I’ve just come back from the internet café, where I ran into Laura, one my fellow med students, as we headed out the door at the same time. She, like me, was in a bit of a self-acknowledged snit. As far as we could gather, internet service was apparently slow all over Malawi – not even the official café had anything resembling functional service, although they’ll certainly charge you for the five minutes it takes you to figure this out. A bit frustrating when you’re trying to do things such as pay your gas bills (me) or finish your looming applications for medical residency (her).
And I know, I know, this is Africa – heaven help the mzungu sucker who assumes (or worse, plans ) that any transaction will go smoothly or efficiently. Power outages happen during peak dinner cooking hours about every other day, ATMs regularly run out of money, scheduled car rides don’t happen. And in the clinic, of course, everyday drugs simply run out and don’t get refilled.
I’d say we only end up using about 10 drugs on a regular basis in the skin clinic: a few antibiotics for infections, some steroid creams and anti-histamines for itchiness, an antiviral for chicken pox, and exactly one antifungal, Griseofulvin, that we give out like candy to the many little guys that come in with tinea capitis – basically ringworm of the scalp. (This, for some reason, is way more common in scalps of African descent than European descent, both here and in the US. As my pediatrics attending once remarked, there’s a bit of a tradeoff – white kids don’t really get tinea capitis, but then, black kids don’t get head lice. Odd.)
So griseofulvin was available and plentiful last week, freely available to any patient we sent up to hospital pharmacy with a handwritten prescription. Easy peasy. And then, suddenly, patients started coming back down to us. The pharmacy was out. And that was the end of it. No one knew when more was coming, and the pharmacy itself was unreachable. From our point of view, there was no way of knowing if the hospital itself was even aware of the problem, let alone working on it. And there’s no real alternative to griseofulvin – for those kids who aren’t rich enough to buy the medicine at a private pharmacy, they’ll simply be stuck with itchy, rather unsightly scalps until the hospital procures more. It’s not life threatening, but it’s stigmatizing and irritating – and contagious. More infections for siblings on the way.
I had trouble figuring out exactly why I can’t just go zen about these sort of situations. I’ve been shot down enough times by now that I’d expect a total shift in expectations, but no – I still find myself naively planning for quick ‘n’ easy in a place that’s more slow ‘n’ convoluted. It was actually kind of a relief to find that Laura was feeling a bit of Malawian fatigue as well – she was a Peace Corps volunteer in Guyana back before med school, so the fact that she was still struggling with her own expectations made me feel a bit better.
The more I think about it, the more it actually seems like classic Pavlovian stuff. Our brains here are victims of inconsistent reward. If we were out in the rural areas, this wouldn’t be an issue at all – no technology or institutions to fail, so no letdowns. But in a place like Lilongwe, which has many of the trappings of developed countries but not much in the way of foundation underneath, the rug just keeps getting pulled out from under you. You see that internet and electricity and banking and gas stations CAN exist here, so you get repeatedly tricked into assuming that they WILL exist when you want them. This is the mistake. My western brain assumes all or nothing, when in fact the reality is somewhere in between.
And now, as I finish this, there is a line of waiting cars wrapping around the block from the gas station down the street, each waiting 2 to 3 hours to fill their tanks. Word on the street is that the country will be out of gas by the weekend, and everyone’s trying to store up. Guess we’ll be walking to the hospital tomorrow?
Tuesday, September 13, 2011
Monday, September 12, 2011
Weekend the first!
After a long week of exhausting, 7-hour days with 2-hour lunch breaks, the other students and I decided that we'd earned a little vacation. Time to blow this Lilongwe popsicle stand and launch out for Malawi's most dramatic feature: Lake Nyasa (as the locals say), aka Lake Malawi.
They nickname it the "Calendar Lake" - 365 miles long and 52 miles wide, a long and skinny freshwater border between Malawi, Tanzania, and a little bit of Mozambique. We flew over it in the plane coming into Lilongwe, a huge blue expanse that stretches out over the curvature of the earth. It begs to have toes dipped in it. We'd decided to do a overnight visit to Cape McClear, a little nubbin of land that sticks out from the southernmost tip of the lake and has national park status. But how to get there? As with all African transport, we're always striking a balance between adventure, comfort, and safety - a private plane is lovely but doesn't give you much of a feel for the country, and public buses, while clearly the people's transportation, might just give you scabies. Ee.
