We’ve been home for over a week now, which is surreal. For next year’s interns, I have a few bits of advice:

1. First, making friends is a crucial part of this internship. You’re there for two months; you can’t really make it unless you try to learn the language and get to know the people.
2. Look out for the friendly faces below. People at the hospital helped us get around every day, but these 10 were constant parts of our lives who made us feel like Namitondo was home.

   

   

   

   

   

   

   

   

   

   

3. Knowing a little bit of Chichewa goes a long way toward showing people that you care about being there. The word list/cheat sheet we compiled over the summer is here: Chichewa Word List. (Note: we DEFINITELY didn’t memorize all of these. You can easily get by only knowing the top half of the page.)
4. Malawi is such a young country that its history and politics really effect a lot of everyday life and the healthcare system. If you’re looking for reading material, it might be worth reading up on while you’re there or before you go.
5. Don’t be afraid to a) drink the water, or b) walk around alone in the daytime. Both are safe and will allow you to make the most of your time.

This week, Ariel and I wrapped up our data collection at Queens and did our final analysis. It is my last night here in Malawi, and it has been a bittersweet end to a wonderful summer. Going around the hospital and saying farewell to all of the random people I’ve befriended, I realized how many people I am going to miss. I am so excited to be coming home to friends and family, but sad to say goodbye to so many wonderful people that I may never see again.

I could try to paint a picture of Malawi by describing all the missing things that we take for granted in the US, but I think that would give an utterly incomplete image of this beautiful place that I have grown to love. Overall, I definitely learned a lot about all of the things Malawi doesn’t have. Some of it I learned in a classroom back at Rice, and some of it didn’t sink in until I witnessed it here, thousands of miles away.  But most importantly, I learned about some amazing things that Malawi has to offer that many places do not have, such as a friendly “Hi, how are you?” from strangers, encouragement from random passerby as I jog around Blantyre, and an abundance of fresh produce on every major street. And frankly, a lot of words just sound better with a Malawian accent (baby, for example).

There were plenty of times this summer when I was overwhelmed by the immensity of the health care problems here, and times when I was overwhelmed by the ability of people to find ways of getting past them and have the courage to go on despite them. I had to see a lot of suffering, but not a day went by when I didn’t also see so much joy. I am so thankful to have had the opportunity to be here. I’m looking forward to continuing to help with the CPAP project from the US and also excited to continue work on the CPAP sleeve with some of the feedback I received here. Zikomo to all the amazing people I had the chance to work with this summer and everyone who helped me get here! TX/CO, here I come!

My last Malawian meal, nsima and pumpkin leaves                    Malawian Monday                                                       With MK and Caroline at implementation

Mural near downtown Blantyre

Satemwa Tea Plantation

Chatinkha nursery                                                                      Rice’s phototherapy light stand in action                                           CPAP training

How Malawians keep their fish cool on the drive home                                      Blantyre                                                   Our Cure house family

We’re back!  After two months in Namitete we are back home and I’ll be the first to say that it was the fastest 8 weeks I’ve ever had.  Although it’s been nice to come back and see my family I’m already missing life back in Malawi.  Our last few days in Namitete ended up being both sad and exciting.  Saying goodbye to all the friends we made during our time there was a hard process.  Saying goodbye was especially hard since we didn’t know when we would see them again, and that was a hard idea to swallow both for us and for our friends in Malawi.  It wasn’t all sad though, in between the goodbyes there were a lot of happy times.  During our last few days we we tried to pack in as much as we could.  Some of our best friends at the hospital made dinner for us and taught us how to make nsima.  We went out to see Gift and his family for one more visit, when his mom insisted we stay for lunch.

Hannah and I making nsima with Sister Justa.

During our last week we also presented Sphygmo to the Matron and some of the other nurses at the hospital.  They were all so excited about the possibility of having Sphygmo at St. Gabriel’s and they wanted to start using it as soon as possible.  It was really cool to see how excited they were about a device that we brought from Rice and we started to think about the impact that the technologies we bring could have on the people at St. Gabriel’s.

