Stats, a dog and two adorable kids!

 Mico, chilling in the yard

 Hollis (born Mphambano)- now adopted by Carson and Jeff White. He made his first appearance on last years blog when he was undernourished and couldn't walk!

 Esime, another child that has suffered repeatedly from malnutrition - please pray that the adoption plans for her (Carson and Jeff) will go through!

 Hollis, laying on the charm!

Coy little Esime

A short blog today, as we are trying to get things wound down. It is harder than it would seem. We did have dinner at the Copper Pot (thanks Jeff and Carson) the other night, and got to enjoy their little ones, Hollis and Esime.

Some quick stats:
Maula prison clinic (lasted about 3 hours)
112 patients
~80 bars of soap
100 doses of ivermectin (the drug for Norwegian scabies)

Mgwayi - another ~3 hour clinic
111 patients registered as seen
~20 plus kids whojust got handed fungal cream for their ringworm.

Not bad!

My left over meds (not many) will go into the 'pile' for the next team that comes. One is scheduled for Oct for sure.

Thanks again to all those who helped in any way to make this possible!

Mgwayi village clinic

 Getting swarmed by the kids - notice the cases and boxes in the background - our medical supplies.

 Look at the tiny table and stool they found for me to be the 'doctor's' desk - hahaha

 Joseph helping out in the pharmacy - we tried to seperate all the COTN kids with ringworm first. This was the first wave of those kids.

 The line forms - the guy with the white shirt is my translator, Chikondi.

 Sitting at my tiny stool - just glad it held me up!

 Nasty rash on a little girl's foot.

 Joseph and his translator, Davie. Joseph didn't even GET a table and stool!

The view out my window - right into a thatched hut!

Today we went to the village of Mgwayi. It is on one of the main roads out of Lilongwe, behind the Children of the Nations (COTN) office. It is a feeding site for some COTN kids (260 I think). We were swarmed by kids as soon as we got there!
 We really went to see the kids, so we started with them. Lots of ringworm and coughing. I did see a couple of kids who had Moms, but they looked malnourished. One quite malnourished, but Mom has HIV/AIDS and is on meds but very thin and appears ill - she is still breastfeeding, but the child was obviously ill and not getting enough nutrition. The second child was also thin as was the Mom. Davie (one of our COTN contacts and Joseph's translator for this clinic) will try to get these kids registered as COTN kids so they can get additional nutrition.  I started out seeing patients, with Joseph helping Sofia in the pharmacy, but when the line grew longer, Joseph jumped in and took care of folks, too. If the COTN kids get really sick, they go to the ABC clinic. The village is a short distance from a main road and the capital, so one would expect the villagers would seek medical care. Unfortunately, they do not. I am not sure if this is the expense involved with transport, the time away from home (it would be an all day ordeal) or just lack of understanding; in whatever case, it is disheartening to see so much 'un-wellness' in a village with reasonable access to the health care system in Malawi.

We did a clinic in this village last year, also. I will say that there was a nasty fungus among many of the children last year (that we treated) that seemed to be significantly lessened in those we saw today.  We can only hope that treatment last year made a difference!

This is our last scheduled village clinic for this year.  We will re-organize what is left of our medication and leave it for any in-coming teams to use.

Thanks to any and all of you who have seen fit to support us with medical supplies, medications, finances or prayers. We do really appreciate you!

Praise:
That we were able to find those two malnourished children and arrange follow up.
That we had the necessary medications for the patients we saw.
Our continued safety here.

Prayers:
continued safety as we wrap up this trip.

