It is good to be home. Strangely the thing that is really hard for me to get use to, is the cold. The six weeks I was away only added up to about 4 days of cool weather. It was hot in Lilongwe and hot in Nairobi. I had a 6 hour layover in Nairobi. They do not have air conditioning in the airport. I didn't take a jacket for the plane because I have been so hot. When I heard it snowed in Denver, I still wasn't too concerned till I hit Amsterdam and felt the cold. I e-mailed Kathy to throw in a jacket for the ride home. The trip home was around 36 hours, that does not include the four hour drive from Mzuzu to Lilongwe that we did on Friday. As we were driving down I was thankful we didn't do the drive the same day we were to leave. The trip home would have been over 40 hours of travel.
The ride down from Mzuzu had some interesting moments. The roasted mice vendors were out, some of the MMs wanted to take pictures so we stopped. They waved a little money at them to compensate for letting their picture be taken. I didn't get a picture, it is pretty gross. The mouse vendor probably made more money having his picture taken then selling roasted mice.
Then there were the funny signs ....
DEAD SLOW
ENERGY COFFINS 24 hours
HOPEFUL SHOPPING
We laugh at the way they say things but they think we are pretty weird too.
Tuesday, October 13, 2009
Thursday, October 8, 2009
It's All a Blur
The week is a blur. All told we probably saw over 1300 people. I have very mixed emotions about the clinic. It all seemed so hectic. As I said it lacked organization and efforts to organize seem to lead to some new problem. The very sweet people at the registration desk would add people without permission, the gatekeeper was letting people in and they were being registered. You would say stop and they kept sending people to be triaged. I need to gather my thoughts. The volunteers were wonderful people but they lacked experience and there just weren't enough people to provide the direction they needed.
I have a hard time understanding why anyone would wait in line and sit in the sun all day because they have headaches or joint pain. Then I remembered the year in the US when everyone was panicked about no flu vaccine only to see all the old people standing out in the cold to get flu vaccine. It makes no sense, but then you wonder about the "free" health care they have here. As I understand it was better before China came in with money.
We did see some very sick people. The thing that is hardest to see is the beautiful faces of the babies knowing what a sad life lies before them. Many of the children we saw were undernourished and small for their age. People in their 60s looked like they were in their 90s. Then their were some elderly people who were real characters and made you laugh. The people were grateful that we saw them, never mind that it felt like an assembly line. There were people that came from long distances. There was a man who walked for 5 hours. He was delighted that we had glasses that we could give him. There were many cases of HIV and malaria.
It's hard to believe that the clinic is over. We enjoyed wonderful dinners with the ROS staff. They are wonderful caring people that we will leave behind to carrying on.
I can hardly believe I will have been away from home for 6 weeks. I am not sure what home even feels like anymore. I just want a hot shower, to soak in a warm bath, clean up. They are sending us home with Malaria medicine.
Tomorrow we head for Lilongwe and will spend the night. Saturday, 2 of us leave for home, 2 for a Safari and 1 to Nairobi, Elaine will have a short respite before heading home to California.
Will I do this again? Probably.
I have a hard time understanding why anyone would wait in line and sit in the sun all day because they have headaches or joint pain. Then I remembered the year in the US when everyone was panicked about no flu vaccine only to see all the old people standing out in the cold to get flu vaccine. It makes no sense, but then you wonder about the "free" health care they have here. As I understand it was better before China came in with money.
We did see some very sick people. The thing that is hardest to see is the beautiful faces of the babies knowing what a sad life lies before them. Many of the children we saw were undernourished and small for their age. People in their 60s looked like they were in their 90s. Then their were some elderly people who were real characters and made you laugh. The people were grateful that we saw them, never mind that it felt like an assembly line. There were people that came from long distances. There was a man who walked for 5 hours. He was delighted that we had glasses that we could give him. There were many cases of HIV and malaria.
It's hard to believe that the clinic is over. We enjoyed wonderful dinners with the ROS staff. They are wonderful caring people that we will leave behind to carrying on.
I can hardly believe I will have been away from home for 6 weeks. I am not sure what home even feels like anymore. I just want a hot shower, to soak in a warm bath, clean up. They are sending us home with Malaria medicine.
Tomorrow we head for Lilongwe and will spend the night. Saturday, 2 of us leave for home, 2 for a Safari and 1 to Nairobi, Elaine will have a short respite before heading home to California.
Will I do this again? Probably.
Monday, October 5, 2009
Another Day
I am losing track of the numbers of people we have seen. It seems endless here. This is not the most organized clinic I've been to, in fact it lacks organization more than anything else. Today the numbers edged into the 150s. Unfortunately, we lack people with the know how to locate patients that have been here before so there is little or no continuity in the care from previous clinics. The registration line is confusing at best. We have excellent translators but not enough of them. One of the nurses has had the role of lab technician, which she is managing very well. She just recently retired so her puncture skills are good. The whole clinic seems overwhelming at times.
One big problem is that the people are hard to screen as they are all sick. We have seen many small babies, then on the other end of the spectrum the really old. How do you say no to a sick baby or an old person who has walked many miles or been waiting from the wee hours of the morning? In the morning there must have been close to 300 people at the gate.