Just me and some kids.

My time in Namitete was an unbelievable experience and I am so thankful that I was given the opportunity to see a part of the world so different from what I know.  The friendships we made and the experiences were had are things that I will remember forever.  I will miss Malawi very much but now I can’t wait to use what I’ve learned in the work that I will do at Rice.  Thank you all so much for reading and keeping up with my adventure and if you have any questions please feel free to contact me!

Zikomo Kwambiri! (Thank you very much)

It’s hard to believe that today is the last day of my ten week stay here in Malawi. Although I am excited to see my relatives in Taiwan, leaving will be very bittersweet. Blantyre has gotten quite homey for me. I’ll miss buying fresh groceries from street vendors on the way home. I’ll miss the lazy Sundays where we all just lay on the porch and relax. But most of all, I think I’ll miss all the wonderful and amazing people that I have met and worked with here.

This summer has truly been and incredible experience and I am so thankful that I have received the opportunity to help out with the CPAP study here at Queens. From travelling up and down Malawi for data collection, helping with implementation, and hanging out with many doctors and nurses, I have learned so much about Malawian culture, healthcare, and the power of dedicated and compassionate people. During the last training that I was at, one of the trainees wrote this as a suggestion on their feedback form: “Continue training more and more nurses doctors and clinicans to improve the quality of our neonates and children for a better Malawi.”

Hopefully one day I will be able to return to Malawi and Queen Elizabeth Central Hospital to work alongside all the inspiring doctors and nurses. For now, Zikomo kwanbiri. Tionana Malawi!! (Thank you very much. See you later Malawi!!)

Our family at the CURE Guest House for my final Malawian Monday:

This past weekend the housekeeper at the Cure Guest House, Alfred, got married! Eager to attend Aflred’s wedding and experience a part of Malawian culture, I biked over to the wedding. When I arrived, I found myself to be the only foreigner in a giant hall of hundreds of Malawians. I definitely got a lot of stares and “ASUNGU!” yelled at me, but overall people were very friendly and I had a great time there.

The bride and the groom were dressed in a tux and a white gown and holding a basket while dancing in the front. While upbeat music was playing, the emcee would call up groups of people, and group by group people would come up and dance with the newlyweds and throw money at them. I joined in with the party and threw money at the newlyweds. Then at one point, another person from CURE Hospital and I presented the CURE gift. We held the gift together and danced down the aisle, presented the gift, and then did a little dance up front. Something that I love about Malawians is how much music and dancing is in their lives. And it seems like they are all amazing singers and dancers. This was definitely reflected in the wedding.

Congratulations Alfred and Brenda!

This week we are on week 3 of implementation and training. We trained nurses and doctors from KCH and Bwaila, and then the whole team went up in different waves to Lilongwe to bring 8 CPAPs, 4 oxygen concentrators, 2 carts and a lot more other supplies. The truck-load was a bit intimidating but our driver, German, is great and managed to get everything up to Lilongwe safely. These trips are great because its very exciting to see CPAP at places for the first time and how thankful all the staff are for having these new machines. But they are also really fun because of all the wonderful people that I get to spend time with.

The CPAP team here is a combination of a wide variety of unique characters from wise and experienced Malawian nurses, to the powerful Ministry of Health representative, to naive college interns that are experiencing Africa for the first time. We have all spent A LOT of time together this summer in long car rides to hospitals all over the country, for long nights of going through hundreds of patient charts, and just simply working alongside each other to make CPAP available to babies all over Malawi. Through this we have shared many great memories together and to think that my summer with this team is winding down makes me very sad. Here are a few funny quotes.

Car Ride to Lilongwe

Glyssie and Florence are two retired nurses that have been working on the CPAP project to help train other nurses. They are very motherly, but also have a great sense of humor.

Glyssie (while eating fries in the car starts choking): “Someone quick! Slap me on the back.”

Florence (looks at her and says): “You need CPAP. Quick! We should put her on CPAP.”

