My apologies- it has taken a while for me to get the chance to post this, but I just had to post the saga of my journey home... it lived up to every expectation I could have had.
Just as a child would carefully set up a line of dominos and hope that the dog wouldn't wag his tail into a middle block before he had a chance to push down the very first piece, I set up my trip home meticulously and with a plan. I'd leave Malawi on Monday, arrive home on Tuesday, beat the jet lag by dinner on Wednesday with my mom, spend Thursday night with my dad, and then head to Philly to see the gymnastics Olympic Trials with my best friend on Friday night. I bought the tickets in advance and even looked into Amtrak from Penn Station in NYC to Philadelphia on Friday. But, the dog wagged his tail...
I arrived at the airport nearly in tears on Monday morning. Zach, Rachel and Kathleen came with me, and it was very hard to say goodbye. They each handed me cards with specific instructions not to open the cards until I was on the plane. I bargained with the check-in representative to pay less for my overweight bags, cried when I said goodbye to my friends, and then noticed the departure board said "Air Malawi - Delayed Indefinitely." Hmm, interesting. My friend (Grosi) is a customs agent at the airport and I asked him how long he thought indefinitely meant...a day? A week? He didn't know. We went upstairs to the airport restaurant (see previous entry and figure out why I refused to accept the free meal). I played the azungu role and bought him a coke, and we chatted at the table for a while. From his radio, I pieced together more of the story:
At one point in time, Air Malawi had 4 aircraft - 3/4 are now not functional. The fourth plane was in the hanger for service. The plan was to charter another plane from Kenyan Airways and the flight was supposed to arrive from Nairobi in time for our 1:25pm departure. By 5pm, there was still no airplane. When an Air Malawi representative finally dared to stand up in front of all the angry people, her explanataion made me chuckle. Air Malawi had never transferred money for fuel for the airplane so the flight was grounded in Nairobi, waiting for gas money. By the time funds were transferred and the plane arrived, I had already missed my connection in Johannesburg. I was scheduled to fly from Joburg to Frankfurt and then Frankfurt to NYC.
Fortunately, I met a really nice guy who worked for PIH. He was on a whirlwind of travel and had to get to Durban for a conference. I recognized his accent from home and we quickly realized that we both were friends with Liz. It helped to have a friend to go through the shuffle of travel. Air Malawi paid for a hotel room for each traveler, though we hardly spent any time there. We got out on the first shuttle back to the airport in the morning - something before 6am. I wanted to get there early enough to get on whatever the earliest flight to NY would be...too bad the airport was essentially closed until 8am.
It is now winter in Joburg, the airport was under major construction so the walls were mostly made of contractor bags, and I was freezing. When the airline offices finally opened, getting me home initially looked like a major challenge. I spent 3 hours in the Air Malawi office trying to get on a flight. The only thing they could do for me was a 7pm departure to Frankfurt - talk about a 12+ hour layover. And, while the Joburg international terminal is actually very nice, I couldn't get there because you can only check in 3 hours before departure. I took my bags, piled them on a trolly, and jumped on the top. I started (and finished) the book, "A Thousand Splendid Suns," slept a bit (but was woken up by a guy who told me to 'watch your sh*t, it's gunna get stolen), and made friends with a waiter who let me hang out at a table for a while at the only coffee shop on that side of security. Hours and hours, and hours, later, after arguing with the luggage guys about not paying again for overweight bags, I crossed into the nice area of the airport, and made it to my Lufthansa flight.
Upon arriving in Germany on Wednesday morning, I had to wait again on yet another check-in line. This rude German guy kept cutting me (more than once- he switched lines and then came back and cut me again!)Fortunately, I was able to bump my flight up a few hours and I got home in the afternoon on Wednesday...just enough time to settle in, say hi to my family, and head to Philly for a fun weekend with Nicole.
I suppose that's enough of a travel saga. I may come back and post one last time, but I hope that I was able to share some of the fun I had this year. I know I'll come back and reread these posts once the med school grind starts and I'll wish I had my Malawi routine back - 4:15am wake ups, sunrise drives, babies and babies and babies, fun runs with the girls, Hunters, cabbage salads, and DVD TV... I'm sure I'll be back - I caught the Africa bug :)
-dkm
Monday, July 14, 2008
Saturday, June 14, 2008
333 down, 2 days to go
It seems perfectly fitting that on my second to last morning in Malawi, regardless that this is a Sunday, I should wake at the ever famous 4:30 am hour. The morning has changed a bit since the far off days of heavy rains and muddy roads - I find myself now clutching a hot cup of coffee to warm my fingers and fight off the chill of this African winter morning. I am somehow comforted by the incessant honking of the minibuses (even at this hour!) that I am hearing now for one of the last times. The nostalgia is hitting now, my last night sleeping in under the protection of my bright blue mosquito net, the last time I'll shop in Blantyre market, the last time I have to say no when a vendor tries to convince me that, "looking is free madam. Just look. Nice things, cheap prices. Looking is free." Here I am, pressed up against the window to keep my internet signal, already missing my African mornings. I have one (maybe two) runs remaining to feel like a celebrity ("azungu! azungu!" I run with you!"), one night to cook a big dinner with my friends, and one last day to drive past the curio market and hear, "Daniel, Daniel!" from every vendor. I suppose I'll have some serious adjustments to make as I re-acclimate to American culture- I'll have to start thinking in dollars and not kwacha, and I'll probably have my work cut out for me to catch up with the current fashion styles. Somehow, I don't think chitenjes came into fashion in the US while I was gone...
I wrote an entry a few days ago and intended to post it, but never managed to load it. It had a political flair to it, though I am certainly no one to make any insightful political comments. However, I must share the funny part of that post. As I have probably mentioned in previous posts, Kathleen is also wrapping up her days here in Malawi. She has been working hard to get all 1,350 interviews translated from Chichewa to English so that she can do some serious data analysis when she gets back home. She has had three people helping her with the translations, and she has been furiously typing their handwritten transcripts into word documents. In doing so, she has come across some really funny responses from her interviewees:
Q: Do you support any political party and if so why?
A: "No. I support nsima and G-d." (recall that nsima is the staple food here, made of corn flour and water only).
Absolutely perfect answer.
Dr. Manary and his son arrived yesterday, and another medical student, Meg came a few days before. The house is filling up, and I'm sure it will be nice when I get all my stuff packed up and out of the house. I know saying goodbye will be really difficult, but I know it will only be temporary before I come back to this neck of the woods. I will probably write one final entry, maybe my last in Malawi or maybe from home...I'm going to miss the blog!
-dkm
I wrote an entry a few days ago and intended to post it, but never managed to load it. It had a political flair to it, though I am certainly no one to make any insightful political comments. However, I must share the funny part of that post. As I have probably mentioned in previous posts, Kathleen is also wrapping up her days here in Malawi. She has been working hard to get all 1,350 interviews translated from Chichewa to English so that she can do some serious data analysis when she gets back home. She has had three people helping her with the translations, and she has been furiously typing their handwritten transcripts into word documents. In doing so, she has come across some really funny responses from her interviewees:
Q: Do you support any political party and if so why?
A: "No. I support nsima and G-d." (recall that nsima is the staple food here, made of corn flour and water only).
Absolutely perfect answer.
Dr. Manary and his son arrived yesterday, and another medical student, Meg came a few days before. The house is filling up, and I'm sure it will be nice when I get all my stuff packed up and out of the house. I know saying goodbye will be really difficult, but I know it will only be temporary before I come back to this neck of the woods. I will probably write one final entry, maybe my last in Malawi or maybe from home...I'm going to miss the blog!
-dkm
Sunday, June 8, 2008
Home Stretch
Last night, while enjoying an awesome thai-inspired coconut curried chicken dinner prepared by Kathleen, Zach, Rachel, Kathleen and I had a pretty good bout of the giggles as we reminisced about our childhood days in the school cafeteria. We started by debating which candy is best (Reese's Peanut Butter Cups had the majority, but I fought hard for Swedish Fish and the whole Twizzler family). This quickly moved into the best snacks in your lunch box - Chips Ahoy being far below Mallomar's and the ultimate treat being Hostess Cupcakes (the ones with white frosting swirly decoration on the top). Kathleen complained that her lunchbox was never decorated with such great things - "The best I got was carrot sticks, my only hope was to trade..." To which Zach replied, "How did you pull that trade off? Trade with the blind kid?!" Perhaps it should not have been funny, but it did send us into roaring laughter for a minute or two, more for the thought of the poor kid who got convinced to trade a Hostess cupcake for a carrot stick.
All the talk of home - cookies and candies, sandwiches and huge cups of coffee to go - made me realize that I am ready to be back and get into the grind of American life, but that I also really had a huge experience abroad. I do miss some of those things, but really, being abroad has been everything I wanted it to be. I can appreciate the luxuries of home in a whole new way, but I will also miss my life in Malawi. I will miss the fresh produce, the incessant greetings, the formal hand-written letters, having children around every day bringing smiles when you're stressed, the beautiful landscapes, the chance to make a tangible difference in a person's life. Maybe this post is too cliche, but the truth is - I have done something that I know has changed my life. I have seen people come and go, and I've met many people who are very committed to working in global development. But I have also learned that working in this exact environment is not for everyone. I know that this is a world were I could work and be happy, and that is quite a realization.
So as I pack up my bags, wrap up wood carvings, pull down pictures, and take my last drives through town, I am only half sad. I know I'll be back - something I didn't know at the end of my time here in the summer of 2006. I remember leaving then and having tears well up as I wondered if I'd ever see my friends and colleagues again. I don't need to get upset like that again, I know for sure I'll be back.
I probably have one or two more blogs to wrap this year up, hard to believe. Thanks to everyone for reading, I know I've had fun looking back through old posts. I'm glad that I kept this going, and I hope that it gave you a sense of what my year has been like. I never knew this thing was searchable by google (naive I suppose - had I known, maybe I would have paid more attention to my grammar!), but I hope even you random people have enjoyed learning about PPB and St. Louis Nutrition Project.
Until my last post,
-dkm
All the talk of home - cookies and candies, sandwiches and huge cups of coffee to go - made me realize that I am ready to be back and get into the grind of American life, but that I also really had a huge experience abroad. I do miss some of those things, but really, being abroad has been everything I wanted it to be. I can appreciate the luxuries of home in a whole new way, but I will also miss my life in Malawi. I will miss the fresh produce, the incessant greetings, the formal hand-written letters, having children around every day bringing smiles when you're stressed, the beautiful landscapes, the chance to make a tangible difference in a person's life. Maybe this post is too cliche, but the truth is - I have done something that I know has changed my life. I have seen people come and go, and I've met many people who are very committed to working in global development. But I have also learned that working in this exact environment is not for everyone. I know that this is a world were I could work and be happy, and that is quite a realization.
So as I pack up my bags, wrap up wood carvings, pull down pictures, and take my last drives through town, I am only half sad. I know I'll be back - something I didn't know at the end of my time here in the summer of 2006. I remember leaving then and having tears well up as I wondered if I'd ever see my friends and colleagues again. I don't need to get upset like that again, I know for sure I'll be back.
I probably have one or two more blogs to wrap this year up, hard to believe. Thanks to everyone for reading, I know I've had fun looking back through old posts. I'm glad that I kept this going, and I hope that it gave you a sense of what my year has been like. I never knew this thing was searchable by google (naive I suppose - had I known, maybe I would have paid more attention to my grammar!), but I hope even you random people have enjoyed learning about PPB and St. Louis Nutrition Project.
Until my last post,
-dkm
Friday, June 6, 2008
Buying a beast and then some thoughts
With the current price of gasoline at home, I will probably never again have the satisfaction of buying a beast. The days of enormous, 9 seater, four wheel drive vehicles with tires that reach my hips are over. But first thing Wednesday, I woke up and wrote a check for a million-ish Malawian Kwacha and bought just this. I took the Toyota Land Cruiser 4WD Turbo home complete with automatic locks, power windows, seat heaters, and a CD player - on top of being a diesel engine and automatic transmission. Quite a posh vehicle... probably makes the other 7 cars in the fleet feel incredibly antiquated.
On Thursday, Franklin, Zach and I headed out to a district to the west of Blantyre called Neno, the site of Partner's in Health's new healthcare facility. Franklin was once a student of Paul Farmer, the famous founder of PIH and known for this work in Haiti (and the book Pathologies of Power). We met up with Liz, who was out in Neno visiting her boyfriend, and then had a tour of the new hospital, the lab, the outpatient facility, and the housing from the country director, Keith Joseph. Keith is a native of Harlem and a real down to earth guy. It was interesting to see the construction progress, but even more interesting was hearing Keith's comments about working in Malawi compared to his previous work in Lesotho, Haiti, and the Dominican Republic. Our visit was very brief, but enough to get a picture of what PIH is all about, at least here in Malawi. Meanwhile, Mike (MBA student from Duke) came back down to Blantyre for some business meetings. I was able to fit in a good run with him in the late afternoon, and then had a chance to chat about some non-work stuff over dinner, which was nice. One of the best parts of working in development is meeting people from such diverse backgrounds who are all so committed to improving the world. It's pretty neat, and I will really miss meeting these people. I think I'll be a bit spoiled when I get home... dumb guys in bars better save the small talk, lol.
Now, as the days before my return narrow, my main focus has become preparations for my departure and making sure that everyone else here feels as oriented to Blantyre as possible. I took all my extra clothes, shoes, and miscellaneous goods to the curio market to try to trade for novelty items. I found some fun gifts and am excited to bring it all back :) I am really looking forward to a brief break before starting medical school, and can hardly believe how fast time has passed. I am still waiting for WashU, but in the meantime, I am getting excited for Stony Brook. My next move is to find housing and a roommate in the area...that is, after I get back from here...
I can't wait to see everyone at home.
-dkm
On Thursday, Franklin, Zach and I headed out to a district to the west of Blantyre called Neno, the site of Partner's in Health's new healthcare facility. Franklin was once a student of Paul Farmer, the famous founder of PIH and known for this work in Haiti (and the book Pathologies of Power). We met up with Liz, who was out in Neno visiting her boyfriend, and then had a tour of the new hospital, the lab, the outpatient facility, and the housing from the country director, Keith Joseph. Keith is a native of Harlem and a real down to earth guy. It was interesting to see the construction progress, but even more interesting was hearing Keith's comments about working in Malawi compared to his previous work in Lesotho, Haiti, and the Dominican Republic. Our visit was very brief, but enough to get a picture of what PIH is all about, at least here in Malawi. Meanwhile, Mike (MBA student from Duke) came back down to Blantyre for some business meetings. I was able to fit in a good run with him in the late afternoon, and then had a chance to chat about some non-work stuff over dinner, which was nice. One of the best parts of working in development is meeting people from such diverse backgrounds who are all so committed to improving the world. It's pretty neat, and I will really miss meeting these people. I think I'll be a bit spoiled when I get home... dumb guys in bars better save the small talk, lol.
Now, as the days before my return narrow, my main focus has become preparations for my departure and making sure that everyone else here feels as oriented to Blantyre as possible. I took all my extra clothes, shoes, and miscellaneous goods to the curio market to try to trade for novelty items. I found some fun gifts and am excited to bring it all back :) I am really looking forward to a brief break before starting medical school, and can hardly believe how fast time has passed. I am still waiting for WashU, but in the meantime, I am getting excited for Stony Brook. My next move is to find housing and a roommate in the area...that is, after I get back from here...
I can't wait to see everyone at home.
-dkm
Saturday, May 31, 2008
Girls Weekend Retreat
With just 17 days to go before I head back to the States, Kathleen, Liz and I decided to take a short weekend retreat to a small town 60 km northeast of Blantyre called Zomba. Zomba was once the capital of Malawi and is set at the base of an incredibly scenic plateau. The streets at the bottom of the mountain are lined with very tall blue gum eucalyptus trees and as you proceed up the plateau, the landscape becomes decorated with lush greenery and strikingly red flowers. Young boys wait along the side of the road with freshly picked strawberries, raspberries, gooseberries, and passion fruits, as well as crystals harvested from the mountain rock face and decorated wicker baskets. We saw several baboons and a few other monkeys as we made our way along the very windy road to the top. Kathleen has a family friend who was once in the Peace Corp in Malawi (in the 60s) and now is directing an NGO based here in Zomba. He is back in the States for a visit, so he offered to let Kathleen stay in his enormous house as much as she'd like while she wraps up her research.
At the top of the plateau is an enormous lodge and restaurant called the Ku Chawe Inn. It has several levels, with low ceilings and many archways leading from room to room. Walking through the darkly lit rooms with dark wood furniture and brick walls is reminiscent of a gothic castle in Western Europe. The house staff are extremely accommodating; drinking tea and looking out this brick arched window makes me feel extremely colonial. We came up to the Inn in order to access the internet - because what would a retreat be without a little work and a little stress? There is no internet access at the house where we are staying, so we took advantage of the excuse to trek up the mountain.
This afternoon, we'll head out for a run along the very narrow and windy roads (don't worry, there aren't many cars around so this is not dangerous). I am looking forward to a quiet and beautiful run, in stark contrast to the runs I've had in Blantyre through crowded streets, dodging little kids, cars, piles of sugar cane and peanuts, or minibuses. The steep grade of the mountain will certainly give my butt an extra kick today...
After the run, I'm sure we'll open some wine, cook a great dinner (we brought chicken, corn, green beans, and lots of salad stuff with us) and probably fall asleep watching some classically girly movie like "Mona Lisa Smile," or possibly something light and humorous like, "Hitch." Tomorrow morning we'll make oatmeal pancakes (recipe ala South Beach Diet...they come out great!), squeeze in another pretty run, and head back to Blantyre. I have a lot of work to do for my research report and with all the commotion of the newly arrived project members, my hands will be full for the next few weeks.
-dkm
At the top of the plateau is an enormous lodge and restaurant called the Ku Chawe Inn. It has several levels, with low ceilings and many archways leading from room to room. Walking through the darkly lit rooms with dark wood furniture and brick walls is reminiscent of a gothic castle in Western Europe. The house staff are extremely accommodating; drinking tea and looking out this brick arched window makes me feel extremely colonial. We came up to the Inn in order to access the internet - because what would a retreat be without a little work and a little stress? There is no internet access at the house where we are staying, so we took advantage of the excuse to trek up the mountain.
