Kasese, retiring "Hello Kitty" and wrapping it up until October's journey

After the wonderful rest in Msundwe, a hardy breakfast, and a tour of the clinic and construction, we regretfully leave for the airport in Lilongwe.  Other than the prolonged layover in Nairobi, the journey is tiring but uneventful.  Haley and I spend the weekend in London for R&R and made it back early Sunday afternoon.

A few people have asked about the clinic site we stopped by on our first day.  There is a clinic and hospital that was built and run by a Canadian NGO for several years in the village of Kasese.  They had to concentrate their efforts elsewhere and therefor it is no longer operating at anywhere near full capacity.  They are looking to sell or lease, and Orant Charities is looking for ways to expand and establish itself in the Kasungu area.  The site is several acres with nicely spaced buildings that include clinic, hospital, and housing.  It seems to be starting to fall into some disrepair, and there also appeared to be some squatters that are moving in.  The location is about 30-40 min from Bowe.

Hospital building in Kasese.

Clinic building in Kasese.

                                            It will be exciting to see what the future holds.

I think it is time for me to retire "Hello Kitty".  Some of you know that many years ago, about 18, I believe, I bought a hot pink Hello Kitty backpack at Target for a family vacation to the beach.  My kids were totally embarrassed, but it was perfect - inexpensive, roomy, conspicuous (so not likely to be stolen) and durable appearing.  Plus, it had a small clear pouch in which to put things you wanted to find easily.   This little Target back pack has since been with me to a multitude of destinations across the country and the world for camping trips, vacations, family visits and mission trips.  It's been so long, that Hello Kitty is back "in".  Just before this trip, I reinforced all the strap insertions, and although those are holding the different seems are unraveling.  Funny how a silly inexpensive article can come to represent so many journeys taken.  I'm a little sad.

"Hello Kitty" on my office chair in in Malawi.

It's been another great journey, and I am already planning to return in late October.  In the meantime, back to our "real world".  At least now I know there are many other types of "real worlds" out here.  Find one to share.  It will change you for the better.

The most innovative person I have ever met.

After checking out of our place at the lake, we head to meet and spend the night with a couple who run an NGO called Child Legacy International. These are people Ray knows so I'm feeling a little weird about the whole thing. We have been told that Jeff came to Africa on a mission trip many years ago and was hooked. He met and married a woman from Zimbabwe. I'm not sure about the chronology, but they have lived and worked in both Boerne, TX and Africa. When they had to leave Zimbabwe, they founded a mission in Malawi and have helped with water well drilling and repair, hunger relief and medical care.

We drive through Lilongwe out to the village of Msundwe. I think we are all getting a little nervous because it appears we are driving to nowhere. It is dry, dusty and relatively desolate. There are dilapidated huts, concerned looking villagers, dense smoke from cookfires, and mosquito breeding ponds. Then all of a sudden we round a bend in the road and see a tall chain link security fence behind which are rows of pine trees, then rows of banana trees, then rows of mango trees. It was beautiful!

Once we enter the compound, the grounds are immaculate, with painted buildings, a giant vegetable garden, a huge tilapia farming pond and fingerling nursery, a mess hall, a clinic and I could go on. And it's ALL WIND AND SOLAR POWERED!!! Including the water pumps, water heaters, and electric lights.

We sat on the patio beside the outdoor fireplace, and listened to the story of Jeff's journey in Africa and in Malawi as we enjoyed a cold beer. His NGO is Child Legacy and in addition to what they have already built, they are constructing a women and children's healthcare facility that should be completed before the next rainy season starts in November. The cook there prepared a wonderful meal, then we had hot showers, and a great nights sleep in comfortable beds. We were all so impressed at what this couple has been able to accomplish since they began there in 2006. Obviously, they have cultivated a lot of support, but still!

Beautiful and claimed from the African bush.

The entrance to our rooms. 

Man made tilapia pond that can hold up to 5,000 fish for harvest.

Morning mist at sunrise in the jungle.

Solar panels, wind towers and beauty.

