Food and dignity are funny things. Repeated studies have shown that when the incomes of people living in poverty and hunger increase, they don’t actually eat more: instead, they eat ‘tastier’– spending more on fewer calories, increasing the proportion of fat and sugar in their food budgets, decreasing consumption of staples and, in some cases, actually reducing the number of calories they take in overall. [1]

I set out during lunch today with the idea of taking a ‘picture tour’ of the street food in Namitondo for this blog. As I walked down the dusty clay road into the market, my head buzzed thinking about dignity and the need to eat for pleasure, not just sustenance. Little did I know.

[Warning: for only the food tour, just scroll through the pictures.]

I walked from the main intersection by the hospital instead of the way we usually walk from Zitha house and passed a woman selling the biggest bananas I’ve ever seen in this country (the ones on the right are more typical, sweeter and less banana-y than the ones in the US). I saw a stand by a construction site with a plastic tub on the counter; doughnuts, I figured, and stopped to buy one and check a food off my to-capture list. Instead, I was surprised to see these: samusas, Irish potatoes with pepper in a pocket of fried dough. I’d never seen them before, but I really hope I see them again.

I passed a corn seller on the way back to where I thought Daniel’s friend Samson’s family shop was. I’ve tried the corn before, and sadly it’s dry and not as good as it looks: this is one we do better in the States.

I emerged from the covered row of stalls what I would call, in retrospect, “completely lost.” I ducked through an alleyway and zikomo’d past the pair of chitenje-clad knees perched at its end into a familiar but mostly empty clearing. Turned around and saw a group of women selling doughnuts and the round flat fried things Sam had told us were called “Africa cakes.” Perfect.

I walked up to them and stood while I tried to decide what to get. Before I could ask for anything, though, one of the women stood up and started gesturing and speaking in rapid-fire Chichewa. I stuttered and my face contorted with discomfort and confusion; luckily this is a pretty everyday occurrence and by now I’ve learned some of the words: “…Ndikuphunzila Chichewa… pangono pangono.” I’m learning Chichewa… slowly, slowly.

She kept speaking, but she slowed down some. Didn’t really help. “PANGONO pangono.” She stopped and smiled. I looked at my watch and realized that I wasn’t just going to buy something from these women and leave. “Muli bwanji?” she asked. “How are you?” Chichewa 101, I had this one down: “Ndili bwino, kaya inu?” Got the accent sort of right, and everything. She smiled at me again, and I tried to give them a sense of my skill level by greeting the woman to her right with the afternoon greeting.

I asked how much the food on the far right cost while a woman on the next stoop over asked loudly about the azungu. 10 kwacha. I began to sit down on the dust on the far right, but the woman closest to me stopped me and arranged some pieces of wood. I sat cross-legged in my blue jeans, smiled at the women, looked around for a bit, and then remembered that I was supposed to be trying the food and pulled a K10 coin out of my pocket.

I still have no idea what it was that I ate. Bottom left picture. Looks like a beignet but I was surprised to find that was salt on top of it. Crispy, smoky, slight fishy flavor. She pointed: “chinangwa.”

For the next few minutes we exchanged halting small talk and they pointed out the names of the other foods they were selling.  They still occasionally raced ahead of my Chichewa abilities, but I pulled out my early-00’s style Nokia cell phone and saved a message to myself with all the words. From left to right above: chinangwa, batatas (soft, sweet, smoke-infused Irish potatoes cooked like the corn), tumbuwa (“Africa cakes”, a rough fried corn meal round), and mandaz (oval doughnuts that taste like the oil they use here; we were told it’s a cheap vegetable oil that would usually be used for mechanical purposes but it tastes good to me.)

Then the kids came, 20 or so in primary school uniforms crowding around our stoop to look at me. I’ve gotten accustomed to it from walking around the village or to and from the hospital, but to be honest it still makes me incredibly uncomfortable to be the focus of so many kids shouting “azungu” and thinking of my presence as a spectacle. The women tried to teach me how to shoo them but I stumbled over the words. The pained look came back to my face. The kids giggled amongst themselves, “azungu”.

I looked up at Catherine next to me and figured it was worth a try. “Zinalanga Hannah… No azungu” My name is Hannah, not azungu. I repeated it like a plea.

