Seizure Clinic

This will be my last post for this trip. Thursday I went to the seizure clinic. This is part of Kathy Bowler's outreach to special needs kids and adults. About 1 out of every 100 Malawians has seizures - cerebral malaria, meningitis, and birth injuries lead the causitive list. Medications are hard to get, as the health centers and even district hospitals often have no medications or they don't have the same medications month to month. If you are familiar with seizures, you will know that randomly switching medications can be bad!  In this country of open cooking fires, most of the seizure patients have fallen into fires / coals on multiple occasions. Families often sleep together. If you have seizures at night, and are incontinent (as is the usual case) and wet all over, the entire family has to get up, get cleaned up, etc. If this happens 3-4 times a night, the whole family is exhausted. If you are school age and have a seizure in school, you can be removed from school for being disruptive. Seizures here can be an all-consuming problem.

Kathy works to procure the same medications, month after month. The clinic meets every other week on a Thursday afternoon. They really need weekly or even an entire day, but there must be a doctor to prescribe the medications and Dr. Young is the only reliable doctor. Kathy says that since July, she has had 68 new patients come to the clinic. That number will likely increase. For any doctors interested, I think it would take 3-4 visits to the clinic to really get 'up to speed' on what they do, how they decide on meds, follow up, etc. Although I saw a few patients for them last Thursday, I would not say I was much help! 

Most of these cases are chronic, with multiple issues - fathers divorce the moms or just leave when a child is diagnosed with any handicap. The families tend to live in abject poverty, with malnutrition a huge issue (Kathy works on a feeding program, too). The patients often have multiple other issues - rarely do you see a simple seizure patient - they may have cerebral palsy, microcephaly, stroke like physical handicaps, developmental delays and behaviour issues. And when they come, they often bring other issues - no shoes, skin infections, etc. etc.  It can be overwhelming. We also saw some very mysterious cases - 'normal' children that began to decline in physical ways, losing milestones, losing speech, developing seizures. There are few, if any, diagnostic tools here, especially for a poor village child. Kathy also operates a preschool and school, with physiotherapy, to help these kids. She is also involved in teaching the adults (especially the women) some skills so that they can earn a living.

On a brighter note - one young woman we saw was a 17 year old who appeared otherwise healthy, but had seizures. She showed up at the clinic about 8 months ago, got started on phenytoin, three times a day, and returned Thursday for a follow up and refill. She also now has a 9 month old baby. Her seizures are completely controlled! For the first time in her life she is not falling down, into fires, into the road way, etc. What a huge blessing for her! Unfortunately, her smiling photo with her sweet baby was the one photo that would not load!!

Today (Sat) I will start the long journey home. It is always hard to leave Malawi, but it is time once again to face that flight. Saying good by to my helpers here on campus (Mr. Whiskas especially but also David, the guard, and Shorty, the gardner) is very hard. I see them everyday, and love their kind and smiling faces, that reflect their hearts. I will miss them.

Praise / Thanksgiving / Prayers: God has been so good - He has provided whatever I / we needed in the way of donations, supplies, and skills. He has opened new doors to future projects and opportunites. He has kept us safe, even with my driving! Pray that my journey home will be uneventful, and that all the ones I love here, Malawian and otherwise, will be kept in the palm of His hand.

Thank you for reading this blog.

John, my translator for the day. We are sitting at the small desks.

 A patient wanders in - you can see the activity in the background!

Kathy Bowler and Dr. Diane Young, hard at work.

Bimphi, village clinic by Gusu

Saturday we left for Bimphi, a village close to Gusu for a village clinic. The group, E-3, had been going to Gusu, but they had found many people traveling from a nearby village, Bimphi, for the clinics. Nearby being ~11 km, by foot or bike. Sam and his team decided to move the location to this village for easier access for the villagers.  The rains are beginning to come, and the soil in this area appears to be quite dark and rich. They grow tobacco here as a cash crop and the fields had early growth. The maize was barely peeking up through the soil. Jolyn told us (she went with us in my car) that this area of Malawi grows many of the crops for Malawians.

The road became a dust / mud road for the last few miles / km. The clinic was set up in the school complex. Sam had his car, a minibus, and my car - a total of 16 people, with some others coming from Gusu. There were two clinical officers, in addition to Jessica and I, Laci helped in the pharmacy. We ended up seeing almost 450 people. We left the village area a little after 5 PM, which meant I was driving in the dark on the way home. I hate driving in the dark here - the roads are bad, there are people on the side of the road - walking and on bikes, the on-coming traffic tends to either have the bright lights on or their headlights are not aimed correctly, so you are blinded! Cars / minibuses just stop on the side of the road - not even pulled off all the way, and you have to go into the oncoming lane to get around them, and some drivers don't have their headlights on. It is very stressful!! However, we made it.  We dropped Jolyn at her home, so we got to meet her sweet family - husband and children. She lives in area 25, one of the booming areas of Lilongwe, but more like a huge village than a suburb of the capital!

In the village of Bimphi, we found the usual problems, but with more malnutrtion that I had seen elsewhere. They have access to a health center but the health center does not always have tests (malaria) or medications. One Mom told me that the nutrition clinic could weigh their child but they had no food to give out. In theory, the nutrition clinics identify the underweight / at risk children and provide a mix of ufa and ground nuts (peanuts) for additional protein. I also counseled several women that they needed HIV testing, as they looked quite wasted. They did not know where to go for the testing, but I think the local health center might have provided that. We saw a couple of neurological cases that were concerning (in children) and referred them to be seen at KCH. However, due to transport issues, they will probably never get there; and if they do, I suspect nothing can be done to diagnose or treat their children. It is very sad.