This afternoon, we'll head out for a run along the very narrow and windy roads (don't worry, there aren't many cars around so this is not dangerous). I am looking forward to a quiet and beautiful run, in stark contrast to the runs I've had in Blantyre through crowded streets, dodging little kids, cars, piles of sugar cane and peanuts, or minibuses. The steep grade of the mountain will certainly give my butt an extra kick today...
After the run, I'm sure we'll open some wine, cook a great dinner (we brought chicken, corn, green beans, and lots of salad stuff with us) and probably fall asleep watching some classically girly movie like "Mona Lisa Smile," or possibly something light and humorous like, "Hitch." Tomorrow morning we'll make oatmeal pancakes (recipe ala South Beach Diet...they come out great!), squeeze in another pretty run, and head back to Blantyre. I have a lot of work to do for my research report and with all the commotion of the newly arrived project members, my hands will be full for the next few weeks.
-dkm
Saturday, May 24, 2008
The Art of the Bucket Shower
It seems as though in my final few weeks, I am returning to the days of the bucket shower. Over the past 10 months, there have been days here and there where the water has refused to run from the tap, or the electricity conveniently gets cut just as dinner is about to hit the stove. But this week, the shower really put up a fight, relentless for 6 days, and leaving me, my bucket, and my red plastic cup to face-off with shampoo and conditioner. Fortunately, the electricity has mostly cooperated this week.
If you don't have the proper technique, bucket showers can be messy activities. Water gets splashed in all the wrong places, any efforts to shave your legs are in vain because you keep getting goosebumps from the cold, and you can find yourself stuck with shampoo in your hair and your bucket dry. You need a sizeable bucket filled 3/4 of the way with water (that you would have certainly been keeping for these emergency situations in large drums in the kitchen), and 1/4 with boiling water. At least you won't freeze. Then you're aiming for speed and efficiency - somehow get the shampoo out and the conditioner in, spread the suds, and conserve the water as you rinse off. Unfortunately, if you are reading this from somewhere in America, you probably will not ever get to practice. I'm sure you're thoroughly disappointed.
* * * * *
In other news, the houses are slowly filling up... On Saturday, Franklin arrived. Franklin is a pretty accomplished guy, undergrad and PhD at Harvard, med school at WashU, and now matched to Mass General Hospital for residency in internal medicine...all by 31. Things have been very low key since his arrival as Sundays in Blantyre tend to be. We did go by the trade fair, an exhibition type thing where several countries displayed their artisans' work and sold some great gifts.
On Sunday, "my boys" all came by - Yohane, Antony, Luca, and some new boys - Chisomo, Chikondi and Julio. Chisomo is an adorable 13 year old boy whose father has passed away and whose mother lives in a village where she has no land to farm or job to do. He came here looking for "ganyu" - small job that he could do for some cash- in order to buy fabric to sew his own school uniform a few months back. Yesterday, he came unexpectedly and hadn't eaten anything in 2 days. He is living on his own with his sister, in a slum area near Blantyre. Yohane and Chikondi helped me in the kitchen to prepare nsima, spinach relish and eggs to feed Chisomo. I also found some sugar, oil, flour, ground nut flour, and washing soap to give him, in addition to a clean shirt, a pair of flip flops (as he has no shoes), and 20 Kwacha (14 cents) for a hair cut. It turned out to be a fun afternoon, cooking, playing bawo, and practicing Chichewa.
It is now early on Monday morning, exactly 3 weeks until I come home. I am going to take Franklin to the Malawi Bureau of Standards, as one of his charges while he is here is to figure out a way to measure protein and fat content in RUTF in our own factory. Franklin is going to try to see what machinery is available in Malawi and how we could adapt it to run these tests. Additionally, he is going to assess the hospital lab to see if a blood-gas analyzer would be a relevant and useful piece of technology, or if it would be more of a waste of money with no real use. Blood-gas analyzers are routine in the US, but each test costs $9 to run and usually is done when you are going to ventilate a patient. Malawi would have a lot of trouble running a test that cost so much per person, and also does not really ever use ventilator machines.
Tomorrow two more guys are coming - one from Duke (business student) and one from UNC (MPH program). On Wednesday, Zach and Rachel will join me here as well. Zach will be running the factory so Liyaka may take a break, and Rachel will be doing a stool collection study for the summer. Daunting projects for both of them! Finally, we have Meg coming on June 10, and Dr. Manary and his son Micah coming on June 14. Hard to believe I am already preparing for all these guests (I bought bunk beds last week to stock up on sleeping places!).
21 days til I leave Malawi, 22 days til I touch down in America.
-dkm
If you don't have the proper technique, bucket showers can be messy activities. Water gets splashed in all the wrong places, any efforts to shave your legs are in vain because you keep getting goosebumps from the cold, and you can find yourself stuck with shampoo in your hair and your bucket dry. You need a sizeable bucket filled 3/4 of the way with water (that you would have certainly been keeping for these emergency situations in large drums in the kitchen), and 1/4 with boiling water. At least you won't freeze. Then you're aiming for speed and efficiency - somehow get the shampoo out and the conditioner in, spread the suds, and conserve the water as you rinse off. Unfortunately, if you are reading this from somewhere in America, you probably will not ever get to practice. I'm sure you're thoroughly disappointed.
* * * * *
In other news, the houses are slowly filling up... On Saturday, Franklin arrived. Franklin is a pretty accomplished guy, undergrad and PhD at Harvard, med school at WashU, and now matched to Mass General Hospital for residency in internal medicine...all by 31. Things have been very low key since his arrival as Sundays in Blantyre tend to be. We did go by the trade fair, an exhibition type thing where several countries displayed their artisans' work and sold some great gifts.
On Sunday, "my boys" all came by - Yohane, Antony, Luca, and some new boys - Chisomo, Chikondi and Julio. Chisomo is an adorable 13 year old boy whose father has passed away and whose mother lives in a village where she has no land to farm or job to do. He came here looking for "ganyu" - small job that he could do for some cash- in order to buy fabric to sew his own school uniform a few months back. Yesterday, he came unexpectedly and hadn't eaten anything in 2 days. He is living on his own with his sister, in a slum area near Blantyre. Yohane and Chikondi helped me in the kitchen to prepare nsima, spinach relish and eggs to feed Chisomo. I also found some sugar, oil, flour, ground nut flour, and washing soap to give him, in addition to a clean shirt, a pair of flip flops (as he has no shoes), and 20 Kwacha (14 cents) for a hair cut. It turned out to be a fun afternoon, cooking, playing bawo, and practicing Chichewa.
It is now early on Monday morning, exactly 3 weeks until I come home. I am going to take Franklin to the Malawi Bureau of Standards, as one of his charges while he is here is to figure out a way to measure protein and fat content in RUTF in our own factory. Franklin is going to try to see what machinery is available in Malawi and how we could adapt it to run these tests. Additionally, he is going to assess the hospital lab to see if a blood-gas analyzer would be a relevant and useful piece of technology, or if it would be more of a waste of money with no real use. Blood-gas analyzers are routine in the US, but each test costs $9 to run and usually is done when you are going to ventilate a patient. Malawi would have a lot of trouble running a test that cost so much per person, and also does not really ever use ventilator machines.
Tomorrow two more guys are coming - one from Duke (business student) and one from UNC (MPH program). On Wednesday, Zach and Rachel will join me here as well. Zach will be running the factory so Liyaka may take a break, and Rachel will be doing a stool collection study for the summer. Daunting projects for both of them! Finally, we have Meg coming on June 10, and Dr. Manary and his son Micah coming on June 14. Hard to believe I am already preparing for all these guests (I bought bunk beds last week to stock up on sleeping places!).
21 days til I leave Malawi, 22 days til I touch down in America.
-dkm
Friday, May 23, 2008
Thursday, May 22, 2008
MOUSE IN THE HOUSE!
With five minutes of me shrieking having past, I am now calm enough to share the gross reality that my cat is a hunter. Some innate switch has turned on making her a ruthless feline on the prowl. Yesterday there were little yellow feathers strewn haphazardly all over my apartment and in recent days past, lizard tails abandoned in the corners. But by far, the least pleasant little guest is Jerry. At the exact moment, Jerry the mouse is trying to hide under the couch...but...wait, I have to pause to jump on top of the chair....
...I'm back. Ella has now caught Jerry in her mouth, and yet there is one smarter than the hunter...Kathleen. Please refer to the blog with the terror of the tarantula a few months back, when Kathleen braved the beast with a Maasai warrior carving. Unlike my skittish self, Kathleen caught Ella by the butt, leaving Ella to dangle with Jerry in her mouth. I think situations like these remind me that when searching for a roommate I should note, "Looking for someone who can act composed in situations of crisis, such as when a mouse is in your cat's mouth or a large spider invades your space."
Now that the lioness and her prey are safely outside, I have taken some photos of this fiasco. I'm being told to applaud her for a job well done. Gross, Ella, gross.
-dkm
...I'm back. Ella has now caught Jerry in her mouth, and yet there is one smarter than the hunter...Kathleen. Please refer to the blog with the terror of the tarantula a few months back, when Kathleen braved the beast with a Maasai warrior carving. Unlike my skittish self, Kathleen caught Ella by the butt, leaving Ella to dangle with Jerry in her mouth. I think situations like these remind me that when searching for a roommate I should note, "Looking for someone who can act composed in situations of crisis, such as when a mouse is in your cat's mouth or a large spider invades your space."
Now that the lioness and her prey are safely outside, I have taken some photos of this fiasco. I'm being told to applaud her for a job well done. Gross, Ella, gross.
-dkm
Tuesday, May 20, 2008
3.5 Weeks (New Photo links at the bottom)
It is hard to believe that in just 27 days I'll be heading home, and yet so much will happen in these next few weeks. My year has been pretty incredible and I'll have a lot to look back on. One of these days, I'll sit down and write a reflective entry, but for now I'll dodge the sappy stuff and focus on the reality... I'm still here, cars still break left and right, we've got a new study to get on its feet, and about 7 new visitors en route!
I have spent most of the past week getting things in order for the new study for 2008-2009. I had new data cards printed up, met with the District Health Officers, engaged the right people on the production end to get the new food ready, and keep pestering the ethics committee for their final consent. Hopefully, in the next 10 days, everything will fall into place and by early June we will begin enrolling children in this new research program. We are now switching gears, focusing on children with severe malnutrition (I worked with the moderately malnourished kids mostly) and will be testing a new, less expensive version of RUTF for these children. This time, we will keep some milk in the formula, but will reduce it by 15% to lower costs.
Yesterday, our trusty ol' Nissan (the diesel one that had the gas tank incident, the broken springs, and other problems) gave us yet another story worthy moment. Nick was on his way out to Mulanje when a very funny thumping started...and then...the wheels stopped. Seems as though the "universal" (I think it is the piece that distributes power to the wheels), broke in half. A long piece of metal just fell from the bottom of the car. Liyaka and I to the rescue with tow rope in hand - we tied the Nissan to my car, I pulled and Liyaka took care of keeping the rope taut. By the time I get home, I'll be a mechanic.
Kathleen and I have gotten back in the groove of long runs, sometimes exploring new neighborhoods, sometimes staying with the routine route to the President's palace. We've been cooking some fantastic dinners with our new favorite thing being cabbage-based salads.
I put some new pictures up on Facebook. For those without an account, you can view the photos here:
http://www.facebook.com/album.php?aid=2091829&l=cd625&id=3104564
And if you never saw these, here are some other good photos:
http://www.facebook.com/album.php?aid=2080138&l=e146e&id=3104564
Will write again soon.
-dkm
I have spent most of the past week getting things in order for the new study for 2008-2009. I had new data cards printed up, met with the District Health Officers, engaged the right people on the production end to get the new food ready, and keep pestering the ethics committee for their final consent. Hopefully, in the next 10 days, everything will fall into place and by early June we will begin enrolling children in this new research program. We are now switching gears, focusing on children with severe malnutrition (I worked with the moderately malnourished kids mostly) and will be testing a new, less expensive version of RUTF for these children. This time, we will keep some milk in the formula, but will reduce it by 15% to lower costs.
Yesterday, our trusty ol' Nissan (the diesel one that had the gas tank incident, the broken springs, and other problems) gave us yet another story worthy moment. Nick was on his way out to Mulanje when a very funny thumping started...and then...the wheels stopped. Seems as though the "universal" (I think it is the piece that distributes power to the wheels), broke in half. A long piece of metal just fell from the bottom of the car. Liyaka and I to the rescue with tow rope in hand - we tied the Nissan to my car, I pulled and Liyaka took care of keeping the rope taut. By the time I get home, I'll be a mechanic.
Kathleen and I have gotten back in the groove of long runs, sometimes exploring new neighborhoods, sometimes staying with the routine route to the President's palace. We've been cooking some fantastic dinners with our new favorite thing being cabbage-based salads.
I put some new pictures up on Facebook. For those without an account, you can view the photos here:
http://www.facebook.com/album.php?aid=2091829&l=cd625&id=3104564
And if you never saw these, here are some other good photos:
http://www.facebook.com/album.php?aid=2080138&l=e146e&id=3104564
Will write again soon.
-dkm
Monday, May 12, 2008
A Special Thank You
Dear Jennifer,
I received your letter today! It was so exciting to get something in the mail. Thank you for thinking of me.
Hope all is well at home. See you in June!
-dkm
PS. Barb, I recognized your handwriting on the front... miss you too :)
I received your letter today! It was so exciting to get something in the mail. Thank you for thinking of me.
Hope all is well at home. See you in June!
-dkm
PS. Barb, I recognized your handwriting on the front... miss you too :)
The Big Decision
It is hard to believe that nearly a year has gone by since I started the painfully long process of applying to medical school. More than two years have past since I first started studying for the MCAT. And it is finally...finally...over. After hours of tearing my hair out, talking to every person on the planet willing to listen to my rationalizations, going back and forth...and back and forth again, I finally declined acceptances at 3 of the 4 schools, withdrew from 1 of 2 wait lists, and confirmed my seat at just one school.
I turned down Albert Einstein. This was probably the hardest one to decline. I had thought I wanted to go there the most - they have an incredible reputation for global health. But their match list was similar to all the other schools that I was accepted at, the students never seemed as happy as students at other schools, and I've heard mixed reviews of the administration. Still, it was the last one I withdrew acceptance from, and very hard indeed.
I turned down George Washington. I was probably most excited after interviewing here. The school is in the coolest location, everything is brand new, and they have so many very interesting programs for med students. Not to mention that the world headquarters for so many major global health players are in D.C. The problem is that the school was so expensive and living in D.C. would put me in more than $200K debt. A scary thought as I look a few years into the future.
I turned down Saint Louis University and withdrew from the waitlist at University of Vermont. And, thus, I have officially joined the class of 2012 at Stony Brook University School of Medicine! I'll remain with my fingers crossed tight for WashU (I'm on their wait list) but otherwise, I'm looking forward to living close to friends and family, saving LOTS of money, and being at a school where the students are so happy. I know that there are some incredible students there and very supportive faculty. It's hard to believe that after living 1/2 a world away, I'm literally coming home.
Well, just had to keep everyone posted. It has been a very long, very hard, and very tiring process.
Yay Class of 2012!
-dkm
I turned down Albert Einstein. This was probably the hardest one to decline. I had thought I wanted to go there the most - they have an incredible reputation for global health. But their match list was similar to all the other schools that I was accepted at, the students never seemed as happy as students at other schools, and I've heard mixed reviews of the administration. Still, it was the last one I withdrew acceptance from, and very hard indeed.
I turned down George Washington. I was probably most excited after interviewing here. The school is in the coolest location, everything is brand new, and they have so many very interesting programs for med students. Not to mention that the world headquarters for so many major global health players are in D.C. The problem is that the school was so expensive and living in D.C. would put me in more than $200K debt. A scary thought as I look a few years into the future.
I turned down Saint Louis University and withdrew from the waitlist at University of Vermont. And, thus, I have officially joined the class of 2012 at Stony Brook University School of Medicine! I'll remain with my fingers crossed tight for WashU (I'm on their wait list) but otherwise, I'm looking forward to living close to friends and family, saving LOTS of money, and being at a school where the students are so happy. I know that there are some incredible students there and very supportive faculty. It's hard to believe that after living 1/2 a world away, I'm literally coming home.
Well, just had to keep everyone posted. It has been a very long, very hard, and very tiring process.
Yay Class of 2012!
-dkm
Thursday, May 8, 2008
Being Domestic
The past two weeks has kept me under house arrest as I try to transition into the next and final phase of my year in Malawi. It's so hard to believe that a year has nearly gone. Right now, Luca, Lucy, Rafael, and Henry are here on my porch, playing bawo and cards - Rafa couldn't walk when I first came, Luca could barely talk. Now they come every afternoon for a snack, a game, or just to laugh and sing outside my door. So when I had to make a test batch of new chiponde for Dr. M's next study (a version with less milk than we currently use, in order to reduce costs), what better group to ask to taste test than my little munchkins outside?
I mixed a batch of peanut butter in the kitchen (it tasted really good - especially since there was no added "medicine" - concentrated minerals and vitamins, and because it is 27% sugar) and brought it out to all the children to try. Luca, Lucy, Henry, Rafa, Nelia and even baby Maggie tried it - everyone loved it. Within just a few minutes, 1/2 pound of peanut butter was gone! I think I'll try playing with the oil content to see if I can make it a little less thick, but things are looking good for that recipe. The next step is to translate a recipe for .25kg of food to a recipe that makes 200 kg of food...
The rest of my days have recently been spent manipulating databases and writing my final report. Nick has taken over in the field with the site visits, which is sad for me, but very necessary for me to finish this work. Some days I feel like my brother when he watches the Giants lose a football game - I yell at Microsoft Excel and hate how Vista just makes everything difficult.
In the coming weeks, I need to get this report finalized, get the new recipe for chiponde up and running at the factory, get the research and ethics committee approval for the new study, have data cards and consent forms printed and organized, and orient the new people.
--> Very cute thing happening here: Rafael is around 1 year old, and the older kids have flipped my outdoor, wicker end table over, and have Rafa sitting on the table part while they pull him around by the legs of the table. When I asked what they are doing, they told me, "Rafa akuyendetsa galimoto!" "Rafa is driving a car!". They are so adorable.
Well thats a short entry for now, just felt like a break from the database.
