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
Saturday, May 31, 2008
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
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