Blantyre

Thursday, the 8th, Jose had another great village clinic experience. We had gone over to the Brown's (missionaries with the Assembly of God) the evening before, and Jose taught Adriane, their daughter from the US, how to take vital signs. She joined him at the clinic and they seemed to have had a great time. He has posted some photos on his facebook (and tagged me so if you are his friend or mine, you can see them). Thursday we had lots of power issues and ended up losing the internet - we finally got it fixed today, Monday, so that explains the time lapse. We had planned to go to Blantyre for the week end and stay at a little lodge. There is a new doctor here, Ty Kreible (not sure about the spelling) who just finished his residency and has come to volunteer for two months. He is a huge help and is fitting right in! Since he is here, we felt we could take off on Friday morning, as it is a ~5 hour drive to Blantyre and the lodge is another ~20 km. We had a great trip, even stopped at Dedza pottery for lunch and a look around. We arrived at the lodge in time for dinner.

I will post more info on the lodge later.

Blantyre is in the southern part of Malawi and is considered the commercial center. It has the only cinema in the country, and a Game - a store sort of like a mini Walmart - but better than anything in Lilongwe! There is also the big Seventh Day Adventist hospital, Queen Elizabeth, and the orthopedic hospital, the CURE. In that area of the country you can also find the tea plantations. We didn't make it to them but hope to some day.

Pictures: The mountains coming into Blantyre, with a village at the foot. A man selling Mouse kabobs on the side of the road - each one of those sticks has several little mice (actually ground squirrels) on it that have been caught, killed, ?gutted, boiled and then dried. They eat them, fur and all. A stick of about 8-10 sells for about $1.50. They stand on the side of the road and wave them at passing cars (that is the next photo). Fourth photo is a small truck with the back end loaded with people and cargo. Lastly is a small house with a tin roof, the tin being held down by big rocks. Those rocks do fall off and, if they hit someone, can cause significant damage. Oh, the many ways you can get injured here! I am not sure of the most recent stats, but a few years ago, Malawi had more deaths per highway mile than any other country in the world. Impressive considering they don't have lots of vehicles - but many of the vehicles - like this truck, huge lorries, minibuses, etc have many passengers, and the emergency response system is pretty much non-existent here. So if you are a trauma victim, you have a much better chance of dying than in other countries.