Maula Prison

This will be short. We did the prison clinic (Maula prison) today. We did this last year, too, and found rampant Norwegian scabies, poorly treated HIV/AIDS and general illness. It was emotionally very distressing.  We were prepared for the worst.  I am glad to say, this year was better!  It appears the clinical officier assigned to the prison has started HIV and TB testing, and is trying to get their medications on time. (I suspect a change in the government may have also helped with this). Charles Musuka (ABC student) has a ministry there and tries to bring some soap in every month or so, along with occasional distribution of clothing and religious tracts.  There are 2000 men in this prison.
Joseph and I were the 'doctors', while Carson and Sofia did the pharmacy. We know they have only one meal a day - nsima and beans. Malnutrition is an issue, especially for those men who also have HIV/ AIDs and /or TB.
Everyone we saw got vitamins and de-wormed. We happened to find the oral medication for Norwegian scabies (a true blessing) and so treated as many as we could, also handing out soap to those guys to wash their bodies and their clothes. We saw a variety of skin infections and conditions along with many, many cases of scabies. We also had the usual cough, asthma, body pains and old traumatic injuries. There were several cases of stomach problems. I did see two men that I suspect have an underlying cancer (one of the esophagus, one colon). We did NOT see any Kaposi's sarcoma - last year I lost count of how many of those I saw. That is another indication that the HIV/AIDs treatment is getting better.  The guards wanted the clinic to end by ~noon, so we obliged. I think we saw everyone that was acutely ill that we could help.  At the end of the clinic, there were prisoners begging for soap. We had already distributed all the soap we brought. This is not good soap, either - bars of green soap for laundry and bathing, with a funky smell and no lather. We bought a couple of cases, but they were soon gone.

The crowd became unruly at the end, when the guards wanted the clinic to end. Charles and Joseph were outside at the time, assessing patients, and the guards told them to get back from the fence (the guards, by the way, were NOT on the side of the fence with the prisoners....or with Joseph and Charles!). With that said, none of us ever felt threatened by the prisoners - they were just desperate for help and soap. All in all, it was a good clinic, in a tiny space and we feel like we may have alleviated some human misery by treating the scabies.

For those of you who donate (or have considered donating) - a bar of the green soap (bought by the case) costs about 20 cents. If you think your small donation 'won't be much help', think of men begging for soap.

Maula Prison does not allow photos during the clinic. Trust me, you don't want to see them, anyway. Norwegian scabies is a nasty, disfiguring, miserable disease.

Praise:
Safety in the prison
Ability to help some of the prisoners.
Finding the right medications that so many needed

Prayer:
Pray for the men -and women- in this prison, as well as other prisons throughout developing countries. Generally the legal system does not work well in these countries, and the health care is almost non-existent in the prisons.
Continue prayer for our safety.

Mount Mulanje - Malawi's Island in the Sky

 Part of the Mulanje Massif

 Joseph on the stair landing to our 'room with a view' (but killer stairs!)

 Dirt road through Fort Lister Gap - before it became an impassable goat track.

 Nyama (meat) - caught by boys in Likabula Forest - I think it is a cane rat.

 Another great African road - found out this was also considered impassable. I love my Rav 4!!

 Getting ready for tea at the Likabula Forest Lodge

 Our stroll on the mountain behind the lodge - led us to a tea plantation

The way down from the mountain - this bridge is actually scarier than the photo!

Tea pluckers in Thyolo. It really wasn't tea plucking season, but we did see some of them out and working.




Joseph and I left on Tuesday for Mount Mulanje (or the Mulanje Massif, Malawi's 'Island in the sky'). This is the largest mountain in central Africa and I think the second highest in Africa. It is in the southern part of the country, and (if you don't get lost) an almost 6 hour drive. Needless to say, it took us a little longer. The road goes through Blantyre, the commerical capital of Malawi, and the road signs are pretty much non-existent. We stayed at Kara O'Mula lodge, nestled up to the mountain with great views. They first put us in what was almost a tree house. The steps were killers, as the width of the steps and the height of the risers were not consistent. However, after two nights of no hot water, they moved us to another, slightly lower room, that did have hot water. All in all, I would recommend this lodge except that they don't give you change for your fees. We paid in US dollars and they were going to give us change in Malawian Kwacha (which is fine with us).. but they wanted us to 'run a tab' at the restaurant and then 'settle up' when we left - again, OK with us... BUT, then they refused to refund the money we did not spend, saying it is against their policy to give refunds!  Trying to explain this was NOT a refund, simply our change from the initial charges was a true Malawian conversation. Needless to say - do NOT come here with US dollars and, due to the difficulties we had getting hot water, I would NOT pay in advance.  With that said, the view was lovely and the food was passable. The beds / pillows were typical Malawian, and the towels were NOT nice (my bad - I usually take towels and I did not). The windows had no screens, and the mosquito nets had so many holes it was not worth putting them down. Pretty much the normal Malawian lodge - except for the 'no change' rule!!

