Pothawira Clinic - WARNING! Graphic photos!

This past week from Monday - Wednesday we worked in the outpatient clinic at Pothawira. It is primarily manned by clinical officer, Peter Maseko, who sees ~200 up to 300 patients a day. Sometimes he has help with another clinical officer. This week he had David, a 4th year med student who was a clinical officer before going to med school. The system is pretty easy - a set fee (I think it is about the equivalent of 50 cents for kids, $1.00 for adults). For that you get register, vital signs, a consultation, tests (they do malaria, pregnancy, HIV, glucose and hemoglobin), injections and medications. You also get wound care (many of the patients are recurrent for wound / burn care). I was seeing somewhere between 75-100 kids a day. The kids are much easier than the adults (not to mention cuter!). The vast majority have malaria, with some lung issues thrown in (bronchitis, bronchiolitis, asthma, pneumonia). There are also a variety of rashes, burns, abscesses and other wounds. There is some chicken pox in the community. I saw 3 kids that had tonsillitis,  one had either a peritonsillar abscess or peritonsillar cellulitis. I saw shingles in a little girl. Lots of stomach pain / vomiting / diarrhea but most of those were due to malaria. There were several very anemic children with malaria - we treated for malaria but then referred to the local district hospital for blood transfusions. It is doubtful if they will get the transfusions due to the almost non-existent supply of blood. One ~2 year old had a hemoglobin of 4. She will probably die.

Besides the current outpatient clinic, the building of a maternal ward is underway. When it is completed, Peter hopes to have a blood center where he can give transfusions. I feel certain if that happens that little ones will benefit from that as well as the mothers. Until then, the mothers and babies are at the mercy of the local district hospital.

Pothawira also has an orphanage and a school. The orphanage has over 100 kids, and is just finishing another duplex to accommodate another 20 kids (well, technically less than that, as technically they should only have 100 kids now, but how do you turn away a child?).

For more information on any of these projects, go to Pothawira Village online or on Facebook. When we were just there, they had 4 new kids from one family. They came in rags. Emma Maseko had some donated clothes for the little boy but nothing for the girls - except the youngest who fit into some donated pajamas. We went to the market and bought all the girls a dress each. Such a little thing but made them so happy. Several of the teen age girls no longer have shoes that fit!

For the pictures: please be aware that many of these are graphic. Monday seemed to be abscess day - we did abscesses on legs, heads, hands and faces. If it is huge and going to be very painful, the patient is given ketamine and valium direct IV push. One lady was falling over before the needle was out of her arm. They are laid on a stretcher (same stretcher for all, no changing sheets..oh, no sheets at all, just a plastic tarp), no IV fluids, no monitors, no oxygen. They are sprawled out while Peter does his 'minor surgery', then they are lifted into a wheelchair and taken to recovery. Recovery used to be under the tree out back, but with the new building, it is now the porch (konde) where the patients gather to be seen. Some wounds are packed, some are not. Some patients come back for their wound care, some do not. I saw two children with specific instructions to get daily injections and come back for 'review' (re-check). Neither came back - one with several periorbital infection, the other with mastoiditis. Some of these patients - both adults and children - would have been admitted in the US, gone to surgery for their abscesses or at least had IV antibiotics. Life is hard here. The local hospitals have almost no medication. We saw several people referred FROM the district hospital to Pothawira for a variety of reasons, mostly involving medications / wound care / sonogram.

Look at the photos and remember that if Pothawira didn't exist, many of these people would die. Peter actually amputated the last joint of an index finger due to gangrene. He opened a hand wound that would be in surgery in the US. If so inclined, contact me - Peter always needs medical help, plus the medications and tests are expensive.

Periorbital cellulitis - this child never came back for additional injections and review.

Shingles. Mom was non-reactive. Child otherwise healthy. You always have to worry about HIV in children with shingles.

Child with an abscess on her foot - Mom said it 'just started' and then ruptured.

Baby with an ugly rash - I suspect impetigo but who knows?

Lady with a history of having a stick poke her foot. This photo was on Monday. The wound was cleaned and dressed. When she came back Wed. the exudate was bright green. I got 'called in' on the case - found she was diabetic (she did not know that), and recommended sending her to the district hospital for IV antibiotics (she was on orals already) and managing her sugar. Who knows if she will go, and worse yet, who knows if she does go if they will have the necessary medications?

Massive hand abscess between 4th and 5th fingers. Patient said it 'just started on its own'. He is already 'out' on the stretcher.

Abscess open and Peter expressing large amounts of exudate. All the fluids, pus, blood, etc go into these buckets.

Splitting the fingers apart and then exploring the wound with his finger.

Peter smiling during the procedure. Note that the patient is in never-never land, with his legs hanging off of the stretcher!

Opening a preauricluar abscess. This poor lady was sitting in the room watching the hand abscess procedure. If it were possible for an African to turn green, she was that color! She was less than happy about what was going to happen to her, but she was 'out' before the meds were totally injected!

Watching the pus pour out of her abscess and down into her ear was disgusting!