Baptist clinics

A group of folks (Baptists) from Oklahoma (Madill and Ada) came into Malawi last week. They graciously carried a bag of medical supplies for us, and were joined by a doctor and his family after a few days. They arranged to set up some village medical clinics on Monday and Tuesday. Jose went on Monday, and both of us on Tuesday (since it was Malawian Independence day and the ABC clinic was closed). The doctor quickly saw that Jose's experience was a very good thing, and set him up to manage all the malaria patients, along with the general body pains (GBP - very common), the coughs and colds, etc. Jose was able to treat most of the problems himself. The village clinics usually have no or very limited testing abilities, and limited medications. Last year Jose was the 'pharmacist' in the clinics we did, so he became familiar with the meds and the dosages. He would listen as I took a history (via translator) and would usually know what meds and dosages I would order before I ordered them! So he was ready to be Dr. Joseph. Tuesday, since I was there, Jose was the 'triage' person / doctor. He and his translator, Charles (more on him later) would get a chief complaint, do blood pressures, check pulse and oxygen level if appropriate, and if the problem was a simple general body pain - he would order the medications from the triage station and they would go to pharmacy. I think we need to use his skills and knowledge more in future clinics (if we have the man power). Monday they saw about 160 folks and Tuesday we saw 180. Of course, many of the cases are heart breaking. One child had been normal, then had cerebral malaria and now cannot walk, talk, or interact. She just cries and squirms. I am sure she has had significant brain damage from that episode of malaria. We saw lots of cataracts, joint pains that are incredibly crippling for the older folks: they still have to walk everywhere, till the fields, carry the water, stir the nsima, etc. One sweet baby girl (10 mo old) came in for a cough. She had Downs' syndrome (Trisomy 21) and no one had ever told the mom. She had no idea why her baby was different, no idea what to look out for or to expect long term. It was heartbreaking to be the one to tell her. I saw a child with sickle cell disease - the mother had the medical 'passport' and could turn to the page where the hospital had diagnosed her, but had no idea what it meant. Makes me a little crazy that most of the time the medical folks here do NOT explain what the diagnosis means, especially when it is a long term problem. We saw the usual malaria, huge spleens, weird rashes, high blood pressure, aches and pains, bilharzia, and cough /cold. Here they call it 'asthma' (sometimes it is) or - if it is acute- the 'flue' or flu -or they are fluy or fluish. A lot of it is the dust - as the dry season begins, there is dust everywhere, everywhere... and the smoke from cooking fires. Because most of the village folk are medically naive, they have interesting descriptions and rationale for their symptoms. We forget how much medical information Americans get just from general TV (ER, Marcus Welby, Grey's Anatomy, etc. ) and from commericals ('ask your doctor if it is right for you')... they have none of that here. They usually can't tell you if something makes it better or worse, they have tried no over the counter meds (they usually can't get them or can't afford them in the village, but even at the ABC clinic they don't try things), they can't tell you how long they have had the pain, if they have been diagnosed with anything in the past, etc. etc. It is a challenge if the patient is the least bit complicated. I have found that if my translator is an ABC student, he or she will soon figure out what questions need to be asked and pursue that. If not, eeesh, (as they say here), it will be a tedious history. Charles, (Jose's translator) is an ABC student and one of our guards. He was posted at our house and found out Jose was doing a village clinic Monday and wanted to come to help (after working all night). He did great. Tuesday he came also (sleeping in small bits between guard duty and village clinic duty), and Jose said Charles was able to get almost the entire history without any prompting from him. I just love the ABC students! These guys - and girls - are the cream of the crop. It is a shame that the school is small and (for here) relatively expensive. There are some great minds here and they need to be cultivated!

Pictures: Me holding the Down's baby, the chimbuzi (outside squatty potty, in the grass 'hut'), the translators - Dadilitso (sp?) and Charles (in green), Dr. Joseph at Tuesday clinic, outside, by his station, and lastly a photo of Dr. Joseph and a patient from the Monday clinic. Enjoy!

Mozambique

We drove to Mozambique Sat, July 3. "WE" included Matt Moffett, one of the leaders of Evangelism Explosion, currently posted in West Africa, George, a recent graduate of ABC and our translator, and Jose and me. We crossed the border at a small -but busy- crossing south of Dedza, then drove another 2 1/2 hours to reach Zobue. It is a border town, also, but the Malawian roads to that crossing are so bad it is much faster and easier to cross by Dedza. We had to fill up the car in Dedza, as there are no filling stations in that whole area of Mozambique - so you see people on the side of the road selling little oil bottles filled with petro or diesel. They either travel to Malawi to buy OR they buy from truckers coming through, who will sell them a little of their fuel (thereby making some spending money for themselves, as the companies pay the fuel fees).. interesting system. We did NOT want to have to buy from the road side, needless to say! In Zobue we stayed at Mr. Piava's house. Actually a little compound, with a main house (toilet, dining and living room area), a house for them to sleep, a guest house with two bedrooms (no toilet) a couple of lean tos and kitchen areas. Very secure behind a wall, with it's own well (hand pump) on the premises. Jose and I had the guest house with the two bedrooms. We were there to visit Davie. Davie is a graduate of ABC and went to Moz some years ago to work with the CCPA (Presbyterian church). He has now started 3 churches and 12 prayer houses. His main church is in Zobue, and his latest church is in Mussacama. He, his wife, Uleme and new baby, Franklin, live outside the Piava compound in a little traditional Malawian house (read - outside toilet and kitchen, no running water, no furniture). Saturday we saw the churches and met many of the church members. We ate traditional Mozambiquan foods - which actually is pretty much like Malawian foods. Moz was involved in civil war for many years (Mr. Piava was a freedom fighter in the war and now works for immigration), and many Mozambique nationals fled the war and crossed into Malawi. The national language there is Portuguese, but in this area of the country, most of them speak some Chichewa (one of the main Malawian tribal languages) along with their own tribal language and maybe some Portuguese. Occasionally a little English. Mr. Piava spoke Chichewa (some) English (tiny) but mainly Portuguese. So with my broken Spanish, we were able to have some very limited - and I suspect very funny - interchanges. I would hesitate the call it a real conversation!! He and his wife were most gracious hosts to us. They did have power, and dish TV!! So were we able to watch some of the World Cup (huge over here)... but no running water. Interesting how technology comes to third world countries in such disjointed ways. Almost everyone has a cell phone, especially in Malawi, but almost no one in the villages has power or running water.