I have a guide book to Malawi that showed a road through the northern section of the Massif, through Fort Lister Gap. The history of this Fort is interesting, as it was built to stop the slave traffic through this area (1893) but was not needed at the end of ~10 years and was abandoned.  Following this road would let one go completely around the Massif. Oops, looks like that road has gotten so bad it is a goat path now - so we made it ~half way through the gap before we had to turn back. The guide book did describe it as 'peaceful and little traveled'. It was both of those! I will not even stress you with descriptions or photos of the bridges. Our second day we drove to Thyolo to see the tea plantations and to find Thyolo Forest Reserve. The guide book was vague, no one seemed to know how to get there (even the police), so we finally gave up and went to the Likabula Forest Reserve, where we got to do some off roading (not intentionally - it LOOKED like a road!!), ran into a couple young men with their still living dinner, and had tea at the Likabula Forest Lodge. We also had to fend off many of the village men who wanted to be our 'guides' in the forest. We turned them down.

Later that afternoon we walked up the mountain path behind the Kara O'Mula lodge and found a tea plantation, some water falls, and a foot bridge that was (even for us) scary.

All in all a very pleasant trip.
Praise:
Safe travels
Fuel is available
God's majesty revealed in nature

Prayers:
Continued safety
The people of southern Malawi, as the rains have not come as expected the last 3-4 years and it appears they may be facing food shortages later this year.

Mico and the yard

 Mico checking out the flower beds.

 ?Shrimp plant?

 Flower

 Camilla

Shorty giving Mico a bath.

OK, this is on the lighter side - Tuesday we left for Mount Mulanje for a few days. I will blog on that later. Before we left, I went around the yard and took some photos. Mico, the guard dog, came with me. He is an old guy, and used to belong to the Browns. He now guards the guest house. He does have a big bark, but I suspect he would just lick anyone who tried to break in. For Karri and Mandy - yes, we are still feeding him some table scraps!  Shorty also feeds him dog food (not just nsima). During our walk-about, I couldn't help but notice a couple things - he smells terrible and he has his own personal collection of flies. Before we left for Mulanje, I concocted a doggie shampoo with tea tree oil (for the flies), and then Shorty found a tube of ointment to keep flies away. He was getting his bath when we left - and actually seemed to be enjoying it. On our return yesterday, he had fewer flies and less smell, and came and laid at our door (aaawwww...). Ok, it is just the hope of food, I know!  So for the girls, Gaylord and Fredna - Mico is doing fine and enjoying his quasi-retirement! Enjoy the photos!

Maula Prison

Saturday morning a group of us went to the Maula Prison here in Lilongwe.  The prison has a women's side with ~ 40 women and some of their children.  The men's side has ~2000 men. The women actually have it pretty good. Some previous groups of 'well wishers' has made sure they have adequate food and clothing. The men are not so lucky. They sleep 200 in a cell built for 60. The have one meal a day - nsima and beans. Each cell block has one toilet ('drop type') with a shower head above it, they sleep on the floor. If you do a search for Maula Prison on the internet, you can see more photos and get more information. Generally, they do not allow pictures to be taken when you visit. However, because we were 'distributing', they allowed photos. Some previous visitors to Malawi had sent clothing to be given out and funds for soap. Each prisoner is supposed to get one bar of soap a month - for all their needs (bath and laundry). They also tend to have few clothes - maybe one outfit of shorts / pants and T shirt. The 'trustees' get a white jumpsuit.  These prisoners are all mixed in together until their trials - so you have a murderer next to a  teen who stole a chicken. HIV / AIDS and TB is common. They have a metal building for their 'clinic', but because it is metal it becomes an oven in the hotter months. No meds can be stored there. The HIV and TB patients are supposed to get their meds everyday but I am doubtful that happens. Charles Musuka, an ABC student (senior) has felt he is called to the prison ministry. He coordinated this trip, as he did the trip last year. You may recognise him as Joseph's translator, also. He has started a non-profit, along with a couple of American missionaries, to reach out to these prisoners, as well as other prisons in Malawi. He currently spent his 'holiday' teaching at the prison, and goes on Saturdays to preach at the church he has on the grounds. He has about ~200 men who attend. Some of the local missionary ladies go to the women's side weekly to do Bible studies. We did a clinic there last year, and our plans are for another clinic this coming Sat. Norwegian scabies is a major health problem there - we were unprepared for the extent of the disease last year, but hope to be more prepared this time. Monday I will go to the Intermed warehouse to get scabies medicines, along with other drugs for the clinic. There are at least 100 cases of severe HIV/AIDS in the prison, most of whom have the scabies. We will also give out vitamins to all that we can.

