Home again

Well, we made it back with no big problems.. except that we didn't really want to leave. Of course, there was the guy who 'went down' on the flight from Nairobi to Amsterdam, that kept Jose and me up all night working with him....

Our last night in town we spent with the Spencers. Little Ester has now learned to walk and she was cruising everywhere. Steven was hungry and got fed early... another crazy, chaotic, wonderful evening with the Spencers - gosh we love you guys!!!

When we left the guest house, Jose left his sunglasses with Mr. Whiskas - he was excited! He and his wife came to tell us good bye. We will miss them.

We arrived in Texas in the rain, lots of rain lately. In fact another storm came through yesterday. I snapped a picture of a double rainbow over my barn.

I want to say a special thanks to all those folks who kept up with the blog and kept us in your prayers. And a special, HUGE thanks to the donors - you know who you are, and you were a blessing to us! If any of you others are interested in still donating, I am still listed as a missionary with ABC, and my bills for this trip are still coming in, so, anything you could do would be appreciated! Until next trip - which I hope will be soon - Blessings to you all and may God bless your lives!

Last CPR, a deer, the Whiskas and a 'gift shop'

Monday Jose taught his last CPR class for this trip. There were 5 guys who are going to start working at the pool. The original plan was to have the class at the pool, but since they were doing swim team try-outs, they moved it to Nell's house. Everything went well until he started to teach some basic back board, C spine precautions. That is not part of the usual CPR class, but since these guys are going to be around the pool, Mrs. Chinchen thought it would be good to have them understand some basics. Sounds easy, eh? Well, they have never even seen a back board or a C collar.... So after the class, Jose and I went to the pool and met the lifeguard, Alexander. He had been in one of Jose's earlier CPR classes, but he also did an official lifeguard course at Blantyre and had CPR there, too. He also understands how to get someone out of the pool with a back board and head blocks - amazingly enough they STILL have the backboard that was there when Jose taught in 2007! They also had a couple C-collars, but he didn't know how to use them. Jose showed him the basics. Alexander really seems to 'get it', so we have asked him to show the other guys how to use the back board, how to do some rescues, review CPR with them, etc. He's a bright and motivated guy. We left some pocket masks with him, as that is one of the most likely places to be using them. Afterwards, we took all the CPR stuff (videos, dolls, etc.)

to the Korean hospital for Abigail - she and Edwards (clinical officer) are going to start teaching CPR to all the staff there. When you drive up to the hospital, there are a cluster of shops outside the gates - sort of the same concept as in US hospitals (gift shop, snack bar, etc.) ... they sell food, drink, basic things... After all our running around, we came home and cooked chicken fajitas for Bambo and Amai Whiskas as our last dinner with them. The pictures: the hospital 'gift shops'; a deer outside Nell's house (where Jose was teaching CPR); Jose and his class - Lovemore, Justise, Hope, Gift and Simeon, and then Jose and the Whiska's and finally Bambo and Amai Whiskas.

Orphan village

After church today we went to the near by orphan village, feeding center. This one is run by Children of the Nations (COTN) and they also have two small group homes for orphans here - one for boys and one for girls. We started coming here in 2007 to visit the older kids, now we try to bring something each time. Usually books, toiletries, 'pretties' for the girls, etc. I brought a jigsaw puzzle for each house this time, too. We enjoy the kids. I sponsor one of the older boys. Usually all the kids aren't there, as many are away at secondary school. Last time at the girl's home we met Diane and Maureen - she had just finished her high school and was hoping to get into college. She is now a freshman at ABC college! What a blessing. She is very bright and will do well. We gave her a ride back to the campus - she is one of 5 kids, lost both parents when she was in 7th grade. She is the only one in the COTN home program, one younger sibling is in a feeding program. She is delightful! Of the boys, I met my new kid, Alex. My previous older boy, Innocent, dropped out of the program, so I took on another older boy. COTN tries to get three sponsors per child - that provides not only food, clothing and basic medical care (plus if they are in a 'house' they have shelter, etc,) but also provides for school fees, even at the college level. Please look up the COTN website, then you can look to sponsor a child, even picking the country, the age, etc. These folks do good work. I have sponsored Lidson (previous blog) for years, and watched him grow into a fine young man. A sponsor gives a child hope for now and for the future, plus lets them know they are special to someone. All for less than a nice restaurant meal in the US! The pictures: driving to the village, we passed some women and children - note the woman with the wood on her head and the baby on her back! Then Jose with the teen age boys - I don't remember all their names, but the one in grey next to Jose is my ex-boy, Innocent (who is trying to get back in the program), and the next in line in white is my 'new boy', Alex. The girls: the girl with the huge smile is Maureen, the one in red is Diane (I think she is still needing a sponsor -check out the COTN website), the other picture is the Auntie and another girl, both of whose names I have forgotten (must be my age...). Enjoy.