-dkm
I mixed a batch of peanut butter in the kitchen (it tasted really good - especially since there was no added "medicine" - concentrated minerals and vitamins, and because it is 27% sugar) and brought it out to all the children to try. Luca, Lucy, Henry, Rafa, Nelia and even baby Maggie tried it - everyone loved it. Within just a few minutes, 1/2 pound of peanut butter was gone! I think I'll try playing with the oil content to see if I can make it a little less thick, but things are looking good for that recipe. The next step is to translate a recipe for .25kg of food to a recipe that makes 200 kg of food...
The rest of my days have recently been spent manipulating databases and writing my final report. Nick has taken over in the field with the site visits, which is sad for me, but very necessary for me to finish this work. Some days I feel like my brother when he watches the Giants lose a football game - I yell at Microsoft Excel and hate how Vista just makes everything difficult.
In the coming weeks, I need to get this report finalized, get the new recipe for chiponde up and running at the factory, get the research and ethics committee approval for the new study, have data cards and consent forms printed and organized, and orient the new people.
--> Very cute thing happening here: Rafael is around 1 year old, and the older kids have flipped my outdoor, wicker end table over, and have Rafa sitting on the table part while they pull him around by the legs of the table. When I asked what they are doing, they told me, "Rafa akuyendetsa galimoto!" "Rafa is driving a car!". They are so adorable.
Well thats a short entry for now, just felt like a break from the database.
-dkm
Sunday, May 4, 2008
I still have a little crazy in me
For most of the 10 months that I have been here, I've held up the act of being the researcher, looking towards beginning medical school, thinking of work day in and day out (minus a few moments - the trip to the Lake being one such example...). But yesterday, I forgot about the research and all its strings, and just had a blast for 24 full hours.
It started on Friday night with a slumber party at Liz and Kathleen's - complete with cabbage salad at dinner (I know, that is the first food ANYONE would think of for a sleepover party right?). We stayed up too late, drank too much wine, and had a lots of girl talk. We woke up too late for a run (imagine, 7:30am on a Saturday is too late), so instead we made whole wheat pancakes and got dressed. Kathleen and I went off to a music festival in honor of the President's late wife, Ethel Mutherika, who died just one year ago. The festival was Woodstock done Malawi - rappers from South Africa, Zimbabwe, Nigeria and Kenya. The best part of the show was far from the knock-off American gansta rap, but instead was the absolutely outrageous outfits that all the Malawian young adults sported. I'm not kidding - at 10 am we had a walking Vogue catalog. It was a total walking fashion show - almost as if the kids didn't realize that a) people don't actually buy the clothes and wear them as they are shown in fashion magazines and that b) even if you did wear something so ridiculous, it wouldn't be at 10 am in the middle of a soccer field. In any event, we got to see the President and his daughters, who made an appearance half way through the show.
After hours of listening to rap and watching (fairly decent) breakdancers, we thought the day was over. We made a nice dinner and decided we'd go out to this new bar down the street from Liz and Kathleen's house, called Mustang Sally's. We intended to be out for one drink only, but when we showed up, the owner told us they were closed for a "private function." We asked for a tour of the place (pretty swanky - indoor pool that changed colors, several levels and different bars, a great dance floor) and he told us that the President had closed the place down and that the cover for entry was $35, with all proceeds going to charity. It was the "after party" of the morning's music festival. We scoffed at the outrageous cover (for Malawi...this is INSANE) and we left. We pulled out of the parking lot, and then decided that we were making a huge mistake. THE PRESIDENT WAS HAVING A PRIVATE PARTY THAT WE COULD GO TO! After a quick make-up change, we went back.
As if being the ONLY (seriously only) 3 white expats in the bar wasn't enough, I decided to gain us even more notice. I took off my shoes, walked across the dance floor on my hands, and did the worm all the way back. A few backhandsprings here and there, and we had free drinks for the rest of the night. (We got the first few from some sketchy guys, and then a few more from some Ministers of Parliament). I danced with all the guys from the show earlier that day, even one of the rappers himself. In the words of Kathleen, "if there were such a thing as People Magazine in Malawi, we'd be in some of those featured pictures from VIP parties." It was so much fun, even if I didn't go to bed until after 2am.
This morning we went for an hour run, and then in the afternoon, my little munchkins came over for several hours of fun. We played Chipako (tag), Kachere (hide and seek), and Yohane even taught me to make nsima. We had a huge feast of nsima and egg/tomato/onion relish for lunch. We colored a bit, and then I sent them all home with popcorn and orange sodas. It was such a fun weekend!
Now, I'm sitting in the fancy hotel getting back to work again. I think I'll lay low for a bit...my friends think I'm crazy now.
42 days til I come home...
-dkm
It started on Friday night with a slumber party at Liz and Kathleen's - complete with cabbage salad at dinner (I know, that is the first food ANYONE would think of for a sleepover party right?). We stayed up too late, drank too much wine, and had a lots of girl talk. We woke up too late for a run (imagine, 7:30am on a Saturday is too late), so instead we made whole wheat pancakes and got dressed. Kathleen and I went off to a music festival in honor of the President's late wife, Ethel Mutherika, who died just one year ago. The festival was Woodstock done Malawi - rappers from South Africa, Zimbabwe, Nigeria and Kenya. The best part of the show was far from the knock-off American gansta rap, but instead was the absolutely outrageous outfits that all the Malawian young adults sported. I'm not kidding - at 10 am we had a walking Vogue catalog. It was a total walking fashion show - almost as if the kids didn't realize that a) people don't actually buy the clothes and wear them as they are shown in fashion magazines and that b) even if you did wear something so ridiculous, it wouldn't be at 10 am in the middle of a soccer field. In any event, we got to see the President and his daughters, who made an appearance half way through the show.
After hours of listening to rap and watching (fairly decent) breakdancers, we thought the day was over. We made a nice dinner and decided we'd go out to this new bar down the street from Liz and Kathleen's house, called Mustang Sally's. We intended to be out for one drink only, but when we showed up, the owner told us they were closed for a "private function." We asked for a tour of the place (pretty swanky - indoor pool that changed colors, several levels and different bars, a great dance floor) and he told us that the President had closed the place down and that the cover for entry was $35, with all proceeds going to charity. It was the "after party" of the morning's music festival. We scoffed at the outrageous cover (for Malawi...this is INSANE) and we left. We pulled out of the parking lot, and then decided that we were making a huge mistake. THE PRESIDENT WAS HAVING A PRIVATE PARTY THAT WE COULD GO TO! After a quick make-up change, we went back.
As if being the ONLY (seriously only) 3 white expats in the bar wasn't enough, I decided to gain us even more notice. I took off my shoes, walked across the dance floor on my hands, and did the worm all the way back. A few backhandsprings here and there, and we had free drinks for the rest of the night. (We got the first few from some sketchy guys, and then a few more from some Ministers of Parliament). I danced with all the guys from the show earlier that day, even one of the rappers himself. In the words of Kathleen, "if there were such a thing as People Magazine in Malawi, we'd be in some of those featured pictures from VIP parties." It was so much fun, even if I didn't go to bed until after 2am.
This morning we went for an hour run, and then in the afternoon, my little munchkins came over for several hours of fun. We played Chipako (tag), Kachere (hide and seek), and Yohane even taught me to make nsima. We had a huge feast of nsima and egg/tomato/onion relish for lunch. We colored a bit, and then I sent them all home with popcorn and orange sodas. It was such a fun weekend!
Now, I'm sitting in the fancy hotel getting back to work again. I think I'll lay low for a bit...my friends think I'm crazy now.
42 days til I come home...
-dkm
Monday, April 28, 2008
Celebrating a p-value and other fine things
"p<0.0001. Extremely significant."
Read on and I'll explain, but first a quick recap of the Cape Town/ Blantyre experience with my mom, rob and Zach...
First off, if I could ever get pictures to load on this blog, I'd send you photos of the house we had in Camps Bay. In Rob's words, "it looked like MTV Cribs." The place was insane - two floors, stark furniture, balconies on both sides of the house (one looking up at Table Mountain, one overlooking the water), an infinity pool on the upstairs balcony, tall ceilings and glass walls. The downstairs was very open and very modern, the upstairs had 3 bedrooms each with its own bathroom. And there was an elevator IN THE HOUSE. It was amazing.
The wealth in Cape Town is astonishing. There were several Ferrari dealerships, with many of their prized engines perusing the downtown streets. There were Jags and Bentleys, and Mercedes were a dime a dozen. We arrived in Camps Bay after 11pm on Saturday evening. When the troops finally (finnnnnallllyyy) woke up on Sunday, we drove down to the Waterfront and admired the beautiful city. We listened to a young jazz band for a while and ate outside at an Italian inspired restaurant called Societi. I was asked if I was yet 18 before they would pour me a glass of wine...
On Monday, we did a little street shopping and ended up eating at an African game restaurant in the downtown part of the city. I think the hit of the night was ostrich steak, though there was no shortage of strange meat including warthog!
We spent Tuesday at Robben Island, South Africa's equivalent of Alcatraz in a way. Robben Island has been used for hundreds of years, with different purposes. In the beginning, it was an isolation island (7 miles off the mainland of Cape Town), where anyone with unidentifiable illness (like leprosy and TB) were cast away to die. It is now most famous for being the place where political prisoners were held during the South African era of apartheid. Nelson Mandela, Robben Island's most famed inmate, was kept at Robben Island for 18 years. We were given an incredible tour by two former prisoners, one who had spent 14 years on the island from the ages of 16-30. Mandela himself has been back to the island 14 times for visits, but no longer will ever return to the island. It was really incredible to hear the stories right from a man who had been imprisoned for so long in that very place.
Wednesday was possibly the best day. We hired a tour guide named Terry to take us through Cape Town's wine country. We started tasting at 9 in the morning and visited two extremely beautiful vineyards. The first was Fairview, where we had some stellar cheeses and tasted 8 or 10 wines. Our favorite was Cyril Black, a pinotage. We didn't spend much time at Fairview, but got a grand tour at KWV Vineyards. We saw every part of production from the oak barrels to the aluminum tanks. They have the largest barrels in the world, holding 208,000 liters in one barrel. We learned how different sources of oak infuse red wines with slightly different flavors. Again, our favorite was a pinotage called Cafe. It had lots of mocha and coffee aromas and flavors - delish!
Thursday was ... interesting. Rather than just drive down the coastline (and follow the signs that were posted), we decided to use the GPS system (a Garmin) to direct us to the Cape of Good Hope. What should have taken 45 minutes, took hours. We were so lost! We drove all over the different districts of Cape Town and only made it to the cape moments before the National Park around it closed. But, it was worth it. The sights were breathtaking. It was sooooo pretty. You can only imagine what the first sailors who went all the way around the Cape from Europe must have thought. After a spectacular but rushed visit, we drove through the seaport towns and ended up eating right on the water in Calk's Bay at a wonderful restaurant called The Harbor House. I even had fish - cob. It was a great meal (beet, butternut squash and goat cheese salad...)
Terry was back on Friday to bring us to a game reserve. We went on a mini safari in a very African looking Land Rover vehicle. We saw lions, cheetahs, antelope, warthogs, rhinos, zebras, giraffes, vultures, elands, wildebeests, and other things. After the drive through the game park, Terry took us on the oldest road in Cape Town, Bains Kloof, a windy road through the mountains that was again spectacular.
Saturday morning we left before sunrise to get to the airport. Then it was back to Blantyre! Rob and Zach stayed only until Wednesday, but my mom stayed for the whole week. I took them out to see my sites, but the weather really didn't cooperate so nothing looked as pretty as usual. Zach didn't like my work because he didn't like to see the sick babies. Rob and my mom helped out a lot at the clinic. I took my mom to see Queen Elizabeth Hospital in Blantyre, and we all made a visit to the orphanage next door, Open Arms (www.openarmsusa.org). It was great to have them here with me, and hopefully next time they will be able to see Mt. Mulanje, the Lake, Liwonde Park and Zomba...we did NO tourist things while they were here.
SO...THE P-VALUE!!!! This past weekend (from Saturday after I dropped my mom at the airport until Sunday mid-day) Dr. Manary and I worked and worked and worked on the data. The exciting thing is that all the data is now collected, analyzed and neatly presented in a few tables. What we found is that the new soy/peanut RUTF I've been working with this whole year is equivalent to the milk/peanut RUTF and far better than the current standard of care, the corn/soy blended flour. I was so excited when we had finally cleaned up the entire database, plugged and chugged all sorts of numbers and then the statistics came back in our favor! Fantastic!!!! I am now in the process of writing the report for USAID, which will hopefully then be published in a medical journal at home. This whole year...was SO worth it!
Now, I'm on to helping with the next major research project... we are going to try to make RUTF with less milk powder for severely malnourished kids to try and reduce the cost. It will be 10% milk and 15% soy, compared to the current formula of 25% milk. I have lots of work to get done before I leave!
Date of depature is set to be Monday, June 16. I can't believe a year went by so fast....
-dkm
Read on and I'll explain, but first a quick recap of the Cape Town/ Blantyre experience with my mom, rob and Zach...
First off, if I could ever get pictures to load on this blog, I'd send you photos of the house we had in Camps Bay. In Rob's words, "it looked like MTV Cribs." The place was insane - two floors, stark furniture, balconies on both sides of the house (one looking up at Table Mountain, one overlooking the water), an infinity pool on the upstairs balcony, tall ceilings and glass walls. The downstairs was very open and very modern, the upstairs had 3 bedrooms each with its own bathroom. And there was an elevator IN THE HOUSE. It was amazing.
The wealth in Cape Town is astonishing. There were several Ferrari dealerships, with many of their prized engines perusing the downtown streets. There were Jags and Bentleys, and Mercedes were a dime a dozen. We arrived in Camps Bay after 11pm on Saturday evening. When the troops finally (finnnnnallllyyy) woke up on Sunday, we drove down to the Waterfront and admired the beautiful city. We listened to a young jazz band for a while and ate outside at an Italian inspired restaurant called Societi. I was asked if I was yet 18 before they would pour me a glass of wine...
On Monday, we did a little street shopping and ended up eating at an African game restaurant in the downtown part of the city. I think the hit of the night was ostrich steak, though there was no shortage of strange meat including warthog!
We spent Tuesday at Robben Island, South Africa's equivalent of Alcatraz in a way. Robben Island has been used for hundreds of years, with different purposes. In the beginning, it was an isolation island (7 miles off the mainland of Cape Town), where anyone with unidentifiable illness (like leprosy and TB) were cast away to die. It is now most famous for being the place where political prisoners were held during the South African era of apartheid. Nelson Mandela, Robben Island's most famed inmate, was kept at Robben Island for 18 years. We were given an incredible tour by two former prisoners, one who had spent 14 years on the island from the ages of 16-30. Mandela himself has been back to the island 14 times for visits, but no longer will ever return to the island. It was really incredible to hear the stories right from a man who had been imprisoned for so long in that very place.
Wednesday was possibly the best day. We hired a tour guide named Terry to take us through Cape Town's wine country. We started tasting at 9 in the morning and visited two extremely beautiful vineyards. The first was Fairview, where we had some stellar cheeses and tasted 8 or 10 wines. Our favorite was Cyril Black, a pinotage. We didn't spend much time at Fairview, but got a grand tour at KWV Vineyards. We saw every part of production from the oak barrels to the aluminum tanks. They have the largest barrels in the world, holding 208,000 liters in one barrel. We learned how different sources of oak infuse red wines with slightly different flavors. Again, our favorite was a pinotage called Cafe. It had lots of mocha and coffee aromas and flavors - delish!
Thursday was ... interesting. Rather than just drive down the coastline (and follow the signs that were posted), we decided to use the GPS system (a Garmin) to direct us to the Cape of Good Hope. What should have taken 45 minutes, took hours. We were so lost! We drove all over the different districts of Cape Town and only made it to the cape moments before the National Park around it closed. But, it was worth it. The sights were breathtaking. It was sooooo pretty. You can only imagine what the first sailors who went all the way around the Cape from Europe must have thought. After a spectacular but rushed visit, we drove through the seaport towns and ended up eating right on the water in Calk's Bay at a wonderful restaurant called The Harbor House. I even had fish - cob. It was a great meal (beet, butternut squash and goat cheese salad...)
Terry was back on Friday to bring us to a game reserve. We went on a mini safari in a very African looking Land Rover vehicle. We saw lions, cheetahs, antelope, warthogs, rhinos, zebras, giraffes, vultures, elands, wildebeests, and other things. After the drive through the game park, Terry took us on the oldest road in Cape Town, Bains Kloof, a windy road through the mountains that was again spectacular.
Saturday morning we left before sunrise to get to the airport. Then it was back to Blantyre! Rob and Zach stayed only until Wednesday, but my mom stayed for the whole week. I took them out to see my sites, but the weather really didn't cooperate so nothing looked as pretty as usual. Zach didn't like my work because he didn't like to see the sick babies. Rob and my mom helped out a lot at the clinic. I took my mom to see Queen Elizabeth Hospital in Blantyre, and we all made a visit to the orphanage next door, Open Arms (www.openarmsusa.org). It was great to have them here with me, and hopefully next time they will be able to see Mt. Mulanje, the Lake, Liwonde Park and Zomba...we did NO tourist things while they were here.
SO...THE P-VALUE!!!! This past weekend (from Saturday after I dropped my mom at the airport until Sunday mid-day) Dr. Manary and I worked and worked and worked on the data. The exciting thing is that all the data is now collected, analyzed and neatly presented in a few tables. What we found is that the new soy/peanut RUTF I've been working with this whole year is equivalent to the milk/peanut RUTF and far better than the current standard of care, the corn/soy blended flour. I was so excited when we had finally cleaned up the entire database, plugged and chugged all sorts of numbers and then the statistics came back in our favor! Fantastic!!!! I am now in the process of writing the report for USAID, which will hopefully then be published in a medical journal at home. This whole year...was SO worth it!
Now, I'm on to helping with the next major research project... we are going to try to make RUTF with less milk powder for severely malnourished kids to try and reduce the cost. It will be 10% milk and 15% soy, compared to the current formula of 25% milk. I have lots of work to get done before I leave!
Date of depature is set to be Monday, June 16. I can't believe a year went by so fast....
