so, yay!
After a brief stop to exchange US Dollars for Malawian Kwacha, we arrive at Malawi central coach station. Now, if you’re picturing Victoria Coach Station [sterile!] or even your average Grey Hound station in middle America [heavenly!], you would be mistaken. Imagine a muddy scrap yard full of old Ford transit vans with makeshift wooden signs in their front window describing their destination. I was half expecting us to drive through to “executive, tourist” coaches at the back [which don’t exist], but alas this wasn’t to be the case. Our 9-seater minibus, was eventually packed with 15 people. Malawi coaches don’t leave at a specific time, but only when they’re full. Whilst we were waiting for a few last human sardines to join us, we were approached by hundreds of vendors selling such random items as portable Nokia phone chargers, a single kitchen knife and DVD-cleaning sets. I didn’t even want to think about where these items, let alone who would even need to buy any of them?!
I’m probably making this sound a bit hellish, but I can assure you that Danni and I were genuinely both seduced by the pungent smells of ripe tomatoes, sweat and mud. It was great to hear traditional Malawian music on the radio and we just couldn’t fathom how everybody just knew where they were going in the chaos – it was astounding. Our journey was close to 5 hours. I was wondering why my feet were getting so hot, until I realized that that was just the heat from the engine burning the bottom of my shoes. If that had happened in the UK, I’d have been fuming [literally] but just 24 hours later, it felt “charming” and “authentic”. What I should have recognized as a genuine #thirdworldproblem [sorry for the hashtag], I saw as a “funny quirk”. Safe transport is a huge problem in the developing world, and the burden of disease from Road Traffic Accidents is enormous [financially, greater than infectious diseases so I hear]. I’m fully aware of how patronizing my views were about some of the difficulties and practicalities of life here, and I feel bad for it. It won’t happen again.
Having travelled to Africa several times before, it did feel like coming home. There was something strangely comforting about seeing women balance huge parcels on their heads [it’s such an efficient way of carrying things!!], and to see roadside stores with ridiculous names such as “Jesus will heal you, if you let him into your heart shopping centre” and “If not now, when Hairdressers”. After just a few hours in the country, we both wish that we were staying for longer.
On Friday night [23/3] we took off for Africa from the lovely, almost-sterile surroundings of Heathrow Terminal 4. We were complaining that the book shop wasn’t adequately stocked [what sort of airport doesn’t have 3 different varieties of Malawi Guidebook?!] and that Gordon Ramsay only has a restaurant in Terminal 5. Sigh [or as I would say on twitter so ironically, #firstworldproblems].
Whilst the flight was uneventful and pleasant – it was quite difficult to sleep. We arrived at Jomo Kenyatta [Nairobi – our stop over] airport at 6am, and it was already a hive of activity. Rows of duty free shops all selling the same things lined the under-decorated corridor that was suspiciously humid [given the mild temperature outside].
After a few hours, we met our connection to Lilonge [the capital of Malawi]. The airport was one of the smallest I’ve ever seen. There were no gates as ours was the only plane expected for several hours. Once passing through arrivals [and yes, of course we were last 2 people through, not having mastered the art of pushing in] our suitcases were waiting for us, looking slightly less pristine than they had when we said goodbye to them at sterile Heathrow.
Our representative from the Hospital said that he would be waiting for us outside customs holding up our names. We see nobody with our names [unless he mistook Dan & Danielle for “Mohammed Hussein”, who did have somebody waiting for him]. Luckily we’d prepared for just such a situation – we had his phone number. He was stuck in a meeting in Lilongwe and would be there very, very soon. Sure. “I will be there in 5 minutes” turned into an hour, and then another. Time seemed to pass very slowly, as we weren’t quite used to “Africa time”, yet.
Eventually we were picked up in a car that would have been condemned as “ancient, rusty and dangerous” in the UK [and that’s being polite]. It barely had seats, let along seatbelts. I made an off-the-cuff remark to Danni about how amusing it is that if we’d died, our travel insurance wouldn’t pay out as we weren’t wearing seat belts. After airing my thoughts, I didn’t find them quite as funny. That was one of the first journeys I’ve ever taken in my life without a seatbelt. As you’ve probably guessed, we didn’t die on that journey as I’m sat here writing this blog post so, yay!
After a brief stop to exchange US Dollars for Malawian Kwacha, we arrive at Malawi central coach station. Now, if you’re picturing Victoria Coach Station [sterile!] or even your average Grey Hound station in middle America [heavenly!], you would be mistaken. Imagine a muddy scrap yard full of old Ford transit vans with makeshift wooden signs in their front window describing their destination. I was half expecting us to drive through to “executive, tourist” coaches at the back [which don’t exist], but alas this wasn’t to be the case. Our 9-seater minibus, was eventually packed with 15 people. Malawi coaches don’t leave at a specific time, but only when they’re full. Whilst we were waiting for a few last human sardines to join us, we were approached by hundreds of vendors selling such random items as portable Nokia phone chargers, a single kitchen knife and DVD-cleaning sets. I didn’t even want to think about where these items, let alone who would even need to buy any of them?!
I’m probably making this sound a bit hellish, but I can assure you that Danni and I were genuinely both seduced by the pungent smells of ripe tomatoes, sweat and mud. It was great to hear traditional Malawian music on the radio and we just couldn’t fathom how everybody just knew where they were going in the chaos – it was astounding. Our journey was close to 5 hours. I was wondering why my feet were getting so hot, until I realized that that was just the heat from the engine burning the bottom of my shoes. If that had happened in the UK, I’d have been fuming [literally] but just 24 hours later, it felt “charming” and “authentic”. What I should have recognized as a genuine #thirdworldproblem [sorry for the hashtag], I saw as a “funny quirk”. Safe transport is a huge problem in the developing world, and the burden of disease from Road Traffic Accidents is enormous [financially, greater than infectious diseases so I hear]. I’m fully aware of how patronizing my views were about some of the difficulties and practicalities of life here, and I feel bad for it. It won’t happen again.
Having travelled to Africa several times before, it did feel like coming home. There was something strangely comforting about seeing women balance huge parcels on their heads [it’s such an efficient way of carrying things!!], and to see roadside stores with ridiculous names such as “Jesus will heal you, if you let him into your heart shopping centre” and “If not now, when Hairdressers”. After just a few hours in the country, we both wish that we were staying for longer.
Friday, 23 March 2012
The Beginning....
So the day has finally arrived!!
Medical students in the UK are all given the opportunity to experience medicine somewhere else in the world, known as the "elective" period. It is often seen as a rite of passage, and many doctors that I've met over the past 6 years have spoken fondly about their elective as a life-changing experience.
After 6+ years of thinking about our electives, we're actually going tonight!! At 7pm, we will be flying to Lilongwe in Malawi, via Nairobi, Kenya. We'll be working at St Martin's Hospital, near Mangochi in Malawi.
I have a bit more packing to do before I head to the airport, so I'm going to leave it there for now. Hopefully we can update you soon!
Dan
Medical students in the UK are all given the opportunity to experience medicine somewhere else in the world, known as the "elective" period. It is often seen as a rite of passage, and many doctors that I've met over the past 6 years have spoken fondly about their elective as a life-changing experience.
After 6+ years of thinking about our electives, we're actually going tonight!! At 7pm, we will be flying to Lilongwe in Malawi, via Nairobi, Kenya. We'll be working at St Martin's Hospital, near Mangochi in Malawi.
I have a bit more packing to do before I head to the airport, so I'm going to leave it there for now. Hopefully we can update you soon!
Dan
Subscribe to:
Comments (Atom)