GVH Chifuka

Saturday we went to GVH (group village headman) Chifuka, to do a village clinic. This village was visited last month by the Woods, two doctors from the US who helped at ABC. Many of the people there had never seen a white person before they came, and we think the same of our experience. It is only 1 1/2 hours from the capital, but sits 2 km from the Mozambique border. Many of the villagers are actually refugees from the civil war in Mozambique (thankfully ended now), but they have chosen to stay in Malawi. The nearest hospital is 40 km. We set up in a small building. Three students from ABC went with us: Steve - it is his home village; Peter: an aspiring preacher, and Thandi: who wants to be in the ministry somehow. Steve has set up a ministry in his village, complete with committee members, with an aim to minister specifically to the elderly and disabled. We started the morning EARLY, and when we arrived, we had to go to the 'resting house' where members of the committee met us. If you have never been to Malawi, the greetings and social protocols are mandatory - and lengthy and sometimes exhausting in themselves- everyone must give a greeting to everyone else! After the greetings were exchanged, we went to the local church - a burnt brick building with a mud floor - no pews. (As an aside, those of you with big building projects in your churches - realize that many of your brothers and sisters in Christ sit on dirt floors, with dust blowing around them, to hear the Word of God preached.....). At the church there was singing, prayer, a short sermon by Peter and then I had to say a few words.. (ugh). Then members of the committee gave little speeches and the big chief spoke a few words. Actually, by African standards, it was pretty quick - only 40 minutes. Then we started the clinic - a little before 9 AM. It was an absolute zoo! I sat at one table with Peter, Jose was the pharmacist again, and he had Thandi to help him. Peter quickly learned what additional questions I would ask for a specific complaint, and Thandi had the 'take this with food' or 'shake before using' down pretty quick, too, considering they are totally non-medical in their backgrounds. We broke for lunch - again we met with the committee members and gave greetings, then they served us rice, greens, nsima and chicken (village chicken). I passed on the nsima this time - I was a little leery about the water sources here - but had rice (hoping boiling water kills all the bacteria, thankful I have had my Hep B shots!), greens (quite good) and chicken. I have eaten village chicken before - but I just couldn't get this down! Then back to the clinic, where people kept coming in. The patients: many of the older patients, especially the ladies, complain of general body pain - I am sure it is from the years of unbelievably hard work that they do! Towards the end, when we knew we weren't going to be able to see everyone, Steve divided out those whose ONLY complaint was body pain - and Jose made up bags of Ibuprofen (until we ran out, then we used aspirin - and we were long out of paracetamol - their 'Tylenol') and distributed them to the 'pain' patients. There were more twisted limbs and other bony abnormalities than I have seen at any other clinic. One man walked on his hands and feet, with his legs partially atrophied - I have no idea what was the cause of this but it was congenital. Several ladies, and one little girl, with twisted, deformed legs - many were born normal, then (at least for the little girl) - became very ill and her leg was twisted - ?polio? One of the ladies with the twisted leg blamed witchcraft. Lots of goiters, high blood pressure, heart palpitations, cough, runny nose, abdominal pains (they, too, use wood ashes in their greens - hmm, I wonder if that's why it tasted so good?). A sprinkling of malaria (it is the dry season), some bilharzia, various rashes, a couple of epileptics, two mental patients, multiple kids with worms, lots of blindness - due mainly to cataracts but also some traumatic eye injuries and a couple of ?? I don't know why they are blind. Many of these people had NEVER seen a doctor, and they really thought I could just 'fix' them. It was very sad to tell them we had nothing - and often we had to tell them that their problem was not fixable at all. We had a couple cancer patients - they had been seen outside the village and knew they had cancer, but their care is just 'palliative' (no chemotherapy, no surgery, no radiation). They came because of pain- so their 'palliative' care is totally inadequate. Several probably HIV patients - we instructed them to go for testing, but tried to treat their immediate problem; lots of patients that I would wager had TB - again, treated them, but told them if they did not get better to go to hospital for TB tests. Lots of people complaining of 'asthma' but almost no one was wheezing. I think they mean they cough and have trouble breathing - this village was so dusty that Jose and I had their version of asthma by the time we left! The cases that will haunt me: a lady came in with her ~6 month old strapped to her back - before she undid the baby I saw the problem - this poor child had a significant birth injury, probably hypoxia with resultant CP - absolutely precious child, but obviously seriously impaired - what will become of this sweet baby in the village? A gentleman with 'asthma' that had low oxygen levels, horrid cough, and every abnormal breath sound in the books - I think he had pneumonia at least, perhaps rampant TB..... and all I had to offer him was PO antibiotics! The little girl with the twisted leg, using a homemade crutch to get around. The lady with leprosy with no toes and the fingers from one hand gone - she needed to get on a years worth of medicine - at least - and be followed, but it sounded like there was no chance for her to get to the hospital! And the last, most tragic, was a lovely girl of 15, whose Mom said 'she has asthma and her feet are swelling'. This child was in fulminate heart failure, with a huge heart murmur, edema of her legs, rapid breathing with crackles in her bases. I suspect a congenital heart condition, but it could be an infective process also. We stressed to the Mom that she needed to go to the big central hospital here in the capital. But who knows if that will happen. As Jose said - in the US she would be in a pedi intensive care unit, being investigated for a cause and possible 'fix'. What could I do? Only vitamins, cough medicine and 'referral'. I really just wanted to load her up in my car and take her home (to Lilongwe) with me.

