Sunday, December 30, 2007

EEEEW


This is what I found on my doorstep today. The biggest, grossest millipede I have ever seen. Of course I screamed, and then I decided I was going to kill it. I grabbed some DOOM, the world's most powerful insect killer, and doused the snake sized insect. To my misfortune, it did not seem too perturbed by the intense shower of nitrates, so I resorted to plan b: pepper spray (don't laugh!). That seems to have done the trick...

In other exciting news, my mom and brother are coming to visit in April! That will be very fun! Until then, I have lots of guests coming in the next few months- a few doctors, our project grant writer and fundraiser, and others. It should make the time pass quickly! I convinced Liz and Kathleen (the other 2 Fulbrighters) to stay here in Blantyre with me for New Year's Eve, so at least we can sit around and miss home together!

Speaking of which, Happy New Year! :)

Saturday, December 29, 2007

Crazy Man

Zach, you will appreciate this:

I was on my way down the dusty road to my house when a man seemed to be approaching my car. He had dreadlocks (unusual for a Malawian), no shirt, and wore torn capri pants. In his hand was a carton of Chibuku ("Shake, Shake") beer - it is beer that comes in a cardboard carton like milk or orange juice. I slowed down to go over a very large speed bump, and he kept approaching my car until he was standing with his thighs touching my car hood. He stared at me like a deer in headlights while I honked my horn several times. He didn't move. I honked again, and motioned for another person on the side of the road to help me. No one would help. With my heart starting to pound, I locked the door and let the car roll a little bit. The man dropped the beer and put his hands on the hood of my car. I couldn't move. (Zach likes to do this to me as a joke when he doesn't want me to leave, except that is funny and this was not). So, I just started to drive, and let the corner of the car brush the guy's leg. I think it pissed him off, so he punched my car window really hard as I drove off. AHH!

That's the story for today. That plus the fact that I bought tons of stuff for the new apartment. Guests start arriving Jan 2!

Thursday, December 27, 2007

Building endurance for medical school I guess...

WHAT A DAY. What I am about to try to do is to give you all a glimpse of the craziest day I have ever had in Malawi. If you get bored, well then, stop reading - and don't volunteer in an area with the poorest nutritional status of a developing country.

We started this morning at 5:30am loading up our truck with all the supplies - milk/peanut chiponde, soy/peanut chiponde, likuni phala (read earlier posts if these foods sound foreign to you), our data cards, measure mats, electronic scales, plastic bags, toilet paper, plastic spoons for eating chiponde, weight-for-height charts, randomization envelopes...the usual list. We started off for Chikweo, a small village to the North-East of Blantyre. Chikweo is part of a larger network of villages called Chipolonga, in a district called Machinga. This is the area of Malawi with the poorest nutritional status in children under 5. We drove the hour drive out to Chikweo and were greeted initially by just a modest number of women with their children slung on their backs. My nurses gave their normal introductions, I muddled through some Chichewa greetings (Hi, my name is Danielle. I am from America. I work with the College of Medicine in Blantyre...they laugh, my accent sucks). What proceeded after this very orderly and warm welcome was mass chaos:

We asked moms to try to make a line at the measure mat, which was situated at the front left corner of the open walled building we were working in. From the measure mat, we wanted them to move to the front right corner for me to weigh the child. With both height and weight measured, I could immediately determine if the child is malnourished, and if so, how severe. This however was wishful thinking. The idea of standing on a line is not only incomprehensible, it is IMPOSSIBLE. So rather than any sort of orderly flow, I had babies being handed to me from the front, left, right and behind! And, despite me standing on top of a table and making an announcement (in English, translated to Chichewa) asking the moms to please, please work with us and stay orderly, women continued to push and push until my table was nearly pushed all the way back against the wall. The crowding caused every under 5 child to join into a cacophonous screaming fest. I'm not talking sobbing, I am talking screeching and wailing and screams that reminded me of Mariah Carey. And what could go better with all those tears than a few temper tantrums, kicking me, pinching me, biting me, scratching me and oh of course - peeing and pooping on me and the scale as well. Great fun, eh?