The patio outside the mess hall.  Nicely done!

Off to Salima...

The welding instructor stopped by this morning and is remarkably improved. The swelling is reduced by at least 50% and he was able to move his thumb, which had been impossible 3 days before. He was also in much less pain and very grateful. In a place like Malawi, an infection like this one could have caused him to lose his livelihood. Thank goodness we were here.   I hope we are able to get some kind of follow up on the little girl with the apparent skin cancer and the little boy with the large tumor on his cheek.

I was so sad to say goodbye to Big E Tuesday morning. He knew I was wearing my sunglasses so he wouldn't see my tears. It felt like I was leaving family. Then as we were heading toward Lilongwe, and just as my sniffles were drying up, Ray gets pulled over at a speed trap. There are police officers standing in the middle of the M1to slow traffic. There is an officer on the side of the road with a primitive radar gun turning back and forth to oncoming traffic from both directions supposedly clocking speeds. They appear to be randomly flagging cars over and then letting some of them pass. A stern police woman walks up, looks the car over, then looks us over. She proceeds to tell Ray he was doing 65 km/hr in a 30 km/hr zone. Ray attempts to argue (because there really is no way we were going that fast) but then says “Just tell me what I have to do to pass”. The answer “Pay the fine.” There was no ticket or record of the offense. He goes to the makeshift office and pays 5000 kwacha which is about $15, does not get a receipt and we are allowed to drive off. The only way to explain away this event was “TIA” which means “This is Africa”.

So we head off for Salima, a town on the west shore of Lake Malawi. Lake Malawi makes up about one fourth of the country and is the third largest lake in the world. We had been booked to stay at a place called the Red Zebra Resort, which was established by a British couple three or four decades ago. The family runs a bed and breakfast of sorts, but the main business is harvesting cychlids from the lake and shipping them to other countries for sale in aquarium shops. They ship most of the fish to China.

When we arrived, we found that the Malawi military, who is conducting drills nearby, had booked the entire place for their officers. We were moved to the Wheelhouse Resort on the next property over. It was very nice with the rooms right next to the water. Lake Malawi is so large it has a tide. So we fell asleep to and woke up to the sound of the waves. (I found this so much more pleasant than the banging of the pipe on the pole or the rooster crowing.)

On Wednesday morning we went into the village to the market stalls to shop for gifts and souvenirs. This experience can be really stressful because there is a great deal of competition among the vendors, we know how poor the people are here, and we know they jack up the prices when they see the mzungus coming. All in all, I think we did okay and so did the sellers. I guess that's fair.

Monday in Bowe

Today Ray and John went into Lilongwe on Orant business while Grace, Mel, Haley and I ran the clinic here in Bowe with the help of Timeyo, Moses, Stefano and Steven, our translators. All four of these men have been helping the community here by helping the priests with their work for quite some time - as long as 5 years I would say.

Most of the patients today had relatively minor problems or were there to follow up. We did not see the welding instructor with the hand injury so I will have to ask Father Emmanuel how to find him. Grace did see a 9 year old boy with the most advanced scoliosis I believe I've ever seen. His torso was so contorted I'm sure at least one of his lungs can no longer fill completely. We will have to brainstorm on how to network and possibly find funding and care for him.

In addition to holding our last clinic, we had to inventory the medications in our pharmacy so the next team can order. Haley and Mel got a headstart on that after lunch so things were pretty much wrapped up by 5:00 pm.

We were enjoying a cold beer and sharing photos when the power went out for the second time of the day. Then, when it was almost too dark for me to be able to recognize them, in walk Fathers Levinius and Joseph. I had given up on seeing them this trip since we leave on Tuesday. They had come for a meeting with the priests here to plan for the dedication of the new mission in Kelembe. The dedication is planned for the end of the month and folks are coming from far and wide.

In addition, they surprised us with an 11 year old patient and his mother. Apparently, Father Levinius had seen him playing outside the other day and stopped to meet him and his family. This child has a growth the size of a softball in his right cheek. They said it had been growing since he was 3. Grace and I are pretty sure it is benign, but a referral to the hospital in Lilongwe will be needed for imaging and treatment. They were given food, and a place to sleep and will be taken home early in the morning when the priests return to Kelembe.