Only 3 days left. I am still wondering how we made it through friday. I am tired.
One big problem is that the people are hard to screen as they are all sick. We have seen many small babies, then on the other end of the spectrum the really old. How do you say no to a sick baby or an old person who has walked many miles or been waiting from the wee hours of the morning? In the morning there must have been close to 300 people at the gate.
Only 3 days left. I am still wondering how we made it through friday. I am tired.
Lake Malawi
Saturday, A beautiful trip to Lake Malawi for lunch. Lake Malawi is about 1 1/2 hours away. It is a deep lake about half the size of Lake Michigan. The water is blue with white sand. It is in the middle of nowhere, a two lane paved road with lots of people walking along it. We passed rubber trees on the way. It was warm at the lake and I did roll up my slacks and wade in the water. We had a nice lunch with the ROS couple, Paul and Aileen, who drove us up. We stopped on the way up to shop at the wood carvers which are about a 1/2 hour drive before the lake. The woodwork is beautiful and we had to barter a price. I could have bought a lot if I would have let myself go wild. I hate to think how much this stuff would be sold for in the US. I 'm guessing some business person gives them less than half of what we pay and charges 3 times as much if not more. What is neat is that it is carved here not in China.
Sunday
A quiet day after church, brunch and some shopping at the pottery shop. Once again beautiful pottery made in Malawi.
Sunday
A quiet day after church, brunch and some shopping at the pottery shop. Once again beautiful pottery made in Malawi.
Sunday, October 4, 2009
A Day in the Life of a Malawi Medical Clinic
What a Day! We saw 193 patients today due to a miscommunication. The numbered tickets weren't confiscated so those thinking they were doing good added over 80 patients without the proper channels.
A lunch I heard we were up 150 patients, thinking we were almost finished triaging I found out we were up to 188.
To add to the already bludgeoning number a small boy with a temp of 104 showed up at the gate. Then the clinic coordinator asked me to check a women sitting at the gate. She had walked for 3 1/2 hours with a friend, stopping along the way to rest. She had a temperature of 102.5. The unfortunate diagnoses was that she was HIV positive, with a urinary tract infection, and malaria. There was no way we could ask those to return on Monday, nor was there any way we could change what already had been done.
It is not unusual to add people to the initial number of given tickets, some are reserved for the sick that show up at the gate. The late comers are to be screened instead of just being let in. We operate on a first come first served basis, many are at the gate by 6 am and already have waited a long time to be seen. We have a long line of people waiting for us to open the gate and give them that precious number.
This is a day I will not forget. It marks the highest number of patients see in one day. Interestingly, the number of patients seen in the Rafiki Medical clinics since about 2003 tops 44,000. We have already seen over 600 here and we have 4 more days to go. We start at 7:00 and try to end by 4:30 so our volunteers do not have to walk home in the dark. There is a bus that gets them to the clinic from Mzuzu, but they walk to the bus. Today, we managed to finish about 5:30.
The day was filled with sick individuals. Right before lunch a women came in carrying an 8 years old girl on her back. At first I thought it was a mentally disabled child. The child had a temperature of 103 . She had a ruptured appendix. She was rushed to a nearby hospital. Another acutely ill women with Aids was sent to the hospital. There were 3 near term pregnant women that showed up, one was immediately send on to the hospital. We are not in the business of delivering babies. There was an 5 year old orphan that was brought by his 8 year old brother who was carrying a 3 year old sibling. The grandmother was also with them. They are being screened for possible children for Rafiki.
What is really hard here is screening the really sick from those who are not so sick. They all look sick.
The eyes are sad, the children fearful. It is hard to get them to smile. They just watch you with those big sad eyes. So many of the people have vision problems. We fortunately came with a lot of reading glasses.
The reality of the day hit when we sat down for dinner. We were all very tired. We can only believe that what we saw as a mistake was God's providence for many of the people. Always faithful, God carried us through a tough day.
And ....... the moon was full!!!
A lunch I heard we were up 150 patients, thinking we were almost finished triaging I found out we were up to 188.
To add to the already bludgeoning number a small boy with a temp of 104 showed up at the gate. Then the clinic coordinator asked me to check a women sitting at the gate. She had walked for 3 1/2 hours with a friend, stopping along the way to rest. She had a temperature of 102.5. The unfortunate diagnoses was that she was HIV positive, with a urinary tract infection, and malaria. There was no way we could ask those to return on Monday, nor was there any way we could change what already had been done.
It is not unusual to add people to the initial number of given tickets, some are reserved for the sick that show up at the gate. The late comers are to be screened instead of just being let in. We operate on a first come first served basis, many are at the gate by 6 am and already have waited a long time to be seen. We have a long line of people waiting for us to open the gate and give them that precious number.
This is a day I will not forget. It marks the highest number of patients see in one day. Interestingly, the number of patients seen in the Rafiki Medical clinics since about 2003 tops 44,000. We have already seen over 600 here and we have 4 more days to go. We start at 7:00 and try to end by 4:30 so our volunteers do not have to walk home in the dark. There is a bus that gets them to the clinic from Mzuzu, but they walk to the bus. Today, we managed to finish about 5:30.