So we opted for a middleground - a boat ride! We launched from Senga Bay, on the west coast of the lake, and zoomed out into some pretty coccyx-smashing waves (the Zimbabwean lady who set up the our ride kept calling the breaking waves "white horses", which I liked). I was having the time of my life in the front, despite some serious wind-knocked-out-of-me moments, but I suspect that some of my fellow riders were very grateful for the fact that we'd chosen to do the return trip by car. If only they'd grown up boatriding with my Uncle Joe, who makes it a point to drive right up and over as many waves as he can, they would've been ready.
No docking necessary - we zoomed right up onto the sand directly in front of our little lodge, where we found our "chalets": basically sturdy little huts with private porches, perched about 20 feet from the lake edge. Couldn't ask for a better view. We took bets on the exact time of sunset as the giant orange ball dipped below the surface.
The lake itself is fully integrated into the community, in ways I wasn't expecting at all. There's a tourist economy, of course - plenty of young guys walking the beach and trying to convince you that you want to go on a boat ride or have a beach fish fry or head out to the nearby island for snorkeling. (For that last one, they were right. We were secretly dying to go snorkeling. I think they saw through our pretended nonchalance during the haggling session, but it was definitely worth it. We plunged off the boat into the cool clear water and were immediately surrounded by cichlids of every color, backlit by afternoon sunlight filtering down from the surface. Awesome awesome awesome.)
But it turns out the lake is more than just looks. It's a huge source of food, of course - we saw dozens of fisherman paddling around off the Cape in handcarved canoes. But it's also a giant kitchen sink. From the time we woke up in the morning until the sunset, there were lines of men, women, and children lined up along the shoreline, washing their clothes and their dishes and their babies. It caught me completely by surprise, mostly because I was expecting Cape McClear to be a tourist spot - a freshwater Aruba, maybe. But even though my brain went "Oo! Ocean!" everytime I looked out into the water, I should've suspected that folks in a country as dry as Malawi would take full advantage of endless, free freshwater.
A hike through a baboon-infested park on Sunday, a cramped-but-amazingly-scenic carride back through the orange Rift Valley mountains, and we were home...if home is a net-covered bunk bed, I guess. A worthy adventure. And no one got sunburned! We're a good little bunch of dermatologists in training.
They nickname it the "Calendar Lake" - 365 miles long and 52 miles wide, a long and skinny freshwater border between Malawi, Tanzania, and a little bit of Mozambique. We flew over it in the plane coming into Lilongwe, a huge blue expanse that stretches out over the curvature of the earth. It begs to have toes dipped in it. We'd decided to do a overnight visit to Cape McClear, a little nubbin of land that sticks out from the southernmost tip of the lake and has national park status. But how to get there? As with all African transport, we're always striking a balance between adventure, comfort, and safety - a private plane is lovely but doesn't give you much of a feel for the country, and public buses, while clearly the people's transportation, might just give you scabies. Ee.
So we opted for a middleground - a boat ride! We launched from Senga Bay, on the west coast of the lake, and zoomed out into some pretty coccyx-smashing waves (the Zimbabwean lady who set up the our ride kept calling the breaking waves "white horses", which I liked). I was having the time of my life in the front, despite some serious wind-knocked-out-of-me moments, but I suspect that some of my fellow riders were very grateful for the fact that we'd chosen to do the return trip by car. If only they'd grown up boatriding with my Uncle Joe, who makes it a point to drive right up and over as many waves as he can, they would've been ready.
No docking necessary - we zoomed right up onto the sand directly in front of our little lodge, where we found our "chalets": basically sturdy little huts with private porches, perched about 20 feet from the lake edge. Couldn't ask for a better view. We took bets on the exact time of sunset as the giant orange ball dipped below the surface.
