women in malawi

You balance it on your head

A heavy bucket

Full of water from the pump

Standing straight and tall

Walking with your head held high 

Some, they don't see this crown

They think you are not fit 

To be a queen

You are not worthy

Of learning, of reading, of owning, of being

They send the boys to school

As they run past you on the dusty road

Laughing

Not recognizing 

You are the backbone

Who wears a crown

With no jewels or gold

But worth kingdoms

Not realizing 

You carry their weight on your shoulders

And the future on your back

I wrote this months ago during our stay in the village, but the longer I'm here, the longer it resonates with me as I see what it means to be female in Malawi.

Peace Corps (per the United Nations) is in the middle of 16 days against gender violence.  I wish I could say I haven't seen any gender violence here, but unfortunately I have.  On my on call shifts I have to medically examine girls who come in for "defilement" or sexual abuse.  I have heard their testimonies, interpreted for me by our registrars, many of them who are young females, so I'm sure it's not easy for them to hear firsthand these accounts of terrible events. Groups of boys jumping and sexually assaulting a girl on her way home from school, a neighbor who raped a developmentally delayed girl, among others.  It is frustrating to say the least.  I am so happy to work in a hospital that has a One Stop Center, UNICEF-created clinics where victims of rape can go for healthcare, exams, and counseling.  Police reports are filed, though I have no idea what happens from there.

I have been amazed here at everything women do.  From a young age, girls do everything.  During our stay in the village, I saw the women of the community run the house.  And by women I mean any female over the age of about 5-6 years old.  They are outside by dawn, sweeping the floor, washing dishes from the night before, fetching water, starting the cooking for the morning.  Girls do go to school, but during their time off, they are busy.  And they can balance almost anything on their head.

When we were at the lake last weekend, we were constantly swarmed by young boys whenever we got in the water.  Laughing, swimming around us, trying to see who could swim the farthest.  The girls were on the shore doing laundry, occasionally getting in the water to fill buckets, but they did not stay long.  The boys can run and play and waste time. The girls work.  

During these 16 days, I have learned more facts about girls and women in Malawi.  Half of girls in here are married before they are 18.  Young women 18-24 also make up 58% of Malawi's HIV infections.  Most girls do not complete their schooling and only 67% of women are literate.  

There are two bills currently being proposed in Malawi's government that are being protested.  One is the right for a woman to terminate pregnancy, the other is to make homosexuality legal. I read an article the other day from an extremely conservative newspaper here discussing how abortion is the gateway to "widespread euthanasia" and other "forms of murder and brutality" (Termination of pregnancy bill). This is happening in a country where contraceptive rates are 46% and the average number of children per woman is over 5.  

The BBC published an article about ritual sex practices in Malawi if you haven't seen it: The man hired to have sex with children.  Recently it was updated that he was sentenced to 2 years in jail and hard labor.

Despite how awful most of this sounds, I am happy to be part of an organization that works hard to empower girls and improve the status of women around the world.  I also work alongside Malawian female physicians who stand up for the mothers and children we see everyday.  They are role models for our patients and girls all over Malawi.  There is still so much work to be done.

Thanks for reading and supporting me while I'm here. I'll post pictures some other time, they didn't seem to fit with the theme of this post. Or follow my instagram (bananneka). I post things there from time to time :)

we are more

sometimes the drumming is so loud it becomes your heartbeat
it becomes everyone's heartbeat
there is no you or me or them
only Us
and We are loud
We are so loud
if you want a wall
We will give it to you
a wall of sound
of voices
of music
of love
dynamic but unbreakable
We will pound eardrums
We will shake souls
We will dance into the night
the moon our only light
We will join hands
We will embrace
We take up space
so much space
We will move this earth
We will shatter history
a force so strong
you'll feel us in your bones
deep to the core
you thought you could quiet us
but We are Us
We are more


drums on drums on drums

I had a post