Ochencheda, Chimwendo and the "shoe that grows"

I'll be darn if I didn't wake up because of a mosquito bite this morning about 4:30 am.  The mosquitos here are tiny and don't really buzz a lot.  Then once bitten, the area burns like crazy and itches like hell.  If you scratch it, it burns worse.  Then it drives you crazy for about two hours. And then it is never noticed again.

Except then I was wide awake and thinking about my mission partner, Martha Ann Flint, sound asleep in the bed on the other side of the room and one of the craziest broads I've ever met.  "Ochencheda" is the word for "crazy" in Chechewe - the native dialect here.  I have been virtual friends with Martha via email and Facebook for a while now.  But we are just meeting in person this trip.  She is a long time friend of Stephen's and he put us in contact with each other a while back.  One of my favorite posts ever by her was "Jump and a net will appear."  Martha is that person who is willing to try anything and everything from balancing a sack of grain or a bucket of mangos on her head, to playing the drums with the choir, to playing soccer in the dirt with the local children in the villages.  It has been a riot being here with her.  She has the biggest heart of almost anyone I have met.  On her first trip to Malawi, she fell in love with a malnourished, ill little boy named Christopher, who she now supports in school.

Today we were busy in Chimwendo but not swamped.  I had visited this very poor little village when I was last here in July, 2014 and Martha had been there with Stephen this past April.  I saw my first snakebite today.  It occurred 5 days ago and fortunately there was only local pain and inflammation - simple as pain meds and antibiotics.  We saw cases of children with malaria, but mostly body aches and arthritis because almost everyone in these remote villages farms manually.  We played a great game of "don't let the balloon touch the ground" with a blown up latex glove and about 20 kids.  And Martha got her but whipped in one on one soccer by a kid she was foolish enough to challenge.  Today, after we arrived back from Chimwendo, I found her passed out cold only halfway on her bed.  I guess it's good today was our last workday.

And finally, the "shoe that grows".  Before my trip here I learned about this awesome non-profit, "Because International" founded by a young man who had spent time in Africa and was touched by the need for shoes for children.  One of my FB friends, Marcelena Racatune had actually posted about it.  To make a long story short, I did a little research and decided I had to bring some with me.  I ordered 100 pair and even had friends pitch in to fund them.  They are amazing - weather proof and adjustable over 5 sizes.  I gave half of them to my friend, Fr. Levinus, but they have yet to be distributed.  He promises to send photos to me.

There was concern that once we started giving shoes away, we would be swamped.  But after our clinic in Bowe, there were some young boys, 11 or 12 years old hanging around, and barefooted.  I asked if they had shoes and only one had a pair of flipflops.  Martha and I pulled out the shoes and fitted them right then and there.  You should have seen the delight on their sweet faces.  Afterwards I left about 15 pair with Fr. John to distribute at his discretion.

Then yesterday we fitted all the little kids that sang and danced to entertain us. Some people said kids would just sell the shoes if they were given as a gift, and that giving away shoes is not sustainable.  Guess what?  I don't believe you and I don't care.  I'm bringing 100 pair next time, too.  I'm not putting a local vendor out of business because none of these families can afford to buy even second hand shoes.  I may have to give them away as free raffle prizes since I can't provide shoes to every kid in a remote village in this area but I can protect the little feet of at least some of these beautiful babies.  I can't wait to post the pictures of them for you!

Kachigamba

This morning I awoke to the sound of silence at around 4:30 am when the power went off.  Dawn is about 5 am and within moments, I realized it wasn't silent after all.  There was the chirping of the little birds.  There was the wind and the leaves rustling.  Then there was a rooster's occasional crow, a child's cry in the distance - so beautiful, these sounds that God gave us that we typically ignore.

We traveled to Kamichanga today.  This is a remote village that we had to travel through a huge tobacco plantation to reach.  The plantation is of course owned by some westerner and the land is farmed by sharecroppers.  Last year there was only two months of good rain and so the crop suffered as did the farmers.  They do the work, the landowner gets paid first and if anything is leftover, it's theirs.  As a result, families may live indentured to the landowner year after year living in a 10x10 room with one small window.  This is what your $7 pack of cigarettes buys in addition to your health problems and the wealth of Phillip Morris - the primary contract.

The team I was on in July, 2014 visited this village so it was quite familiar. We had a great day there seeing patients for follow up from previous teams, and seeing only a few sick children.  Once clinic was over, the children decided to ham it up by singing and dancing for us.  The natural ability to harmonize is so impressive and their dancing skills were too fun.  I will post a video as soon as I get to edit and rotate it on my computer.

Afterwards we told the kids they could ask us anything.  They asked if they could touch our white skin and straight hair.  What an honest, innocent request.  And oh the giggles...

Addendum to Clinical days 2&3

We have lovely man, Mr. Weston, who is hired to cook for us during our stay here.  He seems to be a gentle soul, and has proven himself a fabulous chef.

On Tuesday, while I broke for a bite of lunch from my work at the clinic, he approached me in distress.  He said his wife had awoken in  the wee hours having terrible pain in her leg.  He had just been to check on her and she was still crying and unable to leave the bed.  He asked if I would please go to see her.  I recruited my translator, Gloria, and we followed Mr. Weston to his very modest rent house which is about 100 yards from the clinic compound.  There we found his wife suffering and crying from pain in her right leg.  The leg was swollen and red from the knee down.  I pushed up on the ball of her foot and this exacerbated the pain. Hmmm, a positive Homan's sign, which occurs when there is a blood clot in the deep vein of the leg, also know as a deep vein thrombosis.  As I felt the back side of her leg, I thought I could feel a cord-like area behind her knee.