We stopped at about 5 PM and made it to the tarmac road before dark (our goal). We saw about 200 patients, I don't know how many we really helped, though. Our exhaustion was not just the work - which was pretty grueling - but the emotional stress of so much illness, injury, and deformity about which we could do nothing! The pictures: the first is of Jose and Thandi dispensing medications to the girl with heart failure - she is the one in the orange dress - please pray that her Mom can get her to a hospital and that they can at least make her a little better. The second is Jose and Steve giving out meds to the 'pain patients'. Then the leper's feet - missing toes - note the dust /dirt on the floor - it was blowing everywhere! Me with a patient and my interpreter, Peter. Lastly Jose and Thandi in the pharmacy station. Pray for this village and for Steve and his ministry. Pray especially for the little girl with heart problems.

Lutheran clinic

Today Jose and I went with Jennifer and her mobile clinic. She works with the Lutheran church mission outreach. They have an ambulance that is stocked with medications and nutritional supplements. Every Tues, Wed, Thurs they go to the same village clinic, and on Fridays they alternate between two clinics. They use churches or church outbuildings as their clinics. The villagers gather around the building. The clinic starts with singing hymns, then a mini sermon and prayer. That is followed by a teaching lecture by the clinical officer or medical assistance. Today it was on bilharzia. Then the clinic starts. There is a section for antenatal (prenatal) follow ups, a section for the Under 5 kids (weight, nutritional status is judged with referral for those that are underweight / undernourished, check on immunizations and given if needed), a 'sick line', a family planning line (ladies on depoprovera, the main family planning method here besides condoms), a separate area for VCT (voluntary counseling and testing - for HIV), and a cooking demonstration. The cooking demonstration is held in a little outside 'kitchen' with a pot over an open fire - today they were showing the ladies how to cook ground maize and ground nut (peanut) flour together to make a more nutritious porridge for the children. One or two of the nurses are assigned to the 'pharmacy' to dispense meds and give shots. The immunizations are actually given by a HSA (health service assistant, provided by the government). The whole system is pretty well organized. They even bring buckets to use to wash your hands - and soap, too. Interestingly enough, almost no one uses them, and if they do, they don't use the soap! (Thank goodness we travel with hand sanitizer). Jose and Jennifer did blood pressures on the antenatal and family planning ladies. Those are the only routine vital signs done. The children in the under 5 clinic are weighed, of course. Whenever someone is seen in a different area that appears ill, they are sent to the 'sick line'. I sat with the medical assistant in the sick line and learned more about village medicine - there is always more to learn! I found out that the villagers make a local brew called kachasu - from fermented sugar, rice and /or maize - then distill it into a very strong alcohol. I suspect that there may be some more toxic substances in there than pure alcohol. However, the men can become really addicted to it, and they basically kill their liver. I saw 'scabies' in lots of forms, including infected scabies. And other weird rashes. Some chicken pox, worms, lots of arthritis and abdominal pains. Lots of upper respiratory infections, including a couple of little ones with probably pneumonia. One very sad case - a 5 year old with swelling in her jaws (parotid gland), weakness, weight loss, cough, runny nose and failure to thrive- not a whole lot different from the other sick kids except the parotid swelling and the chronicity of it all - we sent her to VCT and she is positive for HIV ('reactive'). Her mother has never been tested, so we recommended the child follow up with the ART (anti retroviral treatment) clinic and that the Mom be tested, also. Lots and lots of children today, mainly because of the under 5 clinic. The pictures: Jose taking blood pressures, the cooking 'hut' with some ladies in front, the inside of the clinic as they are setting up, and the ladies outside waiting for the clinic to start. I learned a lot about setting up village clinics. There is so much to do here. I hope I will return soon! To think they go every week to this same area and see 100-200 patients every week! And most of them are not 'repeats'. Enjoy the pictures, keep Jennifer and her team in your prayers - this is her mission for 2 years - to go out with this mobile clinic.