Training

Alfred is the representative from the ARI (Acute Respiratory Illnesses) Program from the Ministry of Health that has been helping with Training. He gives very intense and motivational speeches about the difference that CPAP will make for babies in Malawi. His words are always very powerful.

Alfred (while lecturing the trainees on the importance of CPAP): “First you save lives…. then you can have your Fanta”

Malawians LOVE their Fanta. 

Girl Power

For the CPAP study, the Rice side includes MK, Jocelyn, Sam and I. What this results in is a lot of girl time. And inevitably with girl time, we have spent some time pondering about boys and spirit animals.

MK (over any lunch break): “Guys! I’ve got it! I need a blue-grass violinist slash ex-masseuse slash chef. And Jocelyn, you will end up with a country-boy slash computer programmer.”

We clearly have our lives figured out

Anyways, here are some photos from the week.

A few weeks ago, I wrote about the pediatric malnutrition we see here and included some detailed stat sheets that UNICEF and the WHO keep on stunting and wasting in Malawi. The statistics, as I talked about then, are shockingly bad: in 2010, the WHO reported that 70.7% of under-5 rural Malawians showed stunted growth (stunting is defined as -2 SD length for age). What I didn’t get into then was my bafflement at how they’d actually gotten those numbers. I’ve lived in rural Malawi for 2 months now, and I’ve seen a baby’s length taken exactly once.

• Current methods at St. Gabriel’s:

• Weight is recorded pretty universally for pediatric patients, because weight and vaccine records have to be sent to the District Health Officer monthly for trend analysis. The hospital has a number of scales available, though the U5 clinics use a chitenje hooked onto a hanging scale.
• The only clinic in the hospital that currently records length is the NRU (Nutrition Rehabilitation Unit), even though the Malawian Ministry of Health included length-for-weight growth charts in their 2012 redesign of the U5 health passports. They have two UNICEF length boards.
• Labor ward is also supposed to measure head circumference at birth, but it’s not done — having seen how hectic that ward can get, I understand why. They have the tape measures and a donated integrated length-weight scale, but they don’t have the time if nurses don’t feel it’s necessary.
• The sign on the bottom right was posted in the lab. Presumably weight isn’t given consistently.

Depending on the progress of the device this year, this could either be a good technology to bring to St. Gabriel’s next year, or a possible site project for next year’s interns: recreating the design using the length board, chitenjes, and scales already here. The crop scales aren’t hard to find, and an easy-to-use fix could go a long way.

Over the holiday weekend, we enjoyed a lovely weekend back in Blantyre while most people went out of town (it was Independence Day weekend for Malawi too!). Although the familiar scent and sound of fireworks were missing from our 4th of July, we celebrated the holiday with a few other Americans and people from all over the world.

I also decided to try to cook my favorite African food, Zitumbuwa, which I have mentioned before. It was pretty easy, and although Ariel assures me they’re better than the ones at the market, I’m still racking my brains to figure out why they don’t taste the same as the Malawian-made ones!

We also went to Michiru Mountain for the day on Monday. Riding our bikes through the village, we were met with the familiar stares and excitement from the children at seeing white people. By the time I got home I could still hear the “AZUNGUS!” echoing in my head! A lot of them only know how to say “How are you?”, so they will just keep saying it over and over again even if you answer them. It’s strange but always makes me smile to see my acknowledgement entertain people. On the mountain, we were guided most of the way up by a park ranger who carried a huge rifle to “protect us from hyenas, leopards, and other things.” We did not see any animals other than monkeys, but we did come across a large number of poachers, including a group of about 15 children. The first time he saw a man illegally cutting down trees on the nature sanctuary, he actually fired off his rifle to scare him off before chasing him into the mountain. The poacher got away, but we soon saw a huge group kids carrying massive piles of wood on their heads. This time the rifle was not necessary, but they did have to go back down the mountain for “civic education” and got their wood confiscated. It was difficult to think of children and teenagers, gathering firewood for their families to cook with, as criminals, but the law is the same for everyone I suppose. We saw a similar issue at Mt. Mulanje, where people illegally cut down cedar trees and gather firewood. It is one of the major environmental issues I’ve seen in Malawi as well as crop burning and trash burning.

