Ahh, the old switcheroo. I'm up first this time it seems. Well we left off last time when we were just getting on the bus to Monkey Bay, our final destination. That was a month ago . . . . . So what happened? . . . . where have we been? . . .Gather round and i'll begin.
As i'd mentioned before, we got told in Lilongwe that before going to Monkey Bay we had to go to a place called Mangochi to do an orientation period. This wasn't in our plan and we didn't fancy it so we headed straight to Monkey Bay regardless to chance our arms. After a 7 hour bus ride (with a live chicken 10cm away from Kirstys face, 5 wrecked guys behind us and a baby being passed by strangers up and down the packed aisle every 10 minutes) we arrived. It's a small and fairly standard Malawian town with a 200 metre stretch of road with small shops and a market, at the end of the road is the port where ferries leave for the north of the country and just off it is the beach
. We went straight to the hospital only to find that they had already had a visit from the medical council to brief them that we'd be in Mangochi for 2 weeks before starting and they weren't up for any chat about it. So we did a reccy of the town, met some of the more over-friendly locals (these guys call themselves tour guides but just want to sell you anything they can or make money any way possible), ear-marked a place to stay long term and prepared to leave for Mangochi in the morning. The working day at the hospital here starts with the morning handover meeting at 7:30 am and we had a two hour trip to get to there for day one - madness! Mangochi is the main town in the district and has things like internet and a cash machine which Monkey Bay doesn't. It's at the mouth of a river that feeds into the lake so it has no beach and the water is full of reeds and crocodiles so there's no jumping in the water to escape the heat! - an incredibly sweaty place.
The Hospital here takes referrals from the whole district so it's a pretty busy place. It consists of one corridor about 50 metres long with the wards coming off it right and left and an outpatient/casualty department at the front. Theres no splitting up of specialties like at home where you've got renal wards, chest wards, gastroenterology wards for medicine and even more for surgery - oh no. Here you've got Male, female, children and maternity where you fit regardless of whats wrong with you
. TB and malnutrition wards also exist in theory but you could come across someone with TB or malnutrition in one of the wards. They have an operating theatre where they do mainly c-sections but also some general surgery and orthopaedics: some mental shit goes on behind those doors - i'll expand on that shortly.
Once we'd spoken to the boss we managed, with some smooth talking, to cut our 2 weeks down to a week and a day. And we decided that Kirsty would work on the paeds ward and i would be on maternity as this was the stuff that we knew least about and what would be needed most at Monkey Bay.
The maternity ward is the busiest place in the hospital with women dropping sprogs at an alarming rate and about 3 c-sections a day. When you walk on the ward there's women everywhere- lining the walls of the corridor, sitting on the floor, lying under beds, two on some beds. One day there were 208! Bear in mind theres only about 50 beds. Some of them are waiting to pop, some have recently popped and some have had their surgery - all of them are uncomfortable. Initially i was to shadow one of the 1st year intern clinical officers called James. A really sound guy of about 22 who had a pretty horrendous stammer which was much worse when he spoke english. This made the language barrier slightly more apparent but was, i'm ashamed to say, quite amusing as his nostrils would flare in time with the sound he made
. He basically ran the maternity department with the senior doctor popping her head in now and again. He did all the c-sections and more minor 'ladies surgeries', saw all the post-op patients and delivered any babies that the midwives couldn't handle. It was impressive to see and highlighted the difference in training between here and the UK. They just learn by doing here because no-ones gonna sue them if it goes tits up (which it sometimes does!) whereas we've got our hands tied by the law and aren't allowed near anyone till we're years into training and as a result don't gain the practical skills till much later, there's got to be a happy medium!
So the operating theatre here is a mental place. For a start its obviously fairly basic with very old equipment and is not particlarly clean. Looks a bit like what I'd have thought a uk operating theatre would look like in the 70s. I was in there most of the day usually doing the job of scrub nurse and assistant surgeon for the c-sections. You could say there were a few differences to what I've been used to: the scrubbing procedure involves washing your hands in a sink once with normal soap (if the taps are working – otherwise you use a bucket!) the heavily pregnant woman gets wheeled in on a trolley and has to shift her (totally naked) self onto the operating table with no-one offering any help; she’s put off to sleep by the anaesthetist who then promptly leaves and only comes back in at the end or if something out of the ordinary happens
. One example of this was when we were half way through a difficult c-section with the baby out and the inside part of the stitching up done leaving the abdomen still completely open. . . . when the mother woke up! Obviously she started screaming and grabbing for her stomach while James tried to finish up quickly as possible and I held her arms away from the wound with my elbows and tried to help him with the stitching. The anaesthetist sauntered back in quite calmly and immediately did bugger all! I said "aren’t you gonna put her back to sleep or give her something!" and he just looked at me . . .I said "I think we need to give her something now!" His response was that the nurses didn’t like the patients too doped up when they come back to the ward and we were nearly finished anyway! I kept asking but no joy. We got finished quickly but it was pretty horrendous and, I’m sure, something she (or I) won’t be forgetting in a while. However it’s apparently not that uncommon for that to happen! The general impression I got of the hospital was that a lot of the staff just didn’t seem to care about the patients that much and could be pretty rough with them - fair enough they’re very busy and under resourced but it just seemed sometimes that they needed a bit of a kick up the arse to do their jobs properly and go the extra yard. That wasn’t true across the board, some of the clinical officers worked really hard and were frustrated by the lack of resources available to treat their patients
. While there were a lot of deaths and some of it was pretty horrible most people came in very sick and went out well which makes it a bit easier to take. All in all though, it was a good week and a baptism of fire into medicine in Malawi.
