Busy busy busy

Last week I was back down in Chikhwawa again on the Monday and Tuesday to revisit the students there and see how they were getting on. Anyhow I decided this time as I was being let loose all by myself that I would drive. This time I took my camera to take pictures of the road and the obstacles but sadly the battery died and I didn't get many at all. And there would have been some amazing ones. The picture below is the view of the hills/mountains as you are coming out of Chikhwawa. (And a very badly focused picture also – but then my camera battery said no)
Now if you can imagine a steep road curving all the way down those hills, with nothing but cliff on one side.

On the way up I had to overtake 3 huge broken down Lorries, who have of course conveniently broken down on a steep part of the hill right on the apex of the blind bends. We are coming to the conclusion that it is probably a law in Malawi that if you break down it should always occur at either a junction where there is no room to overtake or on a blind bend, preferably on the steepest hill you can find. 'You always get lots of warning though (if it is in town – a long queue of traffic and if it is in the country – half a dead tree for about a hundred yards in front). Will have to get some pictures so you can see what I mean.

Otherwise have been busy supervising the students on the ward, doing OSCE tests, skills practice in the lab, lots of marking, and helping the college with the end of year collation of all the exam marks and clinical evaluations. The students all finish the school year at the end of this week and are then off on holiday, as am I. Very excited about that as have friends coming from the UK with more goodies for me. Prior to that though on Friday am meeting up with Bex and Matt who have also just returned from a short break in the UK, and who have also ............ yup you guessed it brought back stuff for me, and happily have picked up two parcels from the main VSO office that were sent out back in July for my birthday and have now finally arrived. It feels rather like Christmas.

How to make a volunteer happy

One of my housemates has recently returned to Malawi from a trip to the UK, she brought back loads of goodies for me, and also

and this was not all of it
this should keep us going for a little while. It is not that you can't get cheese here, but the cheese we can afford to buy is of the plastic cheddar variety, a decent bit of cheese requires a mortgage being taken out, and as we are volunteers I fear the bank will think we are not a good risk.
Not only did the huge amount of cheese come back with her, but on hearing of my tragic tale of woe regarding rodent activity, to my utter amazement and delight, not one but two bags of giant chocolate buttons were in the Mary Poppins suitcase as well.

Watch out there’s a chisoni about

Recently we have taken up gardening; well this is of course the royal we. My role has been very influential in so much as that I have brought the seeds and directed where they need to be planted. Then of course there is the surveying of the growing pattern. What is coming up and what isn't. All very time consuming I am sure you will agree. Whilst walking around the garden I noticed lots of holes in the ground. I decided to ask Wayson our night guard/gardener what was causing these holes and he informed me it was the chisoni that were causing them. Unfortunately he didn't know how to translate chisoni in to English and my hideously bad understanding of Chichewa didn't extend to translating this either. So we both agreed to not being able to translate.

Later that night I was taking the tea out for him and he said he had something to show me. He brought over an old charcoal bag and informed me that he had caught one of the chisoni's and had it in the bag. Busy holding it out for me to see, I gingerly peered in wondering what strange creature might possibly be lurking in there, imaging all kinds of wild beasts, snakes obviously being on top of the list, and very worried that whatever was lurking in the bag might jump and bite or sting me. Imagine my relief when this is what was in there,

 

So chisoni is Chichewa for hedgehog. Well that was a relief as there are an awful lot of holes in the garden. One side effect though of this is that we have had to deflea the dog (I am refering to the royal we here again as my house mate actually did it)

It has not been my best week

It would be fair to say it has not been my best week, not withstanding the chocolate tragedy, I have also still not been able to get into my old email address to check for post, so therefore have had to arrange a whole new email account, for which ofcourse I don't have any of the old contact addresses so am having to rebuild my contacts. If you are reading this and have tried emailing me in the last 2 weeks on my old email account and have not received a reply, you now know why. Please let me know how to contact you again with my new email address. The latest mishap ............
I don't know if this is age related or just general stupidity.

I got up for work this morning and thought, that is strange.........the freezer door was open, I don't remember going in there..........

Had a look and then the evidence caused me to remember

I had got home from work the night before and thought – I know what would be really nice, a little vodka and diet coke, however there was no ice, and hadn't put any cokes in the fridge to chill, so had a brilliant idea, I will stick a can in the freezer, that will be the quickest way.

Got caught up with cooking dinner and playing solitaire, reading my book and then went to bed. It is an exciting life that I lead sometimes.

Anyway you guessed it – sometime during the night the can exploded. Fortunately no damage to the freezer was incurred.

It has been a tragic day

It was my birthday at the end of July and I have been making regular forays to the post office to see if any of my parcels have arrived yet. My first inclining that it was not all as it should be at the post office was when the postmistress looked at me with pity when I asked if there were any parcels for me. She went and retrieved my parcel and I could see that there was a piece of white paper attached. I carefully perused the said letter –

If it doesn't show up properly it says

"Apology Letter. The attached package was damaged by rodents in transit. Please, we are sincerely apologise for the inconvenience caused."

Now I knew what was going to be in that package and had been dreaming about it for weeks, ever since I knew it had been sent.

I took said package tenderly in my hands and noticed the damage corner.

I was still optimistic but sadly that optimism proved to be misplaced when I got back to work and opened the parcel. It was not just the corner of the packaging that had been chewed off.

I did inspect the remainder of the contents quite thoroughly to see if anything could be retrieved but with great regret had to admit defeat and consign the rest of the package to the bin.

Obviously rats/mice or whatever love giant chocolate buttons as much as I do.

It is not as though you can't get chocolate out here, you can, just not this particular type, my favourite......

You can even get chocolate named after you. Thank you very much Ruth for these.and thank you to everyone else in Malawi for all the lovely birthday gifts that you gave me and for coming to the partae. Great time.

I should be grateful that it made it this far as am still waiting for parcels sent in February and still for some others sent after that a further 3 that I know of. It is very depressing knowing that people have taking all that trouble, effort and money to send you stuff and you never seem to receive it.

Oh well guess I will just have to wait until Christmas.

