Seizure Clinic, KCH and Chitipi

Thursday was the seizure clinic again. It is a bittersweet clinic, knowing that a few of the patients have ‘gotten their life back’ because of the antiseizure medications, but most of them will live a life of disability, even if the seizures are controlled. One sweet little guy we saw was normal until he had cerebral malaria, then he developed seizures and paralysis of the left side. His seizures are slowly coming under control, and he is in physiotherapy – he can now more his left leg! There is hope for thie litte guy. Most of the others cannot expect this sort of improvement.

Friday morning we went back to KCH and attended morning hand over rounds and then ward rounds on 1A. Earlier in the week the team had compiled a list of surgery cases for Tuesday – 8 cases. Turned out that one of those was so complicated and long that all the other cases had to be canceled. One of the men we saw last Monday and got surgery (I suspect he was the complicated case) died Thursday night in ICU. The other cases were either sent home to return this coming week, hoping for surgery, or are stuck in the hospital. There are a few ‘mystery’ cases on the ward, one in particular is very sad. It is hard to run a hospital with limited resources – CT scan not functioning, limited OR space, many specialists not even available. The staff, from nurses to students to interns and residents to full fledged doctors do amazing work under the most difficult circumstances. One of the nurses confided to Joey that many times patients die because there isn’t enough staff!

Saturday Joey and I went to the COTN (Children of the Nations) orphan home and farm outside of Lilongwe. It is called Chitipi. They have about 42 kids in the orphan home and another, smaller home with the teen age / young adult girls.  I know the sponsors of several of the kids at Chitipi, so I try to see them and bring them greetings from their sponsors. I also bring gifts to not only those kids, but things for all the kids to share. Joey Swartz and Kelley McGowan helped with that this year, with suckers, trucks, balls, cars, jump ropes, etc. A good time was had by all!  If you are interested in sponsoring a child through COTN, I can attest that, at least in Malawi, these kids get excellent care. A child in the orphan home seems to really thrive. They have feeding programs in some of the villages for at risk kids. They still live with extended family, but COTN seems to keep a close eye on them, too (harder when it is 500 kids in a village) and I know they have taken at least one girl OUT of the village and into a home because of sexual abuse by a step Dad. The village kids get basic medical care, the ones in the homes get great medical care.  A simple sponsorship CAN change a life! These kids were excited to show me the pictures of them and their sponsors (aunties and uncles) when they had visited or even just photos – they could point to their sponsors and name them! Ideally each child has 3 sponsors. These kids are so precious! If you have been following me on facebook, you will have seen my sponsored ‘child’, Henry Lidson Masamba. I started sponsoring him when he was about 4, now he is 21. He is away at secondary school in Dedza, about 1 ½ hours from Lilongwe. Last year he came down with cerebral malaria (a potentially fatal condition), and was put in the Dedza district hospital, COTN was notified and they came, fetched him to Lilongwe where he got better care and survived! He is Chewa and traditionally they are very short people. He is probably close to 6 feet tall. I am convinced it is a combination of consistent good nutrition and good medical care.  I believe that there are two ways Malawi, and Africa as a whole, will thrive – Jesus Christ: preached, believed, and His teachings followed; and education!  Prayerfully consider making a difference in a child’s life through sponsorship! You will  be blessed! Enjoy the photos!

This is the little one at the seizure clinic who has gotten the use of his left leg back. Pray that the same happens for his left arm!

We are always surrounded by God's created beauty. This is an Oleander Hawk moth, quite a large moth, sitting on our drive way the other morning.

Handing out goodies at COTN, Chitipi.

Esnart and Caleb with some of their goodies!

Checking out some of the stuff. The boy in the striped shirt is Blessings, and the one at the end of the table, wide-eyed and smiling, is Joseph. I have told his story on face book, but basically he was found at 3 months, living with his grandmother who had been giving him orange fanta (and only orange fanta) and was terribly malnourished. He is now a healthy looking, fun loving boy!

Here I am with Selina on the left of the photo and Esnart on the right. What precious little girls!

Jump rope! Thanks Kelley for the long rope. Jo Swartz has posted a video of this girl jumping. her name is Mary and she is quite good! The girl holding the far end of the rope is Esnart. Notice the laundry in the background - these clothes are all washed by hand.