-dkm
Monday, April 21, 2008
A bit of luxury, a bit of Africa
Well, this will be a quick update because I am on my way out the door, but in good company...my mom, Rob, and Zach are here! We just had an incredible trip to Cape Town, South Africa, which is one of the most beautiful places I've ever been to. We visited the waterfront, Table Mountain, Robben Island (where Nelson Mandela was a political prisoner during apartheid), the Cape of Good Hope, a game reserve/safari place, and the vineyards of the Cape. It was amazing. Now we are back in Malawi, and they are all surviving through the limited water, on and off electricity and bumpy, bumpy roads...
Look for an update very, very soon with more details about Cape Town and the Malawi visit!
Off to the village with them now!
-dkm
Look for an update very, very soon with more details about Cape Town and the Malawi visit!
Off to the village with them now!
-dkm
Thursday, April 10, 2008
Pepani...it's been a while
(Pepani means "I'm sorry" in Chichewa).
It seems as though my routine blogging discipline may be slipping, but with all the hustle and bustle of new guests coming and going over the past 10 days, it's been difficult to find some time to write. Here's who has been in and out...
April 1: Great Birthday! Kathleen told me she'd meet me for a run in the afternoon, but in fact was at my house much earlier to decorate with balloons and a "Happy Birthday" Banner. She even had 3 presents for me to unwrap, which in Africa, is quite a treat! (Santa doesn't have directions to Blantyre, so wrapping paper seems novel). I got some trashy girly magazines, American candy (KitKat, Twix and Mentos) and even a gift certificate to have a manicure in Blantyre! Very creative! After a nice run, we went out for dinner with a few girls who are med students from Michigan State.
April 2: Nick arrived today. Nick is a student who will be working with the project until August and has come from Trinity College in Dublin, Ireland. He is originally from a small place west of Toronto, and this is his first trip to Africa. He was in a one year masters program in global health. He arrived on a Wednesday- the day we go out to the village and stay at the Catholic mission. Given that Hannah had also arrived on a Wednesday and that she thought being brought out to the village from day 1 was really exciting, we spared Nick just a few minutes for a hot shower and to throw his bags down, and drove him up to Machinga. I think it was a bit more overwhelming for him (perhaps since Hannah had done lots of work in developing countries before), but he did great for the first day. Now, 10 days later, I have him driving (needed to learn to drive a manual), operating the site visits, and learning the day to day routine. This is all good news, as I am leaving for a one week trip to Cape Town on Saturday (more on this to come).
April 4: On Thursday evening, when I finally was back at a computer, I received an interesting email from a 4th year medical student from UMass who had just arrived in Zambia to do a 2 month elective. She had been in Zambia in 2007 for 4 months and had returned with the goal of starting a more effective nutritional therapy program in the area around Lusaka. She asked if she could visit Malawi. Being as I was only going to be in town for one more week, she decided to fly to Malawi on Friday (She flew to Zambia on Thursday). With very shaky and sporadic communications, she actually bought a ticket, and after lots and lots of delays, made it to Malawi late Friday night. It turns out - she's awesome! She had the most insightful questions, was really excited about the project, look lots of notes, and seems so cool. We talked about med school choices (I'm still undecided), went running, and she even taught me how to do a physical exam (sooo exciting for me!). She's been here for a week, and will head back to Zambia today to try to get an RUTF program running more smoothly. Talk about ambition!
April 6: Dr. Manary is back in town. Busy as ever, but really ready to concentrate on helping me complete the rest of my study and get the data analyzed a bit.
April 9: A guy named Pete arrived from Ithaca. He is in the business of food development and technology and will be collaborating with Dr. M to start PPB in Uganda. He has 4 children - two in their 30s and two under 10. He has food technology labs in Ithaca, NY, Naples, FL and Redding, England. I took him up to the village with us on Wednesday evening and he helped at the clinic on Thursday - which was huge. We had 180 children actually enrolled in the program (combining new patients, continuing patients and graduates of the program) and screened many, many more! What a day!
April 10: A business consultant from Pfizer came from Lilongwe. Charles is working for USAID and is a very prominent business man from the Upper East Side in Manhattan. He has travelled ALL over the world and has worked on incredibly large business acquisitions for Pfizer over the past 38 years. We took him out for a fancy shmancy dinner - 6 people, drinks, meals and desserts for $100. What a steal! He will be working with PPB to improve the business aspects of the organization.
Lots of small things have filled in the gaps here and there. The potential of Dr. M buying 4 new vehicles today is there, Sheena is back with a new, beautiful baby girl (Rabecca; Sheena is our housekeeper. She's been on maternity leave), and most excitingly - I go to Cape Town TOMORROW!!! My mom, brother and Rob are meeting me in the JoBurg airport for one week in South Africa. I'm so excited. We are scheduled to go to Robben Island, where Nelson Mandela and other political prisoners were held during apartheid, we'll see the Cape of Good Hope, the peninsula with all the South Africa penguins, and take a trip to the vineyards. The photos from Cape Town are all incredible, so I'm looking forward to a great escape! Then we'll return to Malawi to see what my year in Africa has been all about.
Well, that catches the blog up mostly. I owe all you people who are still reading this thing a good, funny, and short blog. It will come soon...I'll be on the lookout for some ridiculous African Moments.
And PS - Unkie...I still don't know where my brother came from, but I'm getting closer to the answer... :)
-dkm
It seems as though my routine blogging discipline may be slipping, but with all the hustle and bustle of new guests coming and going over the past 10 days, it's been difficult to find some time to write. Here's who has been in and out...
April 1: Great Birthday! Kathleen told me she'd meet me for a run in the afternoon, but in fact was at my house much earlier to decorate with balloons and a "Happy Birthday" Banner. She even had 3 presents for me to unwrap, which in Africa, is quite a treat! (Santa doesn't have directions to Blantyre, so wrapping paper seems novel). I got some trashy girly magazines, American candy (KitKat, Twix and Mentos) and even a gift certificate to have a manicure in Blantyre! Very creative! After a nice run, we went out for dinner with a few girls who are med students from Michigan State.
April 2: Nick arrived today. Nick is a student who will be working with the project until August and has come from Trinity College in Dublin, Ireland. He is originally from a small place west of Toronto, and this is his first trip to Africa. He was in a one year masters program in global health. He arrived on a Wednesday- the day we go out to the village and stay at the Catholic mission. Given that Hannah had also arrived on a Wednesday and that she thought being brought out to the village from day 1 was really exciting, we spared Nick just a few minutes for a hot shower and to throw his bags down, and drove him up to Machinga. I think it was a bit more overwhelming for him (perhaps since Hannah had done lots of work in developing countries before), but he did great for the first day. Now, 10 days later, I have him driving (needed to learn to drive a manual), operating the site visits, and learning the day to day routine. This is all good news, as I am leaving for a one week trip to Cape Town on Saturday (more on this to come).
April 4: On Thursday evening, when I finally was back at a computer, I received an interesting email from a 4th year medical student from UMass who had just arrived in Zambia to do a 2 month elective. She had been in Zambia in 2007 for 4 months and had returned with the goal of starting a more effective nutritional therapy program in the area around Lusaka. She asked if she could visit Malawi. Being as I was only going to be in town for one more week, she decided to fly to Malawi on Friday (She flew to Zambia on Thursday). With very shaky and sporadic communications, she actually bought a ticket, and after lots and lots of delays, made it to Malawi late Friday night. It turns out - she's awesome! She had the most insightful questions, was really excited about the project, look lots of notes, and seems so cool. We talked about med school choices (I'm still undecided), went running, and she even taught me how to do a physical exam (sooo exciting for me!). She's been here for a week, and will head back to Zambia today to try to get an RUTF program running more smoothly. Talk about ambition!
April 6: Dr. Manary is back in town. Busy as ever, but really ready to concentrate on helping me complete the rest of my study and get the data analyzed a bit.
April 9: A guy named Pete arrived from Ithaca. He is in the business of food development and technology and will be collaborating with Dr. M to start PPB in Uganda. He has 4 children - two in their 30s and two under 10. He has food technology labs in Ithaca, NY, Naples, FL and Redding, England. I took him up to the village with us on Wednesday evening and he helped at the clinic on Thursday - which was huge. We had 180 children actually enrolled in the program (combining new patients, continuing patients and graduates of the program) and screened many, many more! What a day!
April 10: A business consultant from Pfizer came from Lilongwe. Charles is working for USAID and is a very prominent business man from the Upper East Side in Manhattan. He has travelled ALL over the world and has worked on incredibly large business acquisitions for Pfizer over the past 38 years. We took him out for a fancy shmancy dinner - 6 people, drinks, meals and desserts for $100. What a steal! He will be working with PPB to improve the business aspects of the organization.
Lots of small things have filled in the gaps here and there. The potential of Dr. M buying 4 new vehicles today is there, Sheena is back with a new, beautiful baby girl (Rabecca; Sheena is our housekeeper. She's been on maternity leave), and most excitingly - I go to Cape Town TOMORROW!!! My mom, brother and Rob are meeting me in the JoBurg airport for one week in South Africa. I'm so excited. We are scheduled to go to Robben Island, where Nelson Mandela and other political prisoners were held during apartheid, we'll see the Cape of Good Hope, the peninsula with all the South Africa penguins, and take a trip to the vineyards. The photos from Cape Town are all incredible, so I'm looking forward to a great escape! Then we'll return to Malawi to see what my year in Africa has been all about.
Well, that catches the blog up mostly. I owe all you people who are still reading this thing a good, funny, and short blog. It will come soon...I'll be on the lookout for some ridiculous African Moments.
And PS - Unkie...I still don't know where my brother came from, but I'm getting closer to the answer... :)
-dkm
Tuesday, April 1, 2008
The Hash...and things
Imagine if you were Malawian for one minute - you walk far distances to work, you harvest acre after acre of maize, your favorite food is nsima with relish, you carry even a single bar of soap on your head. What possibly could be more ridiculous to you than (a) running for absolutely no real reason, (b) seeing a bunch of white people running as fast as they can in one mass group like sheep, (c) watching these azungu's then stop for beer along the way! Bringing this sort of entertainment, live to the people working in the maize fields, is the service provided by the Blantyre Hash.
The Hash is a group that apparently has existed in Blantyre for many, many years (they have t-shirts, one guy was wearing his from 1994). And while I felt absolutely ridiculous participating in such an activity, it was admittedly, very fun. The idea behind the Hash running group is that one member volunteers to set up the run for the next week. That person is responsible for finding a route for the entire group. The group can be anywhere from 10-50 people...all expatriates. However, the route is not set along a regular paved road; rather, the route can wind through maize field, down abandoned train tracks, across school soccer fields and undoubtedly past a popular bar. The goal is to find the route by following chalk markings on the ground. At each juncture in the path, there is a large O painted. At this point someone yells, "Check it out!" and everyone scatters in different directions. What you are looking for are three consecutive solid dots along the path. You may instead find 2 dots and then an X, and alas, you've run in the wrong direction. Once someone finds the correct route, they yell something like "Onward!" and the whole herd of white people turn around and follow the leader until the next large O. There are HH markings, "Hash Halts," where everyone can catch up and get on the same path again.
About midway through this activity, there is a beer break. The group has an age range of about 20-60, and a mix of guys and girls. The guys mostly take the beer at this point, the girls sort of moan that the stop is ruining the cardio and that the beer has too many calories. At the end of the run, the group makes a large circle and sings this really hilarious, clearly British pub-inspired song that says something like, "you are a hasher for life, your never going to heaven because you drink when you run, drink it down, down, down, down..." This is when different people get pulled into the center of the circle have have to chug a beer. Guess who the lucky ones are to go every time? The newbies. Me and Kathleen (and 2 other new girls). Drink it down... or pour it on your head. So, like I said...drink it down.
My birthday turned out to be a lot of fun. Kathleen decorated my house with banners and balloons, and got me cute little things to remind me of home - mentos, kit kats, and twix, a Glamour magazine and a Nalgene bottle. It was really sweet. We went out for dinner with some new medical students from Michigan State and baked low-fat brownies made with apple sauce. I got TONS of wonderful emails and even got some phone calls and text messages (even from Australia- thanks Hannah!). In all, it was one to remember.
Other than that, today Nick arrives and will be joining the team until August. The next few months will be about passing on the torch while I try to figure out where to go to medical school. Dr. Manary will be here next week and we'll start doing some more serious data analysis and evaluation of the program. I'm looking forward to some positive results!
My mom, brother and Rob are visiting me in Africa from April 12-26. I'm so excited. We are going to tour Cape Town, South Africa for a week, then head back to Malawi for some real Africa experiences. Lucky for them, they won't have the extra special experience of getting insanely stuck in mud or having to screen hundreds of screaming babies - those days have seemed to pass. By the time they go home, there will be only very few weeks remaining of my time in Malawi (for now). I'm sad and excited to be at the end!
Thanks again to everyone who sent birthday wishes!
-dkm
The Hash is a group that apparently has existed in Blantyre for many, many years (they have t-shirts, one guy was wearing his from 1994). And while I felt absolutely ridiculous participating in such an activity, it was admittedly, very fun. The idea behind the Hash running group is that one member volunteers to set up the run for the next week. That person is responsible for finding a route for the entire group. The group can be anywhere from 10-50 people...all expatriates. However, the route is not set along a regular paved road; rather, the route can wind through maize field, down abandoned train tracks, across school soccer fields and undoubtedly past a popular bar. The goal is to find the route by following chalk markings on the ground. At each juncture in the path, there is a large O painted. At this point someone yells, "Check it out!" and everyone scatters in different directions. What you are looking for are three consecutive solid dots along the path. You may instead find 2 dots and then an X, and alas, you've run in the wrong direction. Once someone finds the correct route, they yell something like "Onward!" and the whole herd of white people turn around and follow the leader until the next large O. There are HH markings, "Hash Halts," where everyone can catch up and get on the same path again.
About midway through this activity, there is a beer break. The group has an age range of about 20-60, and a mix of guys and girls. The guys mostly take the beer at this point, the girls sort of moan that the stop is ruining the cardio and that the beer has too many calories. At the end of the run, the group makes a large circle and sings this really hilarious, clearly British pub-inspired song that says something like, "you are a hasher for life, your never going to heaven because you drink when you run, drink it down, down, down, down..." This is when different people get pulled into the center of the circle have have to chug a beer. Guess who the lucky ones are to go every time? The newbies. Me and Kathleen (and 2 other new girls). Drink it down... or pour it on your head. So, like I said...drink it down.
My birthday turned out to be a lot of fun. Kathleen decorated my house with banners and balloons, and got me cute little things to remind me of home - mentos, kit kats, and twix, a Glamour magazine and a Nalgene bottle. It was really sweet. We went out for dinner with some new medical students from Michigan State and baked low-fat brownies made with apple sauce. I got TONS of wonderful emails and even got some phone calls and text messages (even from Australia- thanks Hannah!). In all, it was one to remember.
Other than that, today Nick arrives and will be joining the team until August. The next few months will be about passing on the torch while I try to figure out where to go to medical school. Dr. Manary will be here next week and we'll start doing some more serious data analysis and evaluation of the program. I'm looking forward to some positive results!
My mom, brother and Rob are visiting me in Africa from April 12-26. I'm so excited. We are going to tour Cape Town, South Africa for a week, then head back to Malawi for some real Africa experiences. Lucky for them, they won't have the extra special experience of getting insanely stuck in mud or having to screen hundreds of screaming babies - those days have seemed to pass. By the time they go home, there will be only very few weeks remaining of my time in Malawi (for now). I'm sad and excited to be at the end!
Thanks again to everyone who sent birthday wishes!
-dkm
Thanks and Apologies
First off...thanks for all the bday wishes that came in via Facebook, emails and ecards. It really made my birthday seem a bit more birthday-ish :)
Second, my apologies for those following the blog that I haven't written in a while. And you're going to be disappointed...I'm going to have to wait til tomorrow to update. But, tomorrow I'll write to you about my experience with "the Hash," Blantyre's Premier Running (and Chugging) Club and some other tid bits. For now, I have to get to bed...Tomorrow another new student is coming, Nick. As far as I know, Nick is from Canada and is currently completing a master's degree at the University of Dublin. I am sure I'll have more details to follow.
For now, bedtime.
Gona bwino,
-dkm
(sleep well)
Second, my apologies for those following the blog that I haven't written in a while. And you're going to be disappointed...I'm going to have to wait til tomorrow to update. But, tomorrow I'll write to you about my experience with "the Hash," Blantyre's Premier Running (and Chugging) Club and some other tid bits. For now, I have to get to bed...Tomorrow another new student is coming, Nick. As far as I know, Nick is from Canada and is currently completing a master's degree at the University of Dublin. I am sure I'll have more details to follow.
For now, bedtime.
Gona bwino,
-dkm
(sleep well)
Monday, March 17, 2008
I've heard it said, that people come into our lives for a reason...
Bringing something we must learn,
And we are led to those who help us most to grow,
If we let them,
And we help them in return.
-Wicked
This past week has been a bit sad, but also sort of marks the end of another part of my time in Malawi. Let's see if I can back up and fill you in on some of the stories:
Wednesday, 3/12 - Hannah treated the entire research team to lunch at the Hippo View Lodge, an incredible spot right on the Shire River. The place sort of reminded me of the African attempt at a theme park lodge or something. There are large hippo statues at the gates and enormous eagle statues all over that actually are sinks (the water comes out of the eagle's beak!). Lunch was nice, and then we headed up to the village. Unfortunately, the baboon baby that Hannah got so attached to the week before died while we ate dinner. It was really sad, and the Father was really upset. It was so malnourished and probably wasn't old enough to be away from it's mom. Poor thing.
Then in our bedroom that night there was a SCORPION! Scary...Vegas killed it for us! eeek.
Friday, 3/14 - I had to deal with one of those African tragedies that you hope is just a terrible generalization: A young girl showed up very late for our clinic with a baby strapped to her back. Rosemary, our nurse, asked if the child was her sister and of course it was her daughter. The girl was just 16 years old, the baby 8 months. This means she potentially could have gotten pregnant as young as 14 years old. At the time she was in grade 5 in Blantyre, living with a relative. She stayed next to a more wealthy Malawian man, who often commented to her that she looked thin, that her clothes seemed worn and pointed out how well dressed his wife and children were. He promised he could provide for her, and she says she was "tricked" into marrying him. I needn't explain what happened between this young girl and some pedophile-type man but now this 16 year old mom is desperately trying to take care of her son, and has just learned that she is HIV+. The baby as of now is not infected, but he will need to be retested at 9 months and 1 year. It was a pretty rough story to hear. I gave her some gifts and a bit of cash to help her in some small way. I'll bring some clothes donated by Hannah for her next visit.