Korean hospital

Today I did a little presentation at the Daeyang Luke Korean hospital - I spoke on Swine flu (H1N1). My only claim to expertise is that I have seen some cases! But I did spend a lot of time on preparedness for any overwhelming disaster - whether it is a pandemic, a huge RTA (road traffic accident) or an industrial accident. There is pretty much no 'OSHA' here, so working conditions can be pretty scary. The hospital is located close to the government granaries, and to a large conglomeration of tobacco storehouses, handling areas, etc. Anyway, it seemed to go well, with some questions asked at the end. Then the presentations for the CPR classes were given out. Fortunately, Jose did NOT have to give out the certificates - he was recognized as the instructor, and we took pictures at the end, but he was concerned about pronouncing their names - some are pretty easy, others not so much! Even the presenter had trouble with some of the names. Here are a few photos - Jose with some of the CPR students and their certificates, me in front of the class, and the flags in front of the hospital. The two little guys in the foreground were calling 'Azungu, azungu' to Jose (white person, white person).

Kasungu national park

Kasungu national park is about 2 1/2 hours away from Lilongwe, mostly tarmac road, with the last ~55 km dirt. The park encompasses 2500 sq km of natural habitat - one of the owners of the lodge says the most untouched in Malawi. However, due to heavy poaching in the past, and continued poaching today, the animals are few and wary. The Lifupa lodge, where we stayed, is on a little lake, made when a small man made dam was erected. The lake is home to a small pod of hippos, who came out during the day. We watched them, with the babies, eat and sleep on the opposite shore. There are also lots of birds to see. The park has some roads - all in varying degrees of drivability, one lane dirt / dust roads. However, Thomas (the lodge owner) loaned us a map and wished us luck. On our first trip out we saw three warthogs (and got some video) and a small herd of kudu. In the afternoon, we decided to drive to black rock. We did not plan on climbing up the rock, because the car was constantly swarmed with tsetse flies. If we opened a window or door, they came in and began biting us. We saw blue and white 'flags' set on poles throughout the park. These are fly traps. The jar hanging on one end has a chemical that smells like buffalo urine - that attracts the flies, they bite the flag which is impregnated with a poison and they die. Apparently this has really decreased the number of flies. We couldn't really appreciate it by the number on our car (I was wondering if and why our car smelled like buffalo urine!) We were told later that the flies like the cars, but if you get out and run a few yards, they will not follow you, but stay by the car. We drove to black rock, looked around (in the car) and then headed 'home' - when we met a bull elephant on the road. He really didn't want us to pass him. He made a couple of questionable mock charges, then went off the road, followed along parallel and then charged out of the woods towards the car. I got some of that on video, along with his trumpeting! However, he soon gave up the chase, we traveled on, seeing a couple of small herds of elephants (females and young) without incident. On day two we traveled the same route, seeing puku and vervet monkey in the morning, then going back to black rock in the afternoon. We met the bull elephant again (I thought they wandered around????) We got past him - after backing up as fast as we could for yards and yards, then waiting for him to go into the woods, then zooming past him! We went to black rock, looked around, and then headed back. He was waiting for us! And standing in the middle of the road - and began chasing us (they can move pretty fast!). We backed up again, finally found a place we could turn around and took off. He stayed on the road, tearing trees down into the road. We felt we had no choice but to go onward. Our map showed a loop road up ahead, so we kept driving. The sunset was beautiful, but not when you are in the bush and don't know if the elephant is still following you! We finally gave up (a good thing, too, because Thomas later told us that loop road never existed except on paper!) We had to turn around and go back. I don't know enough about elephants to know if they go into the forest to sleep? Do they sleep at night? Do they really 'never forget?' Well, we were lucky - he was gone and we just drove over the trees he had pulled down. We got back late enough that Thomas was beginning to worry about us.... but we were glad to be back at the lodge, and I think we are done with elephants for awhile! **When we get home, I will ask my talented video pro daughter, Mandy, to put together a video and post on YouTube. She has done some for me in the past - if you are interested, search my name on Youtube and then check out the Malawi and Zambia videos. We may get this one posted, too, when she finds time in her hectic schedule!**