Jo Swartz holding Daniel, I think he came at 3 days, he is currently the youngest child at this orphanage. And growing like a weed! He gets lots of love and attention from everyone!

The 'mama' at the teen age girls home. Their house is in the background.

We found some of the girls from the teen age girls home 'resting' in the shade, but they were more than happy to those for a photo. They are getting not only food, shelter and a safe place to live, but help with furthering their education!

This is Steven, sponsored by Devin Kennedy. He is a bright-eyed little chap, always with a smile!

Two of the girls hamming it up for Jo and her camera, I think the little one's name is Marsha. She was very outgoing, not to mention too cute for words!

Mnzumanza Village

Wednesday we went to Mnzumanza village, outside area 25, near Lilongwe. Ione Podgore has a project there where she feeds 750 children breakfast and lunch, along with Kathi Nunley who helps with the hostel for secondary school girls (food, shelter, etc). Anyone interested in either of these projects, please contact me. Remember that the statistics show 75% of Malawian girls /women are sexually molested during their lifetime. Girls walking long distances to school are at risk (along with the difficulty in rainy season, etc). Having a safe place, close to school is a huge benefit for these girls.
We set up the clinic in the dining hall, which they use mainly as a gathering place for meetings, etc. The kids usually eat outside when the weather is nice. The team was Joey Swartz and Nancy McGlawn, RNs, then newly minted MD from the UK, Claire, along with a premed student from Mississippi. Charles Msukwa helped organize it, and we had the awesome talents of two of our regular translators, Lewis and Jollyn. We saw 154 patients. Ty did almost 100 malaria tests and about 2/3 were positive. Malaria seems to be hanging on this year, longer than usual. We also saw an assortment of other illnesses, including a lot of chronic problems, especially GBP (general body pain). When you live a life of hard work, hoeing, carrying everything from water to firewood to maize on your head, you tend to have neck and back pain.  Thankfully, we only saw one child who I think was malnourished. I am sure that is due to the feeding program that Ione has started!  Enjoy the photos.

Claire checking a patient. Hand's on thermometers! We need extra help next year, folks! We can teach you to take temps / BPs and do malaria tests / count pills! You don't have to have skills, you just need a willing heart!

Three cuties in the village!

Lining up to be seen.

This little old lady was so weak she was having her granddaughter help her. Ty saw them coming and ran outside to help her. She had malaria and had become dehydrated due to vomiting and diarrhea, along with fever. Fortunately I had some of the powdered pedialyte and we were able to orally start rehydration, along with antiemetics and malaria medication. We have used the pedialyte before and it seems to be more enjoyable than the ORS.

Breakfast anyone?

Me examining a patient with neck pain.

Nancy McGlawn examining patients  preparing for wound care.

Joey Swartz and her local translator, Stock, handing out meds in the pharmacy.

Ty doing malaria testing.

Checking a BP on an elderly patient.

Clarie and I consulting on a case.

Fungal infections are always present, this one was pretty bad.

Claire examining a patient.

Local hospitals

I have not posted in a few days, but if you follow me on Facebook, you will see we have been busy! Two mornings spent at Kamuzu Central Hospital with morning hand off rounds and then rounds with the surgeons on the floor. It is amazing what they do with so little. I have had the pleasure of meeting physicians not only from Malawi, but also the UK, Cuba, China and Pakistan. I have heard their reports of limited time in the surgical suites, power outages, no CT scan, no equipment. We are not allowed to take photos in the hospital, for obvious reasons, but the overcrowding is severe. You can search the hospital on line and usually turn up some images. For those of us who have been there, it is not so much about the overcrowding, the torn sheets, the lack of space, the lack of privacy, or even the smells, but is about the vast amount of suffering humanity, with a small but dedicated group of providers trying their best to alleviate some of the suffering.

We spent Saturday in Dedza, with the young man I have sponsored for years through Children of the Nations. His name is Henry (Lidson) Masamba and he has become a fine young man. He is in secondary school at Umbwi school in Dedza. We picked him up, got permission from the head master, and took him the Dedza pottery for lunch.