Being worried about a deep vein thrombosis (DVT), I knew we had to get her to the hospital.  In the meantime I consulted with George and he suggested I give her an injection diclofenac, a medicine not available in the states similar to ibuprofen, but stronger.  This should help her pain and perhaps reduce the chance of further clotting.

When Ray returned from Lilongwe early evening, he had Timeyo drive her and Mr. Weston to the hospital.  They arrived too late to be seen that evening and so boarded overnight and were seen yesterday.  Fortunately, I was wrong and the tests did not confirm a DVT, but instead a cellulitis, which is an infection that is diffuse through the tissue.  She received some IV antibiotics and was discharged in the evening to complete her antibiotics at home.  Hopefully, someone will be able to retrieve them today.

In the meantime, kudos to Ray's wife, Jennifer, who is here with their four small children.  She has taken over the role of company cook and refused to let as subsist on breakfast bars and PB&J, as we have insisted we can do.

Clinical days 2 and 3

Yesterday I worked in the Kasese clinic alongside George Matanpadeu who is the other clinical medical officer that works here full time.  I am very impressed with both Wilson and George and their clinical skills and expertise.  It has been so helpful to learn from them the way things are managed here.

We are diagnosing and tracking two diseases that really should no longer exist on this earth - pellagra and malaria.  It is so heartbreaking to see these sick babies with temperatures as high as 104.8, so ill they cannot even sit up, with severe headaches and body pain.  We are seeing several cases a day.  

I was quite tired at the end of the day and managed to go to sleep before 9 and other than a little tossing and turning slept really well.

Today the entire team loaded up and went to Bowe.  It was quite nostalgic for me as this is where my work in Malawi started back in 2011 and continued through 2013.  We met the new priest, Father John, who has been here a year and admitted that his work is quite the challenge.  We did not meet his compadre, Father Joseph, as he is away learning Chichewe, the native tribal language in this area.

The people in Bowe were so grateful for our coming as they do not have any other healthcare available in their district.  Fortunately, we did not see a large number of very ill people.  Many were there for minor problems or medication refills.  The children were in school so we only saw a few of them.  At the end of the day, we heard choir practice around the corner at the church and went to check it out.  Stephen is a musician and sat right down and joined in the drum playing.  Video to follow, and it is indeed a "joyful noise".

Tired again and sorry the blog is a bit boring with no photos to post due to my being technologically challenged.

Attack of the mosquito net, pellagra and the ride...

In spite of the great night's sleep during the layover in South Africa, I had trouble adjusting last night.  I slept soundly from about 9 pm to 1 am and then I was wide awake.  I tried to be still and not disturb Martha, but I couldn't take it anymore and sat up to quietly read and answer email.  I thought I was being so good, but after a few minutes, she rolled over and said, "Oh good.  I was trying to be still and not wake you up".  Then we both sat on our beds in the wee hours and typed away.

By about three, I was ready to try for some more sleep.  The next thing I knew I was bound and gagged and panicking.  As I surfaced to conciousness, I realized my mosquito net had come loose from the ceiling and had me completely entwined.  Martha, being the most helpful friend assisted by dying laughing.  She did however hold the flashlight for me while I stood on the bed in the dark and resuspended the thing.

Today I stayed in Kasese and worked in our clinic with Wilson Bett.  He was great at offering guidance as I don't really see the same problems at home that we see here.  I diagnosed and treated three cases of malaria today.  This is worrisome because the rain hasn't started, so I don't know where the mosquitos are breeding.  We are also seeing an outbreak of pellagra, which is a vitamin B3 deficiency.   This was eradicated in the US in the 1930s.  It starts as a skin condition and then progresses with time to dementia and even death.  Stephen has figured out that it must be associated with the cyclic availability of certain foods.  Now how to prevent it?

After clinic, Father Levinus retrieved me as promised.  However the 45 minute trip to Kalembe was not 45 minutes as I know them  We arrived there around 4:45 pm after a guided commentary of all the small villages along the way.  I had a tour of the compound, shared a beer, and then he graciously served the re-heated dinner that had been prepared for us last night once Father Joseph arrived.  We had a delightful visit.  Then, we started with our farewells and as we moved outside to the truck, it was pitch black.  The time was 6:30!!!  I'm afraid of very few things, but traveling at night in Malawi is one of them.  I will just summarize by saying it was harrowing and surreal.   Dolly Parton's "Joleen" is blaring (Fr. L loves  country music) and there is no street lighting.  There are pedestrians, bicyclists, motorcyclists, soccer playing children, goats, chickens, dogs and cattle along the dirt road that is so obscured by dust, that I was reminded of a west Texas dust storm.  How in the hell, we did not kill someone or something amazes me.  Back to Kasese at 7:55 pm.  Forty-five minutes my ___.  Thank you dear Lord.  I promise to be good from now on.

What do now?

Sunday and we're here!!!!!