The Flames came to Blantyre

Today the Malawi Flames – Malawi's national football team – were playing at home to Botswana. It has to have been one of the most wintery days so far here, very stormy and windy with that horrible drizzly rain that is moving sideways so that you can't hold up an umbrella without it blowing inside out and all the rain comes in underneath anyway. This did not dampen the spirits of the Malawians who are extremely passionate about their football. Apparently according to my students the president had declared that there would be a half day public holiday so that people could get to see the match as it was being played midweek and in the afternoon. I can't imagine that they would have an evening match as there would probably be a power failure and the flood lights wouldn't work and there would be absolute uproar. Malawians are very passionate about their football. From lunch time onwards there was the sound of the horns again (just like the world cup all over again). Where I work is the other end of the road to the Kamuzu stadium so lots and lots of the fans went past braving the very inclement weather. I could also hear all the cheering etc from the stadium as I sat in my office wrapped up in 3 layers with the electric fire going trying desperaltly hard to keep warm without success as the louvre windows let a howling draft through them constantly. My office is on the cold side of the building which will be great in the hot season but not so good in the winter. My housemate was taken to see the match and said the atmosphere was absolutely amazing and it was a great experience but was absolutely frozen to the marrow by the time she got home. Perhaps as part of the cultural experience I should try and go and see a game for my self but think I shall wait until the weather is warmer. The result was a draw apparently with Malawi managing to equalise at the end of the second half.

Internet difficulties

Besides work, life and the universe for not writing much, one of the reasons that I am not very up-to-date with posting is the somewhat erratic internet connection. Have been having quite a lot of problems recently, the internet at work is not working at the moment and hasn't been for at least 3 weeks if not a month. Something wrong with the box where all the internet cables go into it. I have my own internet dongle but that didn't work for a while either as someone pinched the internet fibre optic cables and these were replaced with I am sure go much slower than usual cables. Also someone told me that the internet cables that run under the sea were cut as well. At the moment I am managing to access most things except for my email. Have not been able to get into that for most of this week – don't know why but it is really frustrating as I know there are few emails I need to reply to which are related to work and also it is the main way of being connected with people at home etc. Although no doubt when I do get access I will be extremely disappointed to find that it is just the usual circular emails etc and nothing nice to see at all, most of them will end up being deleted without being read as lovely as all the money off offers are at boots etc they are of no great use to me at the present time. If the internet were to work quickly enough I would take myself off their mailing lists, but when it can sometimes take as long as 40 minutes to be able to load and read the emails I want to read I really don't have the patience to read and get rid of the ones I don't want.

Whoops it’s been a while now

Haven't written anything on here for ages now, it is not because I haven't been doing anything but rather I have probably been more busy with work and from starting off with not very much to do I now seem to have too much to do, isn't that always the way. Work wise things have certainly been getting busier; the students have all been doing their end of year exams. This meant that we had to put together exam papers for each subject for each year as well writing the supplementary exams at the same time for those that might end up not passing. These papers all then had to be vetted, at the same time there were students on the ward to be supervised. The students have now all done their exams so we are busy marking and second marking them. It wasn't only the student nurses doing exams but also the trainee clinical officers had their midterm exams and as I had been teaching them as well needed to do exam questions for them and mark those papers as well. So having marked 350 exam papers and second marked a further 300 I feel quite worn out by it all – poor me.

Some of the students have also just started their district placements so we have had to go and supervise them in the district hospitals. Once students qualify they can be sent to work at the health centres, the district hospitals or the central hospitals. The system of employment post qualification works very differently here to what I am used to, as the nurses will get assigned to these different places and don't actually apply for jobs specifically as such. The good thing though is that as part of their training they do get to work in all the different types of places they might get sent to.

So last week saw me and a colleague travelling to Chikhwawa, which is quite some distance from Blantyre. I would meet my colleague at the Catholic Institute which is the staging post for the minibuses going in that direction. This was about a 15-20 minute walk from the house. We would then get the minibus to Chikhwawa, the journey involves one of the most scenic roads I have been on so far in Malawi but also sometimes a bit of a scary journey, and is about 45-60 minutes long. Chikhwawa is at a much lower altitude than Blantyre and getting down the side of the mountain is via a long steep windy road with not much leeway on the cliff side of the road. Often there are very big trucks / lorries that need to be overtaken on a blind bend. I chose to be in the back of the minibus as didn't want to witness overtaking on a blind bend at first hand. As you went over the top of the mountain each day the valley below was always below the cloud line. Each time we went we were fortunate enough that we only had to wait for about 20 minutes at the longest for the minibus to fill up. Next time I go on that route I will have to get some photo's – it always makes me think of Top Gear and how they like to go on steep curvy roads very fast and am sure they would enjoy this road. Getting to Chikhwawa involves going through at least 4 police check points, we were stopped each time and the vehicle inspected, on one occasion we all had to get off so they could see properly inside. This is quite a palaver as there are lots of people crammed on along with all their possessions. On one occasion the driver got fined much to the hilarity of the passengers, he had too many passengers having picked up someone just outside the town, so to make 50 kwacha he had to pay a fine of 1500 kwacha. There was much discussion about this for a long time and teasing of the driver.

On arrival in Chikhwawa the difference in temperature was quite noticeable, at present it is still fairly wintery in Blantyre, so I would arrive there warmly wrapped up in my fleece only to end up needing to discard it within a few minutes of arrival. The district hospital is still a couple of miles from the main boma of Chikhwawa and no minibuses go along that route, so the only way to get there besides walking is to get a bicycle taxi. These are literally bicycles with a cushioned seat at the back which the passenger sits on. The bicycle riders have a hard job lugging everyone up and down the road to the hospital; they can make the same journey up to 20 times a day. I wouldn't fancy cycling myself up there let alone doing it with some great big passenger on the back. I have to my hat off to them, the ride was very stable and I felt very secure, they were very careful of dodging the myriad of potholes in the road and even off road were very smooth. Being more a rural area I of course was the object of attention and all along the route would hear the children shouting out Mzungu and waving at me. You often hear people calling out Mzungu in Blantyre but not to the same degree, as we are not such a rare sight here.

This is me and my bicycle taxi just outside the hospital on the way back to get the minibus. The taxi driver is called Money.

