It was a relief to had finally step off the airplane to face the welcoming sign announcing the Malawian Interntaionl Airport. It was hard to imagine that Elizabeth and I only left Houston three days ago. The long airplane rides and the lessons we learned along the way all seem to blend into a murky dream. Stepping foot on the airport where people are all jostling to find their bags on the only conveyor belt and where the sounds of squeaking go carts pierce the air quickly awakened me to the nostalgic atmosphere of the wonderful country Malawi. To make our travel adventures short some lessons we learned along the way:

–          Never eat beef and cheese burgers on the airplane or else risk the body forcefully ejecting it out (i.e. I threw up)

–          When the check-in and carry-on bags must be switched, make sure to switch the liquid substances as well or painfully observe brand new toothpaste and body wash discarded

–          Always arrive an hour early in Johannesburg airport to check-in. We had to rebook our flight from Johannesburg to Lilongwe—in the process, staying an extra night—because we missed the mark by about 15 minutes.

Driving from the airport to St.Gabriel’s Hospital, I was filled with an intense déjà vu; after all I had been here before on this exact road a year ago. However, what was so strange to me was that nothing has changed. Malawi seems to stand still amidst its red dust. Everywhere kids and adults alike were walking barefoot on the red sandy sidewalks beside the paved road. Woman were balancing huge baskets of produce as they walk while babies were strapped saddle on their back; men, riding their black bicycles carrying goods or their families; kids, playing outside or trying to sell mice on sticks to passing cars. The towns were filled with animals and people conversing outside buildings that badly needed repainting or even reconstruction. Homes are still isolated villages of clay and straw huts with open fires to cook. Strange half-finished brink constructions sat on the side of the road without a shadow of a worker in sight. In fact, the only change I saw was a diversion of traffic and the road for the new, blindingly white Parliament building in front of a billboard that promised the roads would be fixed at a “record rate”….

Starting our first day at St.Gabriel’s Hospital, I was glad to discover many changes. The ART ward that I saw was in construction the last time had been opened for six months now. I remember the days when HIV patients would line up crowding the OPD hallway to wait for their check-up and next dose of medication. Alex, the nurse in charge of ART and community outreach, would see patients in a narrow room where one side there would be a small table and the other side, shelves of crammed records and medicine. Now the ART ward is a spacious building where patients can wait outside in the open air under the shade to wait their turn in the reception room. There were rooms for each of the jobs: dispensing and storage of medicine, pill counting, records keeping and offices. I think the ART clinic opened at an opportune time as Malawi has a HIV prevalence rate in the teens; it shows that the hospital realizes and places importance on the HIV/AIDS issue.

A hospice and palliative care unit also opened adjacent to the ART clinic. In the past, Matilda– the nurse who worked with a previous intern Z on the community health worker backpack—would ride a motorbike to check on the patients on palliative care (I still remember the time when the motorbike broke down when I was with her). Now patients are housed in this clinic where the nurses and doctors can try to make the last few days for them as painless and peaceful as possible. The project is something new the hospital is trying out. Patients are referred from the wards where proper assessment of the condition is used to determine whether the patient can move to the ward in order to minimize overcrowding of the small unit. Foreign doctors seem to head the effort for this project as the Canadian resident Ilene (on a 6 month program) is the main doctor who makes rounds in the afternoon. She along with the nurses for the ward work part-time as they have other hospital duties in other wards the other half of time. We had an opportunity to sit on their bi-monthly meetings where they discuss challenges they encounter such as mothers who refuse HIV testing or caregiver fatigue. One particular problem is related to the free-of-charge policy the hospice has enacted. Many patients in the wards request to be admitted because they know that care is free. Despite the problems, the nurses and Ilene recalled fond memories of patients who passed away and the grateful thanks they received from the family members.

I am once more glad and proud to be in this small but exciting hospital. While the landscape may not have changed, the hospital continues to explore new ways to bring healthcare to the quarter million Malawians it serves. The downside this summer is that the hospital is experiencing an internet crisis. We barely have 10 minutes day, segregated at random times of the day that are hard to catch. We would have to travel to Lilongwe to use internet cafes to use the internet.