So it's not a trip to Africa without some kind of language difficulty.  We get through the chaos at the Johannesburg airport after arriving over two hours early, only because Martha has Star Alliance status as a frequent flier and tells them that Stephen is her brother and I am his wife - cut to the front of the line!  We ride trams to the tarmac where everyone is scrambling for luggage space and to get to their seats.  Stephen witnesses a gentlemen trying to explain to a woman that she is in his seat.  She refuses to acknowledge him until Stephen asks for her boarding pass.  After she gives him a blank "language barrier" look, he shows her his boarding pass.  She pulls hers out and voila!  She's in the right seat on the wrong flight.  As Stephen shows her the destination on his boarding pass, she jumps up and gathers her belongings shouting "What do now? What do now"?  He tried to help her to the flight attendant, but she scrambled over him and the gentlemen whose seat she occupied and disappeared down the isle.  I hope she made her flight.

What a coup!  Once again all of our luggage has made it.  This might be a first.  Ray, Orant's in country director,  and Timeyo, the right hand man in Malawi met us at the airport.  Orant also has a contractor here working on the renovations of the clinic.   His name is Jimmy Wilder and he was there as well.  Jimmy has spent several months here and is back to finish up the final touches.  He drove us to Kasese while Ray and Timeyo completed some errands they needed to run in the city.

I feel it is important to see the friends I've made here in Malawi even though they are no longer working directly with Orant Charities.  Timeyo was suppose to take me to Kalembe to visit Father Joseph and Father Levinus and see their mission and parish there this afternoon.  But unfortunately, it became too late for me to have more than a half hour or so to visit with them - which wasn't long enough considering I traveled 3 days to get here, it's an hour and half round trip and I have no idea when I'll see either of them again.  So the plan is that I will work at the clinic in Kasese tomorrow rather than going into the field and Fr. Levinus will retrieve me around 3:00 or 3:30 and bring me back before dusk (6-6:30).  It's best to be off the roads by dark here.  Although there are few vehicles, some don't have working  headlights and there is no public lighting.

Our team will be split for our clinical work this week, Stephen and I each working with either Wilson or George who are the clinical officers that work at the clinic.  Clinical officers in Malawi function as general practitioners use to practice in the states before the age of specialization.  They take care of almost everyone and everything, with minimal access to ancillary services including lab and x-ray.  They are true clinicians and they do an amazingly excellent job.  Although I had hoped to have more of a shared experience with Stephen and Martha,  it will be a big help to work one on one with a clinical officer, as there are illnesses here I don't see at home and their guidance and advice will be appreciated.

Ray's family lives here in country with him and Jennifer, his wife, prepared dinner for all of us and had us to their home last night.  Homemade chili and homemade bread.  The power failed just in time for us to have a candlelight dinner and returned in time for the fan to work while we slept.  Whew!

Journey Day #3

We arrived in Johannesburg sweaty,  tired and generally gross yesterday morning.  The flight was crowded and the cabin was really too warm to rest comfortably.  Once through customs, we headed to the baggage claim where we patiently waited to collect our bags.  We had all but one bag of shoes and one bag of medications and were about to give up when, the last two items to fall onto the carousel were the shoes and the medications - Victory!

Stephen had been here before so knew exactly where we needed to go to catch the shuttle to our hotel.  In spite of this, we had to wade through a sea of porters wanting to handle our baggage, and escort us to the shuttles.  There have been other times in my life when I have wanted a shower as badly - but not many.  On arrival to the hotel,  they graciously stored our baggage, but had no rooms available for early check-in.

It is while hanging out in the lobby waiting that I first read of the terrorist attacks in Paris.  How can this behavior be explained?  Why can't each of us realize that we all have so much more in common than we have differences that set us apart.  I am praying for peace and comfort to all those affected by this senseless event, and courage and wisdom for those who will have to determine how we move forward as a result.

So... the only thing I can do is what I can do.  Share a burger and fries with Stephen, check into our rooms finally and take a shower.  The hotel room design is a bit unusual.  I've never quite seen one exactly like this so I decided to take my shower before Martha gets in because we are sharing a room.

Yes.  The shower and tub are right in the middle of the room with a glass enclosure.

Martha arrived uneventfully and we enjoyed a nice dinner and visit.  The team is together and onward tomorrow.

New Journey - Day 2

A.M.
I am still at 33,000 feet, only now about halfway between Dublin and London.  The sun is rising and it's beautiful here above the clouds - the same clouds that will make sure it's cold and rainy in London.  You are asleep as it is 1:56 am at home.  We will be landing in about a half hour and my mission will be to determine where Stephen's flight arrives and intercept him.  He left Guatemala City mid-day yesterday and connected in Miami.  His flight is to arrive about an hour after mine and as your alarms are going off so you can be off to work, we will be in Trafalgar Square enjoying fish and chips with malt vinegar and ginger beer.  Our flight to Johannesburg doesn't leave until 8:00 tonight.

More to come...

P.M.
London was stereotypically London - cold, windy and wet.  But the clouds did clear a bit allowing for some great photos.  We had our traditional lunch as planned with mashed peas then walked over to the Thames River, took pics of Big Ben, the House of Parliament, and then took the tour of Westminster Abbey.   Although it is still an Anglican church in use with regular services, I find the number of remains housed there a bit creepy.  It's much more like a public mausoleum.