So what why didn't I simply title this post - The Terrible, Horrible, No Good, Very Bad day? Because we enrolled a total of 40, yes, F-O-R-T-Y!!! children in my study. That is huge! First off, for the study - that is a significant number of children added to our total count. For the children, that means that we've reached 40 children who were on their way towards adding to the number of children who are severely malnourished in Machinga. As much as this day was exhausting and challenging, that is pretty damn rewarding.

Anyway, this blast of an afternoon continued from 7:30am until approximately 3:30pm, with an estimated 400-500 children participating in the symphony of screams. From there, we had to take a child to the district hospital for some very terrible skin rash (I won't describe this, it will gross all you non-doctor type people out). From there, we headed back to Blantyre, a 3 hour drive home. You know that you have been in the car too much when you start the day out listening to the soundtrack to Lion King, and then proceed to listen to albums ranging from Celine Dion to Dispatch to Kanye West to VNV Nation. The drive home was at least pretty - the country is so green now and there are neat rows of planting on every last inch of ground. Even along the highway, someone is out with their hoe softening the ground and making mounds to plant their crop. There are thousands and thousands of mangos stacked up on the sides of the roads as well - small yellow ones, larger green ones, huge red ones. Women also make piles of freshly chopped corn stalks and hold the whole stalk out in the road as your car drives by, hoping that one car will stop and buy an ear or two.

After a very jarring ride all over Blantyre to drop all my staff members home at their houses (we came in too late for them to take any public transportation, it was dark), I finally got home at 8:30pm. So, that is about a 15 hour day, or so...and thus the title of this post. So, maybe its not the real 18 hour deal that I hear about from residents, but it was good practice. And guess what, this is a wash, rinse, repeat type work- we resume tomorrow morning at 5:00am.

Now, don't you all wish you were here? Can someone pass the Malawian gin and tonic please?

-dkm
PS. I am not reading this over to proof read it. I hope you made it through the run on sentences, poor grammar, misspelled words and what ever else is sprinkled in. I'm exhausted, I promise to pay more attention next time. :)

Monday, December 24, 2007

Yabwino Christmas!

Ho, ho, ho, hello,

Season's greetings everyone! Things in Malawi are, well, WET. If it were only like 85 degrees cooler, we would be looking at a record breaking white Christmas, but we are having flash flooding instead. It is at times like these that you appreciate the brilliance of having the 4 seasons.

I spent the day today finishing decorating Project Peanut Butter's second apartment/house. I'm actually really excited with how it turned out - deep chocolate brown couches, earthy tones of brick red, greens, golden yellows, and khaki colors. I bought a really nice kitchen table today, a book shelf, mattresses for the 3 beds in the house, hung the curtains, and hired an electrician to install the stove and the fridge. It was quite a productive Christmas Eve! Visitors of PPB will arrive on January 1, 3 and Dr. Manary on Jan. 5 so I had to spend significant time today to be sure everything was ready when they arrived in the new place.

Tonight, my Fulbright friend Kathleen and I cooked a nice dinner of chicken caccitore, rice and of course, mango salsa (what would a meal be here without a 0.007 cent mango accompaniment?) The other Fulbright, Liz, is out in Neno village for the evening, and we miss her!

I will write again soon! Merry Christmas to all, and to all a good night.

-dkm

Tuesday, December 18, 2007

Holiday Cookies and Hysterectomies

Nothing can put you in the holiday spirit more than snow on the ground, Salvation Army Santa's ringing bells at the mall, and the window displays at Saks and Bloomies. But, since I am sporting a watch tan after just one day in the sun and the Salvation Army delivers here rather than collects, I have turned to baking cookies and listening to the soundtrack of Love Actually to remind me that it is in fact December. And what could bring family (me and Ella) together more than...getting Ella spayed. At least there will still only be 2 stockings up this year, mine and hers, and no new kittens. (ha...just kidding, we don't really have stockings...)