The afternoon was bittersweet as well. We had a going away party for Hannah and the nurses gave us each a lovely ivory wrap skirt with the project logo stamped along the bottom. They sang a beautiful goodbye song and presented the gifts in very traditional Malawian style - on their knees in front of us. It was actually really special and incredibly thoughtful.
Saturday, 3/15 - In the morning, Hannah, Kathleen and I went to the market and bought gifts for Hannah to bring back home, new chitenje skirts, and some paintings for the bare walls in my house. Then we picked up the little boys that live at my house and took a field trip to the airport to see Hannah off. We all sat on the veranda of the airport and watched the plane land at the airport. The boys were so excited and I bought them all ice cream as a special trip. They were wearing their church clothes and were so well behaved. Saying goodbye to Hannah was awful, I cried. She was so wonderful, I am so glad that she joined me these past two months. Now I have a friend in Australia... guess where I wish my next vacation to be?
Sunday, 3/16 - I went for a run, by myself (JCF, MAM - don't worry. It was lovely!). I ran out to the President's house, talked with the army guy (a little Chichewa even!) and felt great. Kathleen and I met up with Liz and her parents for a really great dinner. Liz's parents are visiting Malawi for 2 weeks and treated us at the Italian restaurant in Blantyre. After, Kathleen stayed over at my house for the night.
Monday, 3/17 - No notice of St. Patty's Day whatsoever. Work was icky because it was raining and I was at a center with very little shelter. Then more bad news came - way, way back I wrote about a little girl named Margaret whose mother passed away at the Makhwila health center. She has stayed in our program since then as her aunt has no way to feed her. She has been doing so well, her weight has reached normal levels and she looks beautiful. Unfortunately, her HIV status changed this past week and she has seroconverted. I was really upset about this too. It is heart breaking, and in some way I feel very attached to this little girl. I hope she gets ARVs and I will continue to help her aunt care for her as best as she can.
28 Days til my mom and brother come to Africa!!! Whoo hooo. That's the benchmark to look forward to :)
-dkm
And we are led to those who help us most to grow,
If we let them,
And we help them in return.
-Wicked
This past week has been a bit sad, but also sort of marks the end of another part of my time in Malawi. Let's see if I can back up and fill you in on some of the stories:
Wednesday, 3/12 - Hannah treated the entire research team to lunch at the Hippo View Lodge, an incredible spot right on the Shire River. The place sort of reminded me of the African attempt at a theme park lodge or something. There are large hippo statues at the gates and enormous eagle statues all over that actually are sinks (the water comes out of the eagle's beak!). Lunch was nice, and then we headed up to the village. Unfortunately, the baboon baby that Hannah got so attached to the week before died while we ate dinner. It was really sad, and the Father was really upset. It was so malnourished and probably wasn't old enough to be away from it's mom. Poor thing.
Then in our bedroom that night there was a SCORPION! Scary...Vegas killed it for us! eeek.
Friday, 3/14 - I had to deal with one of those African tragedies that you hope is just a terrible generalization: A young girl showed up very late for our clinic with a baby strapped to her back. Rosemary, our nurse, asked if the child was her sister and of course it was her daughter. The girl was just 16 years old, the baby 8 months. This means she potentially could have gotten pregnant as young as 14 years old. At the time she was in grade 5 in Blantyre, living with a relative. She stayed next to a more wealthy Malawian man, who often commented to her that she looked thin, that her clothes seemed worn and pointed out how well dressed his wife and children were. He promised he could provide for her, and she says she was "tricked" into marrying him. I needn't explain what happened between this young girl and some pedophile-type man but now this 16 year old mom is desperately trying to take care of her son, and has just learned that she is HIV+. The baby as of now is not infected, but he will need to be retested at 9 months and 1 year. It was a pretty rough story to hear. I gave her some gifts and a bit of cash to help her in some small way. I'll bring some clothes donated by Hannah for her next visit.
The afternoon was bittersweet as well. We had a going away party for Hannah and the nurses gave us each a lovely ivory wrap skirt with the project logo stamped along the bottom. They sang a beautiful goodbye song and presented the gifts in very traditional Malawian style - on their knees in front of us. It was actually really special and incredibly thoughtful.
Saturday, 3/15 - In the morning, Hannah, Kathleen and I went to the market and bought gifts for Hannah to bring back home, new chitenje skirts, and some paintings for the bare walls in my house. Then we picked up the little boys that live at my house and took a field trip to the airport to see Hannah off. We all sat on the veranda of the airport and watched the plane land at the airport. The boys were so excited and I bought them all ice cream as a special trip. They were wearing their church clothes and were so well behaved. Saying goodbye to Hannah was awful, I cried. She was so wonderful, I am so glad that she joined me these past two months. Now I have a friend in Australia... guess where I wish my next vacation to be?
Sunday, 3/16 - I went for a run, by myself (JCF, MAM - don't worry. It was lovely!). I ran out to the President's house, talked with the army guy (a little Chichewa even!) and felt great. Kathleen and I met up with Liz and her parents for a really great dinner. Liz's parents are visiting Malawi for 2 weeks and treated us at the Italian restaurant in Blantyre. After, Kathleen stayed over at my house for the night.
Monday, 3/17 - No notice of St. Patty's Day whatsoever. Work was icky because it was raining and I was at a center with very little shelter. Then more bad news came - way, way back I wrote about a little girl named Margaret whose mother passed away at the Makhwila health center. She has stayed in our program since then as her aunt has no way to feed her. She has been doing so well, her weight has reached normal levels and she looks beautiful. Unfortunately, her HIV status changed this past week and she has seroconverted. I was really upset about this too. It is heart breaking, and in some way I feel very attached to this little girl. I hope she gets ARVs and I will continue to help her aunt care for her as best as she can.
28 Days til my mom and brother come to Africa!!! Whoo hooo. That's the benchmark to look forward to :)
-dkm
Monday, March 10, 2008
Just for a laugh
Transporting charcoal is apparently illegal in Malawi, although the majority of the country relies on it for cooking and warming water.
As we are driving, we pass a huge truck carrying something under a tarp. My driver honks, waves and smiles.
Me: "Vegas, do you know him?"
Vegas: "Yes. I give him money, he bring me charcoal."
Hmm...it was funnier in person.
As we are driving, we pass a huge truck carrying something under a tarp. My driver honks, waves and smiles.
Me: "Vegas, do you know him?"
Vegas: "Yes. I give him money, he bring me charcoal."
Hmm...it was funnier in person.
Saturday, March 8, 2008
How many times have you gone to a zoo, held your nose, and spent a while in the primate house before then moving on to the area of the great apes? You've pointed to their opposable thumbs, their nearly human ears, their tiny fingernails. Maybe you even took a class with Prof. Smith, Sussman, or Rasmussen and had to memorize who ate what, where and with whom. Yet, though nearly human, you never really, really want to touch one. So what happens when a Catholic mission Father decides to adopt an orphaned baboon infant, one barely two pounds, visibly malnourished, dehydrated, and abandoned? You get the experience of Hannah and my Wednesday afternoon.
Hannah arrived first to find the baby baboon sprawled out on the cool cement floor, barely able to walk yet. I got a text message requesting infant formula or powdered milk- for a monkey! When I pulled up a bit later, baby Jaye was sleeping on Hannah's belly. When I walked into the room, the infant woke, cried a bit, pooped all over Hannah's white t-shirt, and then peed all over me. It was at this point that we found some cloth, folded it into a triangle, cut a hole for Jaye's tail, and tied on the diaper. Just like a human baby, the baboon would cry when left alone, wanted to be held very securely, and obviously wanted to suckle. We tried to feed it milk, but it seemed unsure of how to drink from a spoon. Hopefully, by next week's visit, Jaye will have learned.
In the spirit of fun weekends, Hannah and I headed out to Mulanje Mountain (3000 meters, the highest point in Malawi and al of Southern Africa north of the Drakensberg). We didn't climb all the way to the top (such a trip can take 3 days of hiking with stops at small huts stationed along the route), but we walked up quite a bit. The views were spectacular, and more impressive still were the men carrying huge planks of wood down insanely steep, wet paths. The timbers easily weighed 50kg or more (>100lbs) and the path was very narrow, very very steep, and the rocks were covered with moss. We took pictures, and I will post a link for photos shortly. We played on some boulders, sat at the waterfall, and imagined swimming in the 64 meter pond below the waterfall. It was all incredible, and great cardio too!
In the evening, we went out to celebrate a friends birthday. We ended up dancing all night long at a crazy Malawi bar with lots of techno and house music before heading back to my house where we stayed up far too late for me to be blogging before 6am on this Sunday morning. All in all, a great weekend so far! Now if only I didn't have to do data entry...
-dkm
Hannah arrived first to find the baby baboon sprawled out on the cool cement floor, barely able to walk yet. I got a text message requesting infant formula or powdered milk- for a monkey! When I pulled up a bit later, baby Jaye was sleeping on Hannah's belly. When I walked into the room, the infant woke, cried a bit, pooped all over Hannah's white t-shirt, and then peed all over me. It was at this point that we found some cloth, folded it into a triangle, cut a hole for Jaye's tail, and tied on the diaper. Just like a human baby, the baboon would cry when left alone, wanted to be held very securely, and obviously wanted to suckle. We tried to feed it milk, but it seemed unsure of how to drink from a spoon. Hopefully, by next week's visit, Jaye will have learned.
In the spirit of fun weekends, Hannah and I headed out to Mulanje Mountain (3000 meters, the highest point in Malawi and al of Southern Africa north of the Drakensberg). We didn't climb all the way to the top (such a trip can take 3 days of hiking with stops at small huts stationed along the route), but we walked up quite a bit. The views were spectacular, and more impressive still were the men carrying huge planks of wood down insanely steep, wet paths. The timbers easily weighed 50kg or more (>100lbs) and the path was very narrow, very very steep, and the rocks were covered with moss. We took pictures, and I will post a link for photos shortly. We played on some boulders, sat at the waterfall, and imagined swimming in the 64 meter pond below the waterfall. It was all incredible, and great cardio too!
In the evening, we went out to celebrate a friends birthday. We ended up dancing all night long at a crazy Malawi bar with lots of techno and house music before heading back to my house where we stayed up far too late for me to be blogging before 6am on this Sunday morning. All in all, a great weekend so far! Now if only I didn't have to do data entry...
-dkm
Tuesday, March 4, 2008
Naked Jane and other anecdotes
On this fine March 4th, my mom's birthday in fact, I reflected on the number of interesting anecdotes that made the long hours of work today seem manageable, and at times, laughable.
The morning started with me having to haul two 50kg sacks of flour from my house down to the cars, no small feat. Fifty kilos of dead-weight flour is damn heavy. I tried to pretend that I was just carrying a 110 pound person, but given that the flour does not "hold on tight" and wrap its arms around you, it really is quite different. Nothing like a quick pre-5am workout to start the day off right.
In the car on the way to pick up my staff, I got a chance to talk to my brother and some friends. (This was very exciting; thanks for the chatting/texting to those involved.) However, what really made the morning drive special was the double rainbow. The first rainbow looked just like the pictures I drew in second grade - clouds on either side of a perfect semi-circle. The second rainbow was just 1/2, but the colors were just as vibrant as the complete rainbow. The background sky was periwinkle/purple and made a striking background for ROYGBIV. Very special indeed.
We had to load the chiponde into the cars in the morning, as yesterday was yet another public holiday, and thus everything was closed. After loading more than 600 kg of milk chiponde and about half as much soy chiponde, our caravan set off for our sites in the foothills of Mt. Mulanje. Unfortunately, a few hours later we'd realize that 600 kg of food wasn't even enough!
Next, I met up with a woman whose child I transported to the district hospital two weeks ago. Her child was incredible anemic at the time, and subsequently had a blood transfusion. The mother was so grateful that she brought us a gift of several really nice pumpkins (squashes or gourds... everything here is called pumpkin). It was such a generous thanks.
Then, midway through screening another several hundred children (seriously, there is an endless supply of children aged 6 months to 5 years in this tiny country), all of a sudden the school children were all stampeding down the road. At first, I thought nothing of it. But when the stampede abruptly turned back and went running in the other direction, all the mom's at my clinic started to turn and look at the commotion. My staff even turned to see what was causing these children to run wildly up and down the street. So what was it? I was told it was a "mad person." I figured a drunk or a schizophrenic man, typical "mad" people in Malawi. I was wrong. I looked up to see a woman walking around with a very loose piece of fabric (chitenje) wrapped at her waist and not a stitch of clothing more. She was gesturing to the trees and then to the children, walking very deliberately in all different directions. I continued to work. But then, she decided it would be off with her chitenje - a much better place for a skirt is clearly on one's head! So, there she was, stark naked with her skirt on her head. You better believe the school children were laughing. Although I do feel bad for this woman, I also had to bite my tongue and concentrate to not laugh myself. Who knows where she was headed, but eventually she disappeared.
When we finally finished work, we headed back to Blantyre and had a quick stop to buy pineapples (4 pineapples for less than $1). Next to the pineapples we saw a woman selling bananas with a very marasmic child on her back. We couldn't help ourselves, so the nurses and I set up shop on the side of the road. We did the measurements, checked for edema, took the child's history and taught the mom how to feed the child chiponde. Our final enrollment of the day, at the market.
To finish the day off, Liz and I went for a bit of a jog in the backyard and then we made a great dinner - egg whites with tomato and feta, pumpkin with brown sugar and ginger, a huge salad, and even a G&T. Good ending to a long, but fun day. Hope all is well at home - send some emails!
-dkm
The morning started with me having to haul two 50kg sacks of flour from my house down to the cars, no small feat. Fifty kilos of dead-weight flour is damn heavy. I tried to pretend that I was just carrying a 110 pound person, but given that the flour does not "hold on tight" and wrap its arms around you, it really is quite different. Nothing like a quick pre-5am workout to start the day off right.
In the car on the way to pick up my staff, I got a chance to talk to my brother and some friends. (This was very exciting; thanks for the chatting/texting to those involved.) However, what really made the morning drive special was the double rainbow. The first rainbow looked just like the pictures I drew in second grade - clouds on either side of a perfect semi-circle. The second rainbow was just 1/2, but the colors were just as vibrant as the complete rainbow. The background sky was periwinkle/purple and made a striking background for ROYGBIV. Very special indeed.
We had to load the chiponde into the cars in the morning, as yesterday was yet another public holiday, and thus everything was closed. After loading more than 600 kg of milk chiponde and about half as much soy chiponde, our caravan set off for our sites in the foothills of Mt. Mulanje. Unfortunately, a few hours later we'd realize that 600 kg of food wasn't even enough!
Next, I met up with a woman whose child I transported to the district hospital two weeks ago. Her child was incredible anemic at the time, and subsequently had a blood transfusion. The mother was so grateful that she brought us a gift of several really nice pumpkins (squashes or gourds... everything here is called pumpkin). It was such a generous thanks.
Then, midway through screening another several hundred children (seriously, there is an endless supply of children aged 6 months to 5 years in this tiny country), all of a sudden the school children were all stampeding down the road. At first, I thought nothing of it. But when the stampede abruptly turned back and went running in the other direction, all the mom's at my clinic started to turn and look at the commotion. My staff even turned to see what was causing these children to run wildly up and down the street. So what was it? I was told it was a "mad person." I figured a drunk or a schizophrenic man, typical "mad" people in Malawi. I was wrong. I looked up to see a woman walking around with a very loose piece of fabric (chitenje) wrapped at her waist and not a stitch of clothing more. She was gesturing to the trees and then to the children, walking very deliberately in all different directions. I continued to work. But then, she decided it would be off with her chitenje - a much better place for a skirt is clearly on one's head! So, there she was, stark naked with her skirt on her head. You better believe the school children were laughing. Although I do feel bad for this woman, I also had to bite my tongue and concentrate to not laugh myself. Who knows where she was headed, but eventually she disappeared.
When we finally finished work, we headed back to Blantyre and had a quick stop to buy pineapples (4 pineapples for less than $1). Next to the pineapples we saw a woman selling bananas with a very marasmic child on her back. We couldn't help ourselves, so the nurses and I set up shop on the side of the road. We did the measurements, checked for edema, took the child's history and taught the mom how to feed the child chiponde. Our final enrollment of the day, at the market.
To finish the day off, Liz and I went for a bit of a jog in the backyard and then we made a great dinner - egg whites with tomato and feta, pumpkin with brown sugar and ginger, a huge salad, and even a G&T. Good ending to a long, but fun day. Hope all is well at home - send some emails!
-dkm
Monday, February 25, 2008
ROAD TRIP!!!!!
Inspired by last Saturday's wonderful-ness and given that Hannah has only 3 weekends left, the 'crew' (Hannah, Chelsea, Kathleen, Liz and I) decided to make the most of the recent beautiful weather and headed to Lake Malawi for the weekend. The events that ensued amounted to about the most fun I've had in many, many weeks.
On Friday afternoon, we planned to head out with sleeping bags and tents to an area of the lake called Cape Maclear. Our plan was to leave by 1pm, given that it is a 5 hour drive to get up there. But of course, we instead left after 3, mistake number one. We piled all our stuff into the car, picked Liz up in Zomba (a city one hour north of Blantyre) and continued north well past sunset. It was getting late and the road was exceptionally horrendous so we decided to find a backpacker's place off the road rather than try to make it all the way to the Cape (and then have to pitch tents in the dark). Our first attempt to find a lodge put us in the middle of a very quiet, dark village with absolutely nothing remotely resembling a guest house. We drove past mud hut after mud hut until a young woman came out of her house, standing in her door way lit just by candles and the moon. In perfect English (what a surprise) she told us that we had come much too far and that we had to head back to the main road towards Monkey Bay. We turned back, and at the next sign (Venice Beach Backpacker Lodge) we again turned off the road. We came to the first fork (Two roads diverged in a road?), took the right side...and promptly turned back. We headed to the left side, and came to another unmarked fork. Left again. Continued down this dirt road for a while and found ourselves at an all boys boarding school - mind you it was after 9pm. Quickly got out of there. Back to the dirt road...down, down, down. We next came upon a huge gathering of school children dancing and singing and clapping. Their whole village is built on the sand of the lake so they were doing gymnastics underneath the stars - how fun. They quickly helped us find our way to the Venice Beach lodge and we thought we had finally succeeded. But, lets be real, what would a trip be without getting stuck? So as I pull in, my tires spun deeper and deeper into the sand. It took all the staff members of the lodge to lift the car up enough to push it forward. (Pictures will be posted on Facebook in time). By now, it was after 9:30pm and these very wonderful guys made us dinner and Malawi gin and tonics. A perfect ending to a very long journey. We were put up in a room with 5 beds and fell asleep with the sounds of hippo cries echoing off the lake.