On the way home again we never had to wait too long for the minibus to be full – I did however only realise that I had had a chicken sleeping on my foot for the whole of the journey back to Blantyre just as the journey ended. The minibus was rather full of chickens that day but I had thought they were all behind me.

It was a really interesting experience going out there and seeing how the district hospitals work, and learning all about it myself whilst at the same time supervising the students.

I have also now started working on the adult oncology unit at the local hospital, this is the first proper adult oncology unit in Malawi and it is great to be working alongside the team there. There has been a paediatric oncology unit for many years, but the consultant for the adult unit is the first trained oncologist to be employed. They have been really welcoming to me, and I spend roughly one day a week there, teaching as much as I can about oncology and chemotherapy administration, writing policies and procedures for them.

We have also been handed our teaching programmes for next year, and I am the programme co-ordinator for two of the modules and also teaching on a third module as well – so currently have about 30 – 40 lessons to prepare ready for the new academic year.

I will definitely been in need of a holiday again soon – am fortunately have one planned for the beginning of September.

I have found the perfect bar

Following on from my visit to Lilongwe market - see previous post, Perhaps not the best selling technique, I have now found the perfect bar to go to, unfortunately it is down in Mwanza, which is a good 90 minute drive away.

Just in case you can't read the sign "Fat Friends Bar"
We spent the weekend in Mwanza celebrating Diana's birthday, another VSO friend, who came out at the same time as myself. In true British style we had a bbq in the rain, well it was a very light drizzle, but it didn't dampen our spirits (I made sure I kept my vodka and diet coke well covered :0)sorry! In the evening we went and watched the football, I must admit to watching far too much world cup football whilst out here. This is for two reasons, one it is very exciting seeing something on a big screen, and two it is what everyone is doing out here, and unless I want to be billy no mates, I need to join in. I do however try and refrain from making comments like who is the guy in the yellow shirt, it appears that generally this is the referee. But have been known to ask who is playing in which colour, just so that I can keep up you understand. One of the sounds that I will now forever associate with Malawi, is the sound of the horns being blown all the time.

Is this the best excuse ever for being late for work?

Thursday 8^th July 2010

This morning I got up as usual, went to unlock the front door ready to go to work, and lo and behold couldn't unlock the door. After calling out to the night guard to see if he could open it from the other side, we realise that I am well and truly locked in, the lock had completely seized up. However bearing in mind the VSO moto, flexibility and adaptability, I got the trusty screw driver out, took the lock to pieces, used a bit of blue band margarine to oil the mechanism and ta da, the lock was soon working gain. In the meantime as this did take a while, I had sent a text to work to let them know that I would be late as couldn't get out of the house!

My fire lighting skills are coming on a treat

No I haven't become a pyromaniac, but it is so chilly in the evenings out here, we are now having to light a fire each evening to keep warm. My fire lighting skills are improving which each night, and tonight managed to get a really good blaze going, without having to resort to a plastic bag ( a well known Malawian technique for getting the fire going). It is amazing that it can get so cold out here, you always imagine that you will be hot in Africa. Today saw me in a T-shirt, jumper with a cardigan on for good measure, and the electric fire on in the office. Who would have thought it. It is currently winter in Malawi, and though it doesn't get to below freezing in Blantyre, if you are in the more mountainous parts of Malawi, it is not unheard of to have a frost in the mornings.

The only downside to having the fire in the house is that you do rather smell of firewood all the time, and every so often have to open the door to let some of the smoke out, this despite having the chimney. I wonder if there are chimney sweeps here, I think we could use one.

A zebra crossing in Malawi

 

Tuesday 6^th July 2010 was a bank holiday in Malawi, celebrating Independence day. Took the opportunity to go on a little day trip to Nyala Park, which is about a 90 minute drive from Blantyre. It still amazes me that I can do this sort of thing as a day trip and see nature at it's best.

Hence the title of the blog (sorry couldn't resist it, it had to be done)?

What you looking at?

Who lives in a nest like this?

Perhaps he does?

And a few other images from a most excellent day out, the sun was shining, the weather was warm.

 

Not necessarily the best selling technique

On Saturday we travelled up from Cape McLear to Lilongwe and after finding the bus station and then the VSO guest house I got settled in. On Sunday I decided to investigate the market in Lilongwe, and after successfully negotiating my way there via public transport (minibuses) wandered round the market to have a good look at the second hand clothes section. This is absolutely huge and sells a very wide range. One of the local traders was trying to interest me in purchasing some dresses, but really rather lost a sale after telling me that this particular dress would be OK as it was made for fat people and would therefore fit me. I wouldn't mind quite so much but having lost over 10kg since arriving here I wouldn't have necessarily classed myself as fat, maybe a touch over weight, but really, fat was pushing it! I said that I would think about it and come back to him. He then hunted me down at some of the other stalls and in the end I had to say no to his very kind offer, despite assuring me that he would give me a very good price.

Zomba Plateau

After leaving Mvuu we headed on back down the road to Zomba where we were staying 2 nights on the plateau. We arrived in Zomba and decided to try our luck in finding this cake shop which we had both heard about and had come highly recommended to us from separate sources. Our sources were correct and had a lovely lunch there and a delicious pudding of meringue with strawberries and ice cream and fruit coulee. We then headed on up the plateau after picking up Peter and his wife (they look after the cottage we were staying at) it was a rather tight squeeze in the back for them as they had to share just one seat as the other was taken up with all our paraphernalia. It was a steep drive up a very winding road but well worth it, and just very grateful that we had the car and didn't have to walk up it. The views from the front of the cottage were breathtakingly beautiful, you can see for miles and could even see Mount Mulanje in the distance, and it is easier to see in person than via the photo I admit.

It was extremely chilly being up that high and we were very grateful for the fire that Peter lit for us (it seems to becoming a theme having fires lit for us, although employing a plastic bag technique I had managed to get the breakfast fire going at Mvuu prior to the camp staff coming to help). We did manage to end up reeking of bar-b-que afterwards though as the wind kept blowing smoke into the house, so we would have to keep opening the door to let the smoke out, rather negating any warmth from the fire. Our fire the following night was much more successful though. We were also treated to a power cut on both nights for a couple of hours which is why it all looks rather glowing in the candle light.