This past week has been pretty hectic as we are opening up 4 new centers for my research in the next two weeks or so. Tomorrow will be another trip out to the villages for the night, soon to be part of the normal weekly routine. The research is moving along, but this will help increase enrollments so that I can stay on schedule to finish the study on time. The goal is 1200 children and we are probably just a bit more than halfway through enrolling.

Other than research work, I went to a gospel "concert" last Friday night that was less than exciting but at least a change of routine for Friday nights. The performers all had recorded their own albums, but the show consisted of them telling the DJ which track number to play and the singer lip syncing with the CD. It did not sound like the gospel you'd think of in America, but more like music you'd hear on the beach in the Caribbean sipping on some frozen drink. The only difference is that the lyrics to those songs probably mean, "Don't worry, keep drinking" and the lyrics here were more like, "Start worrying, stop drinking". Still, it was fun to experience the Malawian music scene.

I will post again before the holidays, but in case you don't read again until after - Happy Holidays and a Healthy New Year!

Thursday, December 13, 2007

251152

That is exactly how many miles my car had on it when I pulled into the gas station this afternoon. Look at that number, perfect symmetry. Well, maybe if it were 251125 then it would really look like someone held a mirror up between the 1's. Anyway, it amused me.

I have spent the last two days mainly in the car - driving out to the far villages of Namandanje. It really felt like we were driving to the edge of the world when we got to the village of Chikweo, but that was nothing compared to the second leg of our trip this morning, out to a place called Ngokwe. I am sure GoogleEarth does not have Chikweo or Ngokwe, but if it did, you'd find Ngokwe about 8km from the border of Mozambique on Malawi's south eastern border. (Mozambique surrounds Malawi from the south west around the bottom of the country and almost all the way to the north east side of Malawi. Tanzania and Zambia make up the northern borders.) We met with the most senior health officers to introduce the soya program to their centers. We will be adding these two, plus two others (Ntaja and Mlomba) for a grand total of 11 health centers participating in this study! Talk about community health connections :)

I have to give Sheena a ride to the bus station. More updates to follow!

-dkm

Sunday, December 9, 2007

wrap up of weekend 1

The rains are VERY heavy; the bugs are crawling from every crevice and corner; my kitten is taking over my pillow every night...but I'm happy to be back. This weekend was really very relaxing- Saturday I dropped Laurel off at the airport, did some yoga, and had dinner with my friend Kathleen (one of the 2 other Fulbrights, who now lives in Blantyre about 1 mile from me). We watched one of my all time favorite movies, The Shawshank Redemption, and ate lentils for dinner. Then, (thanks to MEP) I stayed up allll night watching episodes from 24. This morning, I woke up late, picked up Kathleen, did some errands and we went for a nice run to the President's house. Dinner at Liyaka's and now here I am giving you the run down of a quiet weekend in Blantyre.

This afternoon, the boys whose father works around my compound came by asking if they could sweep my porch. I let them, gave them a small payment and made peanut butter and jelly sandwiches for them. By the time they were done, it was pouring, so I invited them inside to play cards and a marble game called Bawo. They are all very adorable - Yohanne, Antony, Valero and Mphatso. I had fun, and even showed them a few magic tricks, which they loved!

Tomorrow it is back to work - 4 am wake up, 4:45am departure. I'll pretend to go to bed, and watch some 24 instead...

Friday, December 7, 2007

happy happy happy happy

I got my first acceptance at Saint Louis University med school.

When I calm down (tomorrow) I'll add some substance to this post. Right now, I am going to....SCREAAM because there is a tarantula next to me. OMG I hate bugs...bye

Wednesday, December 5, 2007

My Adventure, Part II

At the request of many, I have decided to revive the blog and now that I know people are actually reading this, I am going to make an early New Year resolution to post regularly*. (*Note, girls are notoriously bad at keeping resolution, but since this one does not involve the words diet, weight, gym, or alcohol-induced romps, there may be more success.)

