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.

Daeyang Luke Hospital Conference

Tuesday we attended the Annual Daeyang Luke Medical Conference at the Daeyang Luke Hospital (DLH). We had attended one of the first conferences here several years ago and found it beneficial and informational.  Many of the speakers were South Korean physicians, but with a mix of Malawians and other nationalities. The ‘MC’ was Dr. Chisoo Choi – a doctor from the IN HIS IMAGE family practice residency program in Tulsa, OK.  Their common goal was to inform and improve medical care in Malawi. For those of you who do not know – Malawi medical schools operate on the British system – 6 years of training from college to the end of med school. They then have one year of internship, and then they are officially ‘done’ – any additional training has to be obtained outside of Malawi. A major problem – once they go elsewhere to finish training, they often stay in that country (or go further abroad).  They have a vision of starting a Family Medicine residency program by 2014.  This would be a huge boon to the nation, although when you see some of the numbers, you realize it will take many, many years to adequately supply this country with physicians!  They hope to have 4 residents enter the program by 2014 (and it is a 3 year program). Currently they have a 6 week teaching block in the medical school to introduce students to the concepts of family medicine, treating the entire family and psychosocial environment.

Interesting things we learned about Malawi: 

(Please realize I am quoting stats from the meeting, not doing any research on my own!!)

It is the 10 poorest country of 176 countries in the world, with a per capita income of  $859.

There are 260 doctors for the population of 15 million. (or about 1 doctor for every 300,000 people)

1,100 women out of 100,000 die during or immediately after childbirth (compared to 14 in S. Korea)

58 children out of 1,000 die in infancy

92 children out of 1,000 die under 5

Malawi has the 9^th highest HIV rate in the world (estimated at 14% of the population, but felt by many to be grossly underestimated)

The #1 cancer killer among women in Malawi is cervical cancer, with 45.4% of all female cancers being cervical (followed by Kaposi’s at 21% and breast at 4.6%)

Men’s cancer killer is Kaposi’s at 50.7 %, followed by cancer of the esophagus at 16.9%

There are only 2 pathologists in the country (making any PAP smear screening for these women extremely difficult). However, you can train doctors, nurses, clinical officers, etc. to do VIA (Visual inspection and treatment) to find AND TREAT precancerous lesions with reasonably inexpensive tools.  Dr. Sue Makin gave the lecture on cervical cancer. She had fallen two days before and broken her ankle – one of the visiting Korean doctors was an orthopedic surgeon – they contacted an Malawian orthopedic doctor to be ‘in charge’ while the Korean actually did the surgery to repair the ankle with screws and plates. That was done on Monday – Tuesday she was lecturing (albeit sitting) and taking IBUPROFEN for pain.  Attention all ED patients – No, you do not need Norco for your sprained ankle, sorry!!  I was immensely impressed with Dr. Makin.

Malawi appears to be one of the most forward thinking African countries when it comes to treating  HIV/AIDS – they have gone beyond the basic recommendations of  (? WHO or some other world AIDS group) to aggressively treat and keep treating pregnant and breastfeeding women and other at risk groups. Did you know that if one partner is infected and the other non-infected, treatment of the infected partner is 96% effective in preventing transmission?  And aggressive treatment of pregnant Moms can decrease transmission rate to child by 75%, and totally eliminate transmission in breast feeding? To find and treat these women and other at risk people (serodiscordant couples), Malawi has doubled the number of access facilities in the last year or so. That, in an extremely poor, mostly rural country is AMAZING!!!  I want to give a couple of plugs here – Dr. Perry Jansen, founder of Partners in Hope, is, I personally think, in large part responsible for the incredible work being done in Malawi with HIV/AIDS. His is a non-profit organization that not only treats folk with HIV/AIDS, but is also instrumental in research and policy development. If you have a heart for the Malawians as they struggle with this incredible burden of illness, consider donating to Dr. Jansen’s project. He and his family have been in Malawi for many years.  One of the speakers at the conference, Dr. Colin Pfaff (South Africa) works at Partners in Hope and gave a most excellent presentation.

I also found out that DLH has a CT scanner – WOW! They have had one since Jan of last year but only got the fiberoptic cables set up for telerading the images to Korea (to be read) in May. OK, sorry for the doctor talk – that means the machine is there and able to take the ‘pictures’ but they had no way to send those pictures to be read by a radiologist until May. That is very exciting.

Did you know that South Korea (through their airlines, I think) charges $1 per person /per flight to help developing countries? The organizations that want the funds then apply for grants to obtain the money for their project. Project Malawi  (www.project-malawi.org) has been given 2 million dollars for the next two years and has some great projects underway , including male circumcision (reduces HIV transmission by >50%),  and maternal and child health programs. I was impressed with their speaker as she went through the plans AND the methods they are using to see if their interventions actually make a difference in people’s health.

We also had a lecture from Dr. Lungu (who used to be the medical director at  DLH but has moved on) about the best way to use short term missionaries. He actually pointed out that Paul was a ‘short term’ missionary, traveling from church to church, but kept in touch with the churches so that he knew the problems that needed to be addressed when he returned to that area.  Good lecture! We also got to meet Susie Kim, the Principal of the Daeyang Nursing College.  She is a bundle of energy and I look forward to spending more time with her. Her enthusiasm is contagious!