The lake itself is fully integrated into the community, in ways I wasn't expecting at all. There's a tourist economy, of course - plenty of young guys walking the beach and trying to convince you that you want to go on a boat ride or have a beach fish fry or head out to the nearby island for snorkeling. (For that last one, they were right. We were secretly dying to go snorkeling. I think they saw through our pretended nonchalance during the haggling session, but it was definitely worth it. We plunged off the boat into the cool clear water and were immediately surrounded by cichlids of every color, backlit by afternoon sunlight filtering down from the surface. Awesome awesome awesome.)
But it turns out the lake is more than just looks. It's a huge source of food, of course - we saw dozens of fisherman paddling around off the Cape in handcarved canoes. But it's also a giant kitchen sink. From the time we woke up in the morning until the sunset, there were lines of men, women, and children lined up along the shoreline, washing their clothes and their dishes and their babies. It caught me completely by surprise, mostly because I was expecting Cape McClear to be a tourist spot - a freshwater Aruba, maybe. But even though my brain went "Oo! Ocean!" everytime I looked out into the water, I should've suspected that folks in a country as dry as Malawi would take full advantage of endless, free freshwater.
A hike through a baboon-infested park on Sunday, a cramped-but-amazingly-scenic carride back through the orange Rift Valley mountains, and we were home...if home is a net-covered bunk bed, I guess. A worthy adventure. And no one got sunburned! We're a good little bunch of dermatologists in training.
Friday, September 9, 2011
Hospital-ity
One week over at the skin clinic, and it's already very familiar - I chat up the nurses, I have the one clinic room that I like best, I know where the secret bathroom (with the unbroken toilet seat!) is. But our little clinic is a little ways away from the true Kamuzu Hospital complex, so my perspective until recently was limited to our building and the canteen.
Yesterday, however, we got a personal tour of the hospital grounds from the Head Matron herself, a friendly woman dressed in a sharp blue suit with green/white epaulets and a matching tiny hat. Very stylish. She led us all over the grounds through the different wards, stopping to introduce us to various nurses, therapists, and doctors, most of whom offered just a "You are very welcome!", but some of whom offered mini tours of their own departments.
I've seen a number of hospitals in Tanzania during my time there, and I have to say that I was pretty impressed with Kamuzu Central Hospital, overall. In what seems to be a common architectural style for hospitals in hot, lower resource areas, most of the walkways between wards are open to the air - probably not the utmost in terms of sanitation, but definitely pleasant when you're walking through. Kamuzu has these covered walkways too, but the hospital was remarkably clean - we saw many folks engaged in active mopping as we walked by, and many the indoor areas were totally spotless, at least to my casual eye.
The actual quality of the care being offered seems to vary quite a bit depending on which ward you happened to be walking through. The general medicine ward, usually the most miserable and crazy place in any hospital, was somewhat disheartening: multiple patients to a dim room, a noteable absence of bednets, and frequent nursing shortages. (Just like University of Chicago, now that I think about it, though with rather dingier beds.) Then there were wards that had great potential but weren't quite living up to it just yet. We saw a fine dialysis unit, for example with at least eight modern machines - but all were broken, waiting to be fixed. Didn't look like any patients had been there in a while.
And then, the brand spankin' new maternity ward, named ostentatiously for the president's wife - very impressive indeed. Wide white spaces, a dedicated OR for C-sections, and individual patient rooms, each armed with its own armada of emergency drugs. A giant reminder to encouarge breast feeding was painted in foot-high letters, high on the wall, and a clear list of prices for patients was tacked to the waiting room wall for all to read. (You can save 700 kwacha (about $5) by not coming in until the third stage of labor!) It was great to see it all. I could work there. I could do this.
So an interesting tour of a hospital working its way towards western standards, albeit a bit unevenly. But there are still a few features to remind visitors that no matter how high-tech the hospital gets, it's still smack in the middle of Malawi.
Today, for example, as the morning in clinic ended, we heard the definite sounds of drumming and harmonious wailing coming from the nearby hospital parking lot. Our chief Malawian dermatology officer, Mr. Jimmy, informed us that a member of the Chewa tribe had recently died in the hospital, and his fellow tribe members had come to collect him from the morgue. Since a hospital death can't be marked by the traditional dancing, singing, and music as it would in the countryside, the Chewa tribe has decided to bring the funeral to the hospital.