For the distritbution yesterday - every woman got a bar of soap and at least one piece of clothing, along with a tract and a pamplet.  For the men - all the church members who came got soap, tract and pamplet. The members of the church who were among the 'sick' (i.e. HIV and / or TB) also got clothing. There was prayer and singing with the women, and preaching for the men - along with prayer and singing. Being in a small concrete / brick building with ~200 men singing aceppella and clapping is quite an experience. We were blessed by this event - the kindness of the donors, the appreciation of the prisoners, and the unadulterated worship of the Lord, Jesus Christ, in the midst of misery.

Praise:
Opportunity to sing and praise God with the prisoners
Our continued safety

Prayer:
Again, as aways, our continued wellness and safety
Availability of medications we need!

 Outside the prison - the people on the outside of the fence are visitors. That is as close as they get to their loved ones

 This picture says it all....

 The men dancing and singing.

 Another view of the prison fence

 Some of the women and their children

 Giving out soap and clothes

 Some of the women and their pamplets

 Distribution  - Roberta (in the pink shirt) is giving out clothing. I am in the background with Praise Musuka (Charles' son) on my lap.

 The women's distribution, this is the meeting area for the women.

 The men singing

We are joining in with the men - Joseph, myself and Roberta Nagel.

New Grand son and Permaculture

Today, 24 August, we started the day by visiting the orphan home at Chitipi, on the outskirts of Lilongwe, run by Children of the Nations (COTN). After our clinic at the boy's home and farm in Chichere, my daughter Mandy flew home to the US and sponsored a child at Chitipi.  I was excited to get to see him. His name is Kalebu and he will be 10 months old tomorrow.  We stopped by the main office to pick up Davie, then off to Chitipi. Kalebu is adorable! Oh my, what a cutie!!  We already had plans to do a mini-clinic there for the kids (there are 27 children in this house) and seeing him made it even more important.
Just a plug here for COTN. I have personally sponsored several kids through this group, with Lidson being the longest (of course, I started sponsoring him when he was ~4). He is now 18. He calls me Mum and Joseph is his brother. He was excited to meet Mandy, because now he has met his 'sister'. During the years we have corresponded, I have sent photos, etc, so he feels like he knows Mandy.  So, in my extended African Ivey family, I have a new grandson, Kalebu, and Joseph and Lidson are uncles!  The COTN folks do a great job with their kids. They have several homes where the children live full time. They also do feeding villages - they have 3 feeding villages. You can sponsor kids in the home or you can chose one in the feeding village.  The village kids usually have at least one living relative that assumes some responsibility for their care, but they tend to be very vulnerable.  Of course, Davie hit us up about doing a clinic in the local feeding villages - I think we will try the last week to go to one of them (has ~260 kids) and at least see the kids. Of course, that never happens, you end up seeing aunties, guardians, chiefs, their families, etc. etc. We have not finalized those plans as of yet, however.

After our visit with Kalebu, we visited David Epperson's permaculture garden and aquaphonics (I think that is the correct term). He is busy teaching and implementing the permaculture techniques. Currently he has several garden areas on the ABC campus, but is going to be exporting the concepts to Gusu as part of the E3 project. If you are a gardener, you would have loved to see this! He also has built an aquaphonics tank (don't know the correct terminology here). A combination gardening area with fish tank to supply the 'poop' water for the plants. Ok, I know I am not explaining this very well. But, David gave us a great tour and we enjoyed seeing all the great things he is doing.

