Tuesday night dinner, then Ntchisi Prison

Tuesday we had dinner with Ione Podgore at her home at Daeyang Luke. We were joined by Dr. Sue Makin and Kathi Nunnley and her daughter - Kathi is helping at Ione's project by arranging sponsorship, etc of the secondary school girls, but she also works with 2 villages in Salima District. I am hoping we can do a clinic there, if not this year then next year.

Wednesday morning we left early for Ntchisi but were caught in the morning rush in area 25. We finally arrived at Ntchisi Prison and were set up close to 10 AM. The clinic was on a konde (porch), which included my space and that of the newly minted MD from the UK, Claire; the wound care area with Nancy McGlawn; malaria testing station (Tanya) and pharmacy (Joey Swartz and Tanya when not testing). Not sure how many but thinking about 70-80 folks, not counting the number that received only wound / skin care.  We had to be finished by 1 PM as Charles Msukwa had to be back in Lilongwe to to defend his thesis (which he did and passed! as if any of us doubted he would!).  Ntchisi is a small prison, with only about 350 prisoners, all men. There was an abundance of skin issues, general body pain, stomach issues, and poor nutrition. They apparently get one meal a day consisting of nsima (made from white maize). I saw a bad case of pellagra, and several less severe cases, coupled with malnutrition. We gave out lots of niacin and vitamins, along with some 'super B complex' vitamins. A huge thank you to those who donated some of these supplements (many of which we cannot get here).   There were also several people who claimed to have 'asthma'. This time of year there is much smoke from fires and the land is dry enough to create red dust everywhere. The nights are cool (especially up there). All this combined to make people feel breathless / 'asthmatic'. There were also many prisoners who were HIV positive, but all the ones we saw, with the exception of one who did not have his 'book' (medical record) were receiving their ARV.

We were glad it went so well, and I am continually impressed by the people I am surrounded by who love and serve the Malawians, even 'the least of these'. Enjoy the photos.

Before we started the clinic, there was a little presentation, with a prayer by Charles. In the photo are Nancy McGlawn, Annualita Metope, Joey Swartz,Clair, Tanya and me with some of the guards.

Charles Msukwa and H2O (His2Offer.org) provided soap for the prisoners.

Joey Swartz and Nancy McGlawn setting up the wound care area.

Prisoners waiting.

'My office', even the guards wanted to be seen.

Tanya and Joey Swartz working in the pharmacy.

Large boil that Claire treated with an incision and drainage.

Claire doing the Incision and Drainage.

Examining a patient.

Nancy McGlawn in charge of wound care. She did a truly awesome job!

Ear infection / impetigo

Nancy McGlawn chatting with me. A real 'porch side' consultation!

The konde (porch) clinic!

Nancy McGlawn and her wound care line!

Severe pellagra rash from niacin deficiency.

Team when we were ready to leave, minus Claire who took the photo. Great job, team!

Mdazi dnima (Gusu) with E3

Friday night, one of our guards, Grey, brought his nephew to the house for me to check. The child (about 2 years) has a rash and had been to the hospital and given a 'prescription' for calamine but there was none in the hospital pharmacy. He looked like he had chicken pox and fortunately we had calamine lotion here at the house, so were able to give him a bottle. What a cutie he was! It is so sad that many of the hospitals here are out medications and supplies (the government run ones).

Saturday we were privileged to join the amazing team that E3 has here in Malawi. We all went to an area called Mdazi dnima ('where the water is' according to my translator). I am not sure how many people are actually involved, but it appears to be about 20. There are several nurses that are 'regulars', plus Kelley McGowan and Joey Swartz (came with me); there were 6 clinical officers this time; people to help with crowd control, setting up the pharmacy, triage (not always done by a nurse), translators for those of us who need it, etc.  This area is about 45-60 minutes off of the tarmac, down the airport road into Dowa district. The closest trading centre is Mphongela for those of you familiar with Malawi. E3 has done much work in this area, with wells dug and water storage, all on solar power, permaculture, a hydroponic set up that is amazing, composting toilets, raising goats (fenced, a novel idea), and pigs (also contained). They have now started raising rabbits. They also have a very vigorous sports ministry in this area. Many of the local projects are run or overseen by Sandram, a Malawian who graduated from ABC. E3 was also instrumental in getting the school built that we used in the clinic.