On the Wednesday morning we headed off on a walk around the plateau, having procured a map from the nearby hotel, and deciding that we therefore wouldn't need a guide, off we trotted. What should have been an hour's walk to the Williams falls became a 2 hour walk. Obviously the map when it said go straight on really meant turn right, but this finer point of Malawian map reading was lost on us. A short detour through the woods, across dale and river and we ended up back where we had started none the worse for our slight diversion. We did make it to Williams falls though, possibly not quite as spectacular as had been anticipating but still a really lovely view and a lovely walk.
We then walked around to the dam and then down the mountain via a very steep path, how this poor man managed to carry this wood all the way down was beyond me, I was having enough trouble not going down on my backside as it was.

This is the view from the top down to the bottom larger dam.

We left on Thursday morning ready for sun and relaxation at the lake side. There was extremely low cloud though on the way down from the plateau which made for an interesting driving experience, and when we arrived at the lake clearly someone had forgotten to put the sun out as it was cloudy and overcast all the time we were there, so we just had to make do with relaxation. Managed to watch the football match at Hiccups bar although why we bothered I am not sure as the result was pretty dismal. The world cup is being shown everywhere, so if you want to try and pretend it is not happening there is no chance. Wimbledon doesn't seem to be getting a look in, can't think why!

After plenty of relaxation it was off to Lilongwe were I was going to be spending the next week on a training course. All in all a really lovely week off.

Liwonde National Park

I thought it was about time that I had a week of holiday having been here now for over 4 months, so persuading one of my fellow volunteers to join me, we set of to Liwonde National Park. We were booked into Mvuu camp, which is very beautiful and sited on the shores of the Shire River, in the heart of the national park. To get to it you have a 23km drive through the park, or you can go the shorter way round and drive through 8km of country road (for country road read dirt track) and then get a lift across the river in one of their boats. We tried both approaches, it seemed like a good idea at the time. Mvuu consists of a lodge, fixed tents with proper beds etc and a camping area. We were in the camping area where the water hogs kept us company.

We eventually arrived there after a couple of excursions up the Balaka Road, got our tents up and then proceeded to cook our dinner after the staff very kindly lit the fire for us.

On the Monday morning we took a 2 hour boat trip up the river,

this is Danger our boat driver and tour guide. I just love the Malawian names, although Danger is not necessarily the most inspiring when you are going near hippo's and crocs in a small vessel, but he was lovely and looked after us really well!

On the boat trip we had close encounters with the hippo's, which were numerous but rather camera shy, as everytime we approached them they ducked under the water.

We did manage to see one out of the water though.

We were also fortunate enough to see a small herd of elephants by the side of the river,

the occasional crocodile

and a monitor lizard.

In the afternoon we decided to drive around the park ourselves and came across lots more elephants, what we should have done though was ask what to do if an elephant looks unhappy and starts moving towards you in a threatening manner, do you stay where you are or reverse slowly away in an unthreatening manner. We opted for the reverse slowly away in an unthreatening manner, and stop taking photo's, this appeared to do the trick, well not appeared really as it actually did do the trick, and the elephants turned round and carried on grazing. We were really lucky to see so many different herds of elephants, as I know previous people have only seen evidence that they have been there via large dung piles. Elephants are my favourite large animal and I was very content just sitting there watching them going about their business, many of the herds with young ones of different ages.

Be very grateful that I am not putting up the probably rather unnecessary 200 plus elephant photo's taken, I really must get round to weeding them down a bit, as possibly even I won't want to sit through a slide show of 200 pictures of elephants.

We saw plenty of gazelles and antelope etc. One of the advantages of a digital camera is that you can take absolutely loads of photo's in the hope of getting that really good shot, imagining that you are David Bailey etc, it is also a bit of shock though when you realise that you have a picture of a gazelle with it's head in just ever so slightly a different position 5 times in a row, and none of them particularly well focused, easy decision though then which ones to delete.

Although the park does have zebras and black rhino they were in a separate enclosure which can only be reached on the official game drive and by paying extra money, being cheap skates or rather volunteers who have learnt to be frugal with their money we didn't avail ourselves of this opportunity. Also they do have some lions and leopards but they were not in the areas of the park that we visited despite our best viewing efforts. The following morning we left Mvuu and headed off back down the road to Zomba.

A quick update

So it has been awhile since I updated on my different antics here.

14^th May was a bank holiday so we went to the lake again for the weekend. Whilst there went for a walk up to otter point and went snorkelling there, the water is so clear, you can see all the snails which are probably going to give you Bilharzia, as well as loads of colourful fish, sadly no otters – they knew better than being out in the mid day sun.




Otter Point
Otter point is part of the National Park, and within the park there are loads of monkeys, so spent some time watching them play with each other in the trees, which was really entertaining. There were lots of baby monkeys and they were very lively and mischievous.

Have spent quite a bit of time at the Road Traffic Department getting the permits for my car and also converting my driving license from an English one to a Malawian one. It has proved to be a rather time consuming process which involves lots of queuing, in lots of different rooms on lots of different days. In total it has taken me 6 days over a 3 week period to get it all sorted out, and during the various visits have managed to go in and out of 6 different rooms 24 times. For those that know me well, queuing has never been my forte, but I am learning the art of propping up walls here for long periods of time.

There have been various leaving parties that have been attended over the past couple of weeks, so am finding more and more nice restaurants in Blantrye, just can't afford to go to them very often, but it does mean that just as you start getting to know people they leave.

Work has been going well, supervising the students on the wards, planning lesson, teaching and sorting out various projects to be undertaken over the next year or so.

And just for a change we moved house again two weekends ago now.

Celebrating International Nurses Day

INTERNATIONAL NURSES DAY

WEDNESDAY, MAY 12, 2010, BLANTYRE

THEME: Delivering quality, serving communities: Nurses leading Chronic Care.