We watched, amid the crowd of non-Chewa hospital workers, as a chorus of blue-dressed women and accompanying drummers serenaded a trio of extraordinarily dressed dancers, each stomping and swirling and leaping to the music. Dancer outfits consisted of rather terrifying masks (a skull, an eye-less mass of feathers*) and then hundreds colorful strands of fabric tied to the body, which twisted behind them as they danced. Very, very cool. Not your usual hospital lunchtime.
*More sinister than you might think.
Yesterday, however, we got a personal tour of the hospital grounds from the Head Matron herself, a friendly woman dressed in a sharp blue suit with green/white epaulets and a matching tiny hat. Very stylish. She led us all over the grounds through the different wards, stopping to introduce us to various nurses, therapists, and doctors, most of whom offered just a "You are very welcome!", but some of whom offered mini tours of their own departments.
I've seen a number of hospitals in Tanzania during my time there, and I have to say that I was pretty impressed with Kamuzu Central Hospital, overall. In what seems to be a common architectural style for hospitals in hot, lower resource areas, most of the walkways between wards are open to the air - probably not the utmost in terms of sanitation, but definitely pleasant when you're walking through. Kamuzu has these covered walkways too, but the hospital was remarkably clean - we saw many folks engaged in active mopping as we walked by, and many the indoor areas were totally spotless, at least to my casual eye.
The actual quality of the care being offered seems to vary quite a bit depending on which ward you happened to be walking through. The general medicine ward, usually the most miserable and crazy place in any hospital, was somewhat disheartening: multiple patients to a dim room, a noteable absence of bednets, and frequent nursing shortages. (Just like University of Chicago, now that I think about it, though with rather dingier beds.) Then there were wards that had great potential but weren't quite living up to it just yet. We saw a fine dialysis unit, for example with at least eight modern machines - but all were broken, waiting to be fixed. Didn't look like any patients had been there in a while.
And then, the brand spankin' new maternity ward, named ostentatiously for the president's wife - very impressive indeed. Wide white spaces, a dedicated OR for C-sections, and individual patient rooms, each armed with its own armada of emergency drugs. A giant reminder to encouarge breast feeding was painted in foot-high letters, high on the wall, and a clear list of prices for patients was tacked to the waiting room wall for all to read. (You can save 700 kwacha (about $5) by not coming in until the third stage of labor!) It was great to see it all. I could work there. I could do this.
So an interesting tour of a hospital working its way towards western standards, albeit a bit unevenly. But there are still a few features to remind visitors that no matter how high-tech the hospital gets, it's still smack in the middle of Malawi.
Today, for example, as the morning in clinic ended, we heard the definite sounds of drumming and harmonious wailing coming from the nearby hospital parking lot. Our chief Malawian dermatology officer, Mr. Jimmy, informed us that a member of the Chewa tribe had recently died in the hospital, and his fellow tribe members had come to collect him from the morgue. Since a hospital death can't be marked by the traditional dancing, singing, and music as it would in the countryside, the Chewa tribe has decided to bring the funeral to the hospital.
We watched, amid the crowd of non-Chewa hospital workers, as a chorus of blue-dressed women and accompanying drummers serenaded a trio of extraordinarily dressed dancers, each stomping and swirling and leaping to the music. Dancer outfits consisted of rather terrifying masks (a skull, an eye-less mass of feathers*) and then hundreds colorful strands of fabric tied to the body, which twisted behind them as they danced. Very, very cool. Not your usual hospital lunchtime.
*More sinister than you might think.
Thursday, September 8, 2011
Adventures in Hummus
One 0f my medical school professors, who taught a global health course and had been all over the world, always joked that no matter how exotic a location he visited, there was only ever one question people asked when he came back: How was the food?
It's true. We're hungry hungry humans, and by golly we judge our own experiences and those of our friends by how tasty the lunches were. (The main thing patients at the University of Chicago talk about in their comment cards is how much they liked or hated their hospital food - not the nursing, or the surgeon's technique, but how over/under done their eggs were.)