She and the other women took my cause. I know it sounds cheesy, but I almost wanted to cry when they loudly repeated that to the gathered kids and admonished them for treating me like a spectacle. I couldn’t understand most of it, but I looked up when I realized that I thought they said a word I recognized: “zanga,” friend.

I thanked them as profusely as I could in broken Chichewa (there are three common ways to thank someone in Chichewa, we elicited a lot of giggles figuring them out in the first few weeks here).  Catherine smiled and answered her phone; I heard her say something about “zanga Hannah,” and for once I’m certain she said “zanga” and not “azungu.”

The kids didn’t go away, though the older ones left and later kids in torn clothes came carrying younger siblings to come see. Instead, a crowd of primary school kids and one of their teachers helped me talk to Catherine and her friends. I ate a batata, they eagerly watched me write down Chichewa words that I’ll probably never need to use, for “up” and “down” and “arm” and “shoes.” A few brave older kids jumped out and tried their English on me. We were back to the feeling of hanging out, albeit with a few more people. Catherine moved over so I could sit on the stoop, and some of the kids bought snacks. At some point the kids taught me the word for “camera” and I let them commandeer mine until the game ended, as all games of 20-kids-play-with-one-toy must, with it dropping into the dust.

We sat for a while longer, until I looked at my watch and the woman who’d originally stood up and gesticulated at me asked if I had to go. I said goodbye and “zikomo cuambiri, cuambiri, cuambiri,” for which a kid named Useful jokingly mimicked me as they followed me out of the square to get one of the fanta and coke freeze-pops people eat by the side of the road.

This isn’t a picture-perfect story. Once we were further down the road, some of the school kids resumed following me with the typical “azungu, you give me money.” I still walked out of there not knowing all of their names and not remembering all of the Chichewa they’d tried to teach me, and I’m still leaving here in less than three weeks to return to a country most Malawians seem to think of as some untold paradise.

But what made me feel so welcome was that they knew that: they asked me when I was leaving and where I was from, they accepted that mediocre may be about as good as my Chichewa will ever get. For an hour or two, these women pulled me down from my ivory tower thinking about dignity. I always worry that it might seem disrespectful to be spending so little time here and still think that we can do something sustainable, but with that hour and shared food I felt more relaxed and at ease than I have in weeks. We all could acknowledge our shortcomings and keep trying anyway. In the face of the overwhelming, it seemed like the most vital thing in the world to be able to sit on a stoop eating unhealthy street food and laughing at yourself.

 

All right, enough with the talking, back to the food:

No interest in trying the street meat, but these stalls always provide an interesting look at the internal bone structure of common farm animals.

The famous street chips. They’re K100, but for an extra K50 they will put in cabbage and tomatoes. These were a little salty for my taste, but Dr. RRK and Dr. Oden both said they love them and we’ll probably give it another try before we leave.

One day close to the beginning of our time here, we were curious enough about the sticks kids were chewing by the street to buy one of these 8-foot poles of sugarcane (zimbe) for K80. They’re really hard to eat and extremely sweet, but it was definitely worth the adventure of trying them. I think this was one of the first times we went into Namitondo.

This last picture is totally cheating because it’s not even remotely street food, but we’re always amused to see that the sweet rolls at bakeries all over the country are named “Obama rolls.” MK told us that they used to be called “Osama rolls,” and that they changed the name in summer 2011. The baker is Aaron, who started a conversation with us one Saturday while we were drinking Fanta on the general store porch, heard that we were from the US, and immediately asked if we knew (former BTB intern) Elizabeth Nesbit.

 

[1] I pulled these sources from the book Poor Economics by MIT professors Abhijit V. Banerjee and Esther Duflo: Shankar Subramanian and Angus Deaton, “The Demand for Food and Calories,” Journal of Political Economy 104 (1) (1996): 133-162; Robert Jensen and Nolan Miller, “Giffen Behavior and Subsistence Consumption,” American Economic Review 98 (4) (2008): 1553-1577; Angus Deaton and Jean Dreze, “Food and Nutrition in India: Facts and Interpretations,” Economics and Political Weekly 44 (7) (2009): 42-65. They also cite a passage from George Orwell’s The Road to Wigan Pier that was really helpful and is on the reading list for when I get home.