07.00AM :    Nurses/Midwives, Student Nurses/Midwives gather (at Blantyre old Town, Queen Elizabeth Central Hospital, Blantyre Youth Centre)

07.30 AM :    Big Walk by Nurses/Midwives from Blantyre old Town Hall to Blantyre Youth Centre

09.00AM :    Nurses/Midwives assemble at Blantyre youth Centre

09.00 AM :     Guest of Honour the Vice President of the Republic of Malawi, Rt Hon. Joyce Banda, arrives at Queen Elizabeth Central Hospital (QECH) and cheer the sick in selected

09.30 AM:     Guest of Honour and Invited Guests inspect Pavilions at Blantyre Youth Centre

09.40 AM:    National Anthem

     :    Welcome Remarks by Director of Ceremonies

        Nurses Prayer, Nurses Pledge, Nurses Song and Solidarity Song

        Highlights of experiences and Testimonies related to the theme

        Traditional dances, songs, drama and poem

        Special Message and honouring of Best Nurses/Midwives in chronic and orphan care

• Guest of Honour
  

Speeches

• President, National Organisation of Nurses and Midwives of Malawi (NONM) Dr Isabella W A Musisi
  
• Palliative Care (Cancer and HIV/AIDS; Diabetes; Oncology; Psychiatric Ass; Surgical/Orthopaedic; Neuro)
  
• Malawi Health Equity Network Executive Director, Martha Kwataine
  
• PS – Nutrition, HIV and AIDS, Dr Mary Shawa
  
• Guest of Honour, the Vice President of the Republic of Malawi, Rt Hon Joyce Banda
  

12.00 noon    National Anthem

        Guest of Honour takes leave

        END OF PROGRAMME !!!

    Well this is Malawi so things didn't exactly go according to time. Having passed the Blantyre youth Centre twice picking up the CD and seeing that it was very full, it is decided that we would go down into Blantyre to join the march, it is now 9.15 and clearly everyone is at the Youth Centre. So no sign of the marchers, we head back to Youth Centre, when we get there there are no seats left – they have all been taken by those that did get there on time, nurses who had come from the surrounding districts, including Zomba and Lilongwe. We only had to travel from next door, and managed to be the last group to arrive. In the grounds chairs had been set up under marquees to protect everyone from the sun, which worked very well except for the Mzungu from MCHS who was left sitting on the ground along with her colleagues out in the sun. Having not expected to be here I had not prepared by putting on sun cream! (I only found out this was happening on arriving at work that day, I know I am a nurse and should remember important dates like this but there you go).

Well as to be expected everything was running behind time. I think Joyce Banda arrived at about 10.30 and then had a wander around some of the stands that had been set up. And eventually took her place on the stage upon which the proceedings started with first of all a prayer – which they had forgot to put in the programme, and then the National Anthem. I do have copies of the Nurses Prayer, Song and Pledge if anyone is interested. After this and some non timetabled speeches by 5 other people we were running severely behind time. So the master of ceremonies said that as the VP had another important engagement the rest of the timetabled speakers had 3 minutes each so that we could finish on time, and he was Malawian as well and said all of this with a straight face, remarkable.

This was probably the most boring bit as many of the speeches were given in Chichewa, I think they went down well judging by the cheers and Viva's coming from the audience, but there was also some dissent when someone dared to say that nurses were receiving a bad press due to their lack of caring! And that they had to do something to change this. I forget who it was but someone was saying that in their speech the government should provide nurses with a decent wage, a car, a house, pay their children's school fees, the nurses assembled were particularly supportive of this!!!

The traditional dances, songs, drama and poem were pushed back to the end of the programme, before the closing prayers and National Anthem.

The singing and dancing was very good and also extremely funny in places and often had the audience in stitches. There was one young male nurse who could move his hips and backside in the most amazing fashion. The nurse that had written a poem about taking pride in nursing ended with the following words "that he was bursting with pride and the feeling was just like a very full bladder desperate to burst".

We finished at 2pm and then piled in the bus to be taken back to the college. By the end of the day the full effects of the sun meant that I had my own central heating programme going that evening due to the warmth of my skin.

All in all it was an excellent morning/afternoon and great to be able to take part. They celebrate every year but rotate to different parts of the country so it is just fortunate that it happened to be in Blantyre this year.

3 months in Malawi already – where does time go

I can't believe that I have been here 3 months already, it seems quite amazing that so much time has gone by, but then again I suppose so much has happened, and although I have written about living here and weekends away I have not really written about what I am doing here at all.

We had a week of in country training when we first arrived getting lots of really useful information about living in Malawi, the work VSO is doing and how we all fit in to this. Then moved to Blantyre and had a week to settle in before starting a 4 week orientation at the hospital.

I actually finished my hospital orientation quite a few weeks ago, but wanted to wait a while to try and put it all into some sort of perspective, and to find out as much as possible.

My orientation consisted of 4 weeks doing different placements around the hospital based on the requirements from the Malawi Nurses and Midwives Council. It was necessary for two reasons really, one to enable me to be registered with the MNMC, and therefore practice over here, and secondly even more importantly to understand how the hospital works and what happens there as I will be teaching and supervising the students here on their placements.

I think this may take a while to read through and will be rather wordy with no lovely pictures to break up the monotony of the text.

The hospital itself is very large and has over a thousand beds, (no different from where I have come from), however it probably has one and half times that number of patients, if not more at some times of the year. All the wards I worked on had more patients than beds, and nowhere near enough nurses to provide full nursing care. On my first day there were only 2 nurses on duty on the surgical ward and there were over 60 patients. Sometimes there is no space between one bed and the mattress on the floor next to it. There is a severe shortage of the most basic of equipment, such as gloves, aprons, soap, bed sheets, beds, dressing packs and the list goes on. All the basic nursing care such as washing, feeding, and general caring is done by the patient's guardians, who stay there 24 hours a day, there just isn't the time for the nurses on duty to do all of it. The guardians let you know when the IV infusions have finished, they collect the patients' medication, and they do the portering for the patients. Near all the wards are areas that the guardians stay in, this consists of some stone benches with a corrugated iron roof over the top and a wash area. If there are no guardians then the nurses do this care.

All of the ward areas I worked on had an HDU area, this is where the patients go if they require oxygen as there is no piped oxygen or oxygen cylinders, just a couple of oxygen compressors which can provide up to 5l/O2 a min, and these sometimes have to be shared between patients, the same with the suctioning equipment. Patients aren't on extensive lists of drugs like they are in the UK.