I have returned back from a nice month visit home. I interviewed for medical schools, visited friends in all different area codes (thank you to everyone who let me stay with them!), and learned the ins and outs of the 6 and the N/R trains in Manhattan. Thanks to Jacqui, I have a new found appreciation for the crunchy-granola sport of Yoga, and have stocked up on tons of yoga and pilates DVDs. I had to buy a whole new suitcase to transport all the stuff I had to buy for people - lipsticks, perfumes, clothes, digital camcorders, CD players, books, GameBoy Advance games, backpacks, a 5lb bag of chocolate chips, watches, and Nyquil- you name it, someone wanted it. Still, it is fun to be Santa Claus for a day.

Malawi is super pretty now. The rains have made all the flowers start blooming and everything is SO green. The ground and tree trunks are all dark because they are wet, which makes the green look even brighter. It really is beautiful!

This morning, I was on the free shuttle from the hotel to Johannesburg Airport and the following joke was told on the air. Not sure if something like this would be on public radio in the US...:

One day, little Johnny came home from school and heard funny sounds upstairs. He ran up to his parents bedroom, swung the door open, and saw his mom bent over the dresser going at it with his dad from behind. Disgusted, he slammed the door shut and ran back down stairs. A few hours later, when it was time for dinner, little Johnny's dad called his son to come to the table. When there was no response, Little Johnny's dad went to his son's room and opened the door. He saw Little Johnny going at it with Grandma bent over the dresser. The dad just stood there in shock to which Little Johnny replied, "See dad, it isn't so funny when it's your mom!"

Well with that, I'm going to jump in the shower. Just got back from a long run with Laurel (the med student who has been filling in for me while I was home) and got my butt kicked! I promise to write again soon!

Tuesday, October 2, 2007

Updates

Several days have passed again since I last updated this blog. The study is really coming along, with nearly 300 children enrolled in the program and many having already graduated (meaning they fully recovered). We have grown as team to now include 3 nurses, a driver, myself and nearly 35 community health workers spread out all over the Southern region of Malawi. These health workers have been a tremendous help to our project, and as the study grows, so does their enthusiasm. The rainy season (hungry season) is just around the corner, so having a dedicated team will become more and more important. I am hoping to complete enrollments by March, and spend the remaining part of my time in Malawi rolling out an operational moderate malnutrition treatment protocol.

My days are still very long, and Saturdays have been come my day to catch up on sleep. Ella is an adorable kitten, and just about to go to the vet for the first time. I also made friends with some children from the orphanage that is next to my house, and one girl named Tiwonga has promised to teach me some Chichewa on Thursdays when I am not in the field. The children like to come and play soccer with me in the afternoons after I get home from work.

Nothing too much new to add. Of course African moments pop up here and there (a man standing completely naked in the middle of a very busy market this morning, car breakdowns, spontaneous car purchasing by Dr. M, fishing through a huge freezer for stool and urine samples at the hospital...) but generally, all is well and getting more routine. And, being that it will soon be 4pm, it is time for my run - circles in the backyard are really something to look forward to...

Hope everything is well at home. Send some emails :)

-dkm

Monday, September 17, 2007

Catching up on the past 18 days

It has been quite a while since I last updated this blog, and there are probably more stories to tell than I have time to write about. Dr. Manary arrived last Tuesday evening, and since then it has been non-stop and very exciting. Here is a recap of the weekend:

Dr. Manary came to do another study, separate from the research that I am doing here. It is known that people in the developing world do not absorb nutrients as well as people in the west. For example, a person living in the United States will likely absorb 97% of the fat that they consume compared to a Malawian who absorbs about 91%. This small difference is not enough to make the person here fall ill, but in children it has been attributed to growth faultering. When you take a biopsy of the affected individual's bowel, you find that the villi have less surface area and have been flattened compared to a normal biopsy. If you remove the affected person from the environment, they will regain normal bowel absorption function. Similarly, if you put a Westerner into the environment of a Malawian, their absorption will decrease, thus this is definitely environmental.