With only three weeks ahead of us here in Malawi, the team and I have been busy finalizing our work here.

DataPall:

I recently spent a few days trying to figure out how to get some numbers from the data the hospital and government in DataPall and we’ve nearly completed creating the actual quarterly reports the Palliative Care unit needs.  Now all they’ll have to do is push a button after setting the dates of the report they need instead of spending days scavenging for poorly kept paper patient records.

DataPall Training and Manual:

By next week DataPall will be ready for us to take our hands off of and the actual manual will be sent off to printers in Lilongwe to be made into nice binders. There will be a few in English and one in Chichewa. We will also be holding training sessions for the Palliative Care team so that they understand how to effectively and efficiently use the newly improved database.

Community Health Workers and Backpacks:

We are putting together about sixty some badges for the community health workers here. When we went around the villages and talked to the workers, every single group asked for some type of identification. Apparently many of them get stopped when crossing district borders because police suspect them of stealing drugs and medical supplies.

Sphygmo:

The device did not have a good time flying to Malawi. A few weeks ago I was able to make some repairs and resolder popped wires, rendering it functional. We plan to showcase the device to the maternity ward before we leave.

CPAP:

We are awaiting instructions from MK on how we should deal with the CPAP device here. Dr. Jacobs, a pediatrician from the Netherlands, asked us to teach him how to use the device so that he may also train the nurses here.

Morphine Dosing:

We are still brainstorming a better way to make use of DoseRight clips. These clips snap on into syringes and lock the stopper at certain heights ensuring correct dosage. As of now, I personally don’t know if DoseRight will be of any use unless the hospital has a standard syringe they can give out with the clips; DoseRight does not fit universally to different types of syringes. Again though, the hospital uses what it gets and there is no such thing as brand loyalty. We may need to send this over to the next round of interns and global health design teams at Rice.

Malawi-ing:

Last week we met up with Sam and Ariel and camped out in Senga Bay on Lake Malawi. It was an awesome trip. The tent on the right was mine.

 

“Ah you guys leave too soon…” – Sister Justa

 

We have entered the implementation phase of the CPAP Clinical Trial! Previously, we have been collecting data at 8 hospitals around Malawi for baseline data to see what kind of respiratory problems are affecting neonates and their survival rates with treatment on oxygen. Starting this week MK and Jocelyn along with the rest of the CPAP team will be training nurses, clinical officers, and doctors when and how to use the bCPAP and be bringing the bCPAPs to each of the hospitals that have received training. Training/implementation will continue over the next few months until all 8 hospitals have staff trained and equipment at their site. With the bCPAP, we are also bringing a lot of other equipment including a suction machine, an oxygen concentrators, nasal prongs, suction catheters, OG feeding tubes, and a cart to organize all the machines and supplies.

Monday + Tuesday = Training

This week we trained three nurses and clinical officers from Zomba, Machinga and Mwanza. Monday morning, we arrived extra early to set-up for training, and then we sat there anxiously hoping that trainees would actually arrive. This was the first week so we were all a bit nervous. Training ended up going very well and by the end of the second day, I think the trainees had really understood what they had learned and were ready to teach others back at their respective hospitals.

  

  

Wednesday + Thursday = Implementation at Zomba

On Wednesday, Jocelyn, MK, two CPAP nurses, Sam and I hauled two carloads of equipment, including 4 bCPAPs, 2 wooden carts, 2 suction machines, and an oxygen concentrator through bumpy dirt roads to Zomba Central Hospital. When we first arrived one of the trainees came out to meet with us. About 15 minutes later, a dozen other people showed up all very excited to see new equipment. They were so excited that they demanded a photo in the parking lot before we even got a chance to move the equipment in.

  

We put these carts into the ward and all the nurses started crowding around to see this new machine. As we were setting up one of the carts, a nurse had asked me about what we were doing. I explained to her about the CPAP project and she asked if the CPAP was going to be brought to the rest of Africa. I told her just Malawi. She smiled with gratitude and said “We are very lucky then.”

Throughout the morning I was walking around the hospital to get things set up. And I one point I returned to the nursery and found that a giant crowd of nurses were all crammed into the already crowded nursery to watch of a demonstration of how the bCPAP works from our nurse Florence. It was great to see the enthusiasm and interest that everyone had. And then when we were heading out, I peaked around the corner and saw that at the nursing station, they had set up an assembly line to make the stockinette hats! I’m really excited for Zomba to have these bCPAPs and I can’t wait until they start using them.

