Dzuwa children

When the azungus (white people) come into the village, the children flock around. The little tiny ones are often terrified of us, but as they get older their curiosity overtakes any fear. Here are some pictures of the kids. Several of the girls have babies on their backs - little brothers or sisters, usually. They will carry the baby all day, until it cries, then back to Mom for a feed, then once again on the siblings back. If you will, notice how dusty and dry the ground is at this time of year. Since the kids are out in the dirt / dust all the time, they suffer from respiratory problems. Also in at least one of the pictures, the kids are sitting in the dirt, eating the pods from a local tree. I tasted one - mostly something to chew, not much flavor and I am sure not much nutrition. In one photo the back ground shows the local borehole where some of the villagers have gathered to do their laundry. The children are charming, but also heartbreaking at the same time.

Ronald and Ulema Chimzimu, Dzuwa

Ronald and Ulema live in Dzuwa village, where we held the clinic. They graciously let us stay in their house (me) and Gloria and Elliot's house (Jose) Saturday night. The missionaries (the Chimzimus, Gloria, Elliot and a couple of other guys, including my clinic interpreter, McDonald) live in three houses, along with the outbuildings - storage sheds, toilets and bath houses. They have a generator that runs the inside lights and will charge their cell phones, etc. All cooking is done outside over charcoal cookers. The water is fetched from the nearby borehole. The toilets are squatty potties, and the bath houses are for African style baths. One store house is for tools (which also houses a big black snake on occasion, according to Ronald - he thinks it is a black mamba), the other store house is for maize, ground nuts, charcoal, etc (the maize = mice/rats = the big black snake hanging around!). They also have a storage silo for unshucked maize. I got to watch Ulema cook dinner (potatoes and chicken), and got a lot of pointers on how to use a charcoal cooker, plus some good tips on cooking potatoes and chicken. Jose took Ronald into town (Santhe, 44 km away) to buy gasoline for the generator. We had the generator on for about 3 hours, long enough to eat, charge Ron's phone, and for him to do some work with his computer. He occasionally has Internet - but only when he can afford it, as it is very expensive here to be connected. We were able to learn more about what they are doing in the community. Ronald is teaching pastors and deacons - Bible teaching. He is translating materials into their language (Chichewa). Although English is the official business language, in the villages it is not spoken or read often. Ulema teaches at the school and is starting a feeding program - whereby all the school children will get a meal of porridge (thin nsima) with additional protein (ground nuts or soy beans) every school day. She knows that starving children do not learn well. The school is 1st - 8th grade. There are about 500 students, but with the majority being in grades 1-4 - those classes often have 100 children for one teacher. Starting in grade 5, the students must learn English - everything is taught in English. At that point most of the girls drop out, along with many of the boys. The 8th grade this year has about 30 students. After 8th grade, they are eligible to go to secondary school if they pass the national exams and if they can afford the school fees. Most students do not go onward, especially the girls. They often marry between 5th and 8th grade. And they have babies and start the cycle over again. Gloria is doing the micro business with the women - loaning them money to start their own businesses, then watching the finances, etc. She has a little over 40 women in the program - they knit and sell their items, some have started little tea rooms (tiny restaurants), some fry meat to sell or make the local bread. A major problem here is that the men in a marriage control everything - so if they tire of a wife and 'divorce' her (basically drive her out of the hut), she has nothing except hungry children to feed. If she is married and her husband sells his tobacco (a major cash crop here), he can spend the money however he wants - often on beer or other women, leaving the wife and children destitute. So being empowered with a skill is truly life saving for many of these women. These guys (Joy to the World ministries) have also built a maize mill, and of course the clinic that they hope to get staffed and open soon. McDonald is not only a part time teacher, but he is working on an irrigation project to grow Irish potatoes - he says it is going well and the first crop will be harvested this September. These guys are doing quite a work under difficult circumstances! Please keep them and their work in your prayers. The pictures are of the maize silo, Ulema outside her house with some of the village kids that hang around, Ron and Ulema in their living area as we prepare to eat dinner - Ron has the generator going and is working on his laptop!