After the week at the hospital it was time for some well deserved chillin and it just happened to be the weekend of Malawis biggest music festival – Lake of stars. This is a four day booze and reggae fuelled extravaganza and it was just down the road on the beach! We went for the Saturday and Sunday with no accommodation and the plan just to sleep where we fell. Great fun, a bit different from t in the park, you could chill in the sun with a beer and listen to music and if that got a bit too much you could go for a swim in the lake. There was quality reggae in the afternoon and evening then DJs on till 7am – no bad! Met some really good people over the weekend, Malawians and travelers alike and shook off the week at the hospital. There was one small hiccup during the weekend though - on the Saturday night after a few too many scoops and some dancing me and kirsty went for a lie on the beach. It was about 1 am and we both fell asleep for a bit. When we woke up it was 3 hours later and our bag with clothes, cameras, keys and everything was gone! Couldn’t believe it, it was right next to my head! After looking around the place for a while we were ready to give up on it – gutted
! Just then kirsty spotted in the distance a guy with a bag wandering towards the end of the beach. On the off chance I ran towards him and as I got closer saw my rucksack on his back. I shouted, as you do “Here, that’s ma bag” The guy turns round all innocent and says he’s found it - aye next to my head the cheeky bastard! He puts it down and after a quick look inside I realized my sunglasses and multitool were missing. When I quiz him about this he goes “oh these” and pulls them out his pocket and gives me them back – worst criminal in the world. Turned out there were a few extra things in the bag too - the dafty had been walking up and down the beach nicking things off people and using my rucksack as a loot bag no more than 50 yards away from the scene of the crime – not the brightest lamp in the street! Still, a quality weekend.
After lake of stars it was back to Monkey bay to start at the hospital there and settle in to our new digs on the beach.
I can feel a bit of a rant coming on! The last six weeks have been exciting and enlightening but most of all infuriating to the point we often wonder why bother
. As the locals out here say when things don’t go to plan, which is most of the time – TIA(this is Africa)! It’s not all bad though, right now I’m sitting in my hammock, beer in hand, in our new home Venice beach. We live in the village of Masasa just outside Monkey bay and right on lake Malawi. We have been given the penthouse apartment, a double storey tree house complete with thatched roof and a lovely wooden veranda overlooking the lake. It’s completely luxurious when you compare it to the rest of the village, being the only place other than the school in Masasa that isn’t a mud hut. We’re now completely used to our cold showers and the blackouts which happen like clockwork around 6pm most nights. It’s as if when the sun goes down and everyone in Malawi turns on their light switches, a big fuse blows, an hour and a half later someone changes the fuse and right on time we all have light again. The food and the cooking is another matter though. The staff at Venice beach said it would be no problem to use their kitchen to cook which was great news until we found out the kitchen was an open fire! I’ve had a couple of culinary catastrophes over the last wee while, the worst was probably the bread making incident. I thought it would be nice to have some homemade bread so after an hour of sieving, kneeding and firemaking I proudly put my dough into a pot and covered it with coals. After 10 minutes Sye pointed out the pot seemed to be glowing bright red and maybe the heat was a bit high, so I retrieved the pot only to find a huge hole had appeared in it(apparently aluminium isn’t that heat resistant) and inside was a flaming piece of charcoal that was once my bread
. A new pot and a few attempts later my bread is edible and sometimes even quite tasty! We shop at Monkey bay market and haggle our hardest but there is so little choice. You can buy tomatoes, onions, eggs, potatoes, flour and rice and that is really it, I’m starting to dream about roast beef and yorkshire puddings. There are a few restaurants in Monkey bay but the menu is limited to chicken or fish and rice. We went to one restaurant and the man running it handed us a full menu with lots of tasty treats advertised. We were a bit dubious but so relieved not to be having chicken and rice… that was until the food arrived. Sye had ordered potato salad and we couldn’t quite believe it when his plate arrived. The potatoes were the chips you get everywhere in Malawi which are fried by the sides of the roads in big oil drums. These had been cut up into small pieces and covered with, I kid you not, strawberry yoghurt! It’s a bit like everything out here, if you don’t have exactly what you need then improvise. Sye ate the lot and we have been back to the restaurant but we always stick to chicken and rice.