Reflections from the Week

Working day to day here, I feel like I don’t really think about the big picture impact that the CPAP project truly has. But this week through training and implementation I have such an appreciation for everyone who is making this happen. I don’t even know everyone who is involved but just to show how many people and different institutions this takes, I am going to try and list the key players.

• Queen Elizabeth Central Hospital: First hospital to use bCPAP, and where the clinical trial last year was done to show the effectiveness of bCPAP. Also, many doctors and nurses from QECH are involved in training people from the other hospitals.
• Malawi College of Medicine: Where the CPAP project idea was first conceived.
• Texas Children’s Hospital
• Malawi Ministry of Health: Norman and Alfred who are helping us collect data through their ARI (Acute Respiratory Infections?) Program
• District and Central Hospitals around Malawi: They have been collecting baseline data and are now starting to send trainees on how to use bCPAP
• Rice University: Dr. Richards-Kortum and Dr. Oden are spearheading the project from Texas. MK and Jocelyn have been amazing at coordinating the entire study here on the ground and making this actually happen.

From what the nurse at Zomba said, I truly think Malawi is a very lucky place to be able to receive these CPAPs. Oxygen has been the most that majority of Sub-Saharan Africa could offer to babies with respiratory problems. Now with the bCPAP in Malawi, babies with respiratory distress will have a better chance of surviving. From helping out these last few weeks, I have experienced first-hand the complexity and level of difficulty that this project truly is. But we are all very lucky to have so many people who are so passionate and dedicated to making this CPAP project happen. Congrats to everyone on the first successful week of implementation and training!

Last weekend Daniel and I ventured out to Lake Malawi and met up with the Queen’s interns for a few days in Senga Bay.  Lake Malawi is a big attraction here and everyone had been telling us that we had to make time to go see it.  The part of the lake we went to looked more like an ocean than a lake.  We stayed in tents at a place called Cool Runnings which was packed deep in the villages around Senga Bay and right on the water.  Since it’s wintertime here the place was pretty vacant, except we ran into three of the visiting doctors at St. Gabe’s who were staying at Cool Runnings as well.  The first day we enjoyed the beach and the sun and did a little exploring in the town of Salima.  On Saturday we took a boat out to a smaller island in the middle of the lake to do some snorkeling.  We saw some cool brightly colored fish and basked on the rocks there until we were ready to head back to the mainland.  Overall the weekend at the lake was beautiful and very relaxing but we were excited to head back to Namitete.

Sam and Daniel frolicking in the lake.

The boat we took to Lizard Island.

The shore of Senga Bay.

Sunrise on the lake.

Since being back in Namitete, it’s really started to set in for us that we don’t have very much more time here.  We have two weeks after this one and then we will unfornutately have to say goodbye to Malawi.  On the other hand this means that we only have three more weeks to finish everything we want to do for St. Gabe’s.  We are almost done with working on DataPall now and we’ve started writing a user’s manual that we will leave behind with it.  As well as leaving the manual we are setting up small training sessions for us to have with each of the workers in the FCCU (Family Centered Care Unit) to go over some of the new features that DataPall has as well as going over how they should be using the program.  Other than DataPall, we have a few other small projects that we need to finish up in the rest of our time here so the last few weeks are going to be extremely busy for us.

This weekend we are getting a tour of the nearby school by some students that Daniel met a couple weeks ago.  We were also invited to dinner with the Gray’s (the farmers we were staying with our first month here) and we are bringing some of the other hospital workers who live with us at the hospital guesthouse so that should be a fun time.  The Malawian sisters also invited us to a big celebration at the church this Sunday.  They are celebrating their patron saint, and the Archbishop is coming.  The sisters keep telling us how much food there’s going to be so we’re pretty excited about that.  We also are going to be going out on another village tour with our friend Gift.  We haven’t gone in a while because we were traveling the last few weekends, but he told us that the kids keep asking him when we’re coming back so he’ll be taking us exploring again.

Overall things are going great, and it’s going to be really busy from here on out but we’re very excited for the adventures still to come.

