Bzyanzi Juvenile prison

Today (Friday) we drove up to the juvenile prison. They are pretty distant from any health center, so we ended up seeing the staff and their familes as well as the boys. Not a lot of photos because we try not to take identifiable photos of the prisoners. The women and children you see are staff families. We saw few wounds, tons of scabies, some knee / ankle injuries and lots of 'general body pain'. Fortunately, no one was very ill and we were grateful for that. We gave out a huge bag of vitamins and niacin, along with worm meds for everyone. It was a good day. This coming week-end we have a dinner planned with Charles and family, and then leave early Monday morning to go to the game park in Zambia. I firmly believe that if you pay so much money to fly here, dedicate yourself to hard work, you at least deserve a 'safari'.
Enjoy the photos.

The team as we prepare to leave

Checking out an eye with a possible foreign body

Nancy preaching to the prisoners while they wait to be seen

Pharmacy set up

Tom in the pharmacy

Looking out onto the prison yard

Rafeal (translator) and Daniel interviewing staff wife with child

Luke doing malaria tests

Chinsapo Village clinic

On Tuesday, we ran some errands and then Luke Livgren gave a presentation to the staff at the African Bible college community clinic on what we did in Iraq. I think it was eye opening to the staff- not just the horrendous injuries and human suffering, but that this was occuring and they had no idea it was going on. It is interesting that most of the western world ignores what is happening in Mosul, while thousands of people, Muslims and Christians alike, are being targeted, shot, blown into pieces. It is indeed very sad and just another indication that our current media is more interested in pushing forward their political agenda that actually reporting the news!

On Wednesday we went to Chinsapo, a village on the outskirts of Lilongwe. We have been here several times. Their health has improved over the years to the point that I am seriously considering taking them off of our village list. We have limited time and resources, and compared to the remote villages, these folks can easily walk to a mission hospital.  However, that final decision will come next year. We saw 151 people between Dr. Young, myself and Luke. We did 71 malaria tests, 59 % were positive. We only saw one very sick person (malaria), most of the other issues were either chronic or easily addressed with malaria meds or antibiotics.  The area we are in (the school offices, I think), looks crowded but we managed patient flow much better this year.
Enjoy the photos!

Bridge to get into Chinsapo. Hate this bridge, truly!I am driving the Pajero across while Joey takes this photo.

Team minus Charles who was taking the photo

Triage with Alicia (white girl) and Lidson (in orange shirt) helping her

Daniel ready to do malaria tests

Luke (in black) and Daniel doing malaria tests. We were set up for wound care but really didn't have many wounds.

Another photo of Alicia

Inside the school office - Dr Young standing at the door to her 'office', mine is to her left

Joey and Jessie in the pharmacy

These four boys were not sick at all, but their mom sent them to the clinic to get a free malaria test. We saw many people who were either looking for something 'free' or had been to the hospital in the last 2-3 days and were not completely cured yet. (we see that behavior in the US - one or two days of antibiotics, still sick, show up in the ED hoping for some new miracle drug). Since we had a limit of how many patients we were going to see, it is very discouraging to have these sorts of people 'take up space' for someone that could be really ill. Of course, their tests were all negative.

Child with a very ugly rash on his face.

My office, with Lewis (translator) and patient.

Looking inside the school office - pharmacy on your left, Dr. Young's office on your right.

Mlombwe Village and more graphic photos

It is a long story how we got involved in a clinic in this really out of the way spot. However, there are several people in this little village with a foot condition, determined by other doctors, much smarter than me, to be a autosomonal dominant condition called palmoplantar kerotaderma. They traced it back to a grandmother, then 3 of her 4 children, and in the third generation, it appears to have affected at least 3 but some are still young. There is no real treatment, except for the symptoms -wear shoes, treat your feet with petroleum jelly and salicyclic acid and cover them at night. The family thinks they have been 'bewitched' and that is why they have these problems. Fortunately, Charles gave them not only the explanation of how to manage their feet, but also spoke to them that this was a genetic condition, not a curse by a witch doctor. We left them nice socks to 'cover their feet at night'.
The condition starts to become apparent at about age 2, worsens during teen and adult years, and then improves as they get older. It also affects their palms but much less so.

 In this village we found the road almost impassable (some of the guys had to hack out the final part with hoes). There is no well / borehole and they must travel to the river to get water. In the rainy season the river floods, and that cuts off their foot paths to the nearest (but not very near) health center. There was no school that we saw. We used someones hut for my office and the back of the two cars for pharmacy and triage / wound care. The lab sat on the ground, as did Luke most of the time. It appears they have maize (not sure if enough for the coming year) and they were currently growing pumpkins. There were the usual goats and chickens. The did not have any mosquito nets that we saw. In fact, the house we were in had a barely thatched roof and only a straw mat for sleeping.  We saw 100 patients, did malaria tests on ~48 and had a 2/3 positive rate - almost all children, including two tiny infants. The infants appeared healthy otherwise but the age group 2-6 seemed pretty stunted. That would correspond to the years of drought and hunger.

