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

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

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!

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

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

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

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 :)