This week we finally began training for the CPAPs! We started Monday morning at Queens with 3 trainees from 3 different hospitals. Each hospital brought two nurses and one clinical officer. We also had our four lovely CPAP nurses from Queens helping to run the training as well as a couple of Queens doctors, Alfred from the Ministry of Health, MK, Jocelyn, Ariel, and me. We started off a bit late, which we basically anticipated happening. I have learned here to not expect anything to run according to schedule. But eventually, we had 9 eager trainees before us ready to learn all about CPAP.

To start off, Alfred gave a really great motivational talk getting everyone fired up about the CPAP. He talked about how important it is to learn how to use CPAP to save the lives of neonates in Malawi as well as the importance of teaching others and continuing to collect good data so that the project can continue successfully. The training video that was put together was a really great way to introduce the technology. The Queens nurses also really enjoyed seeing themselves on camera! We also did a lot of hands on learning and practiced with baby dolls. On the second day the trainees got to go into the ward and see what CPAP is like on an actual baby. For a simple machine, there is a surprising amount of information to know about it! We taught everything from the basics of common respiratory problems, how to identify potential CPAP patients, feeding tubes and suctioning, setting up the machine, making the stockinette hats, putting the baby on the machine, monitoring, and weaning the baby off of CPAP.

The best part was definitely seeing the enthusiasm of all of the trainees. A couple of them asked to take the manual home with them on the first day so that they could study it more for the next day and one also asked about getting a copy of the training video to bring to their hospital and show others. They picked up on everything really quickly, and I think they will be able to teach more people about using CPAP in their districts. The Queens nurses were equally excited about helping out at training. They take a lot of pride in their work as the CPAP nurses and really enjoy teaching others about it.

Yesterday, we drove up bright and early to Zomba to install the equipment and bring all of the necessary supplies to the hospital. As soon as we arrived, there was a crowd of people that came out to see the new gear. They wanted to all take a photo with the new CPAP before we could even bring it into the wards. (See parking lot photo below)

               

The road to Zomba is under construction, so it was a bumpy 2 hour ride on this dirt road, but all of the equipment (and people) survived thanks to MK and German’s driving skills. It truly takes a lot of skill to avoid potholes, the many pedestrians walking in the road, big rocks, bikers, oncoming traffic, and goats.

Despite a shortage of space on the Zomba wards, we got all four CPAPS and other supplies successfully set up. Then before we knew it, a huge group of nurses had gathered around the new cart and Florence was giving an impromptu orientation on CPAP. It was so amazing to see how interested and thankful everyone was. Before we left, we even saw a big group of people already starting to make the stockinette hats for CPAP patients!

 

Now it’s back to Zomba to finish some data collection. Can’t wait to see if there are any babies on CPAP already!

 

Random Photos:

Lake Malawi!

 

The orange cloth on top of the basket is a People’s Party chitenge supporting the President of Malawi, Joyce Banda. People here in general have mixed views on Banda. She was very popular when she was first elected but has lost support since the devaluation of the Malawian Kwacha.

Early morning at Queens outside of the Peds ward. Notice the woman with the green cloth on her head–she’s carrying two babies on her back which is perfectly normal here. The women here basically lean over so their back is flat, place the baby on their tummy on their back, and then wrap the chitenge cloth around the baby and tie it in the front (and sometimes wrap an extra cloth around for warmth). I am curious to see that process with two babies though!

Malawi driving problems…

It seems like transportation is a hot topic around BTB this week, with Katharine posting about shipping Pumani units and Emily posting a picture of the inside of an Ethiopian ambulance! While easy transportation is an important design criteria for devices that will end up in overseas hospitals (like bCPAP or IV Drip), it can be one of the make-or-break features of a technology like morphine dosing clips that ends up in a patient’s hands.

Bikes are probably the most common mode of transportation other than walking that we see in the villages. Farmers bring their crops to market on bikes, salesmen carry their wares, parents ferry their children to school, and mothers carry a seemingly impossible number of children on their backs and laps to and from the market. The bike taxi bays are always full outside the front gates of the hospital and at the corner of the main road in Namitete, and a 15-minute ride is 300 kwacha.