This is our last night here at the mission. Tuesday morning we leave for some shopping and a night at a hotel near Lake Malawi. This will be the first time I have not worked up until the last minute while here. Ray says we will not have internet again until the airport in Nairobi Wednesday afternoon. Our layover there is several hours before our overnight flight to London.

Will update then.

My Malawi Baptism...

Mass here in Bowe today was held outdoors. I was a little worried about this because the malaria prophylaxis I am taking causes sensitivity to the sun. Last October, even though I sat in the shade, I got a substantial sunburn. But this morning I slathered on the sunscreen and a long sleeved light weight shirt, found a prime seat in the shade and proceeded to be impressed once again. I have always heard the term “to celebrate the Mass”. Here they literally celebrate the Mass. There is singing, drums beating, and dancing at virtually every possible break. Haley and I were the only members of the team that lasted the whole 2 ½ hours. For me, it's as much a cultural experience as a worship experience. For Haley, it was also a social experience. As the time wore on the children around gradually worked up the courage to get closer and closer to her. With her welcoming smile reassuring them, by the end of the Mass, she was surrounded by at least a dozen little ones – one in her lap, another sharing her chair and one leaning on her sound asleep. Just beautiful!

Haley and her fan club.

We had a lunch of pasta, meat sauce and fresh cucumbers. Dingiri and Mr. Mbombo work here cooking, cleaning and generally taking care of the priests. (Dingiri is our nursing student, Temwa's, older sister.) They often cook foods that they believe are more like we eat at home and do a very respectable job. It was delicious.

The other times I have visitied here, we have had leisure time on Sunday afternoon.

I wasn't sure what to expect today as Big E, Ray and John had arranged to repair a couple of nearby water wells and invited/expected us to participate. Orant charities started their work here several years ago with the drilling and repairing of wells. It seems the people here need almost everything they are so poor, but what good is food, medicine or clothing if you don't have water?

The first village was only about 10 km from the mission compound. We loaded up the supplies and off we went. I am really clueless when it comes to almost anything that involves engineering or physics so I wasn't sure how I could possibly help. Well, physics and engineering aside, well repair involves some manual labor which I could contribute. I don't know the names of all the things we used, but we had to force little rubber ring things onto these long skinny rods that had hooks and eyes. Also the ends of the pipes had to be sanded. While Grace, Mel, Haley and I worked at this, Ray and John had Timeyo summon the village committee organized to maintain and repair the well in the future. The men disassembled the pump housing and removed it. The old hook and eye rods were removed all the way down to the last one which was holding a little ball with a rubber ring around it. Apparently “the seal” was worn out and this prevents the pressure from being able to build and force the water up through the pipe.

Then came the first exciting part. The PVC pipe had to be removed and this has to be done without breaking off and losing any or the well is lost. So the men pulled the water filled pipe up until it was high enough to lean. It is then manually sawed off a section at a time while the men desperately hold the lower pipe so as not to lose it. Haley was the first to receive what Orant calls her “Malawi baptism”. As the pipe is cut, all the water sprays as you saw. There was enough pipe for all four of the women in our group to be baptized twice. Haley and Mel are young and made easy work of it. Fortunately, my regular exercise paid off and I had no trouble either. Even Grace, who insists she does not do manual labor, couldn't resist.

My Malawi baptism.

Children gathered to observe the work on the well.

Haley's Malawi baptism.

The new pipe was sealed a piece at a time and lowered carefully so as not to drop it and ruin everything. Once it reached the correct depth the rods were dropped down into the water below and the housing was replaced. You could see the gathered crowd of villagers hold their breath as the pumping began and then the relief and joy when the fresh clear water gushed out. The women began dancing and singing and all the kids wanted to have a turn pumping. This well had been broken for five months and the people were getting their water from a stream a few kilometers away.