We’ve had a taste of what it might be like to be famous – everyone wants to know the muzungu’s(white people). We step outside the front gate of venice beach and straight away people shout and wave, parents point and say to their kids 'look a muzungu’ and the children fight to be the one holding our hands or push our bikes
. Some of the time all the attention is money driven. There are guys who call themselves tour guides who follow us wherever we go and offer us paintings, key rings, Chichewa lessons or anything they can think us to make some money. Others we’ve made great friends with but even then eventually we get the same requests, can we sponsor them to go back to school, help them set up their business or just say to us plain and simply their family is starving and they need some money. We met Alfred a few weeks ago, a really intelligent and humble guy who has written a book about his village Chirombo. It taught me loads about the culture here and Alfred was really keen for us to visit his home. His large extended family all live together in one mud hut and their main business is brewing the local alcohol, a spirit made of maize. He introduced me to his four month old niece Innes and asked me to rename her. Innes is Chichewa means the sister to the first born son and Alfred said it was about time she had a real name. I’m still trying to think of a good name so any ideas let me know. The name thing here is very strange. Most people are born and given a traditional African name but because of the Scottish missionaries and the small amount of tourism they also have an English name. So far I have met delight, gift, Mr Fantastic, funny man and chicken pizza, no joke. I hear there are a couple of happy coconuts in the area but haven’t met them yet. Oh and by the way I’ve changed my name to Kristy as no one has yet been able to pronounce my name properly
. I get called Cast, Kendal, one guy said to me ‘ok Christ, like jesus I get it’, and a couple of people just resorted to calling me Simon.
Anyway, let the rant begin. The two weeks we spent in Mangochi weren’t so great. As Sye said I spent most of my time on the paediatric ward and the staff there just didn’t seem to care. A lasting memory of that place will be the first death I saw. A six month old with pneumonia who was on the paediatric ITU, the only difference between the ITU and the main ward as that it had an oxygen concentrator. When we saw the child on the ward round she was very breathless so we said to the mother that iher child needed oxygen. The mother refused, the reason being that she had two other children who both died on oxygen. There is a huge stigma in Malawi attached to the use of oxygen as it is reserved for the sickest patients and kind of the last resort, so a lot of people actually think that it is the oxygen that causes the death. After an hour of explanations and persuation we finally convince the mother oxygen is the way forward. Half an hour later the baby stopped breathing and as we had no resuscitation equipment there was nothing else we could do. The death was confirmed by the cleaner, believe it or not, and within 15 minutes the grandmother arrived, strapped the body onto her back and walked out. The whole thing was very surreal for me but obviously a normal everyday occurrence for the staff on the ward who didn’t even seem to notice
. I’m absolutely positive that if the mother is ever advised another of her children needs oxygen that she will point blank refuse.
When we arrived at Monkey bay hospital it was a really nice surprise. It is a small community hospital that refers patients to Mangochi hospital if they need extra care so I was expecting it to be even worse than the larger district hospital and have even less resources. It is actually the opposite. The place is so much cleaner(no blood clots in the corridor like Mangochi), it is more organized and on the whole the staff seem to really care about their patients. They have no doctors in Monkey bay but three clinical officers, all trained in surgery, maternity, paediatrics and adult medicine. I have no idea how after only three years training they can know so many things about so many different specialities. They were very surprised to find out after my six years training and four years of work I couldn’t even do a caesarian section as they have performed at least fifty in their intern year! The problem is that because they are expected to know so much and their workload is huge that a lot of mistakes happen. On our first day a child died because it was given five times as much diazepam as it should of to control an seizure. Again other than a couple of shrugs and a shake of the head no one really noticed. Our first few days we weren’t really much help at all
. All the staff speak English but none of the patients so we just shadowed one of the clinical officers, Mr Mazonde, and got in the way. One day we arrived at work and Mr Mazonde told us he was a bit stressed because the other two clinical officers weren’t coming in and he needed to review all the patients, probably around 70 of them, and perform two operations. We told him if he could get someone to interpret that we could do the paediatric ward round to help him out. A month later and we are now the resident paediatricians! The frustrating thing is that rather than the staff thinking it’s great having a couple of extra pairs of hands they think its fine for them to bugger off home to put their feet up and leave us to do all the work. Some mornings they don’t even show up at all and we find out later they have gone shopping in Mangochi. In a way I can’t blame them as they are worked very hard at times – on call for 24 hours a day for 7 days, and get paid very little for the work they do. Working in paediatrics is amazing fun but heartbreaking at the same time. The medicine is actually quite straight forward because we don’t really have any way of investigating things. Other than haemoglobin, HIV testing and malaria testing we only have a thermometer and our stethoscopes so we are quite limited in what we can diagnose. Generally we decide it is either pneumonia, malaria or meningitis and if one antibiotic doesn’t work we change it to another one until the child gets better – simple! A lot of the time this actually works and if it doesn’t you shrug your shoulders and move on to the next patient… I’m learning the African way of medicine pretty quickly.