In order to test this, we collected urine from children for a period of about 16 hours. We gave them a sugar solution that had four sugars, each absorbed at a different place in the body's digestive system. If we find these sugars in the urine, we will be able to identify where the "leaky" part of the system is. As treatment, we are giving these children antibiotics twice a day for 7 days. We hope to find improved bowel absorption after the antibiotic treatment (we will do more urine collection in October).

We had 147 children enrolled, and so far...EVERY child gave urine without any problems (I would NEVER have done this as a kid) and they have all showed up for their medicines twice a day! Amazing compliance! We have 4 medical students (one from England, two from Holland, and one from Germany) who are helping us this week, and are staying up near the village.

Now I am back in Blantyre and continuing with my research. We are now working in 6 centers and have well over 150 kids enrolled. Last week, we went to a village hidden in the hills along a path that has seen few cars in its day and screened more than 100 children and found no children with true malnutrition. It was unbelievable. Apparently, this is a very fertile location and the farms are doing well here. Unfortunately, stories like this are few and far between. Last week, I enrolled a boy who was 7 months old and weighed 2.8 kg. I saw him today (one week later) and he gained 0.2kg, which is phenomenal for a child that small. He was even opening his eyes and smiling a little bit. I promise you that you have never seen a child this tiny. Three kilograms is 6.6 pounds, but unlike a newborn, this child was not nice an plumpy with baby fat. I'm just happy that he has a good appetite and is taking the food well.

There are so many other things to write about, but I think I'll save more for later. Send emails! I miss everyone from home :)

-dkm

Saturday, September 1, 2007

Playing mpira brings all the boys to the yard...

Mpira is football - soccer - and today I had a fun afternoon playing with the boys who live around my house. They are between 7 and 13 years old and we had a blast. It started with them asking to race me across the yard when they saw me running my laps as I do each day...and that 13 year old boy (Johann) is SO fast. The first go at the race I thought, I wouldn't run to hard (I also didn't know how old he was). He smoked me. So I tried much harder the second race, and only barely stayed ahead of him. After the third race, we played football with a ball they made from crumpled up plastic bags and rubber bands. It was 2 on 2, and my team won (me and Antony, 7). Anyway, it was a nice way to finish up a long week of work and med school applications. They speak a little English and always love teaching me new words (mpira today!). I had a great time playing with them, and gave them all sodas for being great teammates :) Very cute!

This week will be very exciting because we are opening three new centers. Check back later this week for research updates!

Anyway, its after 11:45pm and I am totally pooped. The past two days we have had a visitor from Italy who is interested in manufacturing and using chiponde as therapy in Zambia. I'm ready for a nice sleep...if only I didnt have this cold...

Saturday, August 25, 2007

Who would want to climb Mt. Kilimanjaro when you could run a MARATHON around it!?

Absolutely not related to work in any way, but...there is a marathon in the foothills of Mt. Kilimanjaro in Moshi, Tanzania in March. I happened to come across it in some Runner's World email or one of those. Although the race would probably be over before I got to mile 4, that would be a pretty awesome place to run. It would mean running a lot of laps in my backyard...

Monday, August 20, 2007

Remember when you celebrated day 100 in elementary school?

So it is almost time to celebrate 100 children enrolled in my study! I'm thinking 100 tambalas (= 1 Kwacha = $0.007) since it may be hard to find 100 pieces of Trident Spearmint Gum or 100 pieces of macaroni...

Today, I opened a third site at a village called Chamba and we probably screened more than 90 children in about 2 hours. We are all getting this down to a science from teaching the village health assistants, to setting up the most effective "patient flow" model in the field. I just wish there was a way to get from here to there without having to leave at 4:45am...and that is before the rains are here! I hope the cars hold up, it's always great to make it out and back without a visit from a mechanic or the help of some boys along the road.

Anyway, the day to day stuff is going well too. There are always lots of logistical issues to deal with, but those are boring details of research...and adjusting to the concept of "African time."