On a brighter note, they were some of the most unassuming, gentle, appreciative people we have met here (and this country is full of gentle, unassuming folk). The children were delightful. Luke gave them a soccer ball and they were thrilled. At the end of the clinic, the three leaders of the village met with me, expressed gratitude, and then outlined the problems / challenges that they faced in this area. It does bring one to tears at times. All he asked for help with a well. I am not sure the equipment could even get into this remote area, but I have asked Charles to at least put it on the table at H2O. Pray that happens! It would be a miracle for these folks!

Here are the pictures, beware that the 'feet' pictures are very graphic.

Lidson (Henry) hacking down vegetation so we could actually get the cars into the village.

Triage out of the back of on of the vehicles. Lidson was translating for Dan, a nurse we borrowed from ABC.

 My 'office' in a mud hut, the home of one of the locals. Notice the little sliver of mirror on the wall, above it two toothbrushes If you can see it, directly behind me (ont he ground) is a chickens nest with 4 eggs. The gentleman closest to the camera is my translator, Lewis

Here is Pastor Isaac, in front of the 'pharmacy' car!

Lining up for triage. We didn't register the dog!

Grandmothers feet

Her daughter's feet. Those crevices are very deep and malodorous

Grand-daughter's foot. She appeared to be late teens, right at the time when it gets so much workse.

Here I am examining the feet. We got almost all of the affected people here, gave out the meds and have lovely thick socks to give them (thanks to Joseph Maenner, who has let me give away the clothes / socks he has left here). Of course, many people wanted to be there, so not all these pictured have the foot condition.

3 days at Pothawira - some graphic photos!

Monday - Tuesday - Wednesday at Pothawira. For those of you who do not know, Pothawira ('safe haven') is an orphanage with 128 kids, housed in duplexes with ten children and a mommie on each side of the duplex. Unfortunately, the numbers are over what they should be - how do you turn away a child to certain death? So each mommie has more like 11-12 kids. The have a dining hall for meals (3 a day), and a primary school with hopes to build a secondary school. There is a clinic seeing 200-300 patients a day and a birthing center that we hope will be open next year. Anyone interested in donating to these projects, please look up Pothawira at Global Orphan project or through Global Health Innovations.

Monday was very busy, but slowly it improved. We are still seeing lots of malaria (it is close to the lake, so there are pools and puddles all around, abounding in mosquitos). The children with malaria almost all have a 'knitted brow' appearance. They look miserable. Their complaints can be from headache to body aches, gastrointestinal complaints (vomiting and diarrhea, as well as pain) are common. So are weird rashes and mouth sores. The older kids and adults have that same miserable look. A constant reminder to take my malaria prophylaxis.  We also see wounds - often on the heels / feet of children riding on the back of bikes. We also see tropical ulcers - an infection usually on the lower extremities that starts from some minor trauma and blossoms into huge, painful ulcers in a matter of days. Occasional burns come in - most people cook over an open fire, so burns happen.

You will find some photos below - many are of the clinic and the orphanage / school but some are of patients - some graphic so be prepared!

Pray for these people, as we try to help them with limited resources.

David, clinical officer who is in his 4th (of 6) year of med school, he is a great help to Peter when he is on holiday!

My office

The hall out side of my office (this was before the clinic opened this morning)

Signage on the walls

Treatment room before it is overflowing with patients

Pharmacy with Joey already counting pills

View of the orphan duplexes

School room

Sign on the main road.

Infected lip laceration

Tropical ulcer on a little boys leg

Trench mouth

Fresh wound (we usually don't see these 0 most are days old). Little boy caught his heel in the bike. Luke cleaned and sutured

End result looks great. We usually see these 3-4 days of, with infection set in and a gaping wound. Hopefully thrice weekly bandage changes and antibiotics will help this little guy heal well!

Woman chopped of the ends of a couple of fingers while using a machete to cut weeds.

Bike accident, already infected and draining pus... about 4 days old (the wound, not the child)

Mzumanza Viilage clinic and KCH

Thursday we did a small (80 people) clinic in Mzumanza village. Ione Podgore has a project there, 'Chikondi Malawi' where she has a feeding program for vulnerable children and agogos (grannies). The harvest has been good this year (thankfully) and so hunger is not an issue at present. The children looked healthy, with some exceptions due to acute problems - mainly malaria. We did several tests with a 70% positive rate. My COTN son, Lidson ('Henry' as he now likes to be called) helped in triage. Luke saw patients (most were straight forward, but of course asked for my input if he had complicated patients). He did great! Nancy McGlawn (nurse at AoG did malaria tests, wound care and counted pills. Joey was in charge of the pharmacy. It was a good day. I was still under the weather so we made it a short day.  That evening, Nancy sent over some chicken soup. Her night guard, Garnet brought it along with a complaint about his tooth. It was so loose it wiggled and obviously very painful. I fortunately had some local anesthesia and did a dental block, then pulled his tooth. He left with a smile and his tooth in a bag. The only thing I couldn't do was 'put in a new tooth' as he requested!