We were struck by the amount of new construction taking place all over the city.  There are cranes, scaffolding and new high rises every where.  Seeing them interspersed among the classic old structures really changes the look of the place.  Many of the very old buildings have also been enhanced with new facades and in some cases simply with a good power washing.  The city looks great!

Big Ben with the London Eye in the background.

House of Parliament

Westminster Abby

New Journey - Day 1

November 12, 2015

So here I am... 33,000 feet in the air, halfway between Texarkana and Little Rock on my way back to Malawi.  This trip was one that I didn't plan too far in advance.  To be honest, I wasn't sure if or when I'd be going back as things have changed so very much from my earlier experiences there.  But working through and with change is one of the constants of a meaningful life, right?

I only decided firmly to take this trip in mid-October.  Let me introduce my dear friend, Stephen Patrick, MD.  Stephen has been helping Orant Charities with our clinic operations since we hit some stumbling blocks earlier in the year.  He spent time at our new clinic in Kasese back in the summer and graciously wrote a report/critique with recommendations on how we could proceed.  He then met with the Orant Board and offered to follow up with this visit.  As I love him dearly and am inspired by him, and as both of us have been to Malawi several times, but never together, it had to happen.  Stephen is an amazing person.  I hope he won't mind me revealing that we had near concurrent "spiritual awakenings" as Brene Brown would call them, back in the 2011-2012 time period. (If you have not read any of her work on living wholeheartedly - you must.)  Stephen is the guy who left his prestigious job as an OBG residency program director to live in Guatemala City and serve the poor people of La Limonada, the largest slum in all of Central America.  In the process, he has become quite the expert in global healthcare best practices and in "how helping can hurt".

So, if you've ever read one of my other blogs, you know that although my flight left DFW at 6:40 p.m. today, I didn't start packing until about 8:30 last night.  I initially planned on only personal belongings, but then I learned about "the shoe that grows".  The shoe designed by "Because International" aka Kenton Lee, is a shoe that adjusts to fit the foot of a growing child over about 5 sizes.  If you've ever been to a third world country, you understand that shoes are not common and therefor, foot injuries with infections are.  And guess what!!??  This shoe is waterproof  and best of all costs a whole $15 USD.  Gotta buy 100 pair to take and trial.  The really cool thing about trying to "do something" is that I find it makes other people also want to "do something".  As I described the shoe to different friends and even coworkers, they would whip out a check saying they wanted to buy some shoes for me to take.  I even got money for shoes for my birthday!!  Then, I find out Orant Charities needs me to take prenatal vitamins and children's tylenol and ibuprofen.  Malaria season is about to start, and preventing febrile seizures can be life saving so of course I must take this as well. And then, at the last minute, my friends who are living in Malawi to serve the poor there send some requests for food items(tortillas) and personal items, and gifts.  I know I was meant to take this trip as I have checked five 23 kg bags and all my personal stuff is in my carry on.

Life is good.  Realize it.

Readjusting...

A little African monkey in the trees by the lake.

I've been back a few days now and am still not sleeping through the night. Not sure if it's persistent jet lag or something else. I can't seem to get organized or decide if I even need to get organized.

My journey home was notable for a couple of things. Both occurred on the flight from Johannesburg to London and both reminded me of how much so many of us take for granted.

The passenger seated next to me was a South African woman. I'm guessing she was 10-15 years older than I am, and she was both leaving South Africa and flying for the first time. Although her primary language was Afrikans, she did know a little English. She had never fastened the type of seatbelt used in air travel. She was fascinated at the little TV screen in the seatback in front of her and delighted with the headphones and controller as well as the little airplane meals. She had dressed stylishly with a scarf and jewelry. She was also quite unnerved when we hit some mild turbulence but calmed quickly when I told her to pretend it was just a bumpy road. This woman had not seen her brother in 22 years and was on her way to Philadelphia to spend 3 months with him and his family. I saw her getting through security at Heathrow to get her next flight and pray she has a joyous reunion and an excellent adventure.

I had a window seat on this flight and was unable to close the panel to block out the light because it was stuck. A little annoying, but not a real problem because it was an overnight flight. At one point I woke up and looked out the window, which I would not have done had the panel closed properly. The cabin lights were off, so it was dark inside and out, with no reflection on the window pane. What I saw was spectacular. We were flying above the cloud layer so the horizon was below us. There was a dome of black sky and stars that appeared three instead of two dimensional. I could see brilliant stars from my little window when I looked down on the horizon, forwards, rearwards or upwards. I had already been spoiled by the view of the Milky Way from the dark nights in our area of Africa, but this was dreamlike. I must have stared out that little window for half an hour mesmerized and contemplating my smallness.

Grace and Casey's journey home was notable for delays at the beginning and at the end of their trip that resulted in their being on the plane for over seventeen hours instead of the planned nine.

As I readjust to what is the luxury of my life here, with my sweet husband, my good job, my comfortable home, healthy family and spoiled pets, I can't help but think of the people who came to us needing care. There was the boy with the infected burns on his arm that needed antibiotics and wound care. Another boy who had received stitches in his hand after being chopped by a hoe while chasing field mice. They were terribly infected and the redness and pus had extended up the finger into the rest of his hand. Both of these children were referred for immediate and more advanced care. I wonder how long their parents would have waited if we had not been there. There was the 40 year old man carried in by his father and a friend. The son had a stroke about two weeks prior and was paralyzed on his right side and unable to speak. And if that isn't bad enough, the person who took him to the clinic when it first happened, didn't realize his right foot and ankle were resting on the motorcycle exhaust pipe. So he had a terrible burn as well. There are so many others.