Dzuwa clinic

We didn't leave Friday afternoon for Dzuwa as Jose was feeling a little under the weather. He was much better by Saturday morning, so we left very early, arriving in Dzuwa at ~ 9 AM. Ronald was going to meet us in Santhe, where the tarmac ends, but the battery in his car was 'flat', so Jose got to drive on his memory of the roads. Ronald walked and met us a little under half way, but Jose did great getting to that point. There are no road signs.. you just have to remember which way to turn when the road forks... by watching villages and trees, etc. It was just as well that we had not spent the night to start an early clinic, since an 8 month old child had died and the funeral was held Saturday. We had to check with the big chief, Chief Dzuwa, if we could still hold the clinic. He said yes, so we started at about 10 AM. Many of the patients had come from surrounding villages to attend the funeral, so did not have their health passports, which makes taking care of them even a greater challenge. The clinic was set up in a school room. I had McDonald, one of the missionary / teachers / agricultural guys as my interpreter. Jose and Ron Chimzimu were the pharmacy techs. It really worked well. Of course, we had no lab tests, only a scanty history, a BP cuff, a stethoscope, a flashlight, a otoscope (for ears), my hands and our brains (which struggle with some of the African symptoms!). We took a 30 minute lunch break, and then worked until it was almost dark (no lights, so we are have to stop at dusk.) I saw a couple of really ugly rashes on children, lots of upper respiratory illnesses, stomach pains, arthritis (they work hard, dig in fields, carry water and firewood, walk or ride bikes everywhere - their joints are destroyed..), lots of chest pain - most related to arthritis or stomach, some high BP and palpations, diarrhea, bilharizia (the water borne disease that affects your bladder - very common here), some malaria. One child that I think has seizures - probably some partial complex seizure - but we did not see one so it was hard to get a good handle on it. Lots of eye problems - some allergy, but also old traumatic injuries and probable cataracts. A common complaint is 'pain everywhere'. Some yeast infections (you always worry about their HIV status when they complain of yeast infections). Tooth pain and multiple caries was fairly common. We gave out tons of paracetamol (like Tylenol) and Ibuprofen, lots of antibiotics, some BP and heart meds (inc. aspirin daily for the older patients). We ran out of the 'stomach meds' (Prilosec and cimetidine). Dispensed the medications for bilharzia and malaria, along with meds for yeast. Some cough medication. We had one wound that needed to be dressed, and of course the kids with the ugly rashes... it is very frustrating to realize that, for the chronic problems, if we happen to hit the 'right medication' for them, once it is gone, they will once again be in the same situation. Ron and his Joy to the World ministries is trying very hard to have their clinic up and running. Many of these people had never seen a doctor. The closest facility is 44 km - the Santhe hospital - and it is small and doesn't have many resources. Several of the children looked malnourished and wormy, we had multiple vitamins and worm meds to give out, too. All in all, we did pretty well. Ron and Jose were awesome pharmacists, with Ron translating the instructions. After we closed the clinic for the day, we went to Ron and Ulema's house for dinner - Ron asked Jose to take him into Santhe to buy gas for the generator, so Ulema and I had a nice visit. She educated me on some of the eating habits. Their diet is mostly nsima (ground maize flour that is cooked in water, sort of tastes like grits, with a firmer consistency), lots of greens and beans and occasionally fish or chicken. That is a pretty healthy (but low protein) diet, so I couldn't figure out why so many people complained of abdominal pain. Turns out the women often go into the bush to get the greens (inc. okra of which there are multiple kinds growing wild). They cook it with bicarbonate of soda - which is hard to get in villages and very expensive, so they make a substitute using wood ashes and water. For those of who are not aware of this, that makes LYE (like, Drano lye). No WONDER they all had belly aches! I wish I had known ahead of time, I could have talked to them about changing their diet. I also found out that although their village, Dzuwa, has a nice deep borehole (well) that has been tested and found free of contaminates, neighboring villages are still drinking from shallow wells (or the standing water in areas) that are contaminated... those people really suffer from diarrhea and bilharzia. They could come and get water from the borehole, but it is a long trip on foot, so they often chose the contaminated water. The children pretty much run free and play in the dirt (I mean, lie in it, roll in it, etc.).. they also eat a seed pod from a local tree.... mainly to fill their bellies - and I watched them as they rolled in the dirt with this 'food', then promptly put it in their mouths. It is evident why worms are such a huge issue! Between the patients we saw at the clinic, those at Ulema's house, and few that straggled by this morning before we left, we saw over 80 people. I just hope we made a few of them better! The pictures are of Jose and Ronald at the pharmacy, Jose mixing some pediatric medicine and myself examining an unhappy child, with McDonald in the foreground.