Sunday of course was church at Flood, followed by a very lazy afternoon. Monday was KCH, and today we went to Daeyang Luke Hospital to introduce Nancy McGlawn (missionary at AOG who is an RN and has spent almost 30 years in Africa) to Dr. Sue Makin, a missionary doctor, also with years in Africa. They were both in the Congo at the same time and I thought it would be good to introduce them! Well, seems like Sue and Nancy hit it right off, and are already planning some future activities dealing with Sue's passion of screening for cervical abnormalities. Cervical cancer is the number one cancer in this country. They don't do PAP smears (not enough pathologists, etc) but can do the VIA (visual inspection with acetic acid). If they find abnormal uptake ('white patches') with the acetic acid, they can treat and hopefully prevent these abnormal areas from becoming cancerous. Anyone interested in doing something to support this work, let me know!

While at the hospital, I ran into two old friends - Grace (RN) and Dennis (RN). It was good to see them and makes me want to go back and do some time at DLH in Casualty!

Enjoy the photos. Tomorrow, another village clinic.

Me and Nancy McGlawn on the balcony, top floor of Daeyang Luke hospital.

Joey Swartz on the balcony of DLH. Note the reflection of mountains and clouds in the glass door.

Grace and I. She is a fabulous nurse!!

Dennis, another great nurse at DLH

Sue Makin, myself, and Nancy McGlawn.

Tuesday night dinner, then Ntchisi Prison

Tuesday we had dinner with Ione Podgore at her home at Daeyang Luke. We were joined by Dr. Sue Makin and Kathi Nunnley and her daughter - Kathi is helping at Ione's project by arranging sponsorship, etc of the secondary school girls, but she also works with 2 villages in Salima District. I am hoping we can do a clinic there, if not this year then next year.

Wednesday morning we left early for Ntchisi but were caught in the morning rush in area 25. We finally arrived at Ntchisi Prison and were set up close to 10 AM. The clinic was on a konde (porch), which included my space and that of the newly minted MD from the UK, Claire; the wound care area with Nancy McGlawn; malaria testing station (Tanya) and pharmacy (Joey Swartz and Tanya when not testing). Not sure how many but thinking about 70-80 folks, not counting the number that received only wound / skin care.  We had to be finished by 1 PM as Charles Msukwa had to be back in Lilongwe to to defend his thesis (which he did and passed! as if any of us doubted he would!).  Ntchisi is a small prison, with only about 350 prisoners, all men. There was an abundance of skin issues, general body pain, stomach issues, and poor nutrition. They apparently get one meal a day consisting of nsima (made from white maize). I saw a bad case of pellagra, and several less severe cases, coupled with malnutrition. We gave out lots of niacin and vitamins, along with some 'super B complex' vitamins. A huge thank you to those who donated some of these supplements (many of which we cannot get here).   There were also several people who claimed to have 'asthma'. This time of year there is much smoke from fires and the land is dry enough to create red dust everywhere. The nights are cool (especially up there). All this combined to make people feel breathless / 'asthmatic'. There were also many prisoners who were HIV positive, but all the ones we saw, with the exception of one who did not have his 'book' (medical record) were receiving their ARV.

We were glad it went so well, and I am continually impressed by the people I am surrounded by who love and serve the Malawians, even 'the least of these'. Enjoy the photos.

Before we started the clinic, there was a little presentation, with a prayer by Charles. In the photo are Nancy McGlawn, Annualita Metope, Joey Swartz,Clair, Tanya and me with some of the guards.

Charles Msukwa and H2O (His2Offer.org) provided soap for the prisoners.

Joey Swartz and Nancy McGlawn setting up the wound care area.

Prisoners waiting.

'My office', even the guards wanted to be seen.

Tanya and Joey Swartz working in the pharmacy.

Large boil that Claire treated with an incision and drainage.

Claire doing the Incision and Drainage.

Examining a patient.

Nancy McGlawn in charge of wound care. She did a truly awesome job!

Ear infection / impetigo

Nancy McGlawn chatting with me. A real 'porch side' consultation!

The konde (porch) clinic!

Nancy McGlawn and her wound care line!

Severe pellagra rash from niacin deficiency.

Team when we were ready to leave, minus Claire who took the photo. Great job, team!

Mdazi dnima (Gusu) with E3

Friday night, one of our guards, Grey, brought his nephew to the house for me to check. The child (about 2 years) has a rash and had been to the hospital and given a 'prescription' for calamine but there was none in the hospital pharmacy. He looked like he had chicken pox and fortunately we had calamine lotion here at the house, so were able to give him a bottle. What a cutie he was! It is so sad that many of the hospitals here are out medications and supplies (the government run ones).

