Orientation

Mike with one of the clinical officer students, Wyson, discussing a patient on the medical wards.

We have completed 3 weeks of our required orientation at Kamuzu Central Hospital. This last week was a bit of a change as the clinical officer students started their rotation in Internal Medicine, so we had some opportunity to be teachers (although we still feel like students--learning the system and the medicine/culture of Malawi). The Clinical officers are the back bone of the health system in Malawi. Their training is 3 years long starting right after high school. Most of their training is "hands-on" and when they finish their training they are trained in clinical medicine as well as many surgeries--such as C-sections, hysterectomys, appendectomys, and more. We hope to be more involved in the training of the health providers in Malawi in some capacity at Partners in Hope.

The "konde"--this is the balcony which was made for the patients guardians, but most days is occupied by patients. Fortunately we are in the dry season, but during the rainy season apparently this area gets very soggy as the "wall" to the right is open to the outside.

Looking out the window on the 2nd floor you can see the where the patients guardians stay while caring for the patients. Most of them sleep outside. The guardians provide daily care and food for the patients. The hospital provides a porridge and sometimes a piece of fruit daily (I think), but not enough, so the guardians either prepare food or buy it and bring it to the patients.

Jacaranda

We've gotten in the habit of going on a "family walk" on Sunday mornings before church. We are up by 6 and church doesn't start until 9:30, so we have plenty of time to take a walk around the block. It is also hopefully helping train the kids for our future climb up Mt. Mulanje (the highest point in Malawi).

It's a beautiful walk in the morning as the streets are quiet and the trees and flowers are starting to bloom. The jacaranda trees are just coming into blossom and they are a beautiful purple. We have started a game in the car like "pididdle"--the game in which you call out pididdle when you see a car with a headlight out. The Malawi version is "jacaranda"---so you hear Sydney and Sam screaming "Jacaranda" over and over while we drive around town and see all the trees in bloom.

We hope you enjoy the pictures (even though they are a bit fuzzy--our camera is acting up)

Kamuzu Central Hospital

Here's a picture from my previous village visit of a boy drinking juice out of a bag--a homemade juice box. =)

We may have shared with some of you that the Medical Council of Malawi has asked us to do an "orientation" at the central hospital here in Lilongwe in order to receive our license for practicing medicine in Malawi. They have allowed us to practice at Partners in Hope over the summer because of staffing issues, with the intention of starting our orientation in September. And although it's hard to believe, September is here.

So we started our work yesterday. Our first month will be spent on the medicine wards. And despite our knowledge of medicine in Malawi, it was quite shocking! I wish I was a writer so I could paint some word pictures for you. But it definitely overwhelms the senses. The wards are packed with people--all of the many patients have guardians there to care for them, gather their meds from the nurse, and provide them with food. The patients are extremely sick. And the wards are quite short-staffed. There is constant noise from the din of people as well as the constant wailing and mourning going on for the patients who have died. Thankfully it's not too hot yet and it's not diarrhea season, so the smells weren't too bad. In fact you can smell the porridge and nsima being cooked for the patients.

Today we saw patients in the female wards. The patients are separated into a diarrhea ward, a pneumonia/tuberculosis ward, and a meningitis ward. You don't see this in the states--usually it's the cardiac ward and everything else. Two of the patients we saw this morning died by the afternoon. Both of which had meningitis. Although the majority of the patients have HIV, there are many who do not, and yet they are still quite ill. In just two days we have reached a new level of frustration over the lack of resources for these patients.

Please pray for us during these next few months as we continue this orientation:

• Pray that we will continue to learn the medicine in Malawi
• Pray that we might be able to demonstrate the compassion and love of Christ to patients and staff despite the difficult work environment
• Pray that we might make connections with the staff there that might help provide continuity of care for our patients at PIH that need to be hospitalized
• Pray for the staff at PIH while we are away as they will be quite busy with the growing demands of patients.

Thank you for praying!

On a lighter note, here's a picture of Sydney and Sam in their uniforms for school.

Women's conference

I was invited by one of my Bible Study to friends to teach at a local women's conference about HIV/AIDS. Lorrie and her husband come alongside local churches around the Lilongwe area to encourage them and help train and teach when needed. Lorrie and her family spend most Sundays at one of the village churches worshipping together and getting to know the different congregations.

So Lorrie, myself and Sara (another friend who is a dietician) left Friday morning and drove about an hour out of Lilongwe to speak at the womens conference. We had interpreters go with us who had lived in the area, which was great because the dirt roads are not marked and it was a bit of a maze to find. We passed many women walking, or riding on the back of bicycle taxis to get to the conference. Many of the women traveled a full days walk to come to the conference.

We met in a large brick building. The conference opened with wonderful worship songs. And then a choir from 5 different churches presented a song. All of the songs were in Chichewa and fully choreographed. I wish I had video for you because it was an awesome experience.




Sara shared about nutrition using the Malawi food guide as a reference. In short, she encouraged consuming and growing a variety of foods--fruits, veggies, legumes--for all of their different nutritional values. All of which can complement the nsima (maize) which is the staple food.



I shared about the basics of HIV--what it is, how you can get and transmit the virus, also a bit about how anti-retrovirals work to maintain health. I was hoping to encourage discussion about HIV amongst the women, and testing for them to know their status. Unfortunately for this village, the closest VCT (voluntary counseling and testing) center is about an hours walk away. And the medications are only available at a hospital a half-days walk away.

I asked a lady to come up and show me how to tie my chitenje--we got some laughs

Access to care is a very difficult issue in Malawi. (I am excited that Partners in Hope is involved in starting 3 new outreach sites beyond the immediate Lilongwe area to help with this problem) But even more difficult were the questions the women asked--many of which pertained to their lack of power in regards to their own health. It is very common for men to have partners outside of marriage, contract the virus, and bring it back to their wife. And often men will refuse to wear condoms which would help protect their wife.

These questions do not have easy answers, and I certainly didn't have any quick answers that day. But alongside the women "elders" at the conference we prayed for these specific women and for women in general to continue to seek the Lord for wisdom, patience and love in these situations. Please join me in praying for the social structures and cultural expectations of women to change in Malawi--that they might have more of a say in their lives.