For now, I should work on secondaries for med school applications, watch an episode of House, read some "Unbearable Lightness of Being," and get to bed. Another early morning awaits.

-dkm

Wednesday, August 15, 2007

These are the days of miracle and wonder...

Today was great. I doubled my enrollments in Mwakwila village, increasing the total from 24 to 48 children enrolled in the study. We saw about 90 moms in about 2.5 hours. It was really incredible. In Malawi, it is very common for women to sing songs about just about anything. It is almost like watching a Broadway show (like Grease) when all the characters just all of a sudden burst into song and all seem to know the words. Our nurses will just say, "amai, imbira pamodzi nyimbo" ("Moms, let us sing along") and the words are "Chiponde ndi mankwhala" meaning "Chiponde (peanut butter) is medicine!" They sing it over and over in a tune that everyone knows, and they clap and dance. It's great. So, I've at least learned the song, even if my Chichewa is pretty poor. We had representatives from the Clinton Foundation visiting with us today, and I think they really enjoyed watching a clinic in full swing. It gets pretty hectic, but we have 2 nurses, 8 health assistants, 1 food distributor, and me...so its a big team!

After the clinic, Rosemary (one of the nurses) and I went to look for one mom who we have been helping out a little extra. She has 7 children, and she and the last born are HIV+. She walks about 7 miles every two weeks to come to our clinic for her daughter. Last time I saw her, she was still doing well, but we didn't find her at the clinic today. We learneds she had been admitted and was in poor condition. So we went to visit her at her room, and to bring her some things we collected this week (flour, sugar, and some soap). I guess I've never really seen someone actually dying of AIDS. I've met so many HIV+ women and children, and I see orphans whose parents have passed way from AIDS, but seeing someone I knew dying is really difficult to deal with. I told her that we better see her in two weeks...but she pointed to the sky and told me it will be G-ds choice. It was really hard to keep it together in the room with her. These are the people that make you want to be there to help, but it's so hard. I better toughen up.

Well, there is always more to tell, but I'll call it quits for today. Me and Ella (my kitten) need to get back to work for tomorrow.

-dkm

Sunday, August 12, 2007

A New Friend

Shhh...don't tell my puppy, but I got a kitten! She is SO small, probably less than 1 pound but she wont stay still long enough to stand on the scale. I have named her Ella, since I have Mr. Charlie "Chester" Parker, my boxer at home. Ella is all different colors, but her face is half orange/white and half black/brown. She likes to nestle herself between my chin and my neck, and crawls up onto my shoulder while I do chores around the apartment. I got her last night, and she slept on my pillow all night with me. She's so cute! Anyway, she keeps me company :)

Just wanted to share the news!

-dkm

Saturday, August 11, 2007

Some funny things to share

Everyday we see and hear something strange. These are the things that make the day interesting, and since I can't share them at the dinner table, I thought I'd just put them up here for all the chuckle about...

Today I was driving behind a minibus, and there was an ad taped onto the back window saying "WIFE WANTED. CONTACT 09 290 051." Hey, nothing wrong with being straight forward right?

Yesterday, I was driving one of my nurses home. She's sweet, but between the two nurses, shes a bit more...manipulative. I am contemplating getting a kitten to keep me company, and I asked how to say cat in Chichewa. She said "Shashi". I thought that was adorable and thought I'd name the cat Shashi. I came home and told my wonderful house helper, Sheena, and said "Sheena, I am thinking of naming it Shashi!" She looked very suprised. I said, "it means cat in Chichewa right?"...apparently cat in Chichewa is "mpaka" and shashi is a very slang word meaning "very rich person." This is make for an interesting conversation at work on Monday...

Well, besides the usual weird things you see here - rats being sold fried on a stick along the highway, guys begging you to buy mops when you pull up to get gas - that's about all for now. I'll keep you all posted....

Now I need to add the prospective husbands phone number into speed dial. You never know when you might need one of those guys around... just kidding

Friday, August 10, 2007

Life is a road and I want to keep going...