Charles the tailor

Some of my patients in the clinic have had on the most beautiful dresses from African material. I finally asked one lady where she bought it - she looked at me funny and said 'my tailor made it!' That set me on a search for a good tailor. Of course, Mr Whiskas, who is a fount of information, knew exactly the man I needed! After my last day in the clinic... and Jose's last day at the Korean hospital, the tailor Mr. Whiskas recommended, Charles, rode his bike to the house and we all went in the car to Old town or Indian town. This is the area of the city where the previous dictator forced all the east Indians to move their shops. They are now free to be almost anywhere, but many stay in Old town. It is full of shops - large and small - markets, again large and small, and lots and lots of traffic -vehicular (car and bike) and foot. We went to buy material for a traditional African dress for me and a traditional African shirt for Jose. First you find the material. We went to a couple of shops, but didn't find anything we liked, so Charles took us into a market- from the street it looked like a tiny alleyway, but it opened into a hodgepodge of shops and booths - including a long lean-to style building which housed lots of women and each had their own special cloths. We found what we wanted there. Then on to buy the thread, buttons and lining - a different shop, down a different road. Then for zippers... oops, the shop Charles likes did not have the colors he wanted, so no zippers today. While Charles and I were shopping for zippers, etc. Jose and Mr. Whiskas stayed in the car and bonded even more! (More about their bonding , the bike and Mr. Whiskas' retirement property later!) Then home where he took measurements of both Jose and me. The pictures are of Charles doing some measurements before sewing, and some of Indian town. Oh, they don't use patterns - they just do it in their heads. It is pretty amazing to watch these guys with their foot powered, antiquated machines doing their sewing. Most refer to themselves as tailors, although I had one guy (as a patient) call himself a 'fashion designer'.

ABC Clinic and night sounds..

I've just finished another day in the clinic. I thought you guys, especially the medical folks, might be interested in what that is like. I started at about 8:45, took 1-2:30 off for lunch (supposed to stop at noon and be back at 2, but you know how that goes!). Then from 2:30 to ~4 PM. My patients today came from Malawi, Nigeria, Ethiopia, Holland, the UK, the US, India, Pakistan and Eritrea (and maybe a couple places I missed). They worked for the diary association here in Malawi, lots of NGOs (non-government organizations), missionaries, teachers, banks, stores and lots of government workers, including some chief of police somewhere (I should have paid more attention to that info - you never know when knowing the police chief will come in handy!). Their complaints ranged from cough / cold /flu to a horrible pneumonia. Lots of upper respiratory infections this time of year - dry, dusty and cold - so heating fires are everywhere. A RTA (road traffic accident) that was seen at a small rural hospital a couple of days ago - they have no x-ray, so he came in for films. Fortunately only his hand was broken. Pregnancy and pregnancy related problems, inc. vomiting with dehydration. Tooth pain. Lots of belly pain and arthritis pain. A couple of weird cases - unexplained elevated ESR for months - slowly resolving; and a hematuria that I diagnosed and is 'new' - I am hoping it is just bilharzia and not something terrible, like cancer! HIV patients with early onset pneumonia. Probable HIV patients that refuse the VCT (voluntary counseling and testing)... and so will just get sicker until they agree to be tested and started on treatment. Sickle cell anemia patients - two - one in early crisis. Lots of hypertension and diabetes! A little girl with a 'fall down and go boom' on her head - not serious, and a couple minor rashes. An abdominal pain that is hopefully just colitis / diverticulitis (since we don't have a CT scan). So, all you doctors out there - want to come and play next year? They will be in desperate straits when Dr. Young goes on her leave for 8 months! And remember, NO LAWYERS!!! Yeah!! Jose was back at the Korean hospital today, finishing the paperwork on his CPR classes.