Dancing in celebration of the clean water from the repaired well.

During the course of this event, the men were taught how the well works and how to repair it. We also gave a 5 minute lecture on hygeine, clean water and the prevention of illness. We were thanked by the village chief and given a chicken and a large ration of maize flower.

The second well repair went faster because we now knew what to do and the men there knew how to help. Also, the sun was setting and it was rapidly cooling down. We left the sawing honors to Ray and the entire repair took only about an hour and a half. Lo and behold, the children who were so attracted to Haley at Mass this morning lived in this village so there was much laughing and picture taking while the men worked.

I'd say all in all, an exceptional day.

Saturday in Chimajoro...

I am so excited! Maria, Temwa and Gloria are here. They are the nursing students I have worked with on my other trips. They went with us to Chimajoro today and it made a huge difference in our efficiency. This was a great help and on the perfect day. We have found out that the last couple of teams have set aside a night to barbecue for the group we work with. Haley, who grew up on a ranch, and therefor grew up cooking outside has acceped the challenge. I was her assistant. We needed to get back early in order to have time to prepare the feast.

Maria helping us with triage.

Haley, Mel and John setting up the pharmacy.

L to R.  Maria, Temwa and Gloria.

I decided to sleep in this morning rather than go to mass, but although I did not attend, I did not sleep in. As soon as the choir started, which I can hear from my room, God had a rooster perch right outside my window and crow every 2-3 minutes until additional sleep was hopeless.

Today was no different in that there were patients waiting to be seen after Mass and before we left for the village. We told everyone we would be holding clinic here in Bowe on Monday and to return then. Everyone but one. The welding instructor at the mission's trade school had sustained a puncture wound with a piece of metal to the thumb pad of his right hand. Father had given him money to go to the hospital which he said he had done. They gave him paracetamol which is like acetaminophen or Tylenol. His thumb was so swollen, red and tender that it looked like a sausage with the skin peeling off. At home he would be seeing a hand surgeon I'm sure. We again have antibiotics we were able to provide. When he was told he would be receiving an injection in the hip (as well as oral antiotics) his pupils dilated and he looked as if he might faint. He took it like a champ though and we look forward to seeing him again tomorrow to find out if it has improved.

Chimajoro was the most primitive village we have visited. We held our clinic in the worship space. We were more organized with our triaging and again we saw some very ill folks. I saw a young man who had had an abscessed molar removed last week without the benefit of any antibiotic treatment. Unfortunately the abcess had been so advanced that it began draining through his lower jaw. We do have a a pretty good armamentarium of antibiotics, so hopefully with treatment he will not develop a fistula, which is a chronic non-healing tunnel. We also saw a 4 year old albino child with a terrible sore on the back of her neck that appeared to be an advanced basal cell cancer. This is a type of cancer caused by sun damage to the skin. Ray Misomali, Orant's director and one of our team members, was able to contact the hospital in Lilongwe and Dr. Grace Stewart spoke with the doctor there. They have agreed to accept and care for her and Orant will pay the fees. There does not seem to be the stigma of being albino here as in some other African countries where they are thought to be witches or are killed for body parts which are then used by witch doctors for magic and potions.

Private examination room.  Bring your own flashlight. 

Bringing the family to be checked by the visiting doctors. 

Timeyo buys papaya from a villager. 

Kids will be kids for the camera! 

Young mother who is very proud of her healthy child.

Mel, with Stefano interpreting, cares for a patient.

We returned to the mission and Timeyo built a barbecue pit of bricks. John Turner, the Orant board member with us, had gone to town with Big E and they had a welder make a spit out of rebar. The menu was cabrito, red beans and roasted root vegetables. They were surprised that we asked that the goat be skinned. They apparently just cook the hair off in the fire. I cannot imagine that helping the flavor. It took longer than we planned or hoped for the meat to cook but there was plenty of beer so it was just fine. Then we had the best time eating and visiting and the meal was a hit. We brined the meat then made a garlic and seasoned salt rub with some Tony's thrown in. We had so much fun, even Big was dancing before the night was over.

