Powerless

Over the past 10 days or so, we have only had power about 50% of the time (maybe less…). I was expecting outages here and there for a few hours, but this past week has been a lot, especially in our neighborhood. A couple days ago it was out for 12 hours straight!  Malawi relies on hydroelectric dams for all its power and this + huge drought = no power (or water, which here has luckily been ok so far but is a problem in many other parts of the country).  So despite it being pretty annoying, I have also learned that I can get super excited about something I typically take for granted. I literally cheer out loud now when it comes back on at night in time for me to heat something up for dinner rather than eat yet another PB&J.  This weekend I bought a little camp stove. I decided I could splurge and spend $20 for my sanity, plus if I go camping here, I'm set.  Despite how much I do love PB&J, the J here is not the greatest.

This week was not as traumatizing in comparison to last. I was on some of the quieter units.  The malnutrition (Moyo) unit is really nice with lots of big beds (and verrrrry small, skinny children).

Happy Moyo murals

 It is actually a little odd that the unit with the smallest people has a ton of big beds, whereas the HDU (where I was last week) is crammed full of sick kids on small box beds, sometimes with 2-3 sharing one.  I assume it has something to do with where funding for the malnutrition unit comes from (which seems to be the answer to every question)... Currently it is not very full right now given it is not famine season and patients are overall doing well.  One little guy with tuberculosis who is skin and bones, still has tons of energy and runs around with his too big pair of shorts barely hitched up over his bony little hips. He also hates me and will start crying whenever I look at him, even though he is otherwise the picture of TB-infected happiness. One of the med students helpfully pointed out, “It’s because you are different-looking.” hahaha, thanks.

The picture of TB-infected happiness

There was also a lot more time this week to interact with med students and do some teaching.  Last week I had my first lecture. I only had a brief time to prepare and used a previous PowerPoint, so it was more boring that I had hoped for a Friday afternoon at 3 pm, but only a few students fell asleep so I counted it as a success.  I saw one of the student’s notebooks open a few days later on a patient’s bed with notes from my lecture!  That was a little unreal.  I am shaping future Malawian doctors. Scary.

The med students can be pretty timid and afraid to speak up and give answers on rounds, but once we gave them some topics to research and present and they took the ball and ran with it.  One group presented in morning report using some articles I had sent them and they wowed everyone including one of the Malawian pediatricians who said, “I feel like a proud mother!” 

I am getting a little more used to the system and the huge amounts of things I can’t control.  We do what we can. I was happy to see that in some circumstances, like malnutrition, TB, and HIV, this can be quite a lot.  Gangs of cockroaches on the walls, not so much (I swear they stick up their tiny, germ covered, middle fingers at us). I am learning a little bit about coping with alternatives, even if they aren’t ideal.  This week I prescribed a bunch of anti-seizure medications to kids with epilepsy(?) who will probably never have an EEG to figure out exactly what is going on.  So I tried to make sure they were on an accurate dose and trusted that given their report, it was working.  And hope that it isn’t making things worse, because there really aren’t a lot of options.  

Last weekend was jam packed with activities (see below) coordinated by Polly and Karl, currently in the race for most fun and energetic people in Malawi (I think they are entered as a couple so good thing cause competing against each other would get ugly I'm sure). This weekend, I wasn't feeling great so I stuck around the house mostly and made bread, yogurt, granola, and cups of honey lemon ginger tea.


First bread attempt in Malawi! I was determined to keep making bread here and it worked! 

I figured the best way to make friends in a new place is to stay at home making stuff all weekend. :/ In all seriousness, it was pretty great and my cold is feeling better.  I also am really happy to hear from people back home, especially good news, so that was a bright spot in my weekend.  After this week I get added to the Rota (Roter? Rotor? Rotah? Some kind of British term for the call schedule) so we'll see if my homemaking skills continue.  

The hills are alive...

...with the sound of... tea?

Tea tasting at Satemwa. 

This week's relatively awesome list:
Hey, I bought a basket that started at 15,000 for 3,500 (kwacha, so $5)
Hey, someone else from home just gave me another unsolicited poop update (you know who you are)
Hey, some kind of sporting event just ended and there are tons of people in the street giving me high fives as I bike past them and say "chabwino! (good!)" cause I have no idea what else to say to the things they are yelling happily in Chichewa 
Hey, we had the first successful GHSP Taco Tuesday!!!!  
Hey, the internet is sorta working on my computer (for now)
Hey, I found a good (and cheap) spice shop
Hey, I accidentally ironed a hole in my sheets trying to kill any possible bot fly larvae
Hey, my first pair of colorful chitenje fabric pants is in the works (due for pick up Tuesday I AM SO EXCITED)

More to come! Thanks for reading!

ahhhhhhhhhhhhh!

Ahhhhhhhh!

Made it through week one.