That was just day one. Day two was WAY more fun. We woke up, had breakfast, and headed out for Cape Maclear. In the daylight, the driving was much easier. We made it to the place where we ended to set up tents, but found the place closed for construction. Instead, we went two resorts over and found an AWESOME place. It was incredibly beautiful. Though a bit more pricy (night one was $7/night, night two was $12ish...how luxurious!), the place was super clean, great staff, beautiful water front, perfectly manicured lawns and great food. We went on a boat ride, snorkeled with tons of tropical fish (and even learned to catch them with our hands), then fed these enormous eagles. After, Hannah and I did some strength training and gymnastics on top of this ridge that overlooked the lake.
In the evening, we met our roommates - 4 guys from Michigan State who are all medical students (4th years, minus one who was actually a 4th year resident). They were awesome and so much fun. One played for Michigan State football as an undergrad and it was hard to adjust to seeing 6'3" guys again (Malawians are super short). We had the most fun night - dancing, drinking, swimming after midnight! At around 3am we finally called it quits, but all got up by 8 and headed out for a run in the national park (the guys went out on their own - I can't keep up with 6'3" football players...)
Unfortunately, the weekend had to end around noon or so in order for us to get back to Blantyre at a decent hour to prepare for work today. In any event, it was really fun.
Looking forward to many more fun adventures in the coming weekends. I could get used to the work for a week, fun for a weekend routine...
-dkm
On Friday afternoon, we planned to head out with sleeping bags and tents to an area of the lake called Cape Maclear. Our plan was to leave by 1pm, given that it is a 5 hour drive to get up there. But of course, we instead left after 3, mistake number one. We piled all our stuff into the car, picked Liz up in Zomba (a city one hour north of Blantyre) and continued north well past sunset. It was getting late and the road was exceptionally horrendous so we decided to find a backpacker's place off the road rather than try to make it all the way to the Cape (and then have to pitch tents in the dark). Our first attempt to find a lodge put us in the middle of a very quiet, dark village with absolutely nothing remotely resembling a guest house. We drove past mud hut after mud hut until a young woman came out of her house, standing in her door way lit just by candles and the moon. In perfect English (what a surprise) she told us that we had come much too far and that we had to head back to the main road towards Monkey Bay. We turned back, and at the next sign (Venice Beach Backpacker Lodge) we again turned off the road. We came to the first fork (Two roads diverged in a road?), took the right side...and promptly turned back. We headed to the left side, and came to another unmarked fork. Left again. Continued down this dirt road for a while and found ourselves at an all boys boarding school - mind you it was after 9pm. Quickly got out of there. Back to the dirt road...down, down, down. We next came upon a huge gathering of school children dancing and singing and clapping. Their whole village is built on the sand of the lake so they were doing gymnastics underneath the stars - how fun. They quickly helped us find our way to the Venice Beach lodge and we thought we had finally succeeded. But, lets be real, what would a trip be without getting stuck? So as I pull in, my tires spun deeper and deeper into the sand. It took all the staff members of the lodge to lift the car up enough to push it forward. (Pictures will be posted on Facebook in time). By now, it was after 9:30pm and these very wonderful guys made us dinner and Malawi gin and tonics. A perfect ending to a very long journey. We were put up in a room with 5 beds and fell asleep with the sounds of hippo cries echoing off the lake.
That was just day one. Day two was WAY more fun. We woke up, had breakfast, and headed out for Cape Maclear. In the daylight, the driving was much easier. We made it to the place where we ended to set up tents, but found the place closed for construction. Instead, we went two resorts over and found an AWESOME place. It was incredibly beautiful. Though a bit more pricy (night one was $7/night, night two was $12ish...how luxurious!), the place was super clean, great staff, beautiful water front, perfectly manicured lawns and great food. We went on a boat ride, snorkeled with tons of tropical fish (and even learned to catch them with our hands), then fed these enormous eagles. After, Hannah and I did some strength training and gymnastics on top of this ridge that overlooked the lake.
In the evening, we met our roommates - 4 guys from Michigan State who are all medical students (4th years, minus one who was actually a 4th year resident). They were awesome and so much fun. One played for Michigan State football as an undergrad and it was hard to adjust to seeing 6'3" guys again (Malawians are super short). We had the most fun night - dancing, drinking, swimming after midnight! At around 3am we finally called it quits, but all got up by 8 and headed out for a run in the national park (the guys went out on their own - I can't keep up with 6'3" football players...)
Unfortunately, the weekend had to end around noon or so in order for us to get back to Blantyre at a decent hour to prepare for work today. In any event, it was really fun.
Looking forward to many more fun adventures in the coming weekends. I could get used to the work for a week, fun for a weekend routine...
-dkm
Saturday, February 16, 2008
Saturday adventures
What a fantastic Saturday! Days like these are few and far between, but when they come around, one just must bask in the luxury. Although I didn't sleep as late as I wish I could have, I obviously had a productive early morning (see post from earlier today). When Hannah and Chelsea woke up, we all sat around in our PJs having good coffee, muesli, and natural yogurt. After a few hours of chatting and lounging, we called up Kathleen and got her on board for a hike to Mt. Michiru, just near where I live. This mountain is only 1,478 meters high, but the hike is pretty solid.
We headed off to the mountain around 11:30am, faced a broken bridge on the only road I knew to get there, but managed to find a diversion and arrived at the base of the mountain a few minutes after 12. Our guide, Laston, taught us about the different tree barks (some for ring worm, others for cough or to treat cholera) and pointed out some of the coolest looking spiders I have ever seen. These things were about the size of a pinky nail, but were shaped like the Batman symbol. They were insane colors, yellow and black, blue and red, purples, yellow spotted...awesome. I'm sure you wouldn't want to be bit by one (like poison dart frogs probably) but we took TONS of pictures. I'll try to get those on facebook soon as well.
The hike was pretty tough. The path was super steep and now that the rains have come there was a lot of moss and many parts of the path were very overgrown with lush green leaves. The scenery changed so much as we traversed different parts of the mountain. We had a lot of fun hiking to the top which took just under 2 hours. We hiked on some rocks, saw baboons and small mountain rodents called "rock hiluxes." The views were incredible so we took lots of photos. By the time we got back on the road it was after 4pm. We made a quick stop at the market to buy some veggies for dinner (stir fry!) and are about ready to start chopping.
I do have to say, I'm pretty damn tired.
-dkm
We headed off to the mountain around 11:30am, faced a broken bridge on the only road I knew to get there, but managed to find a diversion and arrived at the base of the mountain a few minutes after 12. Our guide, Laston, taught us about the different tree barks (some for ring worm, others for cough or to treat cholera) and pointed out some of the coolest looking spiders I have ever seen. These things were about the size of a pinky nail, but were shaped like the Batman symbol. They were insane colors, yellow and black, blue and red, purples, yellow spotted...awesome. I'm sure you wouldn't want to be bit by one (like poison dart frogs probably) but we took TONS of pictures. I'll try to get those on facebook soon as well.
The hike was pretty tough. The path was super steep and now that the rains have come there was a lot of moss and many parts of the path were very overgrown with lush green leaves. The scenery changed so much as we traversed different parts of the mountain. We had a lot of fun hiking to the top which took just under 2 hours. We hiked on some rocks, saw baboons and small mountain rodents called "rock hiluxes." The views were incredible so we took lots of photos. By the time we got back on the road it was after 4pm. We made a quick stop at the market to buy some veggies for dinner (stir fry!) and are about ready to start chopping.
I do have to say, I'm pretty damn tired.
-dkm
Friday, February 15, 2008
Photos Added!
FINALLY. I got 32 photos to add to facebook. If you don't have facebook, find someone 25 or younger and ask them to sign you on if you want to see them. For the rest of you, I'm working on getting them to load onto picassa (gmail photo thing) but it's slow going.
Credit for most of the photos goes to Jeanne Gibbons at WashU, who visited us in January for 2 weeks. Thanks Jeanne!
Credit for most of the photos goes to Jeanne Gibbons at WashU, who visited us in January for 2 weeks. Thanks Jeanne!
Thursday, February 14, 2008
Valentine's Day Lovin'
Roses are just so overrated. What better way to express love and personal affection than...3 major pee-all-over-your-hands-and skirt and 1 very generous bout of...yeah the other stuff. Over all, the days have been going super well. Here are some of the highs and lows:
Since the preliminary results from the first 770 children to complete the program showed that soya chiponde was the most effective therapy for moderate acute malnutrition (or in the world of alphabet NGO soup - MAM), my team and I have started to roll out "operational" programs in each of our centers. This means that we are in the process of training all the village health assistants to be able to identify and classify the different levels of malnutrition, to properly enroll the children on the correct types of food, distribute the necessary quantity for the child's weight, and to do all the follow-up and record keeping. I've put together a 15 page manual and a short quiz to help gauge how the training is going. Slowly, all the study children will complete the program and all the new children that we see will either be enrolled on either milk/peanut food (for severely malnourished kids) or soy/peanut food (for moderately malnourished kids). The ultimate goal is to have soya chiponde adopted as the national protocol for this type of malnutrition, just as the milk version has been adopted nationwide for the severe malnutrition.
The newest challenge is finding a supply of soy. Theoretically, Malawian farmers grow tons of soy and we should have no problem sourcing it. But, this is Africa. All the farmers have apparently made arrangements to sell their supplies to other people and the harvest is not until April. I have been running around like mad looking for soy - at the local markets, at the small holders union, at different distributors, etc. On Tuesday, I managed to find 480kg at a very busy working class market, which will yield between 3.5 and 4 metric tons of soy peanut butter (7,000-8,000ish pounds). But, to give us a bit more cushion, I'm paying a guy who knows a guy who knows a guy in Mozambique for 1 ton of soy. Dodgy, maybe, but it will make heaps and heaps of soy chiponde. [Thanks to Hannah for the new lingo - dodgy, heaps...Aussie expressions!]
Yesterday, Hannah was asked to visit a man, and father of 3, in his house because he too ill to walk down to our clinic. I pulled up to the house as she walked out, and could see the man being carried down from his house on the back of his father. The man was thinner than any person I've ever seen. His cheek bones jutted from his face, his ribs were so exposed that Hannah could not hear his lungs with her stethoscope. His mother sat in the back of our red truck and his body just crumpled onto her lap. Hannah had walked into his house to see him, and as proper Malawian custom, greeted each person in the room with the proper Chichewa greeting. He responded, in English, "I am doing well, and how are you?" I think hearing his straining voice, his rehearsed English response, and seeing him find enough strength to lift his arm out to her was emotionally very challenging. She got into my car and we left the man to be driven to the hospital some 50 kilometers away. Rosemary, our nurse, travelled with him and told us later that he made it there, but that there was not a single nurse or medical officer to be found. It was around lunch hour, and they could not find even a stretcher to lay him on. Perhaps we should have left him at his home to die with this family around. In the moment, we could only hope that the hospital could alleviate some of the pain he was feeling. ARVs and TB treatment will not save this man now, but perhaps just simple tylenol and a blanket could make him more comfortable.
On a much lighter note, Chelsea has arrived! Chelsea is a recent graduate from Lambuth University in Jackson, TN and has joined the PPB team - in Sierra Leone. She has been running small clinics in Sierra Leone since September and has come to Malawi to learn about making chiponde and running clinics on a larger scale. Dr. Manary will be going to Sierra Leone this spring to help get things rolling for her. She is living in an even less developed place- no electricity, limited water, and more eminent safety concerns. She has been extremely resourceful in finding ways to get PPB started in SL. I'm excited to have her visit for these 2 weeks and hope I can help her learn everything there is to know about chiponde. At least then I will feel part of making PPB multinational!
There are so many other things I want to write. Every time something funny or strange happens I always say, "That has to go in the blog." Of course now, I can't remember any of them. Anyway, this is a bit long and I'm beat. Hannah and I have been doing super killer work outs, which has been awesome. We are such masochists.
Happy Cheesy-American-Holiday Day.
-dkm
Since the preliminary results from the first 770 children to complete the program showed that soya chiponde was the most effective therapy for moderate acute malnutrition (or in the world of alphabet NGO soup - MAM), my team and I have started to roll out "operational" programs in each of our centers. This means that we are in the process of training all the village health assistants to be able to identify and classify the different levels of malnutrition, to properly enroll the children on the correct types of food, distribute the necessary quantity for the child's weight, and to do all the follow-up and record keeping. I've put together a 15 page manual and a short quiz to help gauge how the training is going. Slowly, all the study children will complete the program and all the new children that we see will either be enrolled on either milk/peanut food (for severely malnourished kids) or soy/peanut food (for moderately malnourished kids). The ultimate goal is to have soya chiponde adopted as the national protocol for this type of malnutrition, just as the milk version has been adopted nationwide for the severe malnutrition.
The newest challenge is finding a supply of soy. Theoretically, Malawian farmers grow tons of soy and we should have no problem sourcing it. But, this is Africa. All the farmers have apparently made arrangements to sell their supplies to other people and the harvest is not until April. I have been running around like mad looking for soy - at the local markets, at the small holders union, at different distributors, etc. On Tuesday, I managed to find 480kg at a very busy working class market, which will yield between 3.5 and 4 metric tons of soy peanut butter (7,000-8,000ish pounds). But, to give us a bit more cushion, I'm paying a guy who knows a guy who knows a guy in Mozambique for 1 ton of soy. Dodgy, maybe, but it will make heaps and heaps of soy chiponde. [Thanks to Hannah for the new lingo - dodgy, heaps...Aussie expressions!]
Yesterday, Hannah was asked to visit a man, and father of 3, in his house because he too ill to walk down to our clinic. I pulled up to the house as she walked out, and could see the man being carried down from his house on the back of his father. The man was thinner than any person I've ever seen. His cheek bones jutted from his face, his ribs were so exposed that Hannah could not hear his lungs with her stethoscope. His mother sat in the back of our red truck and his body just crumpled onto her lap. Hannah had walked into his house to see him, and as proper Malawian custom, greeted each person in the room with the proper Chichewa greeting. He responded, in English, "I am doing well, and how are you?" I think hearing his straining voice, his rehearsed English response, and seeing him find enough strength to lift his arm out to her was emotionally very challenging. She got into my car and we left the man to be driven to the hospital some 50 kilometers away. Rosemary, our nurse, travelled with him and told us later that he made it there, but that there was not a single nurse or medical officer to be found. It was around lunch hour, and they could not find even a stretcher to lay him on. Perhaps we should have left him at his home to die with this family around. In the moment, we could only hope that the hospital could alleviate some of the pain he was feeling. ARVs and TB treatment will not save this man now, but perhaps just simple tylenol and a blanket could make him more comfortable.
On a much lighter note, Chelsea has arrived! Chelsea is a recent graduate from Lambuth University in Jackson, TN and has joined the PPB team - in Sierra Leone. She has been running small clinics in Sierra Leone since September and has come to Malawi to learn about making chiponde and running clinics on a larger scale. Dr. Manary will be going to Sierra Leone this spring to help get things rolling for her. She is living in an even less developed place- no electricity, limited water, and more eminent safety concerns. She has been extremely resourceful in finding ways to get PPB started in SL. I'm excited to have her visit for these 2 weeks and hope I can help her learn everything there is to know about chiponde. At least then I will feel part of making PPB multinational!
There are so many other things I want to write. Every time something funny or strange happens I always say, "That has to go in the blog." Of course now, I can't remember any of them. Anyway, this is a bit long and I'm beat. Hannah and I have been doing super killer work outs, which has been awesome. We are such masochists.
Happy Cheesy-American-Holiday Day.
-dkm
Thursday, February 7, 2008
Finally, a moment to spare
The past 10 days have been very long and I haven't had time to sit down and update for a while. The rains stopped for a few days, leaving clear blue skies, lots of opportunity for sun burn, and beautiful afternoons for running (if ever I were home before dark that is). But never hold your breath here...the rains returned yesterday afternoon and all the clothes are back to feeling damp and mildewed. Superb.
What can I tell you about the work? Rainy season has really taken a toll on the nutritional status of the children here, so in places where once I would see a maximum of 50 children in a day, I am now seeing 200 - 300. The dramatic rise in volume of enrollments means that every day we need to pack more and more chiponde - I think I am going to need a U-Haul truck soon just to bring enough food! This week we have again enrolled over 100 children! Man, back in September is was incredible if we enrolled 40 or 50 in a week.
The next phase of my work here is to get this new soy/peanut food into operational use in Malawi. This is no small task, but I'm excited to get it going. First, I am working with some local suppliers to find a reliable source of soy beans. I am spending my day today working on this, I will meet with the supplier, see what he can offer as a product, the pricing, how it will be delivered, how it will be stored, etc. Next will be getting our factory geared up to start making soy chiponde. Starting next week, I will begin training the local village health workers in how to identify moderately malnourished versus severely malnourished children (at the moment, only my staff and I have been doing the evaluations). These health workers will need to learn to distinguish between these two forms of malnutrition, and then will need to understand how to distribute the two types of food - milk/peanut chiponde and soy/peanut chiponde. The idea is for the two foods to run in parallel in every health center. Once my own sites are working operationally (in other words, doing the program on their own), my final task is to get the World Food Programme people and other large groups around here (Ministry of Health, MSF, Clinton Foundation and so on) to also get on board with this as the best treatment for moderate acute malnutrition (MAM). Once all that is accomplished, I can finally say - job complete!
I don't have any real crazy stories to tell, except my run in with the police but I'd rather not blog about that (needless to say, it was a fundraising scam and I just had to pay a stupid amount of money...did I write about this?). At one center this week, all of a sudden the air was swarming with dragonflies - hundreds and hundreds. I imagine experiences like that shaped the idea of locust as it is written in the Book...gross. A bat flew into our window as we were driving up to the far away villages in the dark last week and killed itself. Oops. And Ella is wonderful. She thinks she's a dog for sure, but right now she's sitting on my forearms as I type and purring like a machine. She's the strangest cat, far far too friendly. Good thing, she's great company.
