Wow! Time here has definitely flown by!  I feel like there is so much more to learn and see!  I have loved staying at St. Gabriel’s.  All the staff here are so friendly to us.  It has been great living with other volunteers in the guesthouse.  The lessons I have learned here will empower me to be a more passionate and dedicated student, physician and friend.

I will always remember the children of Malawi.  Since I came here two years ago, the children have had a special place in my heart.  There is nothing like seeing a smile on a Malawian child, whether they are playing with their friends, working in the field, or staying in the pediatric ward.

My time in the labour ward was also extremely rewarding.   Recently, the Malawian government has begun enforcing a rule that all mothers must give birth in a hospital, or the chief of their village fines them. The major problems during childbirth include: hemorrhage, pre-eclampsia and eclampsia, sepsis, prolonged/obstructed labor, ectopic pregnancy and complications with abortions.  Mortality of neonates due to preventable causes occurs much too frequently here, and seems to be an accepted part of life.  This must change.  Pregnant mothers must be monitored more closely and antenatal care must be non-negotiable! The risk of death due to pre-eclampsia and eclampsia can drastically reduced, but here it requires the attentive care of health workers to monitor blood pressure of moms through the antenatal period.  The same is true for neonatal morbidity due to maternal malaria and anemia.  Proper antenatal care ensures that mothers are tested for transmittable diseases such as syphilis and HIV, are given prenatal vitamins, and are educated regarding how to care for their developing baby and ensure a safe delivery.  Stigmas for procedures such as c-sections and preventative measures for transmitting HIV to their babies must be overcome through education. Furthermore, fathers must be involved in the entire pregnancy by attending each antenatal care visit and staying with the mother at the hospital during the birth.  Currently, most Malawian fathers are involved in no more than the conception of the baby.  This leads to unsafe work and stress for the mother, which leads to increased risk for the unborn baby.  If the father knew how difficult the birthing process was for the mother, instead of simply thinking she goes away for a week and returns from the hospital with a child, he would be more willing to think about her health and be more apt to play a role in family planning.

So many things we take for granted as patients in America are completely unheard of here.  People are grateful just to be in the hospital. They never demand to be seen immediately by a physician.  I never saw a rude patient. In the wards, each patient comes with a caregiver.  This person cooks all their meals for them in the hospital’s kitchen and brings them to the patient.  There is absolutely no temperature control in the wards.

I am prepared to have quite a bit of reverse culture shock upon returning, but I am going to try my best not to get TOO frustrated when facing encounters with the American sense of entitlement.

Many of the community health workers are volunteers!  They don’t work for pay, rather for knowledge and for an identity as one who provides care to others!  That is an identity worth striving for! To be a person who cares tirelessly for the people in their community simply to be known for doing so.  What an impression to leave on the world!

This experience has reminded me that I can never allow myself to become complacent.  It is too easy to keep the needs I have seen here distanced from my American life, but this is not what I have been called to do.   I do not know where my future career as a physician will take me or who it will lead me to help, but I have seen so many needs, for both global health technologies and caring health professionals, and I desire to play a role in meeting these needs.

This trip has been so good for me.  I have learned the value of true friendship and been so blessed by the many people I have met.  I have learned to have more trust, to value the slow joys of life- even if they don’t “accomplish” anything, and to have more patience- unnecessary rushing does nothing but add stress.

It’s not always what we do, but the attitude we do it with!  A radiating smile improves the day for everyone who sees it!  When we find it hard to measure the success of a smile or a encouraging conversation given to a friend or patient, I think the problem is simply with our measuring tool!

Until next time…tionana Malawi!

The sunrise in Malawi makes me want to celebrate! It is my favorite time of the day.  The rooster’s caw begins around 530am warning visitors that the sun will come up soon!  People begin walking, whether to work or school, before the sun.  I feel like the rooster is shouting “Get ready! A great new day has arrived- make the most of it!”  Well, I for one am ready for today!  So many things I want to do and so many people I want to see before I leave on Wednesday!  Today we are going to visit Child Legacy International-Woohoo!

 

Well… we visited CLI! I was really impressed!  The entire operation is run completely off of wind and solar power!  I’m sure it cost a fortune to install, but it is a great idea!  I am certain the place will be absolutely amazing in a year or so!  I can’t wait!  I was really inspired by the idea of a clinic for maternal care, schools for teaching trades, and agricultural land for generating income or producing food for the community.  Isaac from Medic Mobile toured CLI with us.  His company provides community health workers with cell phones and SMS capabilities to empower workers and convey health emergencies to local clinics.  They work in 12 countries worldwide and have provided their services to all 140 community health volunteers that work through St. Gabriel’s.

I’d say it was a great day!

The knowledge of the midwives in the labour ward is so important to the integration of the pregnancy care kit we have designed.  I have been able to meet with three midwives here, and we have begun to go through the kit’s user manual to make each procedure consistent with exactly how it is performed here.  Alexa and I have also been able to help these midwives take vital signs for their patients.  For example, today there are 24 women in the maternity ward, so this task is quite large for one midwife to complete.