Cute monkey family hanging out on the road to Machiru.

Since there are not enough doctors and nurses at Queens to constantly monitor the patients, every patient has a guardian with them to look after them, and feed them. It is also customary for Malawians to visit anyone they know who are in the hospital, so there are always lots of people of the grounds of Queens waiting for visiting hours. This area is across the street from Queens where the guardians and visitors cook meals (mostly Nsima).

Our street market

Implementation at Kamuzu Central Hospital.

Implementation and training has gone very smoothly this week. We delivered 8 CPAPs in one day yesterday! We have also been joined this week by our new co-worker, Caroline, who is awesome and a huge help already! However, I can’t help but feel a bit sad to meet such awesome people with such little time left here in Malawi. Ariel and I are already reminiscing, and we still have a week and a half left…

This week we wrote and printed user manuals for DataPall that we will be leaving here.  We’ve also been doing training sessions for everyone in Palliative Care and the HIV clinic next door.  We’ve been doing some last minute data cleanups as well to make sure that we leave the people here with the most accurate numbers and data possible.  Tomorrow is our last training session and then we are officially done working with DataPall!  Another piece of exciting news is that today the bCPAP was used at St. Gabriel’s Hospital for the first time!

With only a short time left here everyone at the hospital has been eager to show us what goes on in the other wards.  Hannah and I shadowed one of the nurses we are friends with, Comfort, on her night shift and we got to see what the hospital is like after dark.  One interesting thing is that every single patient who comes in at night gets admitted, even if they would normally only be sent to outpatient.  This actually causes some problems at the hospital because patients who should come as outpatient during the day but instead are admitted over night don’t actually end up seeing treatment until the following afternoon.  Also, somehow patients have learned that if they come at night they will be admitted no matter what so even if they’ve been told before that they don’t need to be admitted they will just come at night.  Over the last few days we’ve gotten to really experience how the hospital runs and the kinds of problems they face not only in Palliative Care but also in rest of the wards.

Hannah, Daniel and I are starting to get really sad about leaving, and we are trying to squeeze in everything we possibly can before we head back to the states next week.  We’ve been going out into the villages with our friend Gift a lot and this weekend we’ll be going with him a few more times.  We are having dinner with two of our good friends here in a couple days, Nurse Comfort and Sister Justa, and they are going to teach us how to make nsima and some other traditional Malawian food.

Not much else is going on right now, so I’ll put up some extra pictures to make up for it!

Labor ward at a (rare) quiet moment.

Gift’s mom making nsima.

We had lunch with Gift today at his house.

Whenever we go out to the villages with Gift we end up with an entourage of children.

Giraffeeee

On Monday night, Liz and I kept Comfort company during the first few hours of her night shift.

A few things are different at night:

– Thanks to the new solar panels, there’s almost always power at night. However, there are some issues switching back and forth in the evening and morning.

– All patients who come must be admitted. As Liz blogged about, this can create some problems. Apparently some patients know this and, because they want to be admitted, come in at night and then can’t be seen until the following afternoon due to backlog.

– In the pediatrics ward, medications that are supposed to be given at midnight are given at 9PM so that the mothers can sleep. Many mothers sleep on a chitenje under their child’s bed.

– If there are too few nurses during the day, there are even less at night. Roughly 7-8 nurses and 2 clinical officers run the hospital.

– Doctors are “on call” with walkie-talkies. Since all of the doctors are provided housing next to the hospital, range isn’t an issue.

– Female and Labor wards can be significantly busier at night, because women come in from botched abortions (St. Gabriel’s doesn’t do them) or want to come in without their husbands knowing. Something like the SAPHE pad would probably see a significant portion of its use at night here.

From a technological perspective, the shortages and general added confusion in the nighttime reinforce the need for easy-to-use and quick devices. Nurses don’t have the time, particularly for potential-emergency patients who come in at night and need to be diagnosed quickly.

From an observational perspective, we had an exciting night, and I’m glad Comfort invited us!