The day was filled with sick individuals. Right before lunch a women came in carrying an 8 years old girl on her back. At first I thought it was a mentally disabled child. The child had a temperature of 103 . She had a ruptured appendix. She was rushed to a nearby hospital. Another acutely ill women with Aids was sent to the hospital. There were 3 near term pregnant women that showed up, one was immediately send on to the hospital. We are not in the business of delivering babies. There was an 5 year old orphan that was brought by his 8 year old brother who was carrying a 3 year old sibling. The grandmother was also with them. They are being screened for possible children for Rafiki.
What is really hard here is screening the really sick from those who are not so sick. They all look sick.
The eyes are sad, the children fearful. It is hard to get them to smile. They just watch you with those big sad eyes. So many of the people have vision problems. We fortunately came with a lot of reading glasses.
The reality of the day hit when we sat down for dinner. We were all very tired. We can only believe that what we saw as a mistake was God's providence for many of the people. Always faithful, God carried us through a tough day.
And ....... the moon was full!!!
Thursday, October 1, 2009
3 Days Down, 5 to Go
The countdown begins. In a week and a half I will be back home. We have had 3 busy clinic days. So far we have seen just under 400 patients. This clinic is really different. One of my RNs was pulled to do lab so I am busy screening patients and trying to triage them also, fortunately there is help to keep the flow going. The translators are good, for a short while I did not have one so the one we had handled the translation for 2 nurses. There are a fair number of people here that speak good English.
What was good about the translations was they stuck to translating instead of having a long conversation with a patient then you got a short answer and also had to clarify what was being said then find out that you were totally off tract. We were kept very busy because we had 3 doctors that could see any of the patients. Most of the children were seen by Elaine and the other 2 providers saw most of the adults. This was definitely a benefit in moving the clinic forward.
The people here are really poor. We saw a lot of sick babies and kids, rashes, hypertension, coughs and fevers and even some typhoid fever.
Tuesday, it was warm, the past 2 mornings have been very cool. In the 4 plus weeks here I have regretted carrying heavier clothing. I needed them these past 2 days. Yesterday it rained really hard for about 10 minutes. They had a tent covering for the people waiting in the courtyard. It really changes one's perspective about waiting when you have been at a Medical Clinic here. We much to be thankful for.
The clinic here is about a mile from the guest house. We have been getting a ride to and from the clinic, yesterday we walked back along the village perimeter. We met the witch doctor, some kids demanding money. There was a fence between us and them. It is interesting to see kids and people come in who have been at the witch doctor, black strings tied around there wrists and ankles, or their waists.
We have been well taken care of here each evening we have been invited to dinner at one of the ROS homes. We have lunch at the dining hall, I was grateful that they decided to let us serve ourselves , they had been serving us too much. When you see under nourished people you do not want to waste food In other clinics they would serve African portions or mzungo (white person) portions. Which meant that they served larger portions to the national volunteers.
I am at a loss for words to express the emotions I feel being here. I know it will take me a long time to unpack this trip.
On a good note, Ethiopia got their first 2 children.
On a light note, one of the sights as we drove to the village on Sunday afternoon, was people selling roasted mice on a stick.
Good day and good night.
What was good about the translations was they stuck to translating instead of having a long conversation with a patient then you got a short answer and also had to clarify what was being said then find out that you were totally off tract. We were kept very busy because we had 3 doctors that could see any of the patients. Most of the children were seen by Elaine and the other 2 providers saw most of the adults. This was definitely a benefit in moving the clinic forward.
The people here are really poor. We saw a lot of sick babies and kids, rashes, hypertension, coughs and fevers and even some typhoid fever.
Tuesday, it was warm, the past 2 mornings have been very cool. In the 4 plus weeks here I have regretted carrying heavier clothing. I needed them these past 2 days. Yesterday it rained really hard for about 10 minutes. They had a tent covering for the people waiting in the courtyard. It really changes one's perspective about waiting when you have been at a Medical Clinic here. We much to be thankful for.
The clinic here is about a mile from the guest house. We have been getting a ride to and from the clinic, yesterday we walked back along the village perimeter. We met the witch doctor, some kids demanding money. There was a fence between us and them. It is interesting to see kids and people come in who have been at the witch doctor, black strings tied around there wrists and ankles, or their waists.
We have been well taken care of here each evening we have been invited to dinner at one of the ROS homes. We have lunch at the dining hall, I was grateful that they decided to let us serve ourselves , they had been serving us too much. When you see under nourished people you do not want to waste food In other clinics they would serve African portions or mzungo (white person) portions. Which meant that they served larger portions to the national volunteers.
I am at a loss for words to express the emotions I feel being here. I know it will take me a long time to unpack this trip.
On a good note, Ethiopia got their first 2 children.
On a light note, one of the sights as we drove to the village on Sunday afternoon, was people selling roasted mice on a stick.
Good day and good night.
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