After the conference, we spent some time with Mrs. Choi and Dr. Makin in the Podgore house on the campus of DLH. It was delightful. Mrs. Choi had many questions about Malawi and I only hope we answered them in helpful ways!  We finally got to meet Spy, the housekeeper who has served the Podgores for many, many years on their multiple trips to Malawi.

This was an inspiring day spent among folks who want to make a difference, who want to make the world (especially Malawi) a better place.

Praise:

The chance to be here for the conference

Seeing old friends and making new ones

Prayers:

Wisdom as we consider our future plans in Malawi

Continued safety during our travels and time here.

 Dr. Douglas Lungu

Dr. Chisoo Choi

Waterfall outside the staff cafeteria

Joseph enjoying lunch break with a view!

Dr. Sue Makin answering questions after her outstanding lecture.

In the Podgore's DLH house - Joseph, me, Spy and Mrs. Choi

The girls go home!

Monday the girls (Mandy and Karri) left the Warm Heart of Africa to go home to Texas.  We were sad to see them go, but we know they have things that they must do. We were happy to hear that they arrived in Dallas!  I am especially glad that the weather there has turned unusually mild for August, so they didn’t have the shock of going from African winter to Texas summer. We have done that, and the 110 degree plus weather when you exit the airport in Dallas makes you just want to get back on the plane!

The last morning they said their good byes not only to us, but also to Mr. Whiskas, our beloved worker. We have been blessed to have him help us in our ‘home’ with every stay in Malawi except one.

On the way to the airport, we were able to point out ‘Madonna’s project’ (for any of you who keep up with this debacle. Some ground on the top of a small hill, scraped clean, but no building.

The good news is that Mandy and I both felt so much better on Monday than we had on Sunday!

Praise:

The girls safe visit and safe return home.

Prayers:

Our continued safety here.

 Mandy, getting 'psyched up' for the long, long flight.

 The girls saying good bye to Mr. Whiskas!

 Getting on the shuttle - Karri has the orange shirt with white back pack. We are in the 'waving bay' at the airport - you get to sit and watch your loved ones depart - or arrive - for a mere 200 kwacha (less than a dollar). Guess it keeps out the riff-raff.

Top: the girls plane loading

Bottom: another beautiful day in Malawi! Look at that sky!

Pothawira

 Injured hand of the little guy with Erb's Palsy

 Crowd of orphans - (Peter's car is the one coming towards us.)

 Sonogram machine in the clinic - it is kept covered by a quilt because bats are roosting in the ceiling and the droppings would ruin the machine.

 Eddah preparing to bandage the injured hand.

 Peter's office in the clinic, with Karri, Peter and Joseph

 Food storage room in the dining area (for the orphanage). They try to feed the kids protein in some form every day. Eggs are a great source of protein!

 The cooking area for the dining hall - preparing nsima for the evening meal

 Joseph standing in the living area of one of the orphan duplexes

 Maggie holding one of the orphans, Peter.

 Bedroom set up in the orphan duplexes

 Hanging out with the kids - Maggie and Eddah Maseko, along with Karri, are holding some of the orphans.

Here is the little guy with Erb's Palsy

Karri with one of the twin's. He wasn't too sure about an azungu (white person) holding him!!



Pothawira - 'Safe Haven' in Chichewa, Anne Maseko Alaniz's project outside of Salima. You can find out more about this project by checking out the Youtube video, just search for Dr. Anne Alaniz.  Currently there is a clinic that is nearly complete. They lack power (not unusual - Peter has been waiting over a year for the power company, Escom, to set up power). They also lack an inspection by the Medical Council.  As in many third world countries, the process to get something done can be long and tedious.  Last year the clinic was near physical completion (except for power) - this year the physical completion is essentially done but still waiting for all the necessary paperwork and beaurocracy to be finished.  There is the possibility (according to Peter) that a donor may give a generator to supply the power until Escom comes through (and for all the times when the power fails).  Pothawira also includes a church / school, a dining hall and duplexes for orphans. Currently there are 5 duplexes finished, each with 10 orphans in each side, for a total of 100 orphans.   They have been in the orphanage for a few months now.  Each side of the duplex has a bedroom with bunks for the kids (complete with mosquito nets), a room for the guardian / 'auntie', a toilet and a shower, and a living area.  Having an inside 'sit down' toilet and a shower are both unusual in an orphan home. The dining hall has no furniture at present, but the kids and aunties sit on mats to eat. This is not unusual here - most people do not sit at a table to eat their meals. The pantry is well stocked and the kids get  protein of some sort every day.  I saw one of the little guys with Erb's Palsy (a birth injury) who now has very limited use of his right arm. He also had an injury to that right hand - I suspect it is because he can not move his hand well enough to get it out of harm's way!  There is a set of twins, about 8 months old, who are truly fat and happy - well, happy until the azungu picked one of them up!  The other kids came running to greet us and all appeared well.  The plans are for the clinic to open (Phase 1, outpatient) with a plan for Phase 2 - labor and delivery wards, followed by Phase 3 - complete hospital with inpatient care for men, women and children. Peter Maseko, Anne's dad, is the clinical officier who be running the medical portion of the project.

Praise Reports:
We made it to and from Salima and the lake without injury.
Praise for the 100 little lives that are now vastly improved by living in Pothawira.

Prayer needs:
Continued safety
That the Pothawira clinic will be soon opened and ready to serve the community!