That's about all for now.
-dkm
What can I tell you about the work? Rainy season has really taken a toll on the nutritional status of the children here, so in places where once I would see a maximum of 50 children in a day, I am now seeing 200 - 300. The dramatic rise in volume of enrollments means that every day we need to pack more and more chiponde - I think I am going to need a U-Haul truck soon just to bring enough food! This week we have again enrolled over 100 children! Man, back in September is was incredible if we enrolled 40 or 50 in a week.
The next phase of my work here is to get this new soy/peanut food into operational use in Malawi. This is no small task, but I'm excited to get it going. First, I am working with some local suppliers to find a reliable source of soy beans. I am spending my day today working on this, I will meet with the supplier, see what he can offer as a product, the pricing, how it will be delivered, how it will be stored, etc. Next will be getting our factory geared up to start making soy chiponde. Starting next week, I will begin training the local village health workers in how to identify moderately malnourished versus severely malnourished children (at the moment, only my staff and I have been doing the evaluations). These health workers will need to learn to distinguish between these two forms of malnutrition, and then will need to understand how to distribute the two types of food - milk/peanut chiponde and soy/peanut chiponde. The idea is for the two foods to run in parallel in every health center. Once my own sites are working operationally (in other words, doing the program on their own), my final task is to get the World Food Programme people and other large groups around here (Ministry of Health, MSF, Clinton Foundation and so on) to also get on board with this as the best treatment for moderate acute malnutrition (MAM). Once all that is accomplished, I can finally say - job complete!
I don't have any real crazy stories to tell, except my run in with the police but I'd rather not blog about that (needless to say, it was a fundraising scam and I just had to pay a stupid amount of money...did I write about this?). At one center this week, all of a sudden the air was swarming with dragonflies - hundreds and hundreds. I imagine experiences like that shaped the idea of locust as it is written in the Book...gross. A bat flew into our window as we were driving up to the far away villages in the dark last week and killed itself. Oops. And Ella is wonderful. She thinks she's a dog for sure, but right now she's sitting on my forearms as I type and purring like a machine. She's the strangest cat, far far too friendly. Good thing, she's great company.
That's about all for now.
-dkm
Monday, January 28, 2008
Just like election night, preliminary polls with 60% of districts reporting…
Tonight, something spectacular happened. All the data has been entered for 1224 children. All their food groups recorded, their outcomes tallied. Excel worked its magic, sorting and summing. Of a total of 1224 children accurately enrolled, I have complete data for 770 (the remaining children still need to be followed up for a total of 8 weeks or until their weight-for-height z-score is greater than -2 standard deviations, which ever occurs first). So who wins?
Let’s remember the players: milk/peanut Ready-to-Use Therapeutic Food, soy/peanut RUTF, and the standard of care for moderate malnutrition, corn/soy blended flour. We know that over all, milk/peanut RUTF works 95% of the time and the CSB flour works about 55% of the time. The goal of the study is that the soy/peanut RUTF performs as well as a therapeutic treatment for moderate malnutrition as it’s milk/peanut cousin. The study has been designed to be able to determine statistical significance within 5% difference.
Drum roll please….
SOY AND MILK RUTF WORK THE SAME!!!! CSB PERFORMS SUBSTANTIALLY WORSE IN THESE CHILDREN! (However, our rate of recovery with CSB is significantly higher than the percentages published in the literature, which is great and probably has to do with the amount of education and one-on-one interaction our nurses have with each and every patient, compared to the traditional method used to distribute this supplementary food).
For me, this makes all the mud, tarantulas, lack of electricity (going on 3 days now with no hot water, lights, fridge or stove), 45 days of straight rain, and on and off water supply TOTALLY worth it. The study is working!!!!! If you can’t tell, I’m beyond excited.
Someone have some champagne…toast to soy beans, peanuts and Malawian babies!
-dkm
Let’s remember the players: milk/peanut Ready-to-Use Therapeutic Food, soy/peanut RUTF, and the standard of care for moderate malnutrition, corn/soy blended flour. We know that over all, milk/peanut RUTF works 95% of the time and the CSB flour works about 55% of the time. The goal of the study is that the soy/peanut RUTF performs as well as a therapeutic treatment for moderate malnutrition as it’s milk/peanut cousin. The study has been designed to be able to determine statistical significance within 5% difference.
Drum roll please….
SOY AND MILK RUTF WORK THE SAME!!!! CSB PERFORMS SUBSTANTIALLY WORSE IN THESE CHILDREN! (However, our rate of recovery with CSB is significantly higher than the percentages published in the literature, which is great and probably has to do with the amount of education and one-on-one interaction our nurses have with each and every patient, compared to the traditional method used to distribute this supplementary food).
For me, this makes all the mud, tarantulas, lack of electricity (going on 3 days now with no hot water, lights, fridge or stove), 45 days of straight rain, and on and off water supply TOTALLY worth it. The study is working!!!!! If you can’t tell, I’m beyond excited.
Someone have some champagne…toast to soy beans, peanuts and Malawian babies!
-dkm
Thursday, January 24, 2008
Malawi: Gymnastics, Driving: __________
Answer: Balance Beam.
Explanation: After reading the entry from Tuesday, you probably have the idea that driving in Malawi is ever an adventure. But Thursday must have felt jealous, because yesterday topped it all.
When considering the answer to an analogy such as the one in the title above you want to look for the pattern (here we are looking for small parts of a whole). Balance beam fits particularly well here. You’re prepping to tumble across a 4-inch piece of wood, 4 feet above the ground (the massive holes and ditches with parts of the road falling off even a foot). Sure, you’ve practiced many times before, occasionally falling off (ahem, Tuesday’s adventure in the mud trench). But then you get up in front of that judge (the whole village who runs to the street to watch) and all of a sudden everything gets harder. The skills feel harder and performing without a .5 deduction for a fall (visits to the ditch) or a .2 deduction for a wobble (car dancing in the mud) makes you feel so triumphant.
With that concept in your mind, imagine what it was like to drive out to Chikweo village, a site very far from a tarmac road. The sky just opened up and torrentially down poured halfway through enrolling 45 (!) new study children. All I could think was that the balance beam we had to cross to get back to pavement was more rickety, older, thinner and higher than the standard 4 inch, 4 foot high beam.
The road had been morphed into a small white water rapid river. Everywhere that the road was broken, small rapids gathered. The water was several feet deep, opaque, and running down fast. I was in a line of 4 cars – Ramsay ahead of me, and 2 cars behind. We stopped as we approached the only remaining dry spot and waited for about 10 minutes to see if the water level would go down at all. Of course it didn’t, and the brave (or stupid) Pajero driver behind me got impatient and just went for it. When he made it to the other side, the pick-up behind also followed. Now it was just Ramsay and I… he went first. Me alone (with passengers of course). With a bit of encouraging cheering from my peanut gallery (preparing to mount the beam, “Go Danny! You got it! Stick it!”), I went. What a serious adrenaline rush.
Probably not perfect form, a few bent legs and unpointed toes, but it was a pretty decent performance…maybe a 9.0.
And…we’ve made it to 1200 children. Pretty awesome :)
Explanation: After reading the entry from Tuesday, you probably have the idea that driving in Malawi is ever an adventure. But Thursday must have felt jealous, because yesterday topped it all.
When considering the answer to an analogy such as the one in the title above you want to look for the pattern (here we are looking for small parts of a whole). Balance beam fits particularly well here. You’re prepping to tumble across a 4-inch piece of wood, 4 feet above the ground (the massive holes and ditches with parts of the road falling off even a foot). Sure, you’ve practiced many times before, occasionally falling off (ahem, Tuesday’s adventure in the mud trench). But then you get up in front of that judge (the whole village who runs to the street to watch) and all of a sudden everything gets harder. The skills feel harder and performing without a .5 deduction for a fall (visits to the ditch) or a .2 deduction for a wobble (car dancing in the mud) makes you feel so triumphant.
With that concept in your mind, imagine what it was like to drive out to Chikweo village, a site very far from a tarmac road. The sky just opened up and torrentially down poured halfway through enrolling 45 (!) new study children. All I could think was that the balance beam we had to cross to get back to pavement was more rickety, older, thinner and higher than the standard 4 inch, 4 foot high beam.
The road had been morphed into a small white water rapid river. Everywhere that the road was broken, small rapids gathered. The water was several feet deep, opaque, and running down fast. I was in a line of 4 cars – Ramsay ahead of me, and 2 cars behind. We stopped as we approached the only remaining dry spot and waited for about 10 minutes to see if the water level would go down at all. Of course it didn’t, and the brave (or stupid) Pajero driver behind me got impatient and just went for it. When he made it to the other side, the pick-up behind also followed. Now it was just Ramsay and I… he went first. Me alone (with passengers of course). With a bit of encouraging cheering from my peanut gallery (preparing to mount the beam, “Go Danny! You got it! Stick it!”), I went. What a serious adrenaline rush.
Probably not perfect form, a few bent legs and unpointed toes, but it was a pretty decent performance…maybe a 9.0.
And…we’ve made it to 1200 children. Pretty awesome :)
Tuesday, January 22, 2008
I've never "worked" this hard for a tan...
Today was yet another African experience that I will probably look back on and blame for the early onset of gray hair. Although there was not a cloud in the sky by the time I turned off the paved road onto the dirt path, yesterday must have dumped buckets of rain in Mulanje district. The road was SOOOOOOO bad, worse than anything I have ever driven on before (and remember, I drive like 5-9 hours per day on these roads). There were massive ditches and crevices in the road, let alone the trenches on either side of the path filled with 2-3 feet of water and lined with overgrown reeds and rice plantings.
As I approached a particularly muddy section of this gray clay soil, I decided to divert slightly to the left to avoid the largest patch of soft, slippery mud. The tall reeds growing on the side gave me a false sense that the road was strong, and just as I passed through the worst of the mud, the road gave way on the side and half of my car slid into the trench. The car listed at an incredible angle, such that we had trouble getting out without sliding to one side from gravity. We waited in the blistering sun (responsible for the aforementioned "tan") for nearly 1.5 hours until enough men gathered around the vehicle. With 16 young men sporting washboard abs and shoulders only a subsistence farmer can have, we somehow managed to lift the car back onto the road. Unfortunately, it cost me my cell phone...the most important commodity I had out in the middle of no where. The phone was dropped in the mud water, and died on the scene.
The rest of the road was equally terrible, and I gave my forearms a great workout by squeezing the wheel with all my might for the remaining 20 minutes of driving out to the health post. The actual clinical visit wasn't too bad and we managed to make it back to Blantyre without incident. However, I then came to find out that we are almost out of soya chiponde, the very food I am out here working to prove works. So, I start making the necessary phone calls (source the raw beans, buy the beans, find a driver to pick them up) but when I get to the part about roasting the beans (essential, otherwise they are completely uncooked and inedible) I found out that the roaster runs on paraffin (gas) and...Malawi has been out of paraffin for some time. With the current gas hikes worldwide, Malawi can't afford to import paraffin. So, f*ck. That means this weekend will be devoted to roasting 100kg (220 pounds) of soy beans in my itty bitty oven on a cookie sheet...
Top it all off with me backing up into the FedEx truck and breaking the damn tail light and you have a glimpse of my day today.
But hey, I got some color.
-dkm
As I approached a particularly muddy section of this gray clay soil, I decided to divert slightly to the left to avoid the largest patch of soft, slippery mud. The tall reeds growing on the side gave me a false sense that the road was strong, and just as I passed through the worst of the mud, the road gave way on the side and half of my car slid into the trench. The car listed at an incredible angle, such that we had trouble getting out without sliding to one side from gravity. We waited in the blistering sun (responsible for the aforementioned "tan") for nearly 1.5 hours until enough men gathered around the vehicle. With 16 young men sporting washboard abs and shoulders only a subsistence farmer can have, we somehow managed to lift the car back onto the road. Unfortunately, it cost me my cell phone...the most important commodity I had out in the middle of no where. The phone was dropped in the mud water, and died on the scene.
The rest of the road was equally terrible, and I gave my forearms a great workout by squeezing the wheel with all my might for the remaining 20 minutes of driving out to the health post. The actual clinical visit wasn't too bad and we managed to make it back to Blantyre without incident. However, I then came to find out that we are almost out of soya chiponde, the very food I am out here working to prove works. So, I start making the necessary phone calls (source the raw beans, buy the beans, find a driver to pick them up) but when I get to the part about roasting the beans (essential, otherwise they are completely uncooked and inedible) I found out that the roaster runs on paraffin (gas) and...Malawi has been out of paraffin for some time. With the current gas hikes worldwide, Malawi can't afford to import paraffin. So, f*ck. That means this weekend will be devoted to roasting 100kg (220 pounds) of soy beans in my itty bitty oven on a cookie sheet...
Top it all off with me backing up into the FedEx truck and breaking the damn tail light and you have a glimpse of my day today.
But hey, I got some color.
-dkm
Monday, January 21, 2008
Post Scriptum
PS - Thank you to everyone who leaves comments on this blog. It's fun to know that people are reading along, even if some of the entries are long and less exciting than others. I do read them, and just wanted to say thanks for responding!
Bed time for me now.
g'night.
Bed time for me now.
g'night.
The little engine that could...
Remember that story? "I think I can, I think I can, I think I can..." That was how today felt. Read on...
A quick note to bring everyone up to speed on the new visitors: this past Wednesday a girl named Johanna arrived from Australia. She has just finished her final exams from 4th year medical school and will be working with me in Malawi for the next 2 months. She's a really interesting person with lots of very cool life experiences- she was born in Austria, lived for a few years in Germany, then moved to Columbia where she spent most of her childhood, currently lives in Australia while her family lives back in Germany and South Africa. She also lived in Peru for a bit of time as well. She is an avid rock climber in Australia, and just started to do some gymnastics in order to increase her strength and endurance for climbing. She's been great, and quite a trooper. The past few days have been far from easy.
So, this morning we left the house at 5:15 and headed out to round up the troops. With a few small glitches (passed a nurse waiting for us at one place and waited for her for 20 minutes at another place, almost had engine failure in the Hilux, etc) we headed out for Chamba health center. Chamba is a bit far away, about 2 hours driving or so from Blantyre. We turned down the dirt road and proceeded a short distance before meeting our first baracade - a 2 ton truck stuck in the mud going nowhere. Okay, turn around - back down the dirt road, back to the paved road, and down another dirt road. About 15 minutes into that, we find the road is literally broken. Completely unpassable, strike 2. We have strike 3, and 4, and finally we are directed down a very shady looking road. LOTS of water, mud everywhere and to top it off, a maize field. We were literally driving with maize plants pouring into our car window as we passed. Clearly not a place of a vehicle, but we made it and it opened out to the middle of a soccer field. Off we went to the clinic, 5 hours after we left the house.
What next? Every woman from 9 villages with all of her children. And enormous, ominous rain clouds. Somehow, the stars must have aligned in our favor. Even though we didn't finish seeing all the moms until late in the afternoon (we finally got home after 8pm - talk about a long day), the health workers really kept the moms organized and calm while we screened and evaluated each and every child. Johanna taught me to palpate the spleen and we saw tons of kids with splenomegaly, something you apparently hardly every see in the West.
On the drive home, we dropped a patient at the hospital who was suffering from severe anemia and clearly needed a blood transfusion. After that, we passed a large crowd of people who all looked very distressed, their bikes strewn across the paved road. We ended up reversing up the road to find out that an ESCOM (Malawi's electricity company) truck had hit a cyclist and didn't stop. So we drove this man to the police station and hospital (he had a broken wrist only), before finally heading back towards Blantyre.
Phew...what a day!
-dkm
A quick note to bring everyone up to speed on the new visitors: this past Wednesday a girl named Johanna arrived from Australia. She has just finished her final exams from 4th year medical school and will be working with me in Malawi for the next 2 months. She's a really interesting person with lots of very cool life experiences- she was born in Austria, lived for a few years in Germany, then moved to Columbia where she spent most of her childhood, currently lives in Australia while her family lives back in Germany and South Africa. She also lived in Peru for a bit of time as well. She is an avid rock climber in Australia, and just started to do some gymnastics in order to increase her strength and endurance for climbing. She's been great, and quite a trooper. The past few days have been far from easy.
So, this morning we left the house at 5:15 and headed out to round up the troops. With a few small glitches (passed a nurse waiting for us at one place and waited for her for 20 minutes at another place, almost had engine failure in the Hilux, etc) we headed out for Chamba health center. Chamba is a bit far away, about 2 hours driving or so from Blantyre. We turned down the dirt road and proceeded a short distance before meeting our first baracade - a 2 ton truck stuck in the mud going nowhere. Okay, turn around - back down the dirt road, back to the paved road, and down another dirt road. About 15 minutes into that, we find the road is literally broken. Completely unpassable, strike 2. We have strike 3, and 4, and finally we are directed down a very shady looking road. LOTS of water, mud everywhere and to top it off, a maize field. We were literally driving with maize plants pouring into our car window as we passed. Clearly not a place of a vehicle, but we made it and it opened out to the middle of a soccer field. Off we went to the clinic, 5 hours after we left the house.
What next? Every woman from 9 villages with all of her children. And enormous, ominous rain clouds. Somehow, the stars must have aligned in our favor. Even though we didn't finish seeing all the moms until late in the afternoon (we finally got home after 8pm - talk about a long day), the health workers really kept the moms organized and calm while we screened and evaluated each and every child. Johanna taught me to palpate the spleen and we saw tons of kids with splenomegaly, something you apparently hardly every see in the West.
On the drive home, we dropped a patient at the hospital who was suffering from severe anemia and clearly needed a blood transfusion. After that, we passed a large crowd of people who all looked very distressed, their bikes strewn across the paved road. We ended up reversing up the road to find out that an ESCOM (Malawi's electricity company) truck had hit a cyclist and didn't stop. So we drove this man to the police station and hospital (he had a broken wrist only), before finally heading back towards Blantyre.
Phew...what a day!
-dkm
Saturday, January 12, 2008
When DOOM fails...