At the mission in Bowe, we were more in touch with the joyous nature of these poor people as we heard them sing, laugh, cheer futbol games, and watched them play and dance. In Kasese, we are more isolated from the community and so more time spent seeing the suffering as compared to the living. I have tried to embrace the reality that each one of us has the fortitude to navigate what is our life, regardless of how short or painful.

Easy for me to say. But comprehend?

Winding it up and Lake Malawi...

Tuesday morning was more relaxed, except I decided I was sick of my crazy, no blow-dryer hair and decided to get the braiding done. Oh my gosh! How do they ever get little kids to sit still for that? It hurts like hell. It took about an hour, and I swear I was doing Lamaze breathing. She did a really good job, but I probably won't ever do that again not only because of the pain, but because I don't have that much hair to spare and she pulled out a lot. Live and learn.

African do.

The result of Besa's pain inflicting skills.

We finished taking inventory of our meds, had a lunch of leftovers and loaded up our stuff. It was hard to say good bye to James and Timeyo. They have been so much help. On our way to Lake Malawi, we stopped at a refugee camp run by Jesuit Relief Services. There are refugees from Sudan, the Congo, Somalia and other nations that are experiencing violent internal strife. At this camp, they have organized activities to help the residents earn income. There is a group of women who weave crafts out of fiber that they dye, and make beads out of paper for jewelry. UMOJA crafts is the name of their group. We each purchased several beautiful items.

Fiber woven good from the UMOJA co-op at Jesuit Relief Services.

Then we went to the market in Lilongwe, but is was chaotic and stressful, so we only stayed a very short while. We headed off to Lake Malawi for some relaxation and to critically evaluate our team's experience. The weather and the view were beautiful. Of course, the mosquitos were bad.

Our view of Lake Malawi at sunset.

I cannot imagine driving in Malawi. Not only do they drive on the left-hand side of the road like the British, there are bicycles and foot traffic impinging on the two lane pavement, not to mention goats, chickens, cattle and the occasional dog. Sitting in the back seat watching the road as Ray drove was slightly hair-raising. He did a good job, but it was like watching one of those driving video games my kids use to play. Only we didn't hit anything (thank goodness) or crash and get to start over.

I've noticed that there is always the smell of something burning. Trash is burned rather than collected in most areas. The fields are also burned rather than weeded to begin preparing them for planting. And, I hesitate to share this, but they sometimes burn the grass to flush out the mice. The mice are caught, skewered, and cooked several at a time on the stick and then sold roadside as snacks. These are what I call “Malawi sausages” because the first time I saw them I didn't notice the nose or tail. But I digress. They also cook on woodfires, so at dusk there is a lot of smoke in the air.

During our debriefing after breakfast on Wednesday morning, we shopped at the market. I was finally able to buy only the items I wanted, and not buy because someone was begging me to. We went to every one of 37 stalls, asked the prices of the items we were interested in and wrote them down. Then we sat in the car, compared, decided what we wanted and went back only to those stalls and made our purchases after a little haggling. Grace hates haggling. We purchased some beautiful wood carvings and gifts. They all knew we looked at their wares, and I think that was fair. I think they thought it was fair, as well.

We had a late lunch and then tried to tour the Malawi Mango processing plant nearby, but arrived too near closing time. The plant, which is run by the government, provides free mango seeds to farmers and agrees to buy their fruit for processing and exportation. Pretty cool.

Psyching myself up for the journey home. Will write a post once I'm home and have had time to reflect.

Kachigamba

We had a good clinic today in Kachigamba. We got a bit of a late start this morning and so took a supposed shortcut through a privately owned plantation where they grow tobacco, maize and soybeans. The road was so rough, I thought it really slowed us down. I actually saw a tractor on this plantation which is the first mechanized farm equipment I've seen in Malawi.

The first tractor I've ever seen in Malawi

Our clinic went well even though we arrived a little late. We had a steady stream of patients, many who really needed to see a doctor today. Luke and Araceli did a great job in the pharmacy. Timeyo and Ray worked very hard as our translators. The H.S.A agent for this village worked our triage. 

 The area surrounding the village was so beautiful - the farm valleys, mountains, and expansive blue skies. The people were beautiful, too. But the children were terrified of us. We handed out DumDums to bribe them. We are so naïve about what they have been exposed to. One little girl ate hers, wrapper and all.

Luke and Araceli setting up the pharmacy.

The view form our church/clinic window.

Grace was also slightly challenged by a patient that had “twingling” in her side. We all agree this is a great word and will continue to use it in our quest to get the Oxford dictionary to add this next year. We think “twerking'”must have developed from women trying to eliminate their “twingle”. And yes, I had a couple of beers before this conversation.

Grace and Casey contemplating the word "twingle:.

We were planning on working at the clinic here in Kasese tomorrow, but will not afterall, as our presence is somewhat disruptive. I think it will take time for us to integrate our work into the clinic here. But, I think the outreach clinics will thrive with no problem, and this is what the teams really enjoy – the village experience. Because of the early growing pains, we have had less than we hoped of that exposure.