In terms of carrying home technologies, bikes are tricky. Most bikes here have a flat rectangular platform above the back wheel (on the bike taxis, it’s covered by a cushion to make the seat) on which people carry bags and/or family members. Few people other than school age children seem to have backpacks, and, at upwards of 500 kwacha, the drawstring sport bags in Namitete would probably be too expensive a purchase for most patients to justify. Any technology that goes home with a patient who’s walking or biking, then, needs to be able to be secured to one of those bike platforms. Luckily, however, the platforms are stable enough that St. Gabe’s can fairly easily send patients home with commercial water bottles. Anything more delicate than that, like the thin-walled invertabottle, won’t really work.

We also occasionally see motorcycles (in fact, the “community care appointment” button in DataPall is a motorcycle icon, because Alex is known for using his motorcycle to the villages to save gas.)

In trading centers we see these huge flatbed trucks carrying both crops and big groups of people. Judging by the soda sellers who strap on gravity-defying 5-crate pyramids of glass bottles, I think the bike platforms are strong enough that weight is an inconsequential constraint if shape is right (though not for patients walking). In these crowded trucks, though, size become a critical concern: the bed of that truck is filled, wall-to-wall, with people and their bags.

The other way people travel between major centers cheaply is minibusses. They’re prone to functional errors and they make that flatbed truck above look veritably deserted. For patients travelling on this public transport, space is at a premium and sharp edges must be hugely problematic.

(Don’t worry, Mom: they’re expressly forbidden by BTB. When we need to travel into Lilongwe we find a car.)

Once they make it off of a big road and get closer to their village, robustness really comes to the test: transportation that is designed to work for 50kg bags of maize won’t necessarily accomodate a fragile device. Daniel wrote about a patient at Queen’s who doctors thought about sending home to her village. There were clearly bigger obstacles to her care than transportation (namely: supply of oxygen, caretaker capabilities, advancement of illness), but it bears thinking about: even if a local hospital had enough oxygen tanks to give a supply to her family, how would they have gotten it there? Anything designed to go home with patients in this kind of setting should pass a modified kind of high school physics egg drop test: roll it down a gravel stretch of the outer loop on a skateboard, and see how it holds up. That’s what the roads feel like once you get off the asphalt.

“Easy to transport” isn’t exactly the easiest thing to ensure when you’re building a device that needs more features and more functions. It’s a shame, though, when the barrier to use for an otherwise-promising technology is something as simple as getting it home from the hospital.

 

Home sweet home!  We came back to Namitete this week after lots of hectic travel.  We also moved into some new housing back here in Namitete.  We are now living in the hospital’s guesthouse with lots of other German visitors and we are definitely wishing we knew how to speak some German.

It was a big week here in Namitete because the president of Malawi, Dr. Joyce Banda, came to visit St. Gabriel’s to open the new Outpatient Department.  The celebration started at the hospital where Banda was greeted both with the church choir from the hospital as well as her party supporters who follow everywhere she goes.  Her supporters are all decked out in bright orange and they sing and dance for hours before the president even arrives.  Giant orange busses rolled through Namitete with “People’s Party” written on the side.  After the president arrived and toured the hospital there was a huge rally and celebration at the primary school across from St. Gabriel’s.  This celebration was HUGE.  I think every person from here to Zambia came out to the rally.  There was tons of dancing and chanting and yelling and general mayhem.  Many people gave short speeches, very few of which were in English and then the president spoke which once again was mostly in Chichewa.  We didn’t really know what she was saying but people were laughing a lot so we assume it was good.  Once she was done speaking, the real celebration broke out.  There were some traditional dances that involved some wild costumes and a lot of yelling and singing.  It was a really cool experience to be in Namitete when the president visited, I think people will be talking about this for quite a while.

The next day, it was back to work as usual doing DataPall and working on some things for the Community Health Volunteers.  This weekend we are going to Lake Malawi and we will be meeting up with the Blantyre interns once again.  We’ve heard the lake is gorgeous and I can’t wait to see it in person!

Also sorry for how late this post is, my blog has been fighting with me lately.