So I always keep track of my culinary adventures when I'm abroad, in anticipation of conversations back home. But the truth is, I've been here nearly a week and I have no idea what Malawian food is like. The city streets are full of little rundown restaurants selling more greasy, less flavorful versions of Indian, Italian, and American food, and at home we're left to our own devices. Word on the street is that the native meal involves a lot of cassava, but I've only seen that once since arriving - on the plate of a fellow med student at the hospital canteen.
I can, however, tell you of my new found appreciation for all the cooks out there who work from primary ingredients. Take my dinner today, for example: hummus and carrots.
In Chicago, carrots and hummus for dinner involves walking to the grocery store 50 yards from my apartment, buying a bag of baby carrots and a tub of hummus (Garlic Lover's), then returning to my home to eat them in peace. My only difficulty, if any, is getting off that little plastic cover over the hummus. Sometimes it rips and comes off in two pieces. Tragedy.
In Lilongwe, hummus and carrots for dinner is actually a two-day undertaking. Getting the hummus itself ready involves:
1) walking over potholes to the local market, dodging the young men at the corner who want to chat you up;
2) discovering no one sells canned chickpeas, and opting for a huge bag of dried chickpeas instead, then waiting patiently to buy them when the power goes out in the whole indoor market and everyone waits around in pitch black for a bit;
3) taking those chickpeas home and dumping them in water to soak overnight, then draining those chickpeas the next evening to discover many tiny dead and dried bugs floating among your peas;
4) plucking the bugs out one by one, boiling the peas for an hour while mashing the tiniest garlic cloves you've ever seen and deciding that plain yogurt could pass for tahini;
5) deciding that you yourself are the "food processor" mentioned in the recipe and mashing peas with the bottom of a cup until your arm hurts; and
6) resolving that "chunky" is a perfectly good adjective for hummus and sitting down at last for dinner.
Only six short steps! Carrot procurement is not quite as involved, but involves more dodging of young men trying to sell you things and more haggling in an arena where you have no idea what things should actually cost.
So hat tip to all those ladies of old (and of current) who make much more complicated things every day for a much more demanding audience. I'll probably try a few more cooking adventures before I return home, but more likely my future meals will involve quite a bit of peel-able fruit and prepackaged crackers. Solid options.
It's true. We're hungry hungry humans, and by golly we judge our own experiences and those of our friends by how tasty the lunches were. (The main thing patients at the University of Chicago talk about in their comment cards is how much they liked or hated their hospital food - not the nursing, or the surgeon's technique, but how over/under done their eggs were.)
So I always keep track of my culinary adventures when I'm abroad, in anticipation of conversations back home. But the truth is, I've been here nearly a week and I have no idea what Malawian food is like. The city streets are full of little rundown restaurants selling more greasy, less flavorful versions of Indian, Italian, and American food, and at home we're left to our own devices. Word on the street is that the native meal involves a lot of cassava, but I've only seen that once since arriving - on the plate of a fellow med student at the hospital canteen.
I can, however, tell you of my new found appreciation for all the cooks out there who work from primary ingredients. Take my dinner today, for example: hummus and carrots.
In Chicago, carrots and hummus for dinner involves walking to the grocery store 50 yards from my apartment, buying a bag of baby carrots and a tub of hummus (Garlic Lover's), then returning to my home to eat them in peace. My only difficulty, if any, is getting off that little plastic cover over the hummus. Sometimes it rips and comes off in two pieces. Tragedy.
In Lilongwe, hummus and carrots for dinner is actually a two-day undertaking. Getting the hummus itself ready involves:
1) walking over potholes to the local market, dodging the young men at the corner who want to chat you up;
2) discovering no one sells canned chickpeas, and opting for a huge bag of dried chickpeas instead, then waiting patiently to buy them when the power goes out in the whole indoor market and everyone waits around in pitch black for a bit;
3) taking those chickpeas home and dumping them in water to soak overnight, then draining those chickpeas the next evening to discover many tiny dead and dried bugs floating among your peas;
4) plucking the bugs out one by one, boiling the peas for an hour while mashing the tiniest garlic cloves you've ever seen and deciding that plain yogurt could pass for tahini;
5) deciding that you yourself are the "food processor" mentioned in the recipe and mashing peas with the bottom of a cup until your arm hurts; and
6) resolving that "chunky" is a perfectly good adjective for hummus and sitting down at last for dinner.
