This time I was back at the mountain for business.. and I loved it!! The landscape is so unbelievable beautiful now everything is growing and blooming that I could spend hours just walking through the tea fields watching the tea pluckers picking the fresh leafs and the blackbirds flying deep between the trees. At night it is so quiet that you can hear the flattering of flying ants performing their wedding dance around every single source of light until they lose their wings and die. What an act just for reproduction. Millions of them like a cloud!!! A little holiday really away from “big city life”!
I had a short but relaxing weekend and also a new flat mate! Janet has now moved in and is really nice company. On Friday Ash and Liora also arrived for a weekend in Blantyre and as the married ones had a nice quite dinner Liora and me went for some action to a Black Missionaries concert (again) with Raz and friends. A real Malawian experience, with a lot of dancing! The rest of the weekend was quiet with some sight seeing, tourist shopping and trying not to get wet which means staying at home most of the time. I had to prepare some lectures anyway.. Compared to the constant rain in Ntcheu it has gotten much clearer with one or two heavy storms a day. If it rains it is like flood and it is still raining into my bathroom. It’s a challenge to get in touch with my landlord but the bathroom is not the worst place it can rain into so I can cope. After the storm is over the sun comes out again then it gets really humid. I think that’s better than being cold and rainy, in the sunlight everything looks so juicy. It reminds me of German summers!
My way to Mulanje was a bit headless. I took the minibus this time and because I forgot to bring my umbrella from home I bought one before going on the bus. Of course by the time I reached Nkhonya (just before Mulanje) after about 100 stops where people and animals got on and off, I forgot about the umbrella and left it in the bus. Typical me! I´m sure the minibus driver was happy for that little Christmas present that’s always a good thought!
I took a bike taxi up the tea estate to Elleana´s place at Mulanje Mission Hospital, unfortunately she is off for vacation with the family but Alex, the German guy who is a volunteering nurse, was still home. He lives just two houses away and welcomed me with a cake (it was his birthday!) and we had some pasta bollognesa for dinner, what a treat!
The way to work was a bit of a trip. It takes about 20min down a dirt track on a bike taxi, the big mountain in view, overlooking the tea estate till you reach Nkhonya again. From there another 30min (waiting included) on a minibus or bike taxi through Chitakala to the next market, Boma, where its another 10min walk to the District Hospital. That lays right on foot of the mountain and is fairly big with about 4000 deliveries a year. There´s also a female, male and childrens ward, a theatre and several clinics. No one new I was coming (as usual) so I spent the time searching for the District Nurse Officer, then the students, then waiting for them searching for the books and then us searching for cases. Good fun! For a change labour ward was really quiet so we reviewed some antenatal mothers and I couldn´t help but saying a few words about the importance of documentation and paying extra attention on detecting abnormalities especially without having equipments like ultrasound or special blood tests.
One lady lost 20kg in her pregnancy without anybody being concerned, the other one, a 16 year old, had already a history of three abortions and a stillbirth, no one knew when or why, not even herself. The next one had such a big belly that either the due date was wrong or she was expecting twins. But on fairness with mostly uneducated patients who rarely come to their follow ups and never complain of anything it can be really difficult to find out if there is anything wrong. Not knowing when they got pregnant which results in not knowing when the due date is plus only having a measuring band, your hands and experience doesn’t make things particularly easier. Back to basic!
Yesterday morning we went to have a look at a Health Centre in Chonde, kind of close by. For the students a task for practicing health management skills, for me a whole new experience! Already on the way there a mother with her 25 year old son who must have had an epileptic fit at night boarded our minibus. The poor guy was severely brain damaged, couldn’t walk or talk with spasms in all extremities and his face. Carried by two men from the village, his mother and us, we helped him out the minibus and had to sit him on the ground as there was neither a chair nor a bench available. It took a while to find a wheelchair but how to enter the Hospital with a wheelchair if there are only stairs. So carry him again. The admission area was packed, it looked like people had spent the night there as a few were still or again sleeping. People came packed with food, water and blankets, they must have taken a long journey. The Health Centre is relatively small compared to all the other hospitals I´ve seen so far, with around 1500 deliveries a year. The problem is as usual, overcrowded, understaffed, no resources, no equipment.