As we drove back in to Kasese we saw that it was market day and decided to head over.  I scored some beautiful Malawian fabrics.  They were 600MK each.  That's less than $2USD each.

The market in Kasese.

My beautiful Malawian fabrics.

On their way to the market.

We had a dinner of all the food that had been bought but not yet cooked and served, as well as leftovers. We invited all the people who had helped this week to join us for dinner, but only three showed up. So, we still have lots of leftovers.

We will inventory our supplies in the morning so we can re-stock for the next team. They will be here in September. I'm thinking about asking Temeyo's wife, Bessa, to braid my hair tomorrow. And then we are going to a refugee camp run by the Jesuit priests. The women have set up a jewelry coop there and we are going to shop and visit. We will then head to Lake Malawi to de-brief and rest.

Our day of rest…?

Our day of rest – not so much.

This cold I've caught is annoying and apparently a single dadgum mosquito maneuvered the creases of my mosquito net and annoyed me every little while, but I managed to avoid a bite. Whew! Thank goodness we weren't in a hurry to get anywhere.

After breakfast Casey and I psyched up and set off on our quest to contribute to the compound's water supply. Ray and Grace walked with us as we rolled the empty water barrels to the water pump. We were quite the spectacle – a black guy and three white women, two of whom are working. Grace suggested we had raised Ray's status in the community by this appearance.

Taking our barrels up the road to the well.

Ray, ever the diplomat, making friends with  the locals.

Casey filling her baarrel.

When we got to the well, there were several women and children waiting their turn at the pump. Were they surprised! We waited our turn politely and as we moved our barrel to start filling it, the crowd gradually grew, especially the crowd of kids who giggled incessantly as we took turns pumping the water. I gotta tell ya, that was work. Pushing the barrels back was not too bad at first, but then the road became sandy, and uphill. I did have to rest a few times, but by gosh, we got the barrels to the cistern.

Me, filling my barrel.

Resting n the way back to the cistern.

The tank in the ground holds 5000 liters, and each of our barrels held 50. A pump moves the water from the cistern up to the tank that supplies the compound. To give you an idea of the economy here, two men are paid 1000MK(Malawi Kwacha) per month to keep the tank filled and maintain the pump. The exchange rate is about 390MK/1USD.

The tank on top of the tower is where the water
from the green cistern in the ground is pumped.

Mission accomplished.

Preparing to add water to the cistern.

Timeyo, adding the water.

We have given James, our cook, the day off and have invited him for a fajita dinner. Timeyo, who can fix or build anything, has taken a metal barrel and fashioned a wonderful BBQ grill.  There are lots of fresh vegetables right now so I made some roasted tomato salsa. I had also brought some spices, fresh jalapenos, and tortillas for Luke and Araceli that we are using. No cilantro, but it is Africa. I was a bit startled when I started cutting up the chicken Father Levinus had brought as a gift. When I reached in for the giblets, I also pulled out the head and feet (no photo). It is Africa.

So a feast of beef and chicken fajitas, then homemade cookies for dessert, courtesy of Araceli.  The lap of luxury in Africa.

Sunset from our porch.

Ntanda

Ray greeting the children of Ntanda.

Me,  ready for patients.

Very tired today. We had a very busy, productive and somewhat challenging clinic. Plus I have this stupid little cold.

Today we left at 8:00 am to go to Ntanda. Although there was again only one person waiting upon our arrival, there was a steady stream of patients getting in line once we got the clinic set up. The H.S.A. (health surveillance officer) for Ntanda, also named Grace, welcomed us on our arrival and directed us where to set up. She was then able to spread the word quickly of our presence.

Grace, her translator, Gosten, and a grateful
patient.

It amazes me how many problems we come across in the course of one day in the population of one small village. There are so many patients with recurrent malaria, seizure disorders, asthma and HIV. Grace saw a child that had been severely burned in November of last year and has already lost the use of his hand due to tight scarring, also called contractures. His arm was severely infected and he screamed as she changed the dressing. Then as I was helping re-dress the injury, Grace warned me in the nick of time, “Be careful. He's a biter”. We ended up hving to arrange for him to go to the city, hopefully for IV antibiotics and better wound care. His poor mother had been trying to care for this herself with the help of the local “healer”. We often see the patterns of scars on patients who have been to a local healer for their problem. There were two other patients that needed expeditious care and we were able to facilitate that process as well. One was a disabled child, also with an infection. Another was a young woman with severe swelling in her feet and in her abdomen (ascites). We assume she has organ failure, possibly from chronic/recurrent malaria and had run out of her medication. She will go to the hospital in Mdisis Monday to have the fluid drained and get more medication.

Luke and Araceli in the pharmacy.

Luke and Araceli run the pharmacy on these outings, and Temeyo translates all of the medication instructions. They do a wonderful job. We actually have a better stocked formulary than many of the district clinics, which works to our patient's advantage. Not to mention, we come to them. The 12-15 kilometers traveled to reach these villages is along very rough roads that are usually only traversed on foot or by bicycle. And many of the roads are impassable during the rainy season. Our outreach clinics save a great deal of time, effort and money for the villagers.

Casey entertaining the children with their
digital images.  She was quite popular once she
overcame their fear.

The children in Ntanda were very curious and much more timid than I've experienced before. Casey was finally able to get them to loosen up by taking their photos with her digital camera and then showing them the image. They loved it but were still afraid to get too close.

