Having been back in the US for almost a week now is a bit…disorienting is putting it mildly.

I miss St. Gabriel’s so much! That hasn’t changed in a week, and I don’t think that this ‘homesickness’ will dissipate anywhere in the near future. But what a little bit of time and space has given me is perspective on what I truly miss the most about life in the hospital and in Malawi.

 

What’s super convenient is that what, or rather who, I miss the most also serves to illustrate the most important advice I can offer to future interns:

Respect the amazing people who work at the hospital, and make friends when you can!

 

Previous intern blogs have taught me that the roster for each ward can change on a dime; rapid staff turnover is a huge issue at hospitals throughout the developing world, and St. Gabe’s is no exception. With any luck, however, most (or at least some) of these friendly faces will be around to enrich your experiences at St. Gabe’s, both personally and professionally.

There are tons of other people who we didn’t get the opportunity to take pictures with, but the moral of the story is that the staff of St. Gabe’s have really made our experiences during this internship special, and hopefully our friendships will endure in the forms of memories and lessons learned.

 

P.S. Second lesson I’ve learned from looking at these pictures: by Malawian standards, I’m practically a giant. Being a 6ft Caucasian woman has definitely gotten me innumerable intense stares.

Yesterday, our last day at the Polytechnic, Mr. Mafuta taught us a new Chichewa phrase: zikomo kwambiri, muzigona kutali ndimoto. He told us it’s a traditional parting phrase used when you don’t have the words any more to express how grateful you are. Literally, it means “you must sleep far from the fire.” It originates from the practice of using a fire to keep warm during the colder months, which unfortunately causes many accidents. When parting with someone, if you say this phrase, you’re telling them not to sleep too close to the fire, so that they don’t get hurt. It has evolved to mean that you’re telling them not to get hurt because you don’t know what you’d do without them, that they are the cause of a lot of joy in your life.

We found it a very fitting phrase for our last day at the Polytechnic. We expressed the sentiment as we hugged our Poly interns goodbye for the last time (for now), and as we said our goodbyes to the Poly faculty we have been working so closely with. The past ten weeks have been filled with incredible experiences shared with wonderful people in this beautiful country, which makes leaving that much harder.

As is common with all endings, we’ve done a lot of reflecting about the past two months. Our days have been filled with hard work, laughter, and plenty of new lessons, all encouraged by the projects we’ve been working to complete.

We’ve been lucky to spend time working on something we all are so passionate about, which has been a privilege I hadn’t yet experienced. The motivation that grows from being so invested in these projects has fueled us all to finish more than we imagined possible when we first began on June 1, and we are excited to see these projects move to the next step.

However we’ve been even luckier to have gotten to work with such great people along the way. Everyone involved in this process has been inspiring, encouraging, and welcoming, making Blantyre feel like a home I’ve lived in for much longer than these 10 short weeks. So until next time, to all those with Rice who advised us and helped make this possible, to our supervisors at the Poly who helped us along the way (especially Dr. Gamula, Mr. Chadza, Mr. Vweza, and Mr. Mafuta), to those around Blantyre who made us smile every day (Linksone the Banana Man, Henry the Honey Man, Lucia & Aida the security guards, and all those at the cafeteria), to the new BME students we’ve had so much fun getting to know over the past week and see them beginning their time at Poly as we end ours, to Karen, Tanya, Charles, Christina, Francis, Andrew, Emily, and Catherine: zikomo kwambiri, muzigona kutali ndimoto.

Here are a few things I hope you find helpful along the way:

1. Bring many USBs. Access to Wi-fi and Google Drive isn’t reliable; having a method of storing/exchanging information that doesn’t require these luxuries is crucial.
2. Get to know the Poly students. Whether you are lucky to have Polytechnic interns to work with every day or not, find a way to get to know some Poly students—go out to lunch with them, hang out on the weekends, and work with them if possible. They’re likely incredibly smart and have a lot to teach you, will give you a far more genuine perspective of Malawi than is attainable (I think) without getting close to any Malawians, and may be some of the kindest and most enjoyable people to be around that you’ve ever met.
3. Bring all the socks you own. They’re the “limiting reagent” of laundry.
4. Bring small hand sanitizer bottles. Paper soap was also helpful—you eat a lot with your hands here.
5. Learn Chichewa. Learn as much as you can! Not only is it useful and respectful, but it also will bring you closer to those teaching you. Often you’ll be laughed at (in a friendly way) when trying to use your Chichewa, but that just makes the process all the more fun.
6. Don’t make any assumptions. Be open and willing to learn—it will get you much further than trying to teach.
7. Bring a tape measure.
8. Get faculty/clinician feedback on your work, often. They know much better than you do what qualifies as good work and as a good idea, so use them! Work diligently to adapt your communication style away from the aggressive “confidence” of American communication—it won’t get you much honest feedback.
9. Explore the city and the country you are in as best you can. Within the realm of safety and reason, of course.
10. Bring Pepto Bismol.
11. Express your gratitude for those who are helping you. We found that baking did this well; by this point, we’ve probably hand delivered cookies to over a dozen different people, many of whom on multiple occasions. We’ve tried different desserts, and have received feedback on the tastiness of each baked good. The order (from most to least tasty) is as follows: chocolate chip cookies, banana bread with chocolate chips, apple pie, peanut butter cookies, banana bread, snickerdoodle cookies.
12. Bring sturdy shoes. They’ll take a beating. Also, bring tennis shoes or something similar for weekend excursions.
13. Pack a small sewing kit. The total number of holes torn in my pants is currently at 5.
14. Listen more than you speak. Listen to what those around you (who know better than you) deem as important needs to be addressed, and how they (faculty, Poly students, QECH staff) understand the problem and think it best be solved.
15. Bring duct tape.
16. Be thankful and humble. We received a loving, warm welcome from all those we met when we first arrived in Malawi—the Poly faculty, the Poly interns, the produce sellers, the security guards, the cleaning lady on our floor, and on and on. From what we’re told (and definitely from what we’ve observed), making all feel comfortable, happy, and welcome is an important aspect of Malawian culture. Don’t take this for granted!
17. Read some relevant books before you go/while in Malawi. It helps get the most out of the experience; Renata recently wrote a blog full of great recommendations.
18. Don’t expect to solve a huge problem. It’s silly to think doing so is possible in only ten weeks. Instead, be open to helping those around you in whatever way they need help, or solving a piece of a problem if that’s where you fit best. Keeping your mind open in order to help with whatever need presents itself allows you to utilize your own self effectively, and most likely learn the most as well.
19. Spend time in the hospital. Even a half day can provide you with critical knowledge for both current and future pursuits.
20. 10 weeks goes by too fast. Enjoy your time, and always be present—don’t let your mind get stuck anywhere else.

I remember before I left, I was trying to get an idea of what an average day would look like during the internship; looking back, my expectation was way off. So, for all the future interns who are curious about the average day in the life of a Poly intern or for anyone else who is wondering, here is a brief summary.

Monday-Friday

Mornings here are exactly what you’d expect—we wake up, get ready for the day, and eat breakfast. The lodge we live at provides tea and toast in the mornings, so we’ll walk down the dusty road in the mornings over to the main building. At breakfast, we are spoiled with a beautiful view of the hills in Blantyre, which rise up in the distance through the fog; in addition to the toast and tea, we’ll bring down our own coffee from a nearby plantation, fresh bananas or apples, peanut butter (made in Malawi!), jams, and fresh honey from the villages around Blantyre. One thing I didn’t know to expect is just how gorgeous Malawi is. We are here during the winter, but we experience daily temperatures in the mid-70s, and the sun is almost always shining. There are flowers blooming all around, and mountains surround us in the distance (Blantyre is circled by mountains).

The lodge we live at is located about an hour walk away from the Polytechnic, but luckily there is a bus (driven by the lodge owner) that travels from the lodge to the hospital every day at 7:30am. There are many expatriate doctors who live at our lodge, so we all load up into our bus every day to take the 15 minute drive to Queens. The roads are busy in the mornings, filled with both cars and people walking to work. There’s always plenty to view out the windows of our bus on the way to work, as so many people here walk to their destinations, women sell fresh mandasi on the side of the road, men roam the sidewalks with stacks of the day’s newspapers, people set up their airtime stands to settle in for the day, children scurry to school with their backpacks tightened over their shoulders, and the market stalls are opened and carefully set up to display their goods; the streets here are alive with people.

From there, Emily, Catherine, and I walk up the street to the Polytechnic, which takes about 10 minutes (record time is 6 minutes, which is done about once a week when we’re running late). We pass more vendors laying out their goods (fruits, candies, shoes, jackets) in the small market besides Queens, push through the line of minibus drivers shouting their rates to those passing, and join the throngs of people heading to work. We meet Christina, Francis, Andrew, and Charles outside the Poly, bask in the sun for a moment or two, then all head upstairs to our room to work.