After the surgery, on her way to 'recovery'.

The recovery room.

Another view of the recovery room. After they wake up, they get their prescriptions and walk home.

Here is Peter working on a leg abscess. This guy did return for injections and wound care.

Child getting a hemoglobin checked. Look at those big tears coming out of his eyes!

On a happier note, this is me with my translator, nurse Loness.

Julita, another of the nurses.

Limbanie, another of the nurses.

Joey Swartz with all three of the nurses.

Julia working with the hemoglobin machine.

Line outside of my office.

Loness and I in my office. The patients come in through the door (where photographer Joey was standing), then exit door behind me - if they are going for testing, they come back to door behind me, so I often have two lines coming into the office. And you can see how big it is!

These were our last clinics for this trip. I may post some photos on facebook for the last couple of days here, but probably no more blogs. Friend me on Facebook if you haven't done so if you want more photos and background.

Thanks again to all the supporters, both materially, medically and prayerfully!

Until next year!

E3 Mobile clinic - Bimphi

Saturday Joey, Ty and I joined the E3 clinic in Bimphi. It is our last E3 clinic of this year. We saw 518 patients, had less than 50% of the malaria tests positive (and much less testing than last clinic), and no evacuations. We were home just after sundown. The saddest part was that one of their nurse volunteers died this past week. She had severe congestive heart failure, but had still been coming to the E3 clinics to volunteer.  On another sad note, one of the children evacuated from the last E3 clinic died - he needed a blood transfusion due to severe anemia, was taken to a district hospital but still died. I am wondering if he never got the blood? If you are healthy, I don't care WHERE you live, seriously consider donating blood! In Malawi it is a major problem. At KCH we saw many patients, including children, who could not have surgery due to blood shortages.

For those interested in what E3 does: Education, employ, empower. Not just empty words. They work with schools (building, supplying, etc), teach permaculture and animal husbandry (rabbits), work with soil building, composting, etc. They do mobile clinics and work with locals for natural medicines.  Check out their websites on line and their page on Facebook! As always, donations are appreciated. Their goal is to have these communities be self sufficient, but the medicine side of this goal will be much more difficult to reach. E3 does 2 clinics a month in the dry season.

Enjoy the photos!

Chico (Chikonde, my translator) and I at my desk, seeing patients.

Joey doing a malaria test.

Patients waiting outside the pharmacy window to get their medications.

A clinical officer. There were 6 clinical officers and myself seeing patients. We were in a school block. 

Another shot of Chico and me. What I love about this photo is the Mom and one of the kids reaction to Joey taking photos!

Here I am with Sam Kawale, one of the prinicpals in E3

End of the clinic, this is when we were packing up the pharmacy. There is more work in these clinics than just the 'clinic' - prep time, getting medications, setting up the pharmacy, working at the clinic, then breaking down (packing the meds, etc, etc) and finally another inventory to see what you need. When we do E3, we are spared the inventory / re-inventory but when we do our village or prison clinics, we end up doing all of that ... well, let me say that Joey has become the expert inventory / organizer of the medications, not me!

Kids at the car door before we leave.

Grace of God orphanage and Msukwa new home

Thursday we went to the Grace of God orphanage, close to Lilongwe for a 'mini-clinic' to see the kids and the aunties that were ill. The kids looked great - well nourished and happy. There were a few rashes, a lot of cough (dry, hacking - it is winter here and dusty and smoky), and one child NOT in the orphanage who had been hit above the eye with a brick shortly before showing up at the clinic. Usually we don't see acute injuries, but we were able to clean him up and use the steri-strips we have!  We only had 2 positive malaria tests, and only saw 28 patients. We were done before noon, and stopped by to see the Msukwa house in daylight and get a tour of the grounds.  We know have been without water ~18 hours, hoping to have some this evening when we return from the E3 clinic!

Joey at the 'pharmacy'. It was just the three of us (Joey, Charles and me).

A few scrapes and scratches and 'wounds'.

This kiddo had some weird lip swelling, but no other oral lesions.

This is the child with the acute laceration. 

Checking the BP on an auntie.

Charles Msukwa in front of his new house.

Charles showing off his borehole (well). 

His bricks, to extend / build up the wall around his place. He says he will buy '4 kg of meat' and invite people over and they will come and help burn the bricks!

Erita and baby Emily.

The whole family - Ruth (waving), Charles, Praise, baby Emily and Erita.

I am blessed to know these people!

Children of Blessing Trust Seizure clinic.