I'm calling it an early night. Tomorrow we will not hold a clinic. But Casey and I have a quest. We learned that the other night when Grace had no water in the shower, it was because the cistern was empty. We also learned that the well from which the cistern is filled is about a kilometer away. Boys and men are paid to fill a 24 gallon plastic barrel and then roll it to the cistern's tank and pour it in. It takes 50 barrels to fill the tank. Tomorrow, Casey and I have challenged ourselves to contribute one barrel each. More to come...

Chimwendo

Our awesome mission team!
Left to Right
Dr. Grace Stewart,  Dr. Rochelle McKown,  Casey Carney MSII

 0430 You know how annoying your neighbor's dog can be barking all hours of the night? Well, I would say your neighbor's crowing rooster is as or more annoying. Geez. In addition, a mosquito somehow maneuvered the creases of my net and was stalking me and buzzing loudly. It's just time to get up.

Traditional Malawian meal, not James' (because I was too hungry to stop and take a pic). So this is a photo from a previous mission trip. Clockwise staring at 11:00 o'clock - rice, chicken stew, greens, and nsima.

I did go to bed quite early. I believe I've caught Casey's cold, so was feeling really tired. James. our master chef prepared the traditional Malawian meal of chicken stew, greens and nsima, as well as some rice for us westerners. Nsima is a starchy paste made of maize flour that they use to sop up the broth and food. It is often used instead of flatware. I have now had this meal many times and will tell you that James' recipe is superb.

Yesterday, as many days in Africa, did not go exactly as planned. We set off in the morning to do an outreach clinic in Chimwendo. It amazes me how you can drive over treacherous roads through the bush for what seems like forever and then come upon a large organized school with children in uniforms and teachers dressed rather professionally. I was surprised (and a little disappointed) at how much order was maintained by the staff. The children, initially excited and curious, were quickly reigned in resuming their classroom activities indoors and out.

Our waiting room in Chimwendo when we arrived.

When we arrived at the clinic building, there was one patient waiting. Really. One.

Apparently the Health Surveillance Assistant (H.S.A.) failed to inform any of the villagers that we would be coming. Yea. So, we set up our little clinic and over the course of the next 3-3 ½ hours we saw 23 patients. It didn't appear any more people were heading in to be seen in the afternoon. We had made a list of medications we did not have in stock, but could have used several times. Some of these medications are not in stock in the clinic dispensary either. So we used the afternoon to go to a pharmacy in the Lilongwe to buy meds.

My office in Chimwendo.  For anyone who has followed my previous blogposts, this is not my "Hello Kitty" back pack.  I retired Hello Kitty last mission trip.  This is a replacement JanSport pink schoolbag.

It was dusk when we were on our way back and driving on the M-1 was treacherous. The M-1 is the two lane main highway that connects Malawi from the north to the south. There are no street lights, many vehicles without lights, and pedestrians and bicycles everywhere. No wonder we try and never travel at night.

Road trip.

The district hospital - "a baby friendly hospital"

Yesterday evening we packed up our pharmacy and diagnostic supplies to prepare for our village trip today.  Since we are trying to coordinate our work here in Kasese with the district's healthcare system, we invited the District Medical Officer to come with us to the village of Mtambalika, where we were to hold our clinic today. Ray and I left at 0700 to drive to the district hospital to pick her up. 

 Come to find out there is a current DMO, Peter, who will be departing before August 31 to begin a resid-

ACK!! I'm sitting in the dark typing and a huge ant just crawled across my computer screen. Dead now. Must have snuck in while my net was tied up.

Beatrice and Peter, both Malawi educated physicians.

ency in surgery. He is being replaced by Beatrice, who just completed her internship. The drive to the hospital was much further than I expected and once there they both decided to accompany us. 

 We didn't get back to the compound to retrieve everyone else until almost 10:00. The drive to the village was quite rough as once you get off the M-1, the dirt roads are treacherous. There was quite a line of people waiting for us when we arrived and it only seemed to get longer as time passed. 

The lines of patients when we finally arrived.

It got to the point that Peter and Beatrice were both seeing patients to help out. 

Ray coaxing a child onto the scale.  He finally bribed him with candy.

With Casey running triage, Luke, Araceli and Timeyo in the pharmacy, and Ray doing some of everything we saw 170 patients by the time we left around 5:00 pm

Casey triaging as fast as she can.

Through the course of the day we were able to compile a list of medications that are needed but not currently in our inventory.  Sadly, the clinic here is also out of stock. Today most of our patients were treated for only minor ailments and we headed back to the house exhausted but good.

ART. It's not what you're thinking.

Today the clinic held their ART(antiretroviral therapy) clinic. Antiretroviral therapy is used to treat HIV positive patients.  Each Wednesday morning they treat about twenty patients. Many of them are young

women with children.  At home, HIV positive women do not breastfeed their babies, but infant formula is not easily found or afforded here, so all of the babies being breastfed are HIV tested monthly. Once they turn positive, their treatment begins.

We were very impressed with the system of care and record keeping in this primitive environment. The documents and data are meticulously kept without a computer, medication doses being calculated for each patient, each month based on their weight. Apparently, it is common for patients to attend a clinic far away from their own village district so as to keep their diagnosis confidential.

