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

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

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

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

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)

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

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.