There is a new building to extend the male and female ward with a big European Union Sign over the door, it was finished a few month ago but is still empty because there is not enough staff to work there. The hospital manager, a clinician about my age who was trained to be a clinical officer, explained that they have 8 trained nurses/midwifes and 4 clinicians (he is one of them), 8 hospital servants and 1 driver. They don’t have enough supplies and run out of gloves or medications so they have to transfer the patients to the next District Hospital only for that reason. It is tremendous!
In delivery ward there is only one midwife per 12 hour shift, only one for 1500 deliveries! No CTG, no ultrasound, no meds, no nothing! I couldn’t help but thinking of my dear colleagues back in Frankfurt and the staffing problem there: yes it can really be worse! But besides the midwives working crazy hours it is most of all the women who suffer and not getting adequate care. That is really not fair! My hope is the future, when these 22 students are finished there will be another 50 coming next year and so on, with good skills and motivation they can maybe be sent in these places and help.
There are some good interventions on the way, for example a CPD (continuing professional development) books where each and every nurse and midwife has to achieve points each year through attending training sessions, further education, conferences and so on. I think that is a good initiative to improve the professionalism in the health sector. I am very happy with the students, they are well skilled, diligent and interested. I showed them the book I bought in England before I left: Survival Guide to Midwifery (I think that’s a brilliant little book) and they were so amazed. If they could only get them here, only 20 of them for the library, that would be so helpful! All they have is this book anno 1950 from South Africa, that’s anything but up to date. But like that there are so many things which should be here but aren´t. CTG´s, ultrasounds, doptones, weighing scales which work, bedlinen, curtains and so on. You don’t know where to start! It is amazing how they keep on working and delivering and caring I think.
When we left, the young man in the wheelchair was still waiting, his trousers were wet, I don’t think they could help him. That is so sad!
And from this you find yourself jumping out the minibus just on the foot of the beautiful mountain, with its peak named sinwapitu (=”you shouldn´t go there” in Chichewa) with the green tea and maize fields all around you, the smell of firewood in the air and the red soil. So beautiful! That’s Malawi, cruel and beautiful! Hard but warm, the warm heart of Africa.
I walked back a little path through the maize fields passing some huts on the way. All the kids are smiling and waving at you. Then they follow you to the next crossroad. Outside every hut you pass are people sitting and doing some work, they cut wood,cook or knit clothes, collect water or wash pots. Everyone says hello, everyone invites you to have Nsima with them, they are all so friendly. I gave my shoes to some young woman, I already bought new ones in town as my feet were full of blisters and I had to take the old ones off for passing the river which is usually a stream. Its Christmastime after all! So I walked home barefoot through the maize and tea and a guy on a motorbike from the mission hospital saw me and gave me a lift to the house. (I put my other shoes on for that, learned my lessons with the motorbikes this summer haha but he was driving very slow).
I made it to Blantyre just before the rain started.
Today I´m back in the college, it´s my last day before my holidays weeee! I´m so excited to meet Andrea and Clara on Monday, I can´t believe they´re already coming. Now I just hope for good weather and good streets so we don’t get stuck in the mud in Tanzania or Mozambique (I heard the streets are pretty rough up there) but I´m renting Nikki´s 4WD so we will manage somehow I´m sure. We´re planning to spend my birthday and Christmas on the lake somewhere north and then new years eve somewhere in Tanzania, maybe we´ll make it to the Kilimancharo that would be awesome! I don’t know if I have a good internet connection there but I try to write again before the next year. Just in case I can´t, I´d like to say to all of you:
MERRY CHRISTMAS AND A HAPPY NEW YEAR!!!!!!!!!
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