I went to the hospital for the first time on Monday and got shown around to all the pediatric units. There are many: Moyo (malnutrition), High Dependency Unit (or HDU, a step-down ICU more or less), special care unit, medical unit, chronic medical unit, nursery (for patients less than 6 mos old), Chitinkha (the newborn unit which includes a NICU, a kangaroo mother care unit, and a newborn nursery), oncology, the emergency room, plus a variety of surgical units and an ICU where the pediatric consultants routinely have to go to check on some of the pediatric patients being managed by surgeons or anesthesiologists there.  Throughout all these units, there are about 300 or so patients, and this is not the busy season. On the day-to-day, various residents, students, and consultants are spread throughout the units, but when you are on call, you cover ALL of them and just try and keep things from going horribly wrong. 

Just figuring out how to navigate this. Looks pretty easy, right???

This week I thought a lot about how it feels to be in a completely new environment and feel like I have no idea what is going on.  I spent a lot of time in the HDU and saw some horrible things.  We had some patients arrest and need resuscitation and I didn’t know where to find things or what capabilities the unit even had.  There are no monitors, crash carts (where the necessary medicines are kept for a patient who is coding) are haphazardly stocked with drugs needing to be measured, diluted, and drawn up before they can be given.  Patients are crammed all over, sometimes more than one to a bed (and like I said, this is the low season…), so other children and families are looking on as you try to bring someone back from the dead (which here is hardly ever successful).

Luckily we do have a good number of students, residents, and consultants.  It is busy, and patients are very sick, but I learned that some of my colleagues elsewhere are up against far worse.  Some of them have no students right now because they are on strike to protest fees, no residents, and are managing similar numbers of patients on their own or with only a few other clinicians, unable to even speak the local language.  So resource and personnel-wise, I learned I am actually probably in a decent set-up.  Which is good for me, considering I had to rely on the residents, students, and nurses to show me where everything was and help me remember things like how to dilute adrenaline and what concentration we stock in the middle of giving CPR.

I went home feeling defeated and was being really hard on myself. This is my orientation period to get me exposed to all the units for a couple of days, but I wanted to know the system and be up and running RIGHT NOW.  I wanted to be managing things and familiar with the ins and outs of the units and dealing with sick patients.  I wanted to feel competent about everything. I realize that is insane, but I think as doctors, it is so difficult for us not to be good at something.  Even if it is completely unreasonable expect that I just jump in and know everything after 2 days.  I was thankful to have some good reality-checkers back home who told me to stop being ridiculous as I argued that I was the dumbest doctor ever and will never be able to do anything useful. 

So I am going to do my best to be patient with myself and the system. I have started to keep track of the little things.

Small victories for the week:

Hey, the power is back on (kind of a daily occurrence that it goes out for a few hours)

Hey, this 1600 gram baby actually is doing ok and gaining weight

Hey, this medical student just gave a great demonstration of a newborn exam

Hey, not everyone fell asleep during my first lecture

Hey, I found the post office only after getting a little lost

Malawi huevos rancheros. Had to make tortillas myself, si se puede!

The mountain by my house

Sworn in and ready to go!

So first, this happened:

Peace Corps official!

We famous!

Then, I finally made it to Blantyre! But a quick recap first...

Last weekend we went to Dedza, which is quite lovely.  We went to Dedza Pottery, home of beautiful ceramic pottery and excellent cheesecake (no idea where that came from).  We hiked up Dedza mountain, which is a fairly strenuous climb but worth the views.

My legs were Dedza by now (ha ha ha I know. My other fave pun here is: Do you wanna take a shortcut or go Lilongwe?) 

Our guide, wearing what looked like dress shoes and slacks the whole way up, in no way looked tired and then pulled out at least 10 glass bottles of soda at the top, despite there only being six of us, because we “need choices!” He seemed to really love his job and told us it was a blessing to have visitors like us come and climb the mountain.  It was a great day, especially after being stuck in a conference room for like 2 weeks straight.

So many plants and wild flowers along the way

We arrived in Blantyre 3 days ago. Our first day here was a little rough. We arrived late so it was too dark to do anything, since every store pretty much closes when it’s dark, which is about 6 pm. Our house initially looked very sad (think the prison/barracks-type vibe) with concrete floors and a nice layer of dust and dirt over everything. Very minimalist. With the exception of a creepy giant crucifix that is so inviting.

Broken arm Jesus (his left arm is not quite intact)

Turns out thoughts of “Why did I just get rid of all my stuff and leave everything to come here?” creep up a lot more easily when you open a closet and find a layer of dead bugs.

But the layers of dirt and bugs have been wiped away and I actually think my room is now pretty cheerful.  I have already found some awesome batik prints by a local artist

My batik wall so far

We had the purchase of the year with 6 woven grass mats for 8,000 kwacha (about $10) total. Pottery Barn’s got nothing on us! 