As for the clinic, we got set up and ready about 10 AM. Patients were triaged and then saw a clinical officer or myself. Our part was done by about 2:30 and then we helped the pharmacy finish. The malaria testing station was manned by 5 people, but we ran out of malaria tests before noon (they had 200 tests).  When they finished they, too, went to the pharmacy to help. We registered 757 patients. Like Sam Kawale says, we don't do statistics, each number has a face, each face has a story, every story matters to God. How true that is! Some of the stories are so tragic. We did find a girl of about 2 years who had severe malaria and one of the vehicles we had took her and her mom to a hospital. Another 'evacuation' was someone so anemic that she had to go to hospital (anemia is generally diagnosed in the village by clinical signs, not tests).

In the pharmacy, they used 5000 doses of paracetamol (our tylenol), over 2000 doses of ibuprofen (and ran out of both), all the usual malaria medications and several of the antibiotics.  These clinics are very costly - both in time and medications, not to mention fuel for transport, renting a minibus for most of the crew, etc. etc. They have some very faithful supporters in the US, but anyone interesting in partnering with them through financial donations should go to their website (E3 Worldwide).

We finished in the pharmacy, packed up and were on the road just before dark, which meant the main part of the trip was in the dark. If you have not been in African bush dark, you have not been in dark! The road into the village area is a single lane dust road. We had to meet or go around several ox carts, motorbikes, tons of people on foot and on bicycles, cross bridges without guard rails, avoid pot holes, and even had the occasional car or truck coming at us! Thanks to our amazing driver, Chikonde (Chico) who was also my translator, we made it safely to the tarmac, then to face Friday night driving on those roads, with other vehicles with no tail / brake lights, etc.  Praising the Lord that we made it safe and sound.

Saddest stories for me were two little ones - one with obvious CP and a history of a very difficult birth. Mom wanted a cure. She is one and looks to be 3-4 months old and cannot hold her head up. Her life will be incredibly hard, and if the statistics hold true, she will be sexually abused in the future (girls with any disabilities tend to be victimized).  The second was a girl of about 5 with the worst kyphoscoliosos I have ever seen in a small child. Sam is attempting to find if someone at Cure (Blantyre) could do surgery. Apparently the child had been taken to the central hospital (Kamuzu Central hospital) and they could not help her.  She lives with her grandmother, as her mother has a new husband who is 'not interested' in the child. Yes, every number has a face, every face has a story, and every story matters to God. These precious children are here for a purpose, and God has His eye on them.

Pray for us and for them, pray for the amazing organizations that are working so hard in Malawi to bring much needed aid to those that need it.

Enjoy the photos!

Grey's nephew

Crowd at Gusu, waiting for us

Joey Swartz doing malaria testing

Chico and I, in my 'office' seeing patients.

Lining up to see the clinical officers, doctor.

Kids, always lots of kids, especially when the azungus come around!

Sam Kawale explaining to Kelley McGowan how the rabbit raising is working (cages to the right of the photo).

Joey at the 'hub' of the Gusu project - we were taking a lunch break and got a tour of the hydroponics, the rabbitry, and the gardens.

Through the 'pharmacy' window, crowd waiting for their name to be called.

COTN

Friday we visited Chitipi orphanage and farm, on the outskirts of Lilongwe. It is a COTN facility.  They currently house 32 children in the orphanage, plus have another home for older girls behind the main orphanage. The farm has crops, animals (pigs, rabbits, chickens), a tilapia pond, an irrigation system, a preschool (for both kids in the orphanage and local children). It is well run, the children are always healthy and happy. It was a school day so we did not get to see the older kids, but we did get a nice tour for Joey and Kelley. We also met the newest child, Daniel, who came to the orphanage at 3 days of age. His mother died after giving birth, he was premature (about 7 months), weighed in at about 1.2 kg. Now he is a chunk and growing daily. I also got to reconnect with old friends. Joey and I will go back when the kids are around and see all the older kids. Today we are going to another E3 Mobile Clinic, so 'stay tuned' for more photos! Enjoy these of the home and farm.

Kelley McGowan with baby Daniel

Inside one of the preschool rooms. The older kids have ~13 in this class, the 'baby class' (under 5 I think) has about 20 little ones. They teach in English.

Outside of school block

A starter garden bed, these plants will be moved into the bigger beds. They grow maize, soya beans, sweet potatoes (NOT yams), tomatoes, and other assorted veggies.

One of the momma pigs. They have two 'pig houses' with tons of pigs! The goal of COTN is to be able to feed all the children in their homes and the feeding villages using what is grown here at Chitipi and what is grown at the big farm where the teen age boys stay. I was told that this year, they succeeded in that!