Only six short steps! Carrot procurement is not quite as involved, but involves more dodging of young men trying to sell you things and more haggling in an arena where you have no idea what things should actually cost.
So hat tip to all those ladies of old (and of current) who make much more complicated things every day for a much more demanding audience. I'll probably try a few more cooking adventures before I return home, but more likely my future meals will involve quite a bit of peel-able fruit and prepackaged crackers. Solid options.
Wednesday, September 7, 2011
Explanations
It occurs to me, for any readers I have that aren't Mom (do they exist?), that I should explain what exactly I'm doing here in the "Warm Heart of Africa". (Great country motto.) Several months ago, when I was still mincing around on the fence between Ob-Gyn and dermatology as a future career, I set up a three-week away rotation in "Infectious Dermatology" here in Malawi. It's run by a young dermatologist from U of C who specializes in dermatology in developing regions, particularly East Africa and her native Pakistan. She is, as you might suspect, sort of a badass.
I realized after my dermatology rotation at U of C that derm wasn't the right route for me; women's health stuff just calls my name/pulls my heartstrings/pushes my buttons in a way that no other field really does. But hey - I'd already applied for and been accepted to the program, Pritzker had graciously agreed to pay my way, and I still think derm is pretty neat-o. And it even fit my schedule perfectly.
So off I went and here I am. The other med students here all want to be dermatologists when they grow up (with the possible exception of one second-year student, who I may be slowly winning over to Ob-Gyn), but luckily the learning curve in our clinic is so steep that the slight experience advantage they'd have at home is totally wiped out here. There was never any chance that any American medical student, even a gung-ho derm one, would ever recognize zinc deficiency on the first go 'round.
One thing I have come to appreciate, however, is how uniquely suited dermatologists are to short global health missions in developing regions. Unlike other specialties, where you really need to 1) know the patient's history (Does it hurt? When? How long has it been going on? etc.) and 2) be able to follow up with the patient (prenatal visits, blood pressure checks, etc.), dermatology needs none of that. It's all in the visuals. Dr. Sethi doesn't speak much Chichewa - and she doesn't need to. She simply takes a look at a patient's rash, asks whether it hurts and/or itches, and can make a diagnosis in 90% of the cases. It's great to watch. And I imagine most American dermatologists could do the same, with a little practice - it's a speciality that is uniquely visually oriented. I remember a colleague of my Dad's, a dermatologist who often bemoaned the fact that his patients wanted him to talk to them. Why bother? He knew within the first seven seconds what the problem was and how to treat it.
So lots of potential for global health involvement for any young dermatologists out there. It's not enough to turn my head - just love those ovaries! - but I can definitely appreciate the appeal.
I realized after my dermatology rotation at U of C that derm wasn't the right route for me; women's health stuff just calls my name/pulls my heartstrings/pushes my buttons in a way that no other field really does. But hey - I'd already applied for and been accepted to the program, Pritzker had graciously agreed to pay my way, and I still think derm is pretty neat-o. And it even fit my schedule perfectly.
So off I went and here I am. The other med students here all want to be dermatologists when they grow up (with the possible exception of one second-year student, who I may be slowly winning over to Ob-Gyn), but luckily the learning curve in our clinic is so steep that the slight experience advantage they'd have at home is totally wiped out here. There was never any chance that any American medical student, even a gung-ho derm one, would ever recognize zinc deficiency on the first go 'round.
One thing I have come to appreciate, however, is how uniquely suited dermatologists are to short global health missions in developing regions. Unlike other specialties, where you really need to 1) know the patient's history (Does it hurt? When? How long has it been going on? etc.) and 2) be able to follow up with the patient (prenatal visits, blood pressure checks, etc.), dermatology needs none of that. It's all in the visuals. Dr. Sethi doesn't speak much Chichewa - and she doesn't need to. She simply takes a look at a patient's rash, asks whether it hurts and/or itches, and can make a diagnosis in 90% of the cases. It's great to watch. And I imagine most American dermatologists could do the same, with a little practice - it's a speciality that is uniquely visually oriented. I remember a colleague of my Dad's, a dermatologist who often bemoaned the fact that his patients wanted him to talk to them. Why bother? He knew within the first seven seconds what the problem was and how to treat it.