Thursday was our 4th and last seizure clinic for this trip. Joey Swartz went around and took photos. This is part of the Children of Blessing Trust (COBT) for children with special needs. There is a huge population of these kids here, due to birth trauma, cerebral malaria, poorly treated meningitis and other factors. Many have seizures. Although some are tragic and you have to realize that their seizures are just a tiny part of their health issues, we do see people that have been referred in for simple epilepsy. Those people have their lives changed by controlling their seizures! One young man I saw had no seizures since starting medications about 2 years ago. He is able to get on with this life. They also offer physiotherapy, social support (through the school they have), walking frames, and nutritional support. If you have a heart for these kids and adults, check out their website. Kathy Bowler is the powerhouse behind this project.  She has recruited Dr. Diane Young to help with the seizure clinic, every other week, year in and year out. The two of them do the hard patients and the new patients. I just try to do simple refills, etc with the ones I see.  Enjoy the photos but remember if your heart is touched, reach for your pocketbook! This clinic supplies the seizure meds and assorted other medications (fever reducers, malaria meds, occasional other meds) and malaria tests. Plus the feeding supplements.

Two of the kids at the clinic. The little albino girl is precious! Pray for albinos in Malawi - they are being abducted and killed for their body parts which are used by witch doctors for money, health, etc. 

Dr. Diane Young and Kathy Bowler. Hard at work!

The pharmacy. Some of the medications are provided by the health district, but many are purchased by Children of Blessing Trust.

Me with a patient and my lovely translator, Maness. The book in front of her contains the records of these patients. 

One of our patients. She has a little problem with that eye (chronic) and the white thing on her forehead is a sticker from Dr. Kelly Hodges. But she is a charming little girl with a ready smile.

Maness, my translator

Bau, friend and co-worker at the clinic (she is in the pharmacy). 

Kasungu Prison Clinic

Kasungu prison is located about 1 1/2-2 hour drive from Lilongwe. It is a farm prison and houses slightly less than 400 inmates. Due to poor rains this past year, the crops have not come in as needed and this has caused malnutrition here and at other prisons (Kasungu crops usually help feed other prisons in Malawi). They have one medical assistance who states that they have no medications. While we were there, I found several people that needed to be tested for HIV. The medical assistant said they have 35 known cases. They do not routinely test for HIV at this prison. One young man who told me he tested positive in March was not receiving any treatment (ARVs). He also told me that he was told he would 'have to wait until he was released' to get treatment - release date is 2022 (please remember, this is from the prisoner, and as in all countries, they can be less than honest). Our team consisted of the pre-med student, Ty, along with RNs Tanja Muff and Joey Swartz. We had two new translators - Patrick and Gabriella. Of course, Charles Msukwa was in the lead, making all the arrangements.  I was the only prescribing provider. Joey started off in wound care - unsure how many she saw but did consult with on several and we gave antibiotics along with the wound care and ointments. We had a record of 135 patients, but somewhere between 10-15 had their own health passport (most of the women and guards, and a few of the men) and we did not 'track' them. We are guessing about 150 patients seen, not counting the wound care patients. We left Lilongwe at slightly after 7 AM,  arrived about 9:30, found a spot (used the library), and were set up and working by 10 AM. We worked until 3PM and were back on the road before 4. We ate a picnic lunch on the way home, arriving back here at 5:30.  It was a long day. The vast majority of patients has either scabies or a cough (or both) along with general body pain. Several were severely malnourished and the remainder of our 'super vitamin B' (thank you Emily Prince) were used here, along with niacin, iron tablets and multivitamins. We saw several patients I referred for HIV testing, some bony injuries that I suspect were fractures in the recent past (not taken to hospital by the prison). Pellagra in at least two patients, some nasty wounds, a case of hypopigmentation of the forearms only, some asthma, some diarrhea, a moderate number of possible peptic ulcers.  On the bright side, there were only 11 possible malaria cases and only 2 of those were actually positive.  On the downside, we arrived home to find no water, and it is now after 7 AM the following morning, still with no water! Enjoy the photos!

Joey at the wound care station. The prison has been out of water for about 1 week. They did manage to round up a tub of water for her to use.

The double door on the right is the entrance to the library, where we were stationed.

Checking out a prisoner's health passport. My little cubby hole wasn't bad, a little light to see, a nice desk, a comfy plastic chair!

Joey doing wound care (the green bucket has water it in). This was a nasty hand wound.

Close up of the hand wound.

Lots of  coughing, most dry. This shows you how close we all were. There are books along both walls, mostly US textbooks, out of date, and a large number were from Texas!

Malnourished patient (Gabriella, my translator, can be seen on the left).

Tanj Muff in the pharmacy, Patrick  - in green- is her translator. The book shelf behind has several copies of Texas Science on the shelf.

One of the women prisoners. They only have 9 and we saw them all! One had a little baby (saw that one two). You can see one of the female guards standing to the right of the photo.

Tanja and Joey conferring over one of my 'prescriptions'. I am sure Tanja couldn't read my writing! Joey was still in the wound care area, but soon came into help at the pharmacy.

Ty doing malaria tests. The guy in the foreground is the medical assistant. You can get an idea of how small the area was in which we were all working.  I think calling this a 'library' might have been an exaggeration.

Hypo-pigmentation

Pellagra

The team!

Road side picnic - Gabriella and Ty.

Thanks for all your prayers.  For any of you interested in coming, contact me. For anyone interested in donating (supplies, meds, money), again, contact me and thanks to all have been so generous for this trip!!