Sunday George (ABC graduate) preached at Davie's main church, and the rest of us went to the newest church at Mussacama. An American group gave the money for the land, and another church group gave the money to build the church ($1000). The members made most of the brick - dug the dirt / mud, molded the bricks, then made the stack and 'burned them' with fire (so they last longer than just sun dried brick). The mortar is mud. They ran out of bricks to do the gable parts, so had to buy some. They are waiting for the windows and doors to be delivered, and they have bought the roof supports, but do not have quite enough left to cover the roof with the tin sheets. At some point in the future they would love to plaster the walls (to protect the mud mortar from slowly dissolving in the rainy seasons). Maybe even have more than a dirt floor, but who knows. Currently, not even brick pews, just dirt. We had hoped to have the church service in the new building, but there was so much rain the night before, it just was not feasible. So we met in a classroom of the local school. It was a great service, Matt preached (and Davie translated), the church sang traditional Malawian hymns, and there were a couple of solos. I hope to post some of Matt's sermon and the singing on Youtube in the near future. The church had put together a meal for us, the elders and Davie at one of the elder's homes. It was a feast, with nsima, spagetti, chicken, potatoes and greens. His home was nearby the church, so we walked there, the dining area was too small for all of us, so Davie ate outside. This was some GOOD food!! Yummy! Of course, then visiting with the church elders, the ladies who cooked the food, and all the social things you do in this culture (which are delightful but very time consuming) we were able to leave for the border by a little after 2 PM. We made it back to Lilongwe right at night fall. The border crossing was wild this time, and the guys gave me their passports so that I could shove / elbow / force my way in the line.. you will get pushed out of line if you are not pretty aggressive. They thought it was funny to watch me jostle with the Malawians - and others - in the 'line' (not really a LINE, but a mass, of people). So much happened there it is hard to get it into one blog post..... And we got back to crazy - busy, so more later!

As an aside, check out facebook for more photos and videos. As usually, Jose was a kid magnet - he loves the kids and they adore him. And I feel in love with a darling little girl named Celia.

The photos: First is the guest house where Jose and I stayed, the car is Mr. Piava's.

Then Davie eating on the porch of the elder's house (the feast), next in the elder's house eating - Alex (the elder), Mr. Piava, Matt Moffett and me. And yes, that is a mud hut we are in. Next the church at Mussacama in the background (with no roof and no doors or windows yet) with (foreground) one of the men of the church, Mr. Piava and Davie, lastly Davie's main church in Zobue, with George and I in front, and Davie and Matt removing the 'door' (a woven mat to keep out the dogs and goats). Enjoy!

Friday, July 2

Friday, July 2nd... Lots of good news! Our other bag, coming from Oklahoma, actually arrived, and we got to met Geri Marple and a member of her team when they dropped it off at the clinic! It had lots of our village clinic medications and we were worried it was lost for good. It also had the glucometer and 200 test strips, Jose's otoscope, all the CPR teaching mannikins and DVD, so it was an important bag to get! My clinic day was pretty calm, although I had another trauma come in. Makes things a little more exciting - but understand I use the term 'trauma' very loosely! I am seeing a pattern of people getting banged on the head unloading the lorries, though!

The other good news is our water! It is back on!! Yeah!! I am looking forward to a HOT shower tonight!

We are going to Mozambique early in the morning, so this afternoon we had to do chores associated with that trip - gas for the car (it is a small Rav 4 - to fill it up, over $70. ouch!), check tires, buy ufa (ground maize flour) for the family that we will stay with, etc. We hope to get back Sunday afternoon, but most stores seem to be closed on Sunday, so we are having to plan our Sunday dinner and Monday meals now. Plus we needed water to carry with us to Mozambique.