 

“Asungu” is the Chichewa word for “white person” or “foreigner”. In Blantyre, there are quite a lot of “asungu” people. Here, there are doctors who are saving lives at the hospitals, volunteers taking care of babies at orphanages, videographers documenting projects for donors in the States to see, NGO directors coordinating renewable energy projects, or lodge-owners that have created their own little haven in a hidden corner of the world. Every asungu here seems to have a fascinating reason as to how they ended up in Malawi. Meeting people from all walks of life and learning about their stories is one of the things that I love most about travelling. There is also quite a substantial population of Indian people here. They are mainly the business and restaurant owners here. There are so many Indian people that the only movie theater in town plays 2 American and 1 Hindi movie here at all times.

As an asungu in Malawi, people expect you to be rich. If you go to the market here, they will give you higher prices. In addition, the moment you step into the market people will try to offer all sorts of services to you. They’ll hold your bags, watch your bike, or even get groceries for you all with the expectation that you will pay them good money. And if you’re an asian, they will also yell “konichiwa!!” at you for the hopes that it will catch your attention. At first having dozens of people hollering at you to buy their products was a bit overwhelming, but by now I find the market and the game of bargaining quite enjoyable.

This past weekend, Sam and I met up with the St. Gabe’s interns to spend a weekend at the beautiful Lake Malawi. This lake seems more like an ocean and lines nearly the entire eastern border of Malawi. The lodge that we stayed at was hidden amongst the local villages of Senga Bay. Our first day there, we walked through the village to go to a local market. The way that the villagers behaved towards asungus was quite different than what we were used to in the city. As we walked through the villages, tons of children, excited to see a group of asungus would eagerly run up to us to say hello, which sounded more like “Ah – Lo!!!” They would also give us the thumbs up as we walked by and a few even came up to fist-bump us. I’m sure some previous volunteers had taught them that. And once we were a the market, everytime I turned around I could see an entourage of kids trailing about 10 feet behind us. It was quite adorable how intrigued they were by us.

Overall, I think that the Malawians like asungus. Or at least I hope so. When I have explained to Malawians what we are doing here, many respond to us with gratitude. For example, when we first arrived to Malawi, the lady at customs was questioning our twelve suitcases. Sam showed her a letter from Rice saying that these suitcases were filled with donated medical equipment. She said “Thank you so much for helping our country” and let us through with no further questions.

Time for bed now. Tomorrow is the first day of training for the bCPAP!

Sorry I haven’t posted all week! I lost my dongle and spent the weekend reading Game of Thrones instead. Last week, we visited Queen Elizabeth Central Hospital with Sam and Ariel. Even after the week spent visiting district hospitals, Queen’s felt strikingly big and astoundingly full.

Queens’ neonatal record storage unit has a ginormous task to manage. Ariel’s blog this week has more on record keeping, but  I was amused to see the ubiquitous Chiponde boxes repurposed.

They were cleaning the infamous diarrhea bay when we came by, so we didn’t really get to see it. Mixed feelings on that one.

I realized that I’ve never seen a pediatrics ward that wasn’t at least slightly decorated — QECH is no exception. This scene decorates one of the labyrinth windowed hallways that lead everywhere at Queen’s. This was the first hospital we’d seen with completely indoor halls; at St. Gabriel’s everything is open.

There was even a playground near Sam and Ariel’s office. We passed a few of these in the small courtyards created by the hallways, along with clotheslines and empty spots of grass where guardians slept and waited.

As a central hospital and the site of Malawi’s only medical school, Queen’s hosts much more research than St. Gabriel’s. At the sight of the sticker on this stethoscope, I remembered how Dr. Dube mentioned this when she spoke with our GLHT 360 class last spring. QECH is occasionally able to expand their diagnostic capacities by participating in international research. In order to participate in the BTB CPAP study, for example, they needed to be able to reliably, accurately, and precisely measure infants’ birth weights. To make that feasible and ensure good data, BTB provides participating hospitals with a locally-compatible and accurate scale.

I took this picture quickly as we were leaving, but it’s the image I think will stick with me most from our day touring Queen’s. We walked in through the front entrance you see from the top photo, and the first thought that popped into my mind was, “Wow, this looks like the emergency waiting room at Ben Taub.” Queen Elizabeth seems unarguably to be the vanguard of public medical care in this country. We, donors and governments and taxpayer dollars from wealthier countries, remake these hospitals in our own gleaming image. But what happens next, when we’ve transferred the same shortcomings onto a system that already comes up so short?