Tomorrow morning, our plan is to be off to the Maula Prison for a distribution of clothes and soap. This should give me a chance to see the men's side of the prison and also to touch base with the folks there as we are hoping to do a clinic there next Sat. Last year the prison clinic was the most emotionally difficult thing we did. I will keep all of you posted!

 Kalebu and I at Chitipi

 Uncle Joseph and Kalebu

 Giant sunflower in David's garden

 David showing us the composting bins. They use tons of tobacco stems, along with leaves, grass, etc.

 Joseph in front of the aquaphonic set up. The large round tank is the fish tank

 Walking to the main part of the garden. David is explaining how this area used to be a garbage dump, with snakes everywhere. That gave Joseph pause!

 Daivd with a really big tomato.

More of the garden.  The gardens (there are actually about 4 different sections) are feeding the campus workers and the clinic. The missionary families are offered the chance to 'subscribe' to the garden for $20 / month and they can pick anything they want. What a sweet deal!!

Praise reports:
Continued safety
Meeting precious little Kalebu

Prayer:
Wisdom and safety in the prison tomorrow
Continued good health
Findng God's Will in all we do!

Village clinic, Chifuka

Today (Thursday) we went to Steve Potani's home village for a clinic. He is a graduate of ABC and has started a ministry in his village called Caring Hands Foundation.  We did a clinic there in 2009, and wanted to do one last year but the fuel shortage and political demonstrations made it impossible.  We agreed to try this year.  We left early as it is ~1 hour on the tarmack (paved road) and ~40 minutes on the dust (dirt) road. In my little Rav 4 there were Joseph and myself, Charles, Steve and Mpatzo (my translator), plus all the meds and medical supplies we could take. The village is called Chifuka, has about 15,000 residents and is about 10 km from the Mozambique border. It is 40 km from the nearest 'health center' (usually staffed by a nurse that may or may not have meds) and 60 km from an actual hospital.  Doesn't sound too bad until you realize that these folk mostly have to walk.  When we were there in 2009 we saw many very ill persons, including a 15 year old girl with what appeared to be congestive heart failure from an unknown cause. We also saw the results of polio and a presumed leprosy patient. Since that time, a US church has come to the village and dug several wells. The village also has new school blocks. We did the previous clinic in a small, dark, dusty room but this time had a classroom to use!

Steve informed us that the girl with heart problems died last year - without ever getting to a hospital. In fact, he said that about 25% of the people we saw in 2009 have died since then.