The photos -We went to lunch at a tiny little Italian restaurant - while we were waiting for the food, we took a few photos, as the landscaping was so nice. One of me in my office, on the little roller stool I have. I have a nice window with a view of the gate coming into the clinic. Then the lilac breasted roller that sits on the line outside the duplex. A most gorgeous bird, and when it flies, big flashes of turquoise in the wings. And lastly, the sunset from the front of the duplex - thanks Jose for this great shot! Malawian sunsets are beautiful.

Thanks for all of you guys who are following us in the blog and on facebook. Thanks for your prayers and concerns. A special thanks to those who have donated or are planning to donate. We could not do this without your help. You have made it possible for us to have extra bags of medications, items for the orphans, to get medications here for the village clinics, and to eat, drive and do all the things that you must do to survive on a daily basis. We really do appreciate it!. Blessings on all of you!

Pray for our trip to Mozambique. We hope to make connections to help us set up some ministry (?clinics?) in that country at some future date.

Another Ministry of Hope village clinic

Yesterday (Thursday, July 1) Jose went out with the Ministry of Hope to do another clinic. The weather was cloudy and cool, which made it nice for everyone. They think about 200 patients were seen that day, turns out last week it was closer to 300 (after they finished all the counting up). I will admit that we are not as good in keeping count of how many we have seen. The Ministry of Hope has a pretty neat set up - one station for blood pressure and pulse (that is where Jose is stationed), another for weight and temp, a lab (Jose isn't sure what they can test for, but plans to find out next time), the clinical officers, the 'recorders' (who try to get all the info from the patients) and then the pharmacy. One of the photos has two white girls and an empty chair - that is where Jose usually sits. You can also see the lab table with the microscope in one photo, and then outside the building where people are waiting their turns to be seen. Jose has posted some of the videos from this clinic on his facebook. They help you see and hear the clinic. We have gotten used to the crying babies and the general noise overload, but when you hear it on a video it makes it more real. One of the photos he took was of the mountain in the background of the village.

For those of you who do not know, this is a very beautiful country. In fact, other folks have told us that it is the loveliest of all east Africa, and for sure west Africa!

I spent Thursday morning in the clinic, and came home to no water! Well, no real water, just from the holding tank. And for some reason the pressure was even lower than usual and we could get no hot water. Jose got home from the clinic - we had to run to the store (long story) during the 5 o'clock rush hour. There are not a lot of cars in Malawi, but I think most of them are here in Lilongwe and the other large city, Blantrye. It is a zoo. And the drivers are crazy! Think Mexico drivers on steroids! I started dinner when we got home and poor Jose took a cold shower! And last night it was 59 degrees with a strong, strong wind blowing. The power was off and on, but the generator was working... interesting though that with the generator, when you turn on the oven, the kitchen light goes out! I am certainly glad we brought little head lights with us this time. I guess I will have to post a photo of me using that! More later.....

Macdauds and the widows clinic

We had a busy day today - went to the ABC clinic to put in an order for additional meds for the afternoon village clinic, then to get more $$, a prescription for Lariam (malaria medications). I usually take the cheaper stuff but it doesn't have quite the protection as Lariam, and this year I have seen quite a bit of malaria even this late in the 'season'. We decided to eat lunch at 'Macdaud's' - sort of a McDonalds - well, not exactly.. well, not even really close, but they do have arches on their sign: reddish arches. It is probably about as close to 'fast food' as you will get there. Inside they have two big pictures of Obama along with quotes from him, a poster of Islamic prayers and a couple of signs for no smoking or drinking. Take that for whatever you wish. We just thought it was interesting to see Obama's picture and quotes in a Muslim resturant along with Islamic prayers. I had curry chicken, rice and chips, and Jose had crumbed chicken pieces with chips and rice. We both survived! Actually the curry was pretty good!