Although we have been working very hard, I am thoroughly enjoying sharing this adventure with Haley. She seems to be embracing every aspect of the culture and experience. I am also enjoying very much seeing the friends I have made here.

Friday in the village of Zifa...

Each morning Mass is at 6:00 am. The “church bell” is the banging of a pipe on a flagpole. Today was the Feast Day of the Sacred Heart and I wish I had recorded the singing of the men at the service. The African harmony is so different and soothing.

Now that they know we are here, there are usually a few patients waiting to be seen by us before breakfast. Today there was only one. We loaded up the additional medications we needed and headed off to Zifa. The distance was shorter than yesterday, but the road was worse. I really thought we were gonna roll a couple of times, but I was told I was overreacting.

We held the clinic in a classroom at the school located there. Of course this was very exciting for the students which made it in turn exciting for the teachers. We learned that one white person is a “mzungu” and more than one is “azungu”. We heard “azungu” often today. As I explained last year, mzungu literally means wanderer or journeyer.

Haley in her pharmacy.

There was a small group of patients waiting upon our arrival which continued to grow throughout the day. And today was the first time ever in my life I have performed a history and physical exam in the back of an ox cart – while it was still hooked up to the oxen. I have photos to prove it. A dear family had loaded up their 90 year old patriarch to see us. He had stopped eating and drinking a week earlier and was very dehydrated. We really had nothing to offer other than oral hydration fluids to encourage. Grace, the other physician on the trip helped me with the assessment. The gentlemen aroused somewhat during the time and I'm hoping seeing two mzungus hovering over him didn't scare the rest of the life out of him.

Patient brought in his family's ox cart.

My office in Zifa.

Coming to see the mzungu doctors.

Haley diligently working in her pharmacy to prepare medications for those waiting.

Patients waiting for medications.

We ended up seeing about 150 patients again and had many waiting to be seen, when we left. We saw some really ill children as well. One was a 12 year old with full blown AIDS. He had been diagnosed with HIV for some time but for some reason, his mother had not taken him for follow up and medications. She was also HIV positive and his father died from AIDS a couple of years ago. I saw another child with chronic ear infections and pus draining from her ears. She had been seen at the hospital, but had been given no medication – because there wasn't any to give.

We ended the day with dinner and conversation.  We have been trying to debrief each day about how to better approach our work.  

First mission day accomplished

I cannot believe I left on Monday and it's now Thursday, and this is the first time I've had time, energy and internet to write a post.

Our 4:30 flight from Dallas left at 8:30, so we arrived in London around 11:00 am. We hooked up with Dr. Grace Stewart, from Phoenix, hired a cab, and went to the Tower of London for a tour. My niece, Haley, had this on her London “bucket list” and since she got her passport so she could make this journey, we deferred to her.

Even though I had seen them before, I was mesmerized by the Crown Jewels again.

We hooked up with Mel(issa) Beathard, RN, on our flight and our team was complete. Overnight to Nairobi, then a couple hour flight to Lilongwe got us here about 9 am Wednesday. But, we had to go into town to pick up supplies, we ate pizza of all things for lunch, then stopped to tour a potential clinic site for a bit. We were so tired by the time we arrived at the mission, we showered, ate dinner, drank one beer and were asleep by 8:30 pm.

I am so happy that I have learned to make this crazy long journey without decompensating. Even though I was tired, I was ready to work today. The trip to the village was pretty rough. The road was very dusty and very uneven. There was also heavy bicycle and foot traffic. Big E (Father Emmanuel) said the road made even people who usually don't, dance.

It has been great to see Big E and Little E.

We saw about 150 patients today in the village of Mayira (mah-yee-rah). We used a classroom for our clinic, and the school children were so excited to see us there. I met one of the teachers. Her name is Princess and her English is very good. When I asked her about the school she said there were about 500 students and in her class, there were “104 students against one teacher”.

Well, I did forget the correct cable to load my pics on this laptop, so will start using my iPhone in order to share.  Less fun without them. Sorry.