Saturday we were privileged to join the amazing team that E3 has here in Malawi. We all went to an area called Mdazi dnima ('where the water is' according to my translator). I am not sure how many people are actually involved, but it appears to be about 20. There are several nurses that are 'regulars', plus Kelley McGowan and Joey Swartz (came with me); there were 6 clinical officers this time; people to help with crowd control, setting up the pharmacy, triage (not always done by a nurse), translators for those of us who need it, etc.  This area is about 45-60 minutes off of the tarmac, down the airport road into Dowa district. The closest trading centre is Mphongela for those of you familiar with Malawi. E3 has done much work in this area, with wells dug and water storage, all on solar power, permaculture, a hydroponic set up that is amazing, composting toilets, raising goats (fenced, a novel idea), and pigs (also contained). They have now started raising rabbits. They also have a very vigorous sports ministry in this area. Many of the local projects are run or overseen by Sandram, a Malawian who graduated from ABC. E3 was also instrumental in getting the school built that we used in the clinic.

As for the clinic, we got set up and ready about 10 AM. Patients were triaged and then saw a clinical officer or myself. Our part was done by about 2:30 and then we helped the pharmacy finish. The malaria testing station was manned by 5 people, but we ran out of malaria tests before noon (they had 200 tests).  When they finished they, too, went to the pharmacy to help. We registered 757 patients. Like Sam Kawale says, we don't do statistics, each number has a face, each face has a story, every story matters to God. How true that is! Some of the stories are so tragic. We did find a girl of about 2 years who had severe malaria and one of the vehicles we had took her and her mom to a hospital. Another 'evacuation' was someone so anemic that she had to go to hospital (anemia is generally diagnosed in the village by clinical signs, not tests).

In the pharmacy, they used 5000 doses of paracetamol (our tylenol), over 2000 doses of ibuprofen (and ran out of both), all the usual malaria medications and several of the antibiotics.  These clinics are very costly - both in time and medications, not to mention fuel for transport, renting a minibus for most of the crew, etc. etc. They have some very faithful supporters in the US, but anyone interesting in partnering with them through financial donations should go to their website (E3 Worldwide).

We finished in the pharmacy, packed up and were on the road just before dark, which meant the main part of the trip was in the dark. If you have not been in African bush dark, you have not been in dark! The road into the village area is a single lane dust road. We had to meet or go around several ox carts, motorbikes, tons of people on foot and on bicycles, cross bridges without guard rails, avoid pot holes, and even had the occasional car or truck coming at us! Thanks to our amazing driver, Chikonde (Chico) who was also my translator, we made it safely to the tarmac, then to face Friday night driving on those roads, with other vehicles with no tail / brake lights, etc.  Praising the Lord that we made it safe and sound.

Saddest stories for me were two little ones - one with obvious CP and a history of a very difficult birth. Mom wanted a cure. She is one and looks to be 3-4 months old and cannot hold her head up. Her life will be incredibly hard, and if the statistics hold true, she will be sexually abused in the future (girls with any disabilities tend to be victimized).  The second was a girl of about 5 with the worst kyphoscoliosos I have ever seen in a small child. Sam is attempting to find if someone at Cure (Blantyre) could do surgery. Apparently the child had been taken to the central hospital (Kamuzu Central hospital) and they could not help her.  She lives with her grandmother, as her mother has a new husband who is 'not interested' in the child. Yes, every number has a face, every face has a story, and every story matters to God. These precious children are here for a purpose, and God has His eye on them.

Pray for us and for them, pray for the amazing organizations that are working so hard in Malawi to bring much needed aid to those that need it.

Enjoy the photos!

Grey's nephew

Crowd at Gusu, waiting for us

Joey Swartz doing malaria testing

Chico and I, in my 'office' seeing patients.

Lining up to see the clinical officers, doctor.

Kids, always lots of kids, especially when the azungus come around!

Sam Kawale explaining to Kelley McGowan how the rabbit raising is working (cages to the right of the photo).

Joey at the 'hub' of the Gusu project - we were taking a lunch break and got a tour of the hydroponics, the rabbitry, and the gardens.

Through the 'pharmacy' window, crowd waiting for their name to be called.