DOOM is supposed to be a skittish woman's best friend... the end of all household insects' unfortunate lives. I've come to appreciate the smell of the noxious chemicals, a wonderful mix of organic compounds. However, as evidenced by its lack of killing power on the millipede (see previous entry), DOOM is not match for the true African trooper. So tonight, when the giant, black, awful tarantula showed up again, and DOOM failed, we needed to take more serious measures...
Kathleen and Liz came back from Zanzibar today and Dr. Manary took our visitors off to Liwonde National Game Park for the evening. So, I invited the girls over for a run (which was unsuccessful due to the extraordinarily heavy afternoon rains), and we sat around all day sharing stories of the week, of huge enrollment days, wading in mud, endless rain, but also white sand beaches, spice markets and new Swahili vocabulary words. After dinner, we talked about the coming week and Liz started to explain how one can find a safe, clean resthouse in Malawi. She referenced the need to check the door to be sure you can lock it from the inside, how you should inspect the bathroom, and just as she explained that the next thing to do is pull back the bedsheets to look for bedbugs...Kathleen screamed!
TARANTULA. Number 4 is it? Of course it sent me screaming on top of a chair, and Liz jumped on top of the couch. Kathleen, the only brave one, grabbed the DOOM and sprayed tons at the 5 inch creeper. No luck - it ran. I screamed a lot more. It must have sounded like a bunch of 9 year old girls at a sleep over party in here. I told Kathleen to grab a thin wood carving of a Massai warrior and poke at the spider, now hiding under the bookcase. With these assassination attempts clearly failing, I called in the reserves. The SecuriCore Guard watching our gate outside. I had no clue how to say spider in Chichewa, so I just told him to follow me to my house. When he saw what the commotion was about, he grabbed the dust pan, lurched in for the kill, and laughed all the way home.
Crisis resolved. My best guess - a baboon spider. Google it, it's awful.
-dkm
Kathleen and Liz came back from Zanzibar today and Dr. Manary took our visitors off to Liwonde National Game Park for the evening. So, I invited the girls over for a run (which was unsuccessful due to the extraordinarily heavy afternoon rains), and we sat around all day sharing stories of the week, of huge enrollment days, wading in mud, endless rain, but also white sand beaches, spice markets and new Swahili vocabulary words. After dinner, we talked about the coming week and Liz started to explain how one can find a safe, clean resthouse in Malawi. She referenced the need to check the door to be sure you can lock it from the inside, how you should inspect the bathroom, and just as she explained that the next thing to do is pull back the bedsheets to look for bedbugs...Kathleen screamed!
TARANTULA. Number 4 is it? Of course it sent me screaming on top of a chair, and Liz jumped on top of the couch. Kathleen, the only brave one, grabbed the DOOM and sprayed tons at the 5 inch creeper. No luck - it ran. I screamed a lot more. It must have sounded like a bunch of 9 year old girls at a sleep over party in here. I told Kathleen to grab a thin wood carving of a Massai warrior and poke at the spider, now hiding under the bookcase. With these assassination attempts clearly failing, I called in the reserves. The SecuriCore Guard watching our gate outside. I had no clue how to say spider in Chichewa, so I just told him to follow me to my house. When he saw what the commotion was about, he grabbed the dust pan, lurched in for the kill, and laughed all the way home.
Crisis resolved. My best guess - a baboon spider. Google it, it's awful.
-dkm
Friday, January 11, 2008
Half Way Around the World, Postal Workers are Equally Impossible
My apologies in advance if you have friends or family members who proudly wear a blue uniform with the USPS logo on the lapel and enjoy defying every rule of customer service...but rest assured the Malawi Postal Service carefully must select equally miserable people to stand behind their counters. Read on:
My friend Kathleen was unsuccessful at purchasing a Post Office box here in Malawi. The wait list for a PO Box is very long and nearly impossible to side step. As a favor, I offered to let her have packages (for Christmas) sent to the Project Peanut Butter address. Her package (mailed on December 19) arrived in Malawi on January 7 and was cleared and delivered to the Blantye Post Office today. I recieved the package slip which read as follows:
Kathleen Klaus
c/o Danielle Matilsky
Project Peanut Butter
P.O. Box 32664
Blantyre 3
MALAWI
At the counter, I presented the package slip and provided my driver's license for identification. The next thing I know, the package is put down in front of me but the woman takes my license. She returns with the manager who then proceeded to tell me that the package does not belong to me. I gently explained that "care-of" means that I am authorized to pick it up. He disagreed. For some reason, my patience with postal people wears thin pretty quickly, so I then insisted that in fact I was supposed to and expected to pick up the package. This quickly escalated to me basically yelling at this guy and he starts to preach about the laws in Malawi and all sorts of bologne. By now, I have spent 20 minutes waiting for this damn thing, my friend Kathleen is in Tanzania to take the GRE, her phone doesn't work there, and I have now launched into the whole, "I work at the College of Medicine, I am late for an important meeting, I work with very sick children and I don't have time for this..." blah blah blah.
It ended with him wanting to keep the package slip (my only claim to this package). Ha. I didn't think so. I reached across the counter, crumpled the triplicate slip in my hand and proudly reminded myself that I am my father's daughter in some ways..."You, sir, are f*cking ridiculous." I stormed out...and slammed my car door.
I really hate the post office.
In other news - the total for the week came out to be around 180 new study enrollments- SOLID. Very exciting! I am devoting this weekend to updating the database, organizing myself and coming up with a plan of how I will wrap up enrollments. We are currently operating at a total of 12 sites! I'm pretty excited. The next few weeks will continue to be very hectic and busy as the hungry season hits full swing. Also, new researchers and visitors are coming all the time, with the next one being a physician trained in Australia named Johanna that will be joining my study team.
And finally - I got my third medical school acceptance - George Washington in Washington, D.C. I am still waiting to hear back from Albert Einstein and WashU, but I'm pretty excited about the prospect of having the choice of three different cities for med school!
-dkm
PS - I reread some of these entries and have to apologize for some of the poor quality writing that comes out. I guess I am using the blog as a quick and dirty snapshot of the things that come up every day!
My friend Kathleen was unsuccessful at purchasing a Post Office box here in Malawi. The wait list for a PO Box is very long and nearly impossible to side step. As a favor, I offered to let her have packages (for Christmas) sent to the Project Peanut Butter address. Her package (mailed on December 19) arrived in Malawi on January 7 and was cleared and delivered to the Blantye Post Office today. I recieved the package slip which read as follows:
Kathleen Klaus
c/o Danielle Matilsky
Project Peanut Butter
P.O. Box 32664
Blantyre 3
MALAWI
At the counter, I presented the package slip and provided my driver's license for identification. The next thing I know, the package is put down in front of me but the woman takes my license. She returns with the manager who then proceeded to tell me that the package does not belong to me. I gently explained that "care-of" means that I am authorized to pick it up. He disagreed. For some reason, my patience with postal people wears thin pretty quickly, so I then insisted that in fact I was supposed to and expected to pick up the package. This quickly escalated to me basically yelling at this guy and he starts to preach about the laws in Malawi and all sorts of bologne. By now, I have spent 20 minutes waiting for this damn thing, my friend Kathleen is in Tanzania to take the GRE, her phone doesn't work there, and I have now launched into the whole, "I work at the College of Medicine, I am late for an important meeting, I work with very sick children and I don't have time for this..." blah blah blah.
It ended with him wanting to keep the package slip (my only claim to this package). Ha. I didn't think so. I reached across the counter, crumpled the triplicate slip in my hand and proudly reminded myself that I am my father's daughter in some ways..."You, sir, are f*cking ridiculous." I stormed out...and slammed my car door.
I really hate the post office.
In other news - the total for the week came out to be around 180 new study enrollments- SOLID. Very exciting! I am devoting this weekend to updating the database, organizing myself and coming up with a plan of how I will wrap up enrollments. We are currently operating at a total of 12 sites! I'm pretty excited. The next few weeks will continue to be very hectic and busy as the hungry season hits full swing. Also, new researchers and visitors are coming all the time, with the next one being a physician trained in Australia named Johanna that will be joining my study team.
And finally - I got my third medical school acceptance - George Washington in Washington, D.C. I am still waiting to hear back from Albert Einstein and WashU, but I'm pretty excited about the prospect of having the choice of three different cities for med school!
-dkm
PS - I reread some of these entries and have to apologize for some of the poor quality writing that comes out. I guess I am using the blog as a quick and dirty snapshot of the things that come up every day!
Wednesday, January 9, 2008
Crazier and Crazier
Ready for this?
121 ENROLLMENTS IN ONE DAY!!!!! Today made the day at Chikweo (where we are going tomorrow) look like a cake walk. There were so many moms at the very tiny, tiny clinic building, which was fine until the rain started to POUR. The result was 600 women trying to cram into one room the size of my den at home. Not to mention that the roof was tin so it was very loud, and there were no real windows so it was very dark inside. At one point the mothers were so crowded that I couldn't tell who came first, and when I took a child from a mom who may not have waited her turn, the women nearly had a fist fight right in front of me. All my Chichewa went out the window as I screamed, "STOP IT! STOOOPPPP!!!" Eh, little response to that until the HSA took control.
After hours and hours of that in addition to running out of food and data cards and everything else, we managed to make it back to Blantyre after 5 pm and still had tons of errands to run. We were supposed to travel to Namandanje for tomorrow's equally huge Chikweo visit (a ~3 hour drive) but decided to house all 10 of our staff members here at my house, and we plan to depart at 4am sharp tomorrow to make it out to the village by 7:30am.
Then to top it all off, another GIANT tarantula. On my foot with all 10 people in my house listening to me absolutely scream at the top of my lungs. Good thing Ramsay (our driver) was here to kill it and get it out. I was told this type bites (who knows if it was really a tarantula, but it was the biggest, hairiest, black spider I've ever seen!)
Dr. M is around so I won't hog the computer any more. Will update more at the end of the week.
-dkm
121 ENROLLMENTS IN ONE DAY!!!!! Today made the day at Chikweo (where we are going tomorrow) look like a cake walk. There were so many moms at the very tiny, tiny clinic building, which was fine until the rain started to POUR. The result was 600 women trying to cram into one room the size of my den at home. Not to mention that the roof was tin so it was very loud, and there were no real windows so it was very dark inside. At one point the mothers were so crowded that I couldn't tell who came first, and when I took a child from a mom who may not have waited her turn, the women nearly had a fist fight right in front of me. All my Chichewa went out the window as I screamed, "STOP IT! STOOOPPPP!!!" Eh, little response to that until the HSA took control.
After hours and hours of that in addition to running out of food and data cards and everything else, we managed to make it back to Blantyre after 5 pm and still had tons of errands to run. We were supposed to travel to Namandanje for tomorrow's equally huge Chikweo visit (a ~3 hour drive) but decided to house all 10 of our staff members here at my house, and we plan to depart at 4am sharp tomorrow to make it out to the village by 7:30am.
Then to top it all off, another GIANT tarantula. On my foot with all 10 people in my house listening to me absolutely scream at the top of my lungs. Good thing Ramsay (our driver) was here to kill it and get it out. I was told this type bites (who knows if it was really a tarantula, but it was the biggest, hairiest, black spider I've ever seen!)
Dr. M is around so I won't hog the computer any more. Will update more at the end of the week.
-dkm
Thursday, January 3, 2008
Murphy's Law
Murphy must have developed this law after living in Africa during the rainy season.
Let me explain: Many of you may know that our project has a "fleet" of cars - 7 in total. And you may have also heard me say that the fleet is hardly ever all in working order. Why don't I give you an example?
First the cast of characters:
The Pajero (age: 1,398 years)
The Hilux (age: 100 years)
The Diesel Nissan (age: 98 years)
The Red Truck (age: 999 years)
The Drifter (age: unknown, old)
The Column Shift (age: 97.5)
Liyaka's Colt (age: 98)
The setting - 2 hours south of Blantyre, at Chikwawa then 3 hours north of Blantyre, "the villages")
The schpiel:
Given that my project is growing faster and faster as the rainy season goes on, and after the disaster of last Thursday, I hired 4 more staff nurses. As an orientation, I invited them to our Wednesday site at Makwila health center in Chikwawa District. Since there were so many of us, we took two cars on the 2 hour drive down the escarpment. For those who can't picture this, imagine the hills and curvy roads of San Francisco, and then elongate those roads for 40 km (26ish miles). I was driving the Hilux, and Ramsay in the Pajero. We made it down the escarpment without a problem. As soon as we reached the bottom, we were approaching a police stop and - my brakes failed. I couldn't stop! Of course, we stopped after rolling a lot longer than we should have, and I made Ramsay switch cars. I got into the Pajero, and Ramsay started off ahead of me in the no-brake Hilux. With every bump and hole, it felt as though the sides of the Pajero would just fall off like a cardboard box that gets too wet in a cartoon. But, instead, we just got stuck in knee deep mud instead. My poor nurses, in their white uniforms, had to get out and push the car without their shoes on and then wash their feet in a nearby river. Okay, that was part one.
The next leg of the trip is the 2 hour drive back to Blantyre, plus a 2.5-3 hour drive up to the villages. Of course, the Hilux had to go to the mechanic to figure out what was wrong with the brakes. The plan was to pick up the Diesel Nissan and use that as the second vehicle for the day. But that car needed wheel alignment. So I took it to the wheel alignment place, and found a line of 4 cars waiting - an estimated 3 hour wait. Not possible since we had such a long drive to get to the villages. Luckily, I passed Liyaka driving along the road to my house. Thinking quickly, I asked if we could switch cars and I could take his Colt and he could get the wheels aligned in the Nissan - no problem.
Ha, no problem until I got almost to the village and the Colt decided that it no longer wanted to pull the car in any gear. First gear - 4,000 - 5,000 RPM. And the sky decided to spice up the night with some rain in the pitch black. Greatttt. We manage to get to the village, only to find in the morning that the car won't go at all. So, I had to tow the Colt ALL the way back to Blantyre - it took more than 3 hours, especially since the rope I bought kept braking so the cars kept getting separated.
So, that's not EVERYTHING that could go wrong right? Add the fact that the HSAs at one of the two new centers we were opening got the dates mixed up and all the mom's had shown up last week for the first enrollment day, the flying ants that were falling from the sky all night like snow, and the fact that my guests are living in the new house but that none of the plumbing seems to be working and voila! you have Murphy's Law.
Yet, this is Malawi, the land of devout Christians. So what do they say? We are thankful for still enrolling 55 new children in one day today, we are thankful that the brakes held out all the way down the escarpment, we are thankful that we were able to get the car towed all the way back this afternoon, despite all the challenges.
Let me end on a happy note - this past Monday I saw the President of Malawi! Woooo! It was so cool, a story of it's own. Needless to say, he drives a damn fancy car.
To all you kids at home bitching that you don't have the nicest, newest car - be thankful you don't need a fleet just to get by...
-dkm
Let me explain: Many of you may know that our project has a "fleet" of cars - 7 in total. And you may have also heard me say that the fleet is hardly ever all in working order. Why don't I give you an example?
First the cast of characters:
The Pajero (age: 1,398 years)
The Hilux (age: 100 years)
The Diesel Nissan (age: 98 years)
The Red Truck (age: 999 years)
The Drifter (age: unknown, old)
The Column Shift (age: 97.5)
Liyaka's Colt (age: 98)
The setting - 2 hours south of Blantyre, at Chikwawa then 3 hours north of Blantyre, "the villages")
The schpiel:
Given that my project is growing faster and faster as the rainy season goes on, and after the disaster of last Thursday, I hired 4 more staff nurses. As an orientation, I invited them to our Wednesday site at Makwila health center in Chikwawa District. Since there were so many of us, we took two cars on the 2 hour drive down the escarpment. For those who can't picture this, imagine the hills and curvy roads of San Francisco, and then elongate those roads for 40 km (26ish miles). I was driving the Hilux, and Ramsay in the Pajero. We made it down the escarpment without a problem. As soon as we reached the bottom, we were approaching a police stop and - my brakes failed. I couldn't stop! Of course, we stopped after rolling a lot longer than we should have, and I made Ramsay switch cars. I got into the Pajero, and Ramsay started off ahead of me in the no-brake Hilux. With every bump and hole, it felt as though the sides of the Pajero would just fall off like a cardboard box that gets too wet in a cartoon. But, instead, we just got stuck in knee deep mud instead. My poor nurses, in their white uniforms, had to get out and push the car without their shoes on and then wash their feet in a nearby river. Okay, that was part one.
The next leg of the trip is the 2 hour drive back to Blantyre, plus a 2.5-3 hour drive up to the villages. Of course, the Hilux had to go to the mechanic to figure out what was wrong with the brakes. The plan was to pick up the Diesel Nissan and use that as the second vehicle for the day. But that car needed wheel alignment. So I took it to the wheel alignment place, and found a line of 4 cars waiting - an estimated 3 hour wait. Not possible since we had such a long drive to get to the villages. Luckily, I passed Liyaka driving along the road to my house. Thinking quickly, I asked if we could switch cars and I could take his Colt and he could get the wheels aligned in the Nissan - no problem.
Ha, no problem until I got almost to the village and the Colt decided that it no longer wanted to pull the car in any gear. First gear - 4,000 - 5,000 RPM. And the sky decided to spice up the night with some rain in the pitch black. Greatttt. We manage to get to the village, only to find in the morning that the car won't go at all. So, I had to tow the Colt ALL the way back to Blantyre - it took more than 3 hours, especially since the rope I bought kept braking so the cars kept getting separated.
So, that's not EVERYTHING that could go wrong right? Add the fact that the HSAs at one of the two new centers we were opening got the dates mixed up and all the mom's had shown up last week for the first enrollment day, the flying ants that were falling from the sky all night like snow, and the fact that my guests are living in the new house but that none of the plumbing seems to be working and voila! you have Murphy's Law.
Yet, this is Malawi, the land of devout Christians. So what do they say? We are thankful for still enrolling 55 new children in one day today, we are thankful that the brakes held out all the way down the escarpment, we are thankful that we were able to get the car towed all the way back this afternoon, despite all the challenges.
Let me end on a happy note - this past Monday I saw the President of Malawi! Woooo! It was so cool, a story of it's own. Needless to say, he drives a damn fancy car.
To all you kids at home bitching that you don't have the nicest, newest car - be thankful you don't need a fleet just to get by...
-dkm
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