Epilepsy clinic

This afternoon I accompanied Dr. Diane Young and Cathy to the epilepsy (seizure) clinic in area 25 of Lilongwe. It is a village like 'suburb' of the city. Cathy is from Canada and has worked here ~13 years. She has a school for special needs children. She does physiotherapy with the kids - at the school and at their homes if needed. She has all ages and conditions of kids. She also holds nutrition clinics and this epilepsy clinic every other week. Dr. Young is at ABC clinic and comes on every other Thursday to be the doctor at this clinic. The patients are generally young, but even older adults with seizure disorders come in. Some of the medicine is supplied by the government, but a large amount of it comes out of Cathy's own pocket. I have found that most of the missionaries here give their personal monetary support to much of what they do! When they come to clinic (they mostly walk here), they present their health passport - a little booklet that they are supposed to keep with them for all medical visits. Every doctor / clinical officer / hospital writes a note in the book when care is given. Just something short - vital signs, weight, complaints, findings, medications, etc. Usually less than 1/2 of a page. Really ill people may have several of the little books. They are very convenient when they come for care (even at ABC) - I call them the EMR (Electronic Medical Record) OF MALAWI! Ha! But just as our computers sometimes crash, they sometimes lose their books, or they burn up in a fire. However, if they have their book, they turn it in at the start of clinic - their place in line depends on when they turn in their book - first come, first served. If they forgot or lost their book, they are at the end of the line. As for the patients - a great many are due to cerebral malaria as a child. We saw a couple of what we are presuming were birth injuries and some ?? who knows what triggered them. Many of the adult patients had had seizures all their life - now they are on medications and they have a new beginning. Unfortunately, most schools will not let children with seizures attend - too disruptive. So many of the children have not gone past 2nd or 3rd grade. And most of them have old burns, where they have seized and fallen into the open cooking fires. The patients line up outside the tiny room that is the clinic. They come in when their name is called. They are asked about continuing seizures, if they are taking their medicines, if they are unwell, any other problems... the children are weighed, medication is adjusted if necessary and dispensed. Any other significant problem may be addressed by referring to another facility, as they only do the seizure meds at this clinic. (Today we saw a patient with a nasty abscess, and another one with possible filariasis.) At the end of their visit, each patient is prayed for by the team. Enough medicine is given to get them to their next appointment. Many of the patients had not made their last appointment and had been out of medications for some time. Just the logistics of getting to the clinic is overwhelming for some. They may have to take several minibuses and walk long distances to come in. We take so much for granted with our good roads and transport availability!! Some of the women whose children are in the special needs school / programs have been taught how to sew or knit. They have little items for sale. Of course I had to buy some! It is good to support people who are trying to support themselves! The pictures are of me with a couple of items I bought, and one of the ladies who does knitting. The gentleman on the left is one of the helpers at the school. The young lady with the gorgeous smile is Clara, she helps in the clinic. They keep their own records, in case the health passport is lost, and Clara is a great help finding the previous notes, etc. Two of the patients - Amoni is the little guy, he is a twin. His brother is fine, but he was breech and apparently had anoxic brain damage at delivery. He has multiple problems along with his seizures. The two children are Shadrack and his sister. Shadrack has seizures from cerebral malaria. His sister was the accompanying family for him. She is young, but another patient came alone, got his meds and left - he was 12!!! The last picture is Cathy, holding a stack of the health passports. You will notice her record book is laid out on the table. We had a good day, the patients were all either holding their own or had improved with their seizures. I am again reminded that you can only do what you can do..... for the doctors out there - no drug levels, no definitive testing on the mystery patients to see why they had seizures, no checking liver enzymes..... just treating as best as you can.

Jose did his last CPR class for the ABC academy today. They all did well, asked lots of good questions and seem to really 'get it'. Paul Chinchen, the president of all the African Bible Colleges, attended and (thankfully) passed the test!

Tomorrow, after morning clinic, we are planning on going to the village of Dzuwa until Sunday. We hope to do an all day clinic on Saturday for the villagers. Should be interesting. One of the patients I saw last time had a weird rash - I took photos and consulted one of the clinical officers at ABC - he thinks it might be leprosy. I hope to get some better photos. I also will refer him to the clinical officer to get a hands on opinion and possibly medication. Anyway, we will be out of touch for a few days! Keep us in your prayers.