Meeting Yamikani, a young man from COTN who is currently managing the tilapia pond for his GAP year.

The walls of the house have multiple brightly colored murals, this one depicts all the kids and the Mom / Dad and aunties.

One of the older girls with little Daniel on her back

Ran into an old friend, Fineness, in the older girls home. Girls that stay here are in high school or college / advanced school - she is in a Bible college.

Tapiwa is a girl with severe cerebral palsy who lives at Chitipi, surrounded by happy children and adults who all love her.

The home is divided into a girls' side and a boys' side. On the girls side, each dorm room has about 8 beds, with an auntie assigned to each room and usually one of the little boys (Thomas, Caleb, Mikey) also in that room. On the boys side, the Mom and Dad oversee those 2 rooms, and they keep little Daniel with them at the present.  It is a great system and seems to work really well. If you are thinking you would like to be a child sponsor, check out COTNi.org, you can search the countries they serve, the age of the child, etc. The ones in an orphanage are more expensive to support (I am still talking not much money!) than the kids in the feeding village. It can be a great project for a family. Think about supporting the older kids, as they always seem to be in need. COTN gets 3 sponsors per child, to alleviate any problems if someone has to drop off the sponsor program. 

Chinsapo, South Luangwa and Seizure clinic!

Ok this has been a crazy week. We did a clinic in Chinsapo, a village on the outskirts of Lilongwe. Dr. Young, Claire (just finished med school in the UK), Kelley McGowan, Joey Swartz and Malawians Charles (coordinator of all things!), Lewis (general help), Anthony (pharmacy) and Grace  Malawian head of the project) helped. We have done a couple of clinics here before, once under the trees and then last year in the new school building. This year we were in the administrative part of the school. Total of 4 rooms, with the doctors rooms being nice, the pharmacy being nice (but tables all very low) and the 'entrance' room where people gathered, were triaged, had malaria tests, and waiting in 'lines' to see doctors / pharmacies, etc. There was chaos in that room, all the time! We saw slightly over 150 patients, transported two sick ones to ABC for additional care, treated lots and lots of malaria. Much too much for this time of year!!  That was on Saturday. Sunday was church at Flood and dinner with Sam and Malla Kawale, joining us was David Epperson who is in country to help finish a project.
Monday morning we left for Zambia - South Luangwa national park at Mfuwe Lodge.  It is the 'treat' for the hard work that Kelley and Joey have been doing. I won't bore you with the long story, but my car is still unavailable (tied up due to formalities at Road Traffic). Charles graciously drove us in his car. We had a great time and not only saw the usual array of animals, but also a pack of wild dogs hunting impala. The wild dogs are new to the park, they showed up about 2 years ago. Alec, our guide, said they think they came from North Luangwa (which is much more remote and has few lodges, etc). We also saw a pair of lions and a leopard hunting in the daytime.  We also visited Project Luangwa (check out their website) - Karen and David Hopson are involved in building schools, doing 'gender education', working with girls and women to help with their issues and empower them through education and employment. I visited two years ago and am amazed at all the new projects that are either finished or underway. You can also sponsor a child's school fees through their project.

We came back home on Wednesday, up this morning (Thursday) so that Kelley could pick up some items for her family, then seizure clinic this afternoon. This is part of Children of Blessing Trust, and Kathy Bowler and her team do amazing work.  Enjoy the photos.

As an aside - I was told that about 75% of girls / women in Malawi are sexually abused at some time (David tells me it is 70% in Zambia). There are a multitude of factors - females are held in low regard. They are often dependent on relatives (uncles, etc) for their housing / food due to being orphaned and if they report them for abuse, they have literally no roof over their heads. The girls that are mentally or physically challenged are easy targets (we have encountered several girls in this situation that have been raped). There is no justice for a raped or abused woman. The groups that are working to empower women and to protect girls / women need your prayers and your support!  I am so grateful to groups and projects that are working in these areas!

Lions in South Luangwa

Wart hogs in South Luangwa

Grey billed horn bill with some food in its beak

Wild dog

Action shot of elephant as it is shaking its head

Entrance into the school area of Chinsapo. The road was so washed out that they were filling the ravine with bricks. That is the car Charles has loaned me, and that is Charles in the red shirt moving the bricks around. I had Lewis drive the car over them as I am a coward!

Me holding a 2 month old. She had a upper respiratory infection (no malaria) but her Mom was so ill she had to go to ABC.