The hospital is very keen on promoting infection control and the ward areas are all cleaned twice a day, there are sink areas in each of the bays, but no towels to dry your hands on, and sometimes no soap. The cleaning solution used is 0.5% chlorine, this is also used for damp dusting all the surfaces each day at the start of the day shift, or as the sign in one ward area said dumb dusting should be done daily, which made me smile. One pair of my trousers now has red streaks on it from splashing the chlorine on them, bleaching out the dye.

Many of the wards double up during the day as outpatient areas as well, so outpatient clinics will be held in the corridors to the main ward area. At the beginning of the orientation period it was all very confusing trying to work out how the system on the wards worked, some things were very familiar and others not so, but as the time went on it all started to become much clearer, so said the blind man.

The staff on the ward know all the ways of making the most of what they have got and how to adapt for things that they don't have, tourniquets are made up of bits of oxygen tubing for example.

As I have come out during the rainy season, there were an awful lot of patients being admitted with malaria, whilst in the paediatric A&E dept, at least 25-30% of the children that came in unwell where smear positive for malaria, Blantyre is one of the high risk areas for malaria. Yes I am taking my antimalarials religiously and using my mosquito net and insect repellent! Malawi is one of the areas where cerebral malaria is a common problem. There has also been a problem with measles and cholera recently. The vast majority of the patients admitted will also be HIV positive and have been admitted due to complications of the disease. HIV infection rates in Malawi have been reported at 14% of the population, but the infection rate is coming down to about 12%. TB is also a common problem, otherwise the illness you see are much the same as at home. What is different though is that patients often present much later.

If it sounds very negative then I apologise as there is a lot of really positive work happening out here with the assistance of all the different organisations. There is lots of building work going on at the hospital to try and improve the facilities, they are currently building a new accident and emergency department, which at present consists of a couple of rooms. They have just finished expanding the ARV clinic area to accommodate all the HIV supportive care that is given to the outpatients. The unit won an award a few years ago for the work it has done in caring for the patients. There is a palliative care team at the hospital, largely looking after the patients with HIV/Aids, and developed in response to the HIV/AIDs epidemic, but does see cancer patients as well, and works between the hospital and the community.

There is a recently built ward area for treating children with malnourishment accompanied by protocols and supportive care which is also co-ordinated with community programmes. Malnourishment is another big problem out here and the unit at the hospital has worked really hard on developing all the treatment and management protocols and a conducive environment to care for the children. The sister in charge of the unit is very proud of what they have achieved over the past couple of years. The paediatric area is huge in the hospital and consists of over 300 beds in 8 different areas. I spent 7 days working in different parts of the paeds department and really enjoyed the experience. A lot of adults suffer from malnutrition as well, and both children and adults get given "plumpy nut" or chiponde as it is also called. I am not going to go into long descriptions about this but you can Google plumpy nut and find out all about it. Next time you put peanut butter on your toast.......

One of the main challenges though of trying to look after the patients is my lack of skills in speaking Chichewa, the language of the majority of the people living in the south of Malawi. I start my Chichewa lessons soon but am picking up the odd word or phrase here and there. They speak a different dialect in the north of the country. Although everyone is taught English in schools, a lot of people have not been to school, and for those that started at school many won't have completed a primary education, and therefore haven't learnt English. All education is done in English. I did whilst on the wards try and learn lots of phrases and questions, so although I could by the end of my time there ask some rudimentary questions, I couldn't understand the answers! A lot of miming had to be done. Charades will be no problem this Christmas.

One of the things that touched me most whilst doing my orientation was something that I saw far too often really, but was unchanging. When a patient dies on the ward, they are taken to the mortuary on a trolley, with a white sheet with a red cross on top of it. As the trolley leaves the ward, it is followed by the relatives who are naturally very distraught, and all the guardians of the other patients also accompany them, singing prayers and supporting the grieving relatives. As you walk through the hospital corridors, everyone stops what they are doing and stands to one side to let the procession pass. The relatives and all the other guardians accompany the deceased person all the way to the mortuary and wait until the transfer has taken place. It is really touching to see this happen and the support offered, and every time it brings a lump to my throat.

Here are some basic facts about health care in Malawi

The population on Malawi is currently about 13.5 million.

There are 4 central hospitals which are government funded and some district hospitals as well. The other hospitals are run either by CHAM (Christian Health Association of Malawi) or private institutions but these are all private and care needs to be paid for here. Care at the government hospitals is free if you are unable to pay for health care, so that is a bonus.

20% of the population live on less than a dollar a day

The average life expectancy is between 42 and 52 years of age depending on which reports you read.

Healthy life expectancy is 35 years of age here compared to 71 in the UK

The maternal mortality rates are 1100 per 100,000 births compared to 8 in the UK

Infant mortality rates 76 per 1000

Prevalence of HIV infection amongst adults over 15 years of age in Malawi per 100,000 of population is 12,528 compared to 137 in the UK.

The number of nurses and midwives in Malawi in 2004 was 7264; the number of physicians was 266

In 2006 only 5% of the population was over 60 compared to 22% in the UK, whilst 47% of the population is under 15 compared to 18% in the UK.

So what am I doing over here? One of the areas where the government has been working with the different aid agencies is to increase the number of nurses being trained (this is not the only area but is applicable to me). As they also had a shortage of nurse trainers, this made the task quite difficult. VSO is one of the organisations working over here and has a very big health programme, as well as its work in other areas. So I am working as a clinical nurse instructor to help train up more nurses. I have been made to feel extremely welcome at the college, by both the staff and the students, and have been orientating for much of the time, working with the different tutors and seeing how the college works and what the roles are. I have also started doing some teaching now, and am busy preparing lessons for the first years when they start in September. We have also sorted out which area of the hospital I will work in with the students when they are out on placement, so that we can supplement their learning in a practical environment, and help them put what they are being taught into practice, and am also beginning to get other ideas of areas that I can work on but these are at a very early developmental stage – as is appropriate for working in development!

So a not so quite brief update on what I am doing work wise as well as just generally enjoying myself.

