My last post was pretty big picture- definitely information that I wanted to share, but nothing that inherently unique to my experience at St. Gabriel’s. Therefore, this post is going to be basically the polar opposite. This past week has been chock full of surprises- lots of interesting opportunities to learn and to serve. At the same time, Nkechi and I have agreed that it seems like we’re getting into a rhythm here. We’re on friendly terms with a fair number of the hospital staff, and for some strange reason, it seems like they like us! I think that it’s this familiarity that is opening doors for us- now that people see that we’re in it for the (relatively) long haul, our friendships are transforming into partnerships (and vice versa). The result has been our most exciting week yet!!! Here’s a brief peek at what it’s held so far:

 

1. Lunch with a nun (yeah, my Monday was cooler than yours)

On Monday morning, we were going about our business of preparing for the week when we came face to face with Sister Justina. St. Gabriel’s resident superhero, Sr. Justina has spent 50 years in Namitete, raising the hospital from the ground up and expanding support from her order in Luxemburg. At one point, she was placing IVs by candlelight in a 2-room clinic. You know, casual. We weren’t as much invited as instructed to come to lunch that afternoon. And it was great! No, not just because I got to have lunch with a nun. Sr. Justina truly is the authority on Namitete and the hospital, and we benefitted immensely from her experiences and her complete honesty. She told us point blank that one of our ideas wouldn’t work, which was refreshing and some valuable insight from a woman who has been there, done that.

 

2. Watching my first C-section (since my own)

Monday night, we spent some time on night duty with one of the clinical officers. Again, this was thoroughly unexpected- we were just starting to cook dinner when the phone rang, and we were asked if we wanted to watch a C-section. Eating took a backseat to opportunity, and we rushed over (one of the benefits of living 1 minute away from the hospital). I was surprised by how clean it was. Not the operating theater, since I was already aware of the measures taken to maintain the sterile field. Rather, I was surprised by how straightforward the procedure appeared. The incision was made smoothly, exposing the uterus fairly quickly. After a few minutes of maneuvering, it was just a matter of making a quick incision and then BAM! The baby’s head appeared. The whole process of removing the infant occurred so quickly and smoothly that I gasped audibly when the child appeared. The neonate was not breathing upon delivery, and as they were whisked to Labor Ward I was reminded of why so many of BTB’s technologies exist (and what our objectives are for the future). But the procedure itself was still unbelievable- I feel like the whole ‘miracle of life’ thing isn’t such a cheesy description of birth after all.

 

3. Hands-on teaching in Palliative Care (Morphine Tracker’s maiden voyage)

This week we had our first student! Collins is a member of St. Gabe’s palliative care team- although he (and everyone else we will be working with) has responsibilities throughout the hospital, he has been identified by Alex (the main Palliative Care nurse) as a potential ‘point person’ for the use of our software. We spent around an hour each day showing him the program and practicing. It’s been a really great way to identify potential roadblocks in future trainings or in the software itself. I also completely understand why Alex has recommended Collins for this job. He is a fast learner, devoted to the task, and has an unendingly positive attitude!

 

4. Taking a hot shower (yes, this is important enough to be on the list)

It was my first hot shower in a month. Hair was washed. Deities were praised. All in all, a pretty big moment.

 

5. Seeing Malawi’s premier incinerator (AKA only incinerator)

I think that we must be sending off some sort of sonic signal telling people to befriend us, because one afternoon, a man we had never met knocked on our door. His name was Happy, he told us, and he runs the hospital’s incinerator. Would we like to come see where he worked some time?
When someone randomly shows up at your door and asks if you want to see an incinerator, there is only one thing to do: say heck yeah.

We learned from Happy that St. Gabriel’s has the only incinerator in Malawi. While I have been unable to verify this fact, apparently their system is so comparatively advanced that they burn trash for hospitals in Blantyre and the American Embassy in Lilongwe! This tidbit raised some important concerns about waste management in Malawi- apparently, most hospitals dig pits and simply dump their waste (including delicate/organic materials such as post-surgical materials, placentas, and amputated tissues). In contrast, St. Gabe’s system allows for the complete combustion of materials, and the smoke filtration ensures low toxicity for the surrounding area. Although it may not be as glamorous as other areas of the hospital, it was still a great opportunity to understand medicine as a process that starts before the patient enters the doors and ends with the disposal of byproducts of their visit. Waste disposal seems like such a low priority, but when you consider what would happen without it, the process seems anything but trivial.

 

6. Morning rounds in the male ward (venturing into uncharted territory)

Wednesday, we snagged Gift (one of the clinical officers) to show him some BTB technology. After we finished, we stuck around for our first real experience with Male Ward. Male Ward tends to be somewhat of a mixed bag, more so than paeds (mostly pneumonia and malaria) or female (pregnancy or abortion-related, mainly). We had chances to see typhoid, probable tuberculosis, HIV, stroke, pneumonia, heart failure, psychosomatic illness, and diabetes (both types). Working with Gift and Jason, a medical student from New Zealand, gave us tremendous insight into the marriage between patient history and physical examination. It was also interesting to see how they managed patients who were in male ward for the long haul. Especially alarming, it seemed that the diabetes patients were there for the longest periods of time (almost a month for one man!) Diabetes management (which I touched on in my last post) is a complicated problem in Malawi, and seeing such gifted clinicians struggling to stabilize patients’ glucose sparked a desire to learn more about the roles of technology and policy in addressing the problem.

 

7. An ‘American Feast’ (if we dare describe our cooking as such)

Tonight, we repaid a favor to our friend Bright, who is a clinical officer. Bright was kind enough to invite us into his home for nsima with beans, a delicious piece of Malawian culture. We decided to in turn invite him for an American feast at the Zitha House! After a lengthy debate about what constitutes American food, we decided to prepare green beans, mac n’ cheese, fried chicken, and vanilla pudding (the last of these at Bright’s request). They may not have tasted just like home, but we had a great time showing our friend how to cook American specialties, learning some more Chichewa, and swapping stories.

 

This doesn’t even come close to being a comprehensive list of our week’s accomplishments! We’ve had some great experiences getting tech feedback from the hospital director, learning about device repair from the maintenance manager, playing with neighborhood kids, and preparing for our full-scale rollout of Morphine Tracker! And the best part is that our week isn’t even over. This weekend marks both the American and Malawian independence days, so I’m sure it will be one for the books. Keep on the lookout for more updates soon, but till then, tionanna!