Friday I was feeling almost back to normal, so Luke and I went to KCH to do hand over rounds with the surgeons and then surgery rounds. They had changed interns but many of the patients unfortunately were the same. So many infections after surgery, so many cases of wound dehiscence. I know it must be terribly discouraging to the doctors. During hand over rounds it was announced that neither the CT scan or the plain radiographs are currently working. How do you run a central hospital with only a sonogram machine? We saw a gentleman who had a GI bleed... he spoke English and his first name was Whiteman, which is funny enough, but when I asked him if he drank alcohol he replied 'of course' and his wife chimed in 'he is a drunkard'. They both spoke English. His wife said 'someone needs to tell him what will happen if he keeps drinking'. One thing I find fault with in the current medical system is the hesitancy for clinical officers or doctors to give patients information. I told Whiteman that if he continued to drink, he would likely bleed again and could easily die from a GI bleed. He acted as if those ideas had never crossed his mind.  He was a very cheerful sort, but his wife was obviously taxed to her limit with his behavior. Another elderly gentleman was there for 'palliative care' according to his chart, with a history of esophageal cancer diagnosed in January. He was literally wasting away. When I inquired of the interns if anyone had discussed his diagnosis / prognosis with him or his family the answer was no.  I suggested that meeting with the patient and his family and having an honest discussion was the best thing for his care. I am not sure that will happen. In the medical field, we seem to do poorly when faced with death; I don't remember a single class or even lecture in 'how to tell someone they are dying' when I was in school. It is a shame because we are who many people turn to in their time of trouble, their illnesses, their despair and we should be able to share the truth with them in compassion. It is hard to walk that fine line between honesty and destroying hope, but folk need a chance to 'get right' with their friends, families and most importantly their God. Otherwise, I am always surprized by what ends up on the surgery ward - ascites diagnosed as an abdominal mass, an allergic reaction to bee stings (treated in a most extraordinary way), and an abscess that appeared to be in the joint and needed ortho attention. I also ran into the Cuban Urologist who complained last year that he never got an theater (OR) time to do his patients. He is now over 1,000 patients behind who need surgery! What a shame for these patients, most men, who have some increased prostrates and suffer with difficulty urinating!  All in all, it was an interesting morning.

Tomorrow we are hoping to be at the Maula prison for a clinic. There was apparently a jail break from there sometime in the last year. Charles said it was the first jail break ever, and it involved Nigerians I think (not Malawians) who freed their friends but left every one else locked up. Now there is a new director at Maula, security (which was so lax it was scary) has been tightened up, you can no longer drive your car up to the gate and  unload stuff (or actually drive onto the prison grounds as we did many times). I had to write a letter requesting to do a clinic and now we are waiting to see if they will approve for tomorrow. I respect that they needed to increase / tighten security, but it is a little tiresome at times.

Enjoy the photos! Keep us in your prayers, as our plan next week is to go to Salima and Pothawira again, then escape for a couple of days at Nkhotakota so Luke can really see the lake, then drive back through the central part of the country. Should be an adventure!

Our 'offices' - a school room. Luke is getting ready to examine a patient while TK (his translator) looks on. in the background you can see Nancy doing a malaria test.

I am at my 'desk' the elderly gentleman had some prostate problems I could no fix, but referred him to KCH urology (see notes above for how well this might work out!)  The lady leaning over intensely had just had a malaria test done.

Here I am examining a ladys' hand. I always try to position my 'desk' by a window so that I have a breeze and some light!

Luke and TK talking. Notice I positioned him by a window, too!

Some of the secondary school girls at the project. They currently have an infestation of bed bugs in their 'dorm' and had to burn all their mosquito nets but the critters are in their mattresses, in the cracks in their bunks, etc. If anyone has a heart to help these girls (this is just a sample, there are a bunch of them) contact me and I will attempt to put you in contact with the lady that is helping these girls.

One of the secondary school girls presented with what I think are keloids on her feet / ankles. She stated that her feet swelling 'very big' and when they went down she had these scars / marks. She is unsure why they swelled and did not have her health passport with her.

Nancy McGlawn doing some wound care on a gentleman's thumb

Henry ('Lidson') doing some triage. Well, actually he did all the triage!

The team minus TK, Jessie and Luke. From the left - Nancy, Winfred, me, Lidson, Lewis, Joey.

My after dinner activities - pulling a tooth in my dining room with Luke's assistance. I am holding his tooth in that piece of gauze. I am going to try to NOT make this a habit. I really don't like teeth!