Queen’s Day celebrations

This weekend (1^st of May) saw us going down to Mwanza, which is about a 90 minute drive from Blantyre, the us being myself, Bex and Matt. The 30^th April is Queens Day in Holland, and there are 4 Dutch VSO's in Mwanza who had organised a special Queens Day celebration on Saturday 1^st May. The former queen of Holland, Queen Juliana birthday was on the 30^th of April. This day is always celebrated by the Dutch in a very festive way. In 1980 Juliana resigned and Princess Beatrix became queen of The Netherlands, Queen of Oranje Nassau. Although Queen Beatrix's birthday is on 30^th of January, the Dutch still celebrate queensday on the last day of April. The only exception made in Mwanza is to shift this day to the first of May to ensure everybody is able to join.

 

We of course arrived on Malawian time at about 3pm for a 1pm start time, in true festive spirit we went as a combined team effort dressed in the colours of the Dutch flag, Bex in red, Matt in the middle in white, and me in Blue. We did get bonus points for our efforts, Bex got even more points, as she brought a bag of oranges that were actually orange (now before you get carried away and start saying what colour would you expect them to be, oranges in Malawi are actually green as are tangerines), an orange bangle and an orange necklace for Maryse and Marike, and 2 orange water pistols for Elko and Harman.

I think there were about 30 of us there all together and we were in 7 teams. All headed either by someone Dutch. Each team also had to have someone English and Malawian in it as well. The games commenced with an explanation of what was involved along with demonstrations. This is us all listening very carefully to the instructions!

Zaklopen – this was a sack race around an obstacle course which also included a jump! I have to say my performance in this game was sadly lacking but it was better than our team performance in one of the other games – but I digress. We didn't win any points in this round.

Here is a picture of the obstacle course.

After this game I ended up moving teams as some had had to depart early and team numbers were down.

The next game was Spijkerpoepen – the spijker stands for nail – I will let you work out the rest from the photo's.

This game caused a lot of hilarity and actually I proved to be rather adept at it. So adept that I ended up as a ringer in 2 other teams and won all 3 of my races here. The long and the short of it is that you have a nail on a piece of string which is tied round your waist and hangs down behind you at just above knee level. You run up to the bottle at the end of the garden and turn round and then squat down and try and get the nail in the bottle.

The next game was the ruin of us all really and the last active game, this one was Turfstekers wandelen – this involved 2 wooden planks with 5 straps across each one, so as a team you had to stand on the two planks with your feet in the straps and then navigate the obstacle course, 2 teams go at the same time in opposite directions, it is perfectly acceptable, as it was in the sack race to try and knobble the other team as you pass.

This is the other team trying their best to put us off – as this was our first corner and their last, I don't think they had much to worry about from our end as we were particularly bad at this game, and never really got further than about 6 feet past the start line, negotiating any corners would have been completely beyond us, as it was 2 straps broke on each of the planks we were using but not in the same places, and we never really managed to co-ordinate our left and rights, and just ended up in a heap on the floor, laughing hysterically. I don't think the gin punch had helped much!

It started to get dark by this stage and we had to abandon the last physical games until the following morning. Harman lit the braaie and the feasting began.

After eating plenty we partook of a further 2 games, one was the quiz that they had organised – which was all about Holland and the Dutch people and customs and consisted of 36 multiple choice questions. Our Dutch team leaders and team players were not allowed to take part in this although we were allowed 5 jokers were we could call a Dutch member of the team back to help out 5 times. There was only myself and Chosomo left in our team. By this stage there was blatant cheating going on by 6 out of the 7 teams with lots of signalling going on from the Dutch team members to the various teams. One team missed out on this and got about 50%, which I feel was an extremely valiant effort in the circumstances, the rest of us all managed to score 30 something out of 36! I think personally I knew the answer to 2 questions. The final challenge of the evening was for bonus points and as a team we all had to perform a tableau representing Dutch life; the best would get the bonus points. Our team decided to use one of the bicycles and had the four of us on sporting plastic blow up tulips (these had been one of the obstacles on the race course) a bag of oranges and garlands of flowers. In the end the teams tied and we all got bonus points. Photos were taken of all the tableau's for judging purposes of course. Sadly I don't have one though to show you as was too busy posing in the tableau.

At about 10pm we decided to go to the local bottle shop for a game of pool. The bottle shops are the bars round here, when we arrived we rather took over the place, but it had hardly been jumping prior to our arrival it would be fair to say, there were only about 7 people in the place. It was nice to be able to walk around a place a night time; this is not something you can do in Blantyre.

We eventually got to bed at 2.30.

The following morning was spent in their lovely garden having breakfast. Harman cooked in total 63 pancakes, numerous slices of toast and about 5 packs of sausages. We left at about 1pm back to Blantyre to recuperate and recover! A brilliant time thanks to the Mwanza Dutch crew and all their hard work in creating a great weekend.

Slight translation problems

Sometimes you end up having the most bizarre conversations – a couple of weeks ago we were chatting to this young man and the conversation got on to what he liked to do with his free time, and what was he going to do the following day, which happened to be a Sunday. His reply rather took us aback, he said he liked to go pulling on Sundays. Really OK we replied. Yes he said – he always went pulling on Sundays until 5pm. We were both thinking along the same lines, and didn't really want too explore to deeply as it seemed a bit personal and why the 5pm cut off. He then asked if we liked to go pulling, I think we both looked a bit blank at this stage, so he proceeded to demonstrate his pulling technique – it turns out he was talking about.......... pool. He actually likes to play the game of pool on a Sunday and the pool place closes at 5pm. We felt a bit more able to join in the conversation then.

And then this afternoon on the way back from the butchers, this gentleman started chatting to me and said so you are footing then, you like to take exercise – I realised then that he meant "so you are walking". We did then move on to the subject of football, and he assures me he is going to be supporting England in the world cup, after all we all speak English. There is no point in him supporting Spain as they don't speak the same language.