We’ve been stationed in the same room our entire internship. It’s used as a classroom during the school year, though we’ve transformed it into a prototyping room over the past nine weeks. We keep all of our supplies and projects in there, and have stocked up tools like soldering irons, small saws, and hammers to work with. Our activities during the day vary greatly depending on what project we’re focusing on. Sometimes we all sit around the white board to brainstorm design ideas; other times half of us crowd around a circuit board while the others fit together wood pieces; one or two people may be at their computers, completing documentation or working on orientation week lectures. If we need internet, we head over to the library or outside on the porch, where there’s a mystery hotspot with some quality wifi.

For lunch, we head downstairs to the school cafeteria, where we’ve made good friends with all the cooks. If we’re lucky, the air smells faintly of fresh mandasi (freshly fried sweet dough) in addition to the expected smell of beans, meats, and veggies that they cook in the back room. I’ve about memorized everyone’s standard meal, and while ordering we function as a well-oiled machine (unlike the first few weeks of our internship, when ordering lunch for 7 caused a lot of confusion and misunderstood Chichewa).

During the afternoons, we continue to make progress on our projects. About once a week we’ll need to go out and buy some materials, which requires an enjoyable trip to the shops downtown or to Blantyre market. Blantyre market is filled with people and goods; voices of those negotiating prices, laughter between friends, short shouts between coworkers, and music fill the air. There’s a portion of the market outside, which mostly sells clothes, shoes, and produce, then a labyrinth of tightly packed stalls inside the market.

We’ll stay at the Polytechnic until around 4:45pm, when we head back to Queens to catch our 5:00 ride back home. If we need to do grocery shopping, we’ll head out around 4:00 so we can buy our food and get home before dark. There’s a great grocery store called Chipiku right across the street from the Polytechnic, where we buy pasta, rice, peanut butter (which we consume at a rate of 1kg/5days), jams, juices, etc. If we’re looking for produce, we head back to Blantyre market, where dozens of vendors watch over their ample stacks of fresh fruits, vegetables, spices, and meats.

On the bus ride home, we are always lucky to enjoy a beautiful view of the setting sun. After getting home around 5:30 (and after our routine snack of toast + peanut butter), we spend some time finishing up work for the day and blogging, or reading one of the many books we all brought with us. Around 6:30, all five of us crowd into the kitchen to make dinner. Three of the five of us are vegetarians, so we usually make some tasty dish with our fresh produce and rice. There’s no light in our dining room and it gets dark by 6pm here, so we always enjoy a cozy, candlelit dinner.

Weekends

Weekends vary a lot! Sometimes we simply stay at home to get ahead (or catch up on) work; sometimes we go explore Blantyre’s restaurants, shops, churches and weddings which are excitingly busy on weekend mornings; other times we are lucky to go out and see the beauty of Malawi.

I’ve mentioned the orientation week that we are planning a few times on this blog, and have decided it’s time to go a bit more in depth on what the week is all about—especially since it’s starting tomorrow.

The Polytechnic will be offering a degree in biomedical engineering (BME) for the first time starting this coming year, so the incoming 2015 BME students are the pioneer class. At the Polytechnic, all first year students attend a week long orientation (grouped my major) their first week of classes. The orientation is intended to introduce them to resources at the Polytechnic, and help lay the necessary groundwork before they begin their schooling; their orientation lasts a few hours every day, for five days. At Rice, first year students also attend a week long orientation, but it is a bit different from the Poly’s. We are grouped by dormitory, it lasts 10-12+ hours a day for five days, and orients us to Rice campus, college life, and academics.

One of our tasks this internship was to create an orientation week for the incoming BME students at the Poly, that lay somewhere in the middle between Rice’s and the Poly’s existing orientation weeks. Since the Poly students attend the orientation week activities with their majors, we were able to focus exclusively on the incoming BME students and work with the BME faculty; this was helpful, as we learned from the faculty that they wanted an orientation to being an engineer, not just an orientation to being a student. Throughout the past nine weeks, we’ve been meeting with different faculty members at the Poly, consulting Rice faculty, and talking to upperclassmen Polytechnic students to understand the need and objectives for this orientation week.

We’ve focused the week to four main objectives: help the students understand the skills necessary to be a successful BME student, understand the resources at the Polytechnic, build a network of peers, and understand the job of a BME. Using these objectives, we constructed a weeklong schedule of activities and lectures to get our main points across. Choosing and scheduling the events was the most difficult part of this planning process, as we wanted to ensure the week felt cohesive and the information digestible, while maintaining student interest and getting our points across.