At today’s morning doctor’s meeting, a case was presented in which the mother had eclampsia but waited until she was in labor to come to the hospital.  Due to complications that arose, the woman had to be taken into surgery, but the baby did not survive.  Physicians expressed their frustration with the fact that pregnant mothers often wait much too long before coming to the hospital.  Often, they believe that if they come early they will get a c-section, but that if they wait until they are in labour, the doctor will deliver the baby normally.  The doctors stated that there needs to be improved education for pregnant women. The matron replied that women are being told, and that the hospital does not have enough staff members to put someone solely on this task.

 

 

 

My friend who lives in Malawi came to visit!  I was so happy to see her!  We met two years ago when I was here as a mentor for a science/math/technology camp for Malawian high school girls.  She has now graduated from the university and is working for an organization that provides relief and development services, such as HIV education, water/sanitation projects, and health outreach to rural villages throughout Malawi!  She is doing great!

The pediatric ward here is pretty full of children (right now is a “slow” time and there are 45 kids). A volunteer who I live with is a medical student from Holland; she explained that it is a very encouraging place to work, because the children usually have malaria and recover very quickly.  The ward can be very depressing; the children with severe anemia have high fevers and are receiving blood transfusions.  To make the kids smile, Alexa and I started a new tradition- sticker time!  We walked around the ward and let each kid pick out a sticker.  It is so refreshing to see their smiles!

Biweekly, St. Gabriel’s has a team that goes on outreach to rural villages. I was astounded by how efficient these projects are!  We drove about 30 minutes to a large village.  There we set up in 2 community rooms.  One was used for antenatal care and the other, larger building was used to vaccinate and weigh children.  Alexa took weights, while another volunteer and I took the blood pressures of the approximately 60 women who are pregnant in the village.  These women bring in their medical books where we record everything including their weight, fundal height, blood pressure and HIV status/treatments.  The women are also physically examined by a nurse to make sure they do not have TB, malaria, cardiac disease or numerous other illnesses.  If this is the first antenatal check up the mother is receiving, screened for HIV and syphilis, given an insecticide treated mosquito bed net to prevent malaria, supplied with albendazole to get rid of any parasitic infection she may have, and then proceeds to have a normal antenatal checkup.  Children are vaccinated against tetanus, measles, BCG, and polio.  Their nutritional statuses are recorded and their weights are tracked.  It went really smoothly and I enjoyed the experience.  At the end, we were able to play games with the children in the village!  The great number of pregnant women surprised me, but only until I learned that the goal in this village is to have 7-15 kids!

After going on rounds with a top physician at the hospital, I gained a completely new respect for all physicians here.  I feel like the patients come much too late 90% of the time, doctors lack adequate technology to diagnose many issues, and the challenge of being understaffed results in numerous treatments being ignored or wrongly administered.  This is very frustrating to me.  It breaks my heart to see cases such as the one today- a thirteen year old girl who was wasting away with an unknown disease.  Nothing could be accurately diagnosed to explain her huge abdominal extension.  Hopefully the broad spectrum antibiotics she was prescribed will be administered and effective

 

The priest of the Catholic Church here has lived in Malawi over 40 years.  He ate dinner with all of the volunteers and taught us all about Malawian culture.  I did not know that Malawi is a matriarchal country.  When a woman marries, the man joins her village.  If children are born, they belong to the woman’s family and the children’s uncle is largely responsible for them.  Women here are ridiculously tough!  They carry huge loads of firewood in their arms, giant buckets of water on their heads, and a baby on their back- all at once!  Women raise the children, cook and work in the field.  The men (as in comparison to years ago when they merely “supervised) now spend time everyday working in the fields.  Often in rural communities, men sleep in the beds and women have the floor.  Life is improving for women, but at the rate of a snail.

We introduced the technologies to one of the head doctors here at St. Gabriel’s. I was overwhelmed by how enthusiastic he was about the Beyond Traditional Borders Program. He would like to have a constant communication with the program, and absolutely loves the idea of working together. The Doctor said, ”I had absolutely no clue how much you all were working. This is amazing!” He especially liked the multidisciplinary approach of BTB, in which students from all areas of study come together to create solutions to real global health problems.

“No wonder you are so effective… so many great minds all coming together!”

He stated two major reasons he wants to work very closely with BTB:
1. “You all are globally oriented and tomorrow’s future. Being able to see globally will change the world.”
2. “Thus, you all are trying to tackle the largest problems affecting global health (TB/malaria). Then you all focus on country specific. This is extremely effective.”

One of my goals for this trip was to watch a surgery performed. On Thursday, Alexa and I watched two surgeries! The first one was a cesarean section performed on a mother who had a cervical edema and her baby was breech. The surgery went really well and took about 20 minutes. The baby was beautiful! The second procedure was a mastectomy, which took two hours! The patient was a 42-year-old woman. The doctor said he removed the breast because it would cause her extreme discomfort as the tumor grew, but that she would die from the spread of the cancer. This woman was asleep during the surgery. Here, doctors do not have specialties, so they rotate through every area of the hospital! One day you may be treating a child from malaria and the next, performing a cesarean section!