Thursday, November 10, 2011

The best and the worst of Malawi

On wednesday, I had a day that really hit both the best and the worst parts of being in Malawi.

I am not sure if I have mentioned it before, but Malawi is nick-named "the warm heart of Africa." I believe it is because of the well known warmth and friendliness of the people who live here.  I know I have mentioned previously how I find that Malawians are quite reserved (as compared to other Africans, especially West Africans that I have met);  but, with that sense of being reserved, they just seems to contain a gentleness and kindness that seeps from their personalities.

Late last week, the caretaker of the hostel I am staying in came into my room.  "I want to tell you something," he said.  Yolam is an exceptionally soft spoken, gentle fellow, not prone to boughts of extreme excitement.  most likely not accustomed to extreme extroversion that is sometimes included in my personality.  "My daughter...." (silence.)  "Yes, Yolam.  tell me."  (i was in a tiff that week, thinking that everyone was wanting to ask for money.  i, in no good reason, thought that he was about to ask me for money as well... how wrong I was."  "My daughter... My wife.. She had a baby last week."  "WHAT!  OHHHH!  YAY!  Yolam!  how exciting! let me give you a hug!"  and, there it was.

so, on wednesday, as I was walking to the hospital for my clinical rotation, I met Yolam on the road.  We did our regular greeting and I shook his hand.  As he shook his hand, he then (somewhat hesitantly, but, still, he initiated) he hugged me!  and, i don't know about you, but, a hug a day is pretty much something that is essential in my life.  It was such a special moment for me, because all of a sudden, it seemed as if we had crossed the line from "caretaker-liver in hostel" relationship, to friendship.  and, that just made me so happy.

that is the best of malawi.
then, the day at the hospital was a whole other story.  The day started off slowly.  Honestly, I was even debating going home and doing school work, because it was 10:30, and there had been no patients.  but, then, slowly, it started.  Kids started arriving.

I am doing this half of my clinical in the Paediatric Accident and Emergency Resuscitation room.  And... let me tell you... it is INTENSE! This is the department where each child who will be admitted to Queens, or treated and discharged, is screened.  Upon arrival at 7:30am, there are hundreds of mothers with their children waiting to be seen by the triaging clinical officer. The noise and the sights cannot be explained: children with fractures, fevers, tumours, burns, diarroeah… anything you can imagine.  The majority of the children are experiencing some sort of gastroenteritis; if this is not caught early enough, severe dehydration has fatal consequences.  If it is caught early enough, Oral Rehydration Solution (ORS) should do the trick.  The next category of kids is children with Malaria.  If caught too late, a child could die.  If caught early, malaria is easily treated.  The resuscitation room, where I have been placed, is where the most severely ill children are sent.  The room consists of three stretchers, one nurse, and two medical doctors (registrars).  The primary goal in this room is to stabilize a child, and then get them transferred to the appropriate ward.

on wednesday, we had three children pass away within a time frame of about an hour.  long story short, was that it felt like a nightmare.  at times, not enough staff to adequately perform CPR for the 3 children at once, or draw up medication quickly.  equipment that had been soaking in chlorine from prior use, was needed immediately, and was not available immediately.  3 children. 3 lives.  one hour.  and then... the mothers.  In Malawi, the primary cultural reaction to death is wailing and moaning, and this was the reaction to the first child who passed, because that boy had been showing improvement, and death was not expected.  The second mother wailed for a bit of time, and then prepared her daughter to be brought home.  she placed a small hat on the child's head, wrapped her up, and placed her on her back.  Carried her as if she was still alive  (this just about made my heart stop...).. The last mother did not wail.  It was as if she was more prepared for the death of her son.  She quietly accepted it, and again, placed her child on her back and left the hospital. 

that is the worst of Malawi.

I went home thinking "oh holy crap.  what just happened there?" what a nightmare.  and, I just reflected.  I was greeted at home by the night guards.  I went along my business, and then ended up talking to them a bit.  we ended up talking about God, and agriculture, and it went into discussions of Canada.  I started showing them photos of some of my travels... to Hawaii and to Alaska.  I showed them animals, and clouds and pictures of my family.  I showed them videos of snow, and snowshoing, and how we dress when it is the winter.  

I answered questions like "oh!  what is that animal?"  it's a grizzly bear.  it's a moose.  yes.  m-o-o-s-e.    is it good to eat?  what is the meat like?" nope, can't really eat those ones.  they are very tough meat.  and we are not really allowed to hunt them very much. do you have elephants? nope. monkeys? nope. hippos? nope.  antelope? nope.  well, sort of.  we have animals that look like antelope.

"why is your skin red like that?"  well, when it gets cold, white skin changes colour.  "do you have a staple food?"  mmmm, nope, not really.  not like you do.  "what about mangos?  do you have mangos?  what about bananas?" well, we do... but, we have to buy them at places like "shoprite."  those have to come from a long way away.  what is that sport?  are you on a lake?  well, it is like a lake, but it was made by man.  it is beside a river, and it was made specifically for this strange sport called rowing, in long skinny boats. is there a motor on that boat?  nope, the motor is the people, and the paddles.

"so, what do you grow in your farms?"  we grow things like potatoes and grain/wheat, and corn and apples and some peaches (but only in certain areas) and berries and tomatoes.  does your family have a farm?  nope.  but, we do like to garden.  you see, we have farms, but, not like here, where every family has a farm.  our farms are very big, and single families or people or companies own a large plot of land.  then, where does your family get your food? well, at a place like shoprite.  sometimes, we will go to the market, where farmers will sell food, like here.  but, the market is only open once a week.   oh, so, you buy food for the whole week, and then go again the next week.  well... sortof.  but, not really.... :)  

it is conversations like that, in which I am just so thankful.  That we can talk of the differences that exist between the two cultures, but, also the similarities.  I love being able to explain what it is like at home, and hearing what it is like here in Malawi.  because when it is like that... my heart is warmed.  

the very best of Malawi


Bonnie said...

Amelia, love this post especially the conversations.In our professional roles in health care, we often we often feel helpless when we go as far as we can and still tragedy. L&D this weekend two situations of fetal demise at 39 weeks and always the question what went wrong/or was it preventable....sounds like the team in the peds crises room is a good one!

Kelly said...

heart-wrenching and soul-lifting at the same time...I can't even begin to imagine.

Miss you!