Thyolo and the Black Missionaries

Having been very kindly invited down to Thyolo by Bex and Matt for the weekend, I arrived there on Friday evening, courtesy of Bex picking me up. Thyolo was definitely the place to be although possibly not if you were a pig, but we will come on to that later. Two of the Dutch volunteer doctors down there were leaving after 3 years in Malawi and threw a big party in Thyolo Boma. The Black Missionaries were playing (they are Malawi's top reggae band), when we arrived the place was already buzzing and quite a lot of beer had already passed through some peoples lips. Quite early on a rather inebriated older Malawian gentleman was talking to Matt, and as the conversation went on, he proceeded to ask Matt if I was his wife and Bex our daughter, needless to say Bex and I found this highly amusing, I don't think Matt was quite so impressed. (I only found out this nugget on the Sunday but had to repeat it, sorry Matt) The Black Missionaries were really good and we had a really great time listening to them and dancing along, they only stopped in 4 hours when the power went out and fortunately the power failure didn't last for very long. There was much consternation though when the bar ran out of beer, they even had to put a guard on the bar to hold back the crowd, I don't think anyone was going to argue with him as he had a large rifle in his hand. Apparently someone went to get more beer, but I don't think they ever made it back.
On Saturday we went round to the house of the Dutch volunteers for a Braaie. They had had two pigs specially prepared for the party, bearing in mind these pigs had been alive in their garden the day before you might want to turn away from the rest of this post. The cooking / smoking process had started at 4am that morning by the chef, who had also been at the party the night before, so all hail his stamina and cooking ability and they arrived duly presented on two silver platters. OK the platters might not have quite been made of silver.

This is me with Pinky

And here's Perky

My apologies to those of a vegetarian persuasion.
The pork though was absolutely delicious and I was certainly a little piggy myself. Bex had also been busy preparing dishes for the party all morning, and had produced an absolutely delicious semifreddo and beef salad.

On Sunday although the weather was less than inclement, it was very low cloud cover and drizzling (it was just like being at home) we went for a walk around the tea estates, and walked up to the picnic spot, apparently the views from there are amazing and I shall find out the next time I go, weather permitting. All in all a lovely weekend.

A Tactical error

Made a tactical error on Thursday, decided that I needed to go to the bank and get some money for the weekend. Fridays are mad busy at the bank as everyone wants money for the weekend and Saturdays – well just forget it. Having been in to the main branch on a Saturday for sorting things out, where the queue was easily 100 long, I have decided that discretion is the better part of valour here. So I thought, I know I will go up to the Supermarket as I need to get some bits and pieces from there and there is a branch of the bank there. I have an hour for lunch, so 15 mins fast walk each way, half an hour for the bank and supermarket. What could possibly go wrong? What I had forgotten though is that Game (a big store which sells just about everything – it is where I got my tent etc from) always has a special offer day on Thursday's – a free ad paper for Game is sent round on Wednesdays detailing the special offers, and they are queuing round the block to get in. Now the only problem with Game is that you have to pay for everything in cash, paying by credit/debit cards is very unusual here, you can do at the Supermarket but only on designated tills. So needless to say the queue in the bank was on the long side, there were only 3 points open and one of those was for deposits only. Queuing is not my strong point, especially as people here aren't great at recognising or respecting personal space – as an aside it is considered very rude to move away and make space between you even if there is more space. Have not quite got hang of the system here and am sure they send in ringers to stand in line for them, as I swear at least 5 people jumped the queue, they came out of nowhere, when one person got to the front at least 2 different people actually went to the counter in their place. I might have to enquire what the protocol is, do you have to pay for the ringers, and is it alright to sit in the coffee shop whilst they queue for you. Anyway after this had a mad dash round the shop to get a few essentials for making dinner, and decided as the electricity goes off every other night between 6 and 8 that I would cook Fridays meal on Thursday night as well. Then it will only need heating and not cooking. Cunning eh! Thought I was getting the hang of things now, and what happens, low and behold after nearly running home from work on Friday to ensure that dinner was on the table by 6pm for a nice little candle lit affair, no blooming power cut!

A new husband

When walking to and from work someone generally starts up a conversation with you. Some out of genuine friendliness others I am not so sure.

A typical conversation will go along these lines

Good afternoon Madam

Where are you staying, oh that is far. What church do you go to; they then look quite bewildered when I explain that I don't go to church. I generally refrain from saying that my church attendance consists of attending for hatches, matches and dispatches, for two reasons. Firstly I don't think they would understand me and secondly I would not wish to offend. In Malawi religion is very important and people generally associate locating your house by ascertaining which church it is near. The conversations then progress on to what am I doing out here. So I explain that I am a volunteer working at the nursing college and will be here for 2 years. Oh thank you, thank you, that is good and God is great, is the usual reply. Perhaps you would like to come to my church and preach. The conversation then moves onto how many children do I have and am I married. To which I generally answer none, and no I am not, again there are shocked expressions, not so much that I am not married but more that I haven't got children. I am thinking about making up some children, I think they will be grown up and independent which is why I have been able to come to Malawi. The conversation then proceeds in an orderly fashion to where do you come from, and most of the time they have heard of various places in the UK as especially if they are men, they follow the Premiership religiously. Then they start telling me that they would like to go to England someday, is it very expensive to get there, and I explain that it is, and so they say – it will take me a long time to save but perhaps when they come over they can stay with me, especially if they are wanting to study as they will need somewhere to stay for 3 years!! Sometimes like the other day, I had to make up a fictitious husband. This man was talking to me on the way to work and after the usual pleasantries had finished and we were about to go in separate directions, he finished with so how can I contact you again so that we can meet up, I felt the need to say that I would have to check with my husband and see when would be a good time (he hadn't gone through the are you married bit so I had room to manoeuvre here). I wonder is George still available, I think I read that he had split up with his girlfriend recently. Mmmmmmmmm

A new home again

Sorry rather behind on the updates, it has been a combination of events, generally being a bit more busy, and really poor internet connectivity.

After the Easter weekend we moved home again. We are now staying back in Chitawira until the end of May and then moving again. It will be good when we are finally settled hopefully permanently somewhere.

Our house in Chitawira is much closer to work and by taking the short cut it is only a mile or so to the college and hospital. If it wasn't for the cockerel outside my bedroom window I could almost have a lie in.

So here are a couple of photos of where we are currently staying. As you can see the garden is a much more manageable size! Well you will be able to once I have enough internet juice to upload photos.