We then constructed the lectures and gathered materials for the activities we had planned. While this task at first seemed overwhelming, we had a lot of help from Dr. Saterbak (a Rice bioengineering professor), Dr. Wettergreen (a Rice design professor), Mr. Vweza, and Mr. Mafuta (both Polytechnic electrical engineering faculty).

After all of our planning, the orientation week finally begins tomorrow! We will have 42 incoming BME students throughout the week, and we are excited to get started. Our week will consist of events that…

• Introduce student life at the Polytechnic. This includes a tour of the Polytechnic, a lecture on student skills, faculty introduction, “tips and tricks” for success at the Poly, library and resource introduction, academic rules and regulations, and things like paying fees/getting IDs made.
• Teach basic engineering concepts and skills. This is done primarily through a week-long explanation and execution of the design process through tacking a real engineering problem. This process will include things like brainstorming, decision making, and a materials workshop.
• Increase understanding of biomedical engineering. Activities will include a lecture on the BME curriculum, BME career paths, talks from industry workers in the field of BME, a visit to PAM and QECH, and stories of various successful biomedical technologies.
• Form a community among the BME students. This includes welcoming activities and icebreakers, a huge scavenger hunt, working closely in a team of 6 throughout the week, team formation activities, and a matriculation ceremony.

It’s completely surreal to me that today marks my last day in Malawi. All the clichés about time flying and such: completely accurate. I guess that it hasn’t completely sunk in yet, which is probably a good thing. Instead of dwelling on the fact that tomorrow I will be leaving behind wonderful friends and this gorgeous place that has come to feel so much like home, I’ve been doing some happy reminiscing.

 

My family has a tradition of concluding our travel with a ‘top moments’ list, and although this has been far too immersive an experience to sum up in one list, I can attempt to break it down into facets. Some of them are funny things, others serendipitous elements of living in Malawi, and still others insights into global health. But for each category, I’m going to give you my top three. There are stories and context behind each choice, so if you’re interested, send me an email or ask me for details. I promise, I’ll be more flattered that you read this than creeped out by the random questions.

 

Top 3 Malawian Names

1. Chimwemwe
2. Mphatso
3. Various English words that aren’t typically used as names state-side (we’ve met people named Happy, Bright, Gift, Comfort, Charity, and more)

 

Top 3 Ways to Eat Nsima

1. With black beans
2. With hard-boiled eggs and sauce
3. With cabbage and greens

 

Top 3 Chichenge Fabrics

Yeah, this needed to be a category. Please don’t ask how many I have to choose the top 3 from…

 

Top 3 Best Malawian Sweets

1 .Ndazi

2. Tangerines

3. Sugar cane (I’m not a fan, but it’s still a cultural experience)

 

Top 3 Crazy Medical Happenings

1. Clinical officer performs CPR on an eclamptic woman in labor, and then performs an emergency C-section in the labor ward (not the operating room). Both mother and child survive.
2. A child is born with their intestines outside their body.
3. Someone goes almost a week before they are referred from the health center with a likely subdural hematoma following a car accident.

 

Top 3 Medical Field Trips

1. Visiting NdiMoyo Palliative Care clinic
2. Home-Based Palliative Care visits with community health volunteers
3. Under 5 and Antenatal Outreach Clinic

 

Top 3 Ridiculous Occurrences

1. Dogs kill a goat in our front yard, and we have to figure out what to do with it.
2. I accidentally call the hospital director’s cell phone… while he is sitting in our living room.
3. My persistent yet unsuccessful attempts to pick up a baby chick (they’re so fluffy!)

 

Top 3 Crazy Things People Have Said About Americans

1. “So is it true that President Obama is putting microchips in everyone’s brains?!?” – from a random vendor in the market.
2. “I had a theory that all Americans only speak one language”- after I talked to a German medical student auf Deutsch.
3. “You can go to LA and become a movie star, right?”- from a nurse at the hospital.

 

Top 3 Instances of Hypochondria

****Disclaimer: As far as I know, I haven’t actually contracted any of these diseases.

1. Shistosomiasis
2. Malaria
3. Chicken Pox

 

Top 3 Favorite Animals Seen at Liwonde

1. Elephants (we probably saw 75!)
2. Baboons (intelligent and entertaining)
3. Warthogs (they’re the most hilarious-looking animal ever)

 

Top 3 Lessons Learned

1. Just because you have a great device doesn’t mean it will be used. Implementation is a long road involving education, training, and a strategic plan for consumables and repair.
2. Time is perhaps the most precious commodity that medical personnel have here, with education and experience coming in as a close second.
3. Friendships can transcend cultural differences and geographical separation. I have been so lucky to call people at St. Gabe’s my friends.