Dinner with the Spencers

Wednesday night we had dinner with Steve and Marion Spencer and their children, plus a couple of the kids friends. For those of you who know them, you know that total chaos is the rule! We had a great time as usual. At one point Steve was talking on his land line and his cell phone, Marion was on her cell phone, little Stephen was playing his guitar and the piano at the same time and Charlotte and Ester were laughing... if you are into big families, this is the happening place! Steve and Marion (Chinchen) Spencer are missionaries with African Bible College - again, you can search for the site on the Internet and most of the missionaries are listed there. This group (ABC) does fantastic work here. They have the clinic and pediatric ward, an Academy for younger kids, the Bible College where they are giving the leader's of tomorrow a Christian based education, and the radio station. They always appreciate new supporters! The pictures are of Charlotte and Ester (the baby), Stephen - who barely made it through dinner then fell asleep, and Samuel and Ester.

Lidson

Wednesday we drove to Kasungu and the Children of the Nation orphan village of Chiwengo. They have about 88 orphans living on this compound, complete with it's own primary school and church. My understanding is that the former 'President for Life' (i.e. dictator) President Banda used this compound for his extended family when they visited. There are several homes - the younger orphans live in one of the homes - House of Hope, House of Joy or House of Love. When they are old enough to go to secondary school (grade 9) they are seperated into boys (House of Power) and girls (House of Purity). The younger orhpans have house parents and then 'assistant' parents - sort of like aunties who help cook, clean, etc. Each house has about 14-16 kids. ranging in age from babies to ~15 years old. I have sponsored Lidson since he was about 6 (he is 15 now), and I have met him before, but COTN had always brought to Lilongwe. This time we thought we would drive up and see his house. We also met the on site administrator, Eric, who is also a house parent. He introduced us to 'Joseph', a ~14 month old boy. Joseph's mother died at birth, his father ran off and his elderly grandmother was trying to care for him. The social services found him and asked COTN to come and look, to see if they could take him in. Eric said the boy was about 2 months old, the grandmother was very poor and frail, the mud hut was falling down around them, and she had been feeding him Coke and Fanta to keep him alive. COTN agreed to place him in Eric's home, but first he spent ~ 3 weeks in the hospital with pneumonia and malnutrition. As you can see from the picture of Jose (AKA Joseph) and little Joseph, he has recovered quite nicely! We were thrilled to see Lidson's home and to meet some of his 'peeps' in Chiwengo! Although he confided to me as we were leaving 'have them bring me to Lilongwe next time'!! I think he likes the road trip and the fun of getting to travel! He is, as Eric says, 'a lovely young man'. Very quiet and shy.

Monday and Tuesday clinics....

Monday and Tuesday I spent at the clinic. Busy but not overwhelming, and always rewarding.

Such a mixture of folks to see: Malawians, Americans (mainly missionaries), Italian, Swiss, German, Indian, Nigerian, Brits, Pakistanis... all in two days! All ages, from infants to village agogos (grandmothers). Did a few minor surgeries (VERY minor)... Prepared and gave a short talk on anaphylaxis to the nurses and clinical officers at the clinic, even did some flow charts to post up on the walls as references. Jose taught CPR this afternoon. We managed to get the car in for an oil change - sounds simple but nothing is really simple here.. there is no 'Jiffy Lube' - haha. Tonight we had a lovely dinner with Dr. Diane Young and her husband and 3 children. We had a tuna casserole - I hadn't realized how tired I was of chicken - boy, that tuna tasted good! Tomorrow we will head north, towards Kasungu, to see Lidson, the orphan I have sponsored for years through Children of the Nations (COTN). He is in the orphan village of Chiwengo. Usually COTN brings him to Lilongwe to meet me, but this time we want to see his home and his village. It will be an all day trip, but worth it.

Pictures are of some road scenes - a roadside village that was holding some sort of meeting; another roadside village; women carrying ?water? on their heads; and a motola. The motolas are small pickup trucks that load people in the back and transport them. They are a very cheap means of transport, but not very safe! As you can see, the people were literally spilling over the sides of the truck bed! All for now, please keep us in your prayers, especially as we travel tomorrow!