This sweet girl has microcephaly, which we see a lot here. There are no tests to do here so we have no idea if it is Zika virus, or one of the other viruses that can cause this! She does seem to understand a little, but cannot speak. Her mother takes care of her. She is 19.

Grace, the Malawian now 'in charge' of the project. This is a face full of peace and grace in the middle of chaos!

Dr. Young seeing patients

Kelley McGowan recording triage vital signs. The patient is sitting on the floor. Kelley is writing in their medical record = a medical passport that the patient keeps.

The crush of people in the front room (triage, malaria testing, 'lining up' and waiting.

Dr. Young checking out patients waiting outside. We wanted to be sure we did not miss someone very ill. Generally the sicker patients come early in the morning, but occasionally a late-comer will be quite ill, also.

Dr. Young, Kelley McGowan, Joey Swartz and Claire - at the end of the clinic, we were served drinks and cookies. We had not eaten all day, but some of us were able to take a few sips of water. 

Not sure why the pictures are out of order, but here are a couple of giraffes in South Luangwa

Women at the women's project / workshop (Project Luangwa). Busy sewing!

Seizure clinic. The girl standing is Chewemwe (translator), the one sitting is one of the clients. Notice her badly scarred right hand from previous burns. Because cooking is done over open fires, and they use fires to stay warm in the winter, many seizure patients fall into the fire when they seizure. The complications in this resource poor country can be devastating.

Pothawira, Senga Bay and Partners in Hope

Sunday we drove to Peter and Emma Maseko's in Senga Bay (outside of Salima). We had planned on doing Monday - Tuesday-Wed and Thursday at the clinic. However, Monday was Labour Day in Malawi, so the clinic was closed. We went to the Pothawira orphanage and visited the kids, gave some blankets to the babies and gifts to the Mommies and cooks. Then into town where the girls (Kelley and Joey) shopped for chitenje's. It was HOT, so we dropped off Emma and then went to the Livingstonia for lunch and a 'rest' - the lake side is much cooler. I swam so I was really cool. May is the official start of winter but I don't think the Salima area got that memo yet! Tuesday - Thursday (morning) we worked at the clinic. Tuesday was a typical 'day after a 3 day week-end' and Peter and I saw 261 patients. I am starting to get the hang of being a Malawian doctor, although I still see stuff that I have no idea what it is. We saw much more malaria that should be around this time of year (dry season), mostly in babies and little ones. During the week, we saw burns, wounds, sickness of multiple degrees, nasty untreated ear infections, and coughing - lots of coughing. The saddest cases - an 11 year old girl with genital warts who we tested and was HIV positive and a 6 month child who weighed 3.5 kg (a severe failure to thrive). I sent some patients to the district hospital for blood transfusions due to severe anemia due to malaria. I had an awesome translator, Mary, a nurse from Salima District hospital who was on holiday and was working to make extra money. After we finished at Pothawira and got back to Lilongwe, we spent Friday morning at Partners in Hope with morning rounds (always an enlightening experience - makes me realize how I am NOT a Malawian doctor!), then to Intermed to order medications for a village clinic on Sat. and Globemed to buy malaria test kits.  After yet another trip to the ForEx to change money, we went to Four Seasons for lunch. Tomorrow - Chinsapo!  You may find some of the pictures not to your taste if you do not have a medical background, so beware! All photos were taken only after verbal permission from the patients!

Outside waiting area at Pothawira - people everywhere!

Nurse Mary and I.

Several day old burn from hot porridge.

Joey giving blood at Salima district hospital, with Kelley watching (and me taking photos). The guy from the blood bank drawing the blood was named Saviour. 

This poor little guy had a terrible ear infection with drainage and maceration of his entire ear. He was not a happy camper.

Small child with burn on her hand - she dipped her hand in hot porridge. She had been seen at another facility where she showed up with colgate on the wound. It occurred several days before we saw here and it looked pretty infected.

Same girl, palmar surface of her hand. I am really worried about the fact that these burns seemed to be circumferential around several of her fingers.

Lunch at the tearoom at Four Seasons. Joey

and Kelley excited about the meal. It really was delicious.

Oh, darn, we had already eaten before we saw these snacks along the side of the road - mice on a stick ('mouse kabobs'). 

A shout out to all who have supported with medications, supplies and monetary donations! I am already calculating costs for next year. I accept donations year round! Gas is still about $8 / gallon. Food is expensive (except the mice, which are a bargain!). And of course, medications are a big bite out of the budget!