We have known for some time that a major problem of these episodic village clinics is that are just that - episodic.  We have wanted to implement some local 'crash training' if we had a way to continue contact. Steve's brother and sister (Emmanuel and Bridget) live in Chifuka. He contacted them prior to the clinic and they agreed to come and undergo some basic training. I was excited!  The goal was very simple - basic first aid / wound care and when to get someone to hospital.  We did not have anyone ill enough to warrant immediate transfer, but I was able to point out things / signs / symptoms to look for to help determine the urgency of medical care. Actually, most of the people looked remarkedly healthy (for village folk). I think the availability of clean water is a huge factor in this. We also saw many elderly. When you consider that the average life expectancy here is now ~30 something, to see so many 70, 80 and even 90 year old people was amazing! We did see a family from Mozambique - the Mom had 8 kids, 3 of whom were 'sick' - one with what appeared to be a massive sinus infection, the other two with nasty skin infections. The leprosy lady came back, carrying her grand-daughter on her back, never having gone to see about treatment. I had a long talk with her about losing the rest of her fingers (toes gone already), nose and ears AND risking giving it to her grand child. There was one very 'small for age' child that I believe has malnutritional issues - he has been seen and followed for that, but with no follow up for  7 months - Bridget will make sure that child gets to the hospital for re-evaluation!  I also saw a young teen age boy with a mass growing on the back of his neck - I have no idea what it is, but opened it to make sure there was no infection (there wasn't). I was hoping for simple cyst like fluid (none) - but he needs follow up for surgical removal - again, hopefully my 'team' will encourage that with his parent. We diagnosed many elderly with significant hypertension; people of all ages with multiple fungal infections; many 'general body pain' patients, and lots of stomach pain. The mainstay of the diet here is ground maize, cooked into nsima that is eaten every meal (thinned out, it is porridge for breakfast). Many people complained of abdominal pain after eating nsima, but not after eating other foods. Unfortunately, nsima is not only the traditional food but it also one of the cheapest, most available foods. I treated these folks with omeprazole for their stomachs, but told them to stop eating nsima - which made both me and the translators laugh and the patients look at me as if I am crazy. At least they know what to do if they really want the pain to stop! Unfortunately there is alcohol abuse in the community (they make their own from fermented corn) and even some cigarette smoking as they grow tobacco as a cash crop. I was able to instruct Emmanuel and Bridget on the importance of continuing to address these issues with the patients after we were gone.  I did the initial chat, but hopefully the 'health team' will continue to have discussions with these folks.  At one point, Joseph (who was acting as pharmacist and wound care tech) and Charles went out to the 'masses' to do some basic triage. I got any obviously ill persons in the classroom. Joseph called out all the folks who just had general body pain - all got some ibuprofen (about 70-80 people). They also seperated the people who needed salbutamol (an asthma drug) refills and refilled their meds (maybe 5-6 people), and handed out an additional 60-70 vitamin packets to folks, folks that didn't look ill and weren't going to be seen but would probably benefit from vitamins.  All these folks (and the folks seen by me) were de-wormed. They also seperated out all the rashes for me to see. How many did we see? I have no idea. We did a little registration sheet, but mainly so that Joseph ('pharmacy hat') would know what meds to give them. It did work out well, though, as now Emmanuel and Bridget have a name and a notation for follow up on those patients that need it.  Joseph did some wound care with Emmanuel and Bridget, teaching them the correct way to clean a wound; although next time, I am bringing bars of soap!!; and then had them demostrate on other patients.  We left them a big sack of cleaning and bandaging supplies, and the slips of paper with people's name and needed follow up (some of what they do will be encourage these patients to go to the hospital to get more blood pressure meds or whatever, some will be to check on wounds). We also left them a box of gloves and a big bottle of hand sanitizer. Emmanuel's phone has picture taking capacities, and he can contact Steve, who can then contact me. Pray that this system works!  We need eyes, hands and brains in the village after we leave!

We left in plenty of time to drop everyone off and get home before dark. We had fewer meds and supplies to take home, but added an additional person in the back seat (for a total of 4 in the back seat - those of you who have been in my car knows that is a painful experience).  Joseph and I finally arrived home to find NO WATER. Ah, 'it will come' I am sure.

Please be aware that some of the photos may be a little disturbing to non-medical people! 

 Charles (standing) leading the waiting patients in song and prayer.

 Emmanuel and Bridget - our new 'health team' in the village

 This is a ~80 year old lady who radiated elegance. She is beautiful - this picture does not do her justice!

 Mom with sick baby.

 Child from Mozambique - face has hypopigmented scarring. His sister has the same but not as severe. Mom says the scarring followed the skin infections (when I first saw him, I thought maybe discoid lupus?)

 Mozambique child from above photo - large crusted scalp infections. Mom says they started on his face and left the facial scars. All of her children that I saw were very dirty - my new 'health team' was instructed in the healing value of soap and water! Hopefully they will follow up with these kids, but if they return to Mozambique, who knows? Steve says that side of the border is 'very bad'.

 Another child with skin infections - again, soap and water is a major way to combat these!

 My leprosy lady. She still has a few fingers left!

 More kids with skin infections - this girl's lip lesion looked suspiciously like strep - coming from that nostril downward.

Fungal infection of the scalp.

 The mystery lesion on the back of a young teen's neck (after an unsucessful I and D). Any doctors out there with any diagnostic ideas? It was soft but not rubbery, non-tender, mildly vascular. He had no similar lesions elsewhere and no other family members with similar lesions - more research is needed but I am open to suggestions!

 Joseph teaching / overseeing cleansing of the boys legs.

 Emmanuel, Joseph and Bridget. The white trash sack is full of cleaning / bandaging supplies.

 The team (except Joseph who is taking the photo) - note the desks - we moved them around and used them for the pharmacy, my desk and even exam tables!

The entire team, plus village members of Steve's ministry, plus some little ones that wanted in the photo. We are in front of the new school block.