We got to the feeding village, Mtsiliza, at 2 PM. The other team from COTN (with a dentist) came shortly thereafter and checked children's teeth. COTN not only does children, but also has an outreach to widows - they teach new skills, have sewing machines for them to use, do Bible studies and offer general support. They have a little shop in their meeting place where you can buy their handiwork! You can see some of their stuff in the background of the photos. Every year they graduate that particular group and take on another group. Widows in this country do not do well. There is no 'community property' and when the husband dies, his family (parents, uncles, brothers, etc) can come and take everything - food, clothes, money, even children if they want them. The widow is left with nothing. We had agreed to examine the ladies in the widow's project, screening for blood pressure and treating any illnesses that we could. There were only 27 of them, plus the workers that assisted in the program, plus the two girls that translated for us and also one of their friends that they sort of 'slipped' into the line! So maybe 35 total. We found a couple of high blood pressures, lots of eye complaints - cataracts are a terrible problem here, and most people can neither pay for the surgery or get transport to the few places that do that surgery. So they slowly go blind. Some of the ladies probably just needed glasses, but those are hard to acquire, also. We saw tons of coughs, and just about everyone had 'general body pain' - I think it comes from years and years of hard work combined with poor nutrition. A couple of the ladies had malaria, one nasty rash, a burn, and assorted other things. The other team brought over a couple of the kids they saw that had more than dental problems - these two little ones both had very nasty rashes, and fortunately we had some medication for them! We had two young ladies to work as translators - Cecilia and Eddah. We were so busy I did not get a photo of them. They are students at one of the universities, studying nutrition, and are spending 2 months as 'interns' in the home for teenage girl orphans, so I am sure we will see them again. They were delightful.

We finished and got home to NO WATER!! And we really, really want to take a shower! And washing my 'white' coat would be a good idea, too! Oh well, maybe it will be on later tonight.

The pictures: the kids dancing around outside the dental clinic area, Jose and I with the 'head widow' (helps run the program) and one of her helpers where we had the clinic. Macdaud's - inside and outside. Enjoy!

Prayer requests: a piece of luggage that was supposed to come with a team on Monday still has not arrived (none of their luggage has arrived). It contains many of the medications that we need here, plus some of the medical supplies. Pray that it arrives intact and soon.

Also pray for our strength. For some reason, both Jose and I seem to be constantly tired this trip. By 7 or 8 PM we are worn out!

Thursday - clinic and pill counting

Today I did the morning clinic at ABC. Not too busy, but one pretty sick guy. It is hard here - no home health, no nursing homes.... if you are chronically ill or disabled, your family must tend to you, often with not much support. He did seem to have a loving family, so he is probably getting the best there is available here!

Medically it can be the little things that get to you. Today we needed to put in a foley catheter. No kits, of course, so off to the store room to rummage around and see what was available! Finally we found enough of the right things in the right size.. then to find someone to insert it! Turns out the nurses don't insert foley catheters in men, only the male clinical officiers. They were busy. BUT the American nurse, Becky, who is essentially managing the clinic now, does insert catheters so it 'got done'. Oops, the connections to the collection bag were so old they split and leaked. Fortunately another collection bag was found. It is the little things.

Jose was busy in the clinic pharmacy this morning. Becky is doing pharmacy inventory and they are counting the pills... thousands and thousands of pills. Jose, Becky and another American nurse spent the morning counting and recording pills. (I think they liked the break for the foley catheter!!)

In the afternoon we got our photos taken for a visa - we are planning on going to Mozambique this weekend and need a visa to cross over the border. We also visited Anne Brown at COTN (Children of the Nations) to arrange a village clinic with the team currently at COTN. We ended up in the feeding village at Mtsiliza, where we will return tomorrow afternoon to help with the clinic. When we were leaving the village there was a whole road full of kids following three gulu wamkulu (fetish or spirit dancers). We didn't get a picture of them, but did get one of the kids.

Then on to the usual chores, including grocery shopping (always an experience). It was near dark by the time we got home. On the road to ABC we came upon a minibus that had broken down and was being pushed by two guys. By the time we could get a photo, there was only one guy left pushing... ha, I guess that is having a 'HIM i' engine!!

Photos today: two of the road to the village (one with the mass of kids), and the minibus and HIM i. Enjoy!