One thing the pictures don't capture is the flies. They were everywhere - they flew straight into your eyes, they aimed at your mouth and your nose. There was no air movement in our room, so the flies were overwhelming. I watched them covering the faces / mouths / eyes of little babies. No wonder so many diseases here are present - the flies are carriers of illness and disease, especially to the eyes (trachoma) and the skin - open infected wounds, impetigo, etc. I have tried the insect repellant -works pretty good for the mosquitoes but the flies are not dissuaded!

On a sadder note, 3 young people involved in Young Life Malawi were killed in a tragic road traffic accident this past week. Please pray for comfort and peace for the families and loved ones involved.



Praise / thanksgiving / prayers
Praise that we traveled safely!!
Thanksgiving for the people who donated - this clinic had plenty of medications and supplies! Thank you to all the people who reached into their pockets and their hearts to make this happen!
Prayers for continued safety.
Prayers for all our patients yesterday, that they will recover to health.
Prayers for the young people of Young Life Malawi who are mourning 3 of their friends, and pray for comfort for the families of those who died.

Clifford, Jolyn, Charles, Jessica and me - getting ready to leave

 Discussing some logistics with Sam Kawale before leaving

 People waiting to be triaged in.

Clifford and Charles taking lunch - it was about 3 PM before we broke for lunch

These 3 little girls were all my patients - they live with their agogo (grandmother) who was in a different line to be seen! You can see Jessica's station across the room (patient with green shirt on) and the malaria testing area on the far left. We were in a classroom.

After the clinic, we are taking a break as things get packed up!

Clinic building - one of the school blocks. We were on the far left, the pharmacy was in the adjacent classroom

 Jessica doing a malaria test on the little one sitting down.

Checking out Mom and child - this little one weighed 10 kg and was 3 years old. Malnutrition is a major issue in this village area.

Jessica and Jolyn (not really visible) with a Mom and child - the child was more interested in me than in Jessica!

We made it over this bridge before sundown -one of my concerns. If you can see, there is water below but no rails on the bridge. Joseph Maenner - this drive home made me miss your presence and driving skills so much!

Daeyang Luke - last week

 This was our last week at Daeyang Luke. We have had the pleasure to meet and work with some awesome people there - I have been very impressed with the nurses and how hard they work. It has been challenging at times - no water for the entire hospital for over 24 hours. Very, very hot with poor circulation in the Casualty Dept (fortunately the rest of the hospital has open spaces with good air circulation and the ability to 'catch the breeze'. Laci taught CPR to the nursing students on Wed., followed by a tea party / celebration for Sister Baek who won the Florence Nightingale award last May - that is quite an honor! Many dignitaries were invited and were there and we were thrilled to be invited and part of the party!
Thursday was officially our last day. I went to check on a patient from the day before, while Jessica went to the library to check a video she needed to watch. When I walked back to the ED, there was an auto-ped (car versus child) in the ED - it was a mess, but we managed to get STAT CTs of his head and face, IVs, meds, and transfer to KCH (which has a trauma unit of sorts - much more than we have at DLH). I had texted Jessica - turns out the librarian had to go to a meeting, so he locked her in the library while he was gone!!! She made it out in time to see the patient and then ride in the ambulance with him and his family to KCH.
Thursday afternoon we went to the seizure clinic - the doctor in charge is Dr. Diane Young from ABC (although other doctors volunteer and can relieve her when needed); it is the brain child of Kathy Bowler who has a ministry to children and adults  with special needs - brain damage from birth injuries, cerebral malaria, meningitis, etc.  Many have seizures so Kathy and Dr. Young run the clinic to monitor their seizures, give meds, adjust meds, etc. It is hot, it is long, it is heart breaking. It is held in one of the little school rooms at Kathy's school for these kids. Her ministry is Children of Blessings - contact me or search for it on line if you are interested in donating.

There are so many people working very hard here, in desperate circumstances to help the least of the least. They toil away, praying donations come in to meet their needs. If you have a heart for a special type of need - these kids, orphans, medical, victims of sexual assault, etc. contact me and I will try to get you connected with someone working in your field of interest / your area of concern.

Today, Friday, we started at Daeyang Luke so that Jessica could teach the nurses CPR - for some of them, it was a refresher course from when Joseph taught about 4 years ago. Jessica did an awesome job!  Afterwards, we went to Partners in Hope, another great organization, treating HIV/AIDs patients, esp those with TB or other complications, and doing some research with UCLA. Perry Jansen is the founder and the visionary of Partners in Hope - again, another place where donations are well spent!

Tonight, Laci is coming from the Salima area, we are going to dinner at a new place (to me) with a dear friend, and then plan on going to the cantata put on by the ABC choir. Tomorrow - another village clinic - usually Gusu but they have moved the clinic to another village, Bimphi I think, to enlarge the catchment area.

Praise / thanksgiving/ prayers
Thanksgiving for continued safety.
Prayers for the clinic tomorrow.
Praise for God's hand on so many people doing so much good work here in Malawi, and prayers that hearts would be moved to continue to donate to these projects.
Thanksgiving for the people who donated items, meds,  money to my trip. We have almost exhausted the supplies, and the meds will soon be gone as well. I could not have done it without your help!

Sister Baek giving a speech at her honoring tea party

 Lucky and Mr. Phiri looking at a CT scan of our RTA (road traffic accident)

 Scanner going...

 Our young victim of the RTA

 Clinical officer Goffery with his young son who will ill but recovering

 Jessica starting her lecture on CPR. Note the 'doll' - it is the doll used to teach the nurses other skills. Came in pretty handy!!

Lucky (clinical officer) demonstrating his chest compression technique.