Today there were also clinics for Family Planning and a Children Under Five clinic. The scale for the children was hanging outside on the porch and the mom's would tie their sitingi (sp) holding their child to the hook, kind of like weighing vegetables.  A sitingi is a multi-use piece of fabric worn in layers and  used as a skirt, a tablecloth, a sack, a sling for carrying a child or a head wrap.  I'm sure there are other uses I have failed to mention. 

We were suppose to do a village clinic this afternoon, but Ray got tied up in the capital, Lilongwe, taking longer to get supplies than he had planned. So the clinic was moved to tomorrow. We took advanatage of the down time, and Luke and Araceli escorted Grace and I on a walk up the road to the Ngala National Forest. This area is suppose to be protected, but apparently, park rangers are not above being bribed, and Luke says there are swatches where the trees have been recently cut down for firewood.  Most people here have to cook on a wood fire and cutting firewood is illegal because of the extensive problem with deforestation.

On our walk, we were stalked by some of the village children, always so fascinated with white people. Some of them are learning English in school and were greeting us with “Good morning, Madam” and “How are you?”.  I took photos with my camera instead of my phone and now realize that I brought the wrong cable to download them to my computer.  And no, my computer doesn't have a card reader.  It's old, like me.

Casey has contracted a cold and stayed behind to rest. Casey is a very cool kid. She attended Notre Dame for university and is a Peace Corp veteran, having spent two years teaching in Paraguay. So of course she is bilingual English/Spanish, and she seems to be picking up phrases in Chechewe very quickly. I am happy she is here and that I am getting to know her. She is a second year medical student, and I believe is going to be a very good doctor.

Casey Carney, MS II and very cool kiddo!

James, the cook Ray has hired, has really impressed us. Tonight we had fried chicken, mashed potatoes with cream gravy and green beans. It was really good. Last night we had pasta with meat sauce(from scratch - all with fresh veggies)  and it was equally well done. He says he learned to cook from missionaries he has worked for in the past. Pretty cool.

James,  has agreed to work cooking our meals and he has been wonderful.  I might move to Africa if he would let me hire him.

Yes, I speak English

My hot shower felt so good this morning. I slept wonderfully except for the damn rooster that decided to start crowing at around 3:30 this morning, and Luke's sensitive car alarm. Fortunately, I was easily able to go back to sleep.

James and Ray showed up at about 6 am to start breakfast and that's when I made sure they knew about the shower problem. The repair was quickly performed by Temeyo, who can fix anything, so I made a dash for the shower and it was so awesome. 

Temeyo - has worked with Orant Charities for a couple of years now.  He and his family have moved to the compound in Kasese and HE CAN FIX ANYTHING!

I was all warm and clean and breakfast was cooking. The sun was out and the air was cool. So I figured, we are set now. Then I got my hair dryer going...for about 10 seconds before I blew the power in the entire duplex.  Stove, lights, hot water heater. All of it gone. Frizzy fly way hair for the day, here we go. The electrician was called, and we gathered around to eat the oatmeal, scrambled eggs and toast that James had prepared.  Stethoscopes in hand, we then walked over to the clinic to see how we could help.

Kasese clinic waiting area before the patients arrive.

The clinic here in Kasese is pretty much on autopilot and runs with whatever supplies are provided by the government on any given day. A medical assistant named Tamara runs the clinic and typically conducts patient care and recommends any testing or treatment based on their complaints. There is a pharmacy tech student, Agnes, who runs the medication dispensary – not the same as in California or Colorado.

Collins runs the laboratory and showed me my first, real life, in person malaria positive and tuberculosis positive microscopic slides. These illnesses are still very alive and well in this part of the world, which means the patients are not.

We felt a bit intrusive being the first Orant team in this location and stepping into their organization.  I'm afraid we were of more novelty value than healthcare value today. Tamara went about her business as usual and referred only about 10 patients to each Grace and me. I'm sure with time this will change, but it will take a great deal of cultural sensitivity, patience, and education on our part. 

I also had some issues with my translator. His name is Christopher Michael. He was very enthusiastic and very kind, but the problem seems to be he cannot understand my English.

Me: Good morning. Thank you for helping me.

CM: (big smile) Yes.

Me: Where did you learn to speak English?

CM: Yes, I speak English.

Me: Who taught you to speak English?

CM: Yes(smiling proudly), I speak English.

Me: (smiling and a little challenged) Did you learn to speak English in secondary school?

CM: Yes.

Me: That's wonderful.

CM: Yes, I speak English.

The terminology here is also confusing at times.  Christopher explained to me that his title is "hospital attendant".  Then I confused him by asking him where the hospital is.  It took a bit for me to realize they consider this clinic a hospital.  I'll figure it out sooner or later.

Lesson of the day, taught by Grace, “Do not take your clothes off in the shower until you are sure there is water”.   Poor thing finally went in to get cleaned up and was all ready for her hot shower when nothing but a dribble came out of the shower head. And it's pretty darn cold here. I'd say about 60 degrees indoors. Time to call Ray and Temeyo again for repairs. Not to worry, it was fixed by early evening and we are all refreshed. Aesthetic warning – any photos with me will include very bad hair as I don't dare attempt the dryer again.

Ray bought internet time but it will only connect to one device, which is his blackberry. Convenient, huh? So I type away not knowing when I will get to post these or any pics.  More tomorrow...