OK, now for the non medical folks - what are the nights like here in the capital? I included some pictures of where we are staying and my car. As you can hopefully tell, it is a very secure area, surrounded by a high brick wall topped with barbed wire with electricity. We have metal gates and a guard at all times (mainly to open the gate for us when we drive up). All of the doors and windows on the house have bars as added security. But we feel safe- ha, so safe one night we forgot to lock the door! oh well. The sun sets about 6 PM. The call to prayer from the nearby mosque is heard about then. The traffic on the street outside the wall is busy. Everyone has a gate and a guard, so lots of honking to bring guards to open gates. Occasionally a siren on Queen's drive (the closest major, but still two lane - road to us)... after total sunset the car alarms start to go off. It is the weirdest thing, but everyone has a horribly loud car alarm and they go off all the time - usually with four different 'warning' sounds. It seems evening is the time for them (along with randomly in the middle of the night).... then the traffic dies down and everyone settles in for the night. That's when the dogs start - again, everyone has guard dogs. When one starts they all start. Howling, barking, all in a cacophony of canine sounds! Occasionally gun shots - which are a little un-nerving, but some of the guards have guns, and the ex-president lives up the street from us with his henchmen...... of the course, the shots start the dogs again..... and so it goes. Once bedtime comes, I am so tired I usually don't awaken except occasionally for the sirens or gun shots. In the wee, wee hours of the morning (3-4 AM) I have awoken to complete silence. No dogs, no cars, no sirens, no nothing. It is blissful... but by 4-4:30 the roosters are awake, followed by the wild birds....then the predawn call to prayer from the mosque - by sunrise at 5:30 the world is awake and making noise! The worst noise I hear in the morning? The sound of our neighbor's generator - which means we have no power - hahaha. Ok, the pictures - even though it is dry season, there are still lovely flowers everywhere. There is the drive way to the gate, and you can sort of see the high brick wall. And then there are pictures of the duplex where we stay- with Mr. Whiskas bend over working outside. The white car is the Rav 4 that is our reliable transport!

Another thanks to all of you for your prayers, and to those who have donated, a huge THANK YOU. When we do the village clinics, those medications, bandages, etc, etc. come out of my pocket (except the malaria medications, which the government provides). God has helped stretch my limited funds, and with the help of my donors, I think we will have enough to continue the work. We hope to do another village clinic next weekend, plus a few other little things we would like to do. However, our plan is to take this weekend off and go to Kasungu wildlife park and chill out for a few days. I think we have pushed ourselves pretty hard, and need a time to rest for a couple days. More later!

Dinner with the Whiskas

The gentleman who keeps the house while we are here is Bambo Whiskas. He is a lovely man that we first met in 2007. He has worked for the Assembly of God for 40 years, and is about 70 years old now. He is unsure of his date of birth. He is a gem: hard working and always happy. His son also works for the Assembly of God here in Malawi. We started with our first visit to invite Bambo Whiskas and his wife to dinner. They were so sweet the first time - he said it almost like 'being in America'. We try to find American style dishes that we can make and that we think they will like. On our subsequent visits not only have we had them to dinner, but we also have brought them something from the states. Last night we had them over for their second dinner of this visit - we served minute steaks simmered with onions and green peppers, a sweet potato 'pie', beans and garlic bread (we know that they like the garlic bread from previous dinners). Then we gave them their gifts - a blouse, some toiletries and some jewelry for Amai Whiskas and a very nice jacket with a hood for Bambo Whiskas. They seemed to enjoy it. Here are some pictures of this charming couple, including a great picture of Bambo in his new jacket!