Feeling better, we also walked to the market on Friday which was a fun experience. So many colorful chitenjes (the 2 meter pieces of fabric with 100 uses: used to make clothing, wrapped around as an apron, headwear, the list goes on), a weird sort of bar area in little shacks with sheets for curtains (one even had pool tables), electronics… somehow we never even found the part with fruits and vegetables.  We were feeling pretty good and then had 2 kids follow us for about a mile and a half asking for money.  Even after I told them no and go away in English and Chichewa. Or at least I think I said that in Chichewa. That could be why they kept following us.  It was both sad and quite frustrating.  I have a feeling there will be more situations in the months to come.  It is hard when you walk out of a market or grocery store here with bags full of food and there is usually someone coming up to you asking for food or money. Not a great feeling.

More to come! 

Orientation

Whew, so now that you are super concerned about me and my mental health, this post is to reassure you that everything worked out. 

Well, sort of. I'll be honest, I did not actually fit all my stuff in the back of a car. Most of it, yes. But some of it might have had to go in another car and maybe even a house. And maybe several friends loaded all my bags of trash into their cars.  But other than that, suuuuuuper smooth.

Once I got to DC for orientation, I felt so relieved. I found my people. The passion and dedication of my fellow volunteers was palpable. Now that I actually made it, my stress level started to drop. I was still pretty mentally exhausted and didn't do a ton of socializing, trying to fit in as many last yoga classes as possible while my introverted self tried to recuperate and become a real person again (and submit a fellowship application, ugh). 

Orientation was a lot crammed into a short time. So many talks. Teaching strategies, coping mechanisms, tropical disease management, policies, and the list goes on.  The best were some of the small groups and interactive sessions where we learned a little about the others in our cohort and their amazing backgrounds. I am still in awe of all the things everyone has already done.  I was thrilled just to have finished residency, not even thinking about starting NGOs or writing books or teaching in far off lands. It is an honor to be included in this group! 

We had a special visit from Secretary Kerry a couple days in.


Although this was awesome and so encouraging, I was even more affected by the country representatives from Uganda and Malawi who came to our closing ceremony.  Hearing the amount of gratitude that leaders from these countries have for what we are doing brought tears to my eyes (I know, I know, maybe I need to re-title my blog to: "Crying for a Year" or "Taking a boat on the river of tears to Malawi").  It reaffirmed why I signed up to do this in the first place.  

I left orientation excited and ready to go to Malawi.  My hair was so happy to have had an introduction to heat and humidity, thanks DC. I am also anxious to hear about all the great work the rest of our badass crew is heading out to do in Tanzania, Uganda, Liberia, and Swaziland.


The Malawi crew 



Bye DC, your sauna-like weather was a great climate transition

Intro/am I crazy???

Now that I have been in country for a couple weeks, seems like a good time to reflect on the past month or so and the crazy, emotional end to residency.

Let's start with how this year hit me harder than any other.  I have never been a crier, and usually bad outcomes and heartbreaking patient experiences would lead to delayed reactions where I would suddenly feel sad or withdrawn days or weeks later.  But this year was different.  This year there were more difficult events in both my personal and professional life than I had ever experienced in the past.  And it all hit me in the last few weeks of residency.  I fell apart.  I routinely cried thinking of those that I lost, those I was powerless to help, all the ways life is not fair.  I cried when I was happy. I cried when I was sad. I cried when I didn't know what I was.

It didn't help that I had committed to move to Malawi for a year.  When I applied and accepted the position months earlier, I was pumped. It was exactly what I had wanted to do for so long. Work in a resource-poor setting in a more longitudinal, sustainable way for at least a year. Education and acute care in a well-supported program. I could go on.  

Despite all that, the week before I left,  I was a mess. I underestimated packing and the time it would take to fit my life into the back of a car, and how much of my heart was in Oakland. Before I even left myself, I had to say goodbye as those I had spent some of the best (and worst moments) of my life with moved away to start new jobs and fellowships. I was stressed to the point of exhaustion trying to get rid of clothes, furniture, plants... 

So to begin, I want to thank everyone who got me here. You know who you are. You are the ones who listened to the Sad Songs Playlist with me without making fun of the fact that I even had a Sad Songs Playlist. You are the ones who reassured me I was doing the right thing every single time I asked, "Am I crazy?" and promised me that everyone was not going to completely forget me, no matter how many times I argued to the contrary. You brought me food, considered trips to get boxes and drop stuff off at the Salvation Army as social interactions, didn't give me weird looks when I got up from every savasana in tears, read all the rip-your-heart-right-out-of-your-chest poems I sent you, and even sent some back without ever telling me to shut up and get pull myself together.  

This blog is a way for me to chronicle my journey. To stay connected with those who got me here, and reach those who may learn from my experiences and struggles. So I hope you stay with me. Here goes...