So lots of potential for global health involvement for any young dermatologists out there. It's not enough to turn my head - just love those ovaries! - but I can definitely appreciate the appeal.
Monday, September 5, 2011
The Skin-ny
So back in East Africa, and realizing, sort of surprisingly, that I am not quite the same person I was two years ago. And realizing, also, that I recognize many things here, things that I didn't even remember making a mental note of. These didn't make the "final cut" of my memories of Tanzania, so I hadn't really thought about the orange-red color of the dust, or the way every little corner store sells chips and chicken as a combo meal, or the way you have to haggle for some things (tomatoes) but not for others (cell phone minutes).
But now it all comes rushing back. It's couched in a quite different context - I'm among other Americans, in a much cushier living situation, and I seem to know a bit more medicine - but I do like feeling, for once, that not everything is completely new. Yesterday, when I broke my sandal on the first walk through town? Didn't even blink an eye. Walked right over to the corner market and found the shoefixing guy that I KNEW would be there, because he'd always been there in Tanzania, who promptly repaired the sandal for the equivalent of $3. Done. Felt savvy.
But the big story today was our first trip to the Kamuzu Hospital Skin Clinic, where we six students, under the supervision of Dr. Sethi (from the University of Chicago) and the Malawian dermatology officers, see any and all patients that care to show up on a given day. Queueing outside the clinic appears to begin well before we arrive at 9, and continues until we either run out of patients or run out of natural light. (No electricity in the clinic.) A bit of somewhat organized chaos seems to be the order of things.
But exciting! I emerged today having seen several patients with skin conditions I'd only ever read about in textbooks before - most notably pellagra, which truly hasn't existed in the US since the 1930s. It's like seeing someone riding a pennyfarthing bicycle - except, you know, a rather miserable condition that'd could only happen to someone suffering from some serious malnutrition. Amazing and a bit disheartening at the same time.
Looking forward to going back tomorrow. I VOW to recognize measles this time.
But now it all comes rushing back. It's couched in a quite different context - I'm among other Americans, in a much cushier living situation, and I seem to know a bit more medicine - but I do like feeling, for once, that not everything is completely new. Yesterday, when I broke my sandal on the first walk through town? Didn't even blink an eye. Walked right over to the corner market and found the shoefixing guy that I KNEW would be there, because he'd always been there in Tanzania, who promptly repaired the sandal for the equivalent of $3. Done. Felt savvy.
But the big story today was our first trip to the Kamuzu Hospital Skin Clinic, where we six students, under the supervision of Dr. Sethi (from the University of Chicago) and the Malawian dermatology officers, see any and all patients that care to show up on a given day. Queueing outside the clinic appears to begin well before we arrive at 9, and continues until we either run out of patients or run out of natural light. (No electricity in the clinic.) A bit of somewhat organized chaos seems to be the order of things.
But exciting! I emerged today having seen several patients with skin conditions I'd only ever read about in textbooks before - most notably pellagra, which truly hasn't existed in the US since the 1930s. It's like seeing someone riding a pennyfarthing bicycle - except, you know, a rather miserable condition that'd could only happen to someone suffering from some serious malnutrition. Amazing and a bit disheartening at the same time.
Looking forward to going back tomorrow. I VOW to recognize measles this time.
Sunday, September 4, 2011
Moni Moni
Chicago to Ottawa to London to Addis Ababa and finally here, touched down safe in Lilongwe. Beautiful scenery out the window on the final leg over East Africa - our pilot kindly pointed out Mount Kilimanjaro as we flew over, a dark spike from the the earth topped in a dollop of fancy clouds.
More impressions later, but so far, expecting the living to be both 1) easy, and 2) a little less exciting than previous trips of this nature. Already chafing a bit at the restriction to not leave the guesthouse without accompaniment...what's a mzungu to do without the chance to do some solo random wandering and get pointed at by small children?
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