Three Weeks! Things here are moving along well, and I am preparing to open my third research site in a village called Chamba. Our days are quite exhausting, but its easy to be motivated when you are surrounded by such warm people. I love my team, and the HSAs (village health providers) are so eager to help. Here are some of the highs and lows of the past week or so:

Last week, we had a small fender bender on Sunday night. We (the other student researcher, her boyfriend and I) were hit by a man who claimed to be a detective. Funny that his car wasn't insured or registered properly... It was cold and rainy out, so we agreed to touch base sometime on Monday to figure things out. Luck for the driver, she left Malawi on Monday morning! Anyway, once the guy found out I wanted to go through insurance, it seems he may have changed his mind. Perhaps now he'll think twice about driving an unregistered/inspected vehicle...

This past Tuesday I visited a Buddhist monastary. It was the most interesting place - so spiritual. The "master" monk, an "enlightened soul" as they refer to him, apparently had a vision while in Taiwan that he was meant to open 50 orphanages throughout Africa. He has opened a huge one in South Africa, Zimbabwe, (one other African country) and now Malawi. This place was absolutely incredible. It was hard to believe I was still in Malawi. The builds were incredible. Every detail was attended to, with even the tiles having been imported from Taiwan or mainland China. Currently about 200 orphans live in beautiful little self-standing dorms. They have bunk beds that sleep 10 to a room, but the place is immaculate. Every bed made, every shirt hung and pant folded. The master did a prayer for us, a chant or mantra and explained all about the curriculum these children have. They learn meditation, kung fu, chinese and basic principles of buddhism, but just the basics. It must be very difficult to adjust the children to life in this monastary. The temple is enormous, with HUGE (and I mean HUGE) gold statues of different buddhas. It was an incredible experience.

And today I was reminded of why this research is so important. An elderly woman brought her grandson, Matalitso, to us two weeks ago. The child was born in September 2006 and weighed just 3.0kg or 6.6 pounds. I think I weighed more than that when I was born. Today, just 2 weeks later, the child has gained almost 1 whole kg! I still don't think I have seen a child that wasted, his skin was paper thin and hung from his arms as if an oversized shirt. We fed him at the clinic, but he struggled to swallow. He is too sick to be enrolled in my study, but he is still recieving our RUTF food for therapy and I only hope that he makes it back in two weeks for follow-up. His mother passed away, and his widowed grandmother is left to care for him all alone. This is why I'm working here.

I hope you are all doing well. Please write me emails, call me, or for the really ambitious, snail mail. I miss everyone - whereever you all are!

Wednesday, August 1, 2007

Time Flies When...

Since my last entry, so much has happened that it will be hard to catch-up in one (readable) post. So here goes:

I opened my first site on Friday, July 27 in a village west of Blantyre called Mwanza. It is a relatively large district hospital, and we arrived early in the morning. Each Friday, a singing/acting/dancing troupe performs skits related to health topics. I enjoyed a small show about how important it is for husbands to respond to their pregnant wives. In the skit, a stubborn man ignores his wife and his dismissal of her needs ends with her dying from preventable causes during childbirth (if you took Dr. Wall's classes at WashU - this is Why Mrs. X died in action - and why I want to do international medicine). Anyway, this play drew a HUGE crowd of people and everyone was singing and dancing as they learned about this issue. Very creative way of educating people who live far off the paved roads.

At Mwanza, we screened somewhere around 120 children, of which about 20 qualified for my study. Today, in another village called Mwakwila we screened about 50 children and enrolled about 12. It probably doesn't sound like huge numbers, but things here grow by word of mouth and I am really excited about this initial turn out. Today many of the children were severely malnourished and many were HIV+, which makes them ineligible for my study. It is so hard to see so many moms come to the clinic with children who are so sick. But, at the same time, it is also so wonderful to see their huge smiles when peanut butter gets stuck to the roof of their mouth. There is so much work to do here, but even since last year when I was here, so much progress has been made.

In between these visits, I travelled to Lilongwe, the Capitol of Malawi, to meet with the US Ambassador, Alan Eastham and the Fulbright advisors. After a tough interview from Ambassador Eastham, I was warmly welcomed and it seems that there are a lot of organizations who have heard of this project. I am going to present to the alumni organization of Malawians who went on Fulbrights to the US. Also, the Rotary club and a few others have asked about the project - all very exciting!

So, that is the gist of the work here. It is a lot of traveling - many nights in bed by 9pm and up by 4am. Somehow, in Africa, it feels refreshing to go to bed early and wake up at sunrise. And, plus, it means back in the states you can call me as you go to bed and I am waking up!

Send some emails (DMatilsky@gmail.com) if you have a chance - or if you are ever at a Mobil station and venture in, pick up a $5 African calling card and give me a call! (011-265-9-921-656...dont forget the time change! 6 hours ahead of EST, and 7 after daylight savings - they don't do that in Malawi).

Miss everyone at home!

-DKM

Tuesday, July 24, 2007

Settling in...

With the first week almost behind me, I am getting adjusted to life in Malawi. I have had a lot of time to think really carefully about my study that begins this Friday. I thought that since there hasn't been any crazy stories yet to tell, that I would take the time to tell everyone a little about what I am doing here.

Malnutrition in Malawi accounts for 70% of the stunting (not growing enough) in children. Project Peanut Butter has developed a way to treat severe malnutrition using "chiponde" or Ready-to-Use Therapeutic Food (RUTF). This food is like peanut butter, and has 5 ingredients: peanuts, powdered milk, oil, sugar and vitamins. It has incredible recovery rates, especially compared to traditional treatments (flour blends to make porridge with).

The study that I am doing is looking to see if it is possible to switch the powdered milk ingredient with soy. Why? Powdered milk is an extremely expensive commodity and is not produced locally in Malawi. Project Peanut Butter must import the powdered milk from places like South Africa, making milk cost 4x the price of any other ingredient. Soy, on the other hand, is locally grown and we can grind roasted soy beans into a flour that acts just like the milk. What we hope to find is that children recover equally well on a soy/peanut blend as they do on a milk/peanut blend. Since the corn/soy blended flour remains the standard of care for the treatment of malnutrition, we will include this as the third food group and control.

On Friday, we will go to a village called Mwanza to screen children to be included in the study. Children must meet 3 important criteria: 1. They must be aged 1 year to 5 years old; 2. Their mother must not have walked more than 1 hour to get to the clinic; 3. The child is moderately malnourished (versus severely malnourished. These differ by how far the child is from ideal body weight). We are looking to have 1200 children in the study.

So, that is it, in a nut shell. I'm pretty excited, and if this study is successful, this could completely change the standard treatment for malnourishment in rural settings. I am very grateful to Dr. Manary and Fulbright for letting me come do this work!

Anyway, that's all for now. I'll definitely post again after Mwanza on Friday.

-DKM

Friday, July 20, 2007

My Arrival in Malawi

Well, I made it! Here it is, the very first entry from ICON, the internet cafe down the street from my house. Blantyre is exactly how I left it- same store fronts, same sounds and smells, same smiles. I was welcomed at the airport by Lacey (a WashU med student)and Liyaka (one of the PPB team members and a friend from last visit here). I'm excited, tired, and a bit nervous, but I am looking forward to getting my feet on the ground here. It's going to be a great trip, and the study is set to begin this coming Tuesday!

It has been quite a long journey (left NY on Wednesday night and arrived in Malawi on Friday night!) so I think I'll leave this entry short and sweet. I hope everyone who reads this will share the excitement of this trip and will send me emails from home. Miss everyone already!

-DKM

Saturday, June 9, 2007

First Entry

Seeing that many of my peers have set up "blogs" to chronicle their oversea adventures, I decided to give it a shot and see if I like the idea of blogging. I'll be leaving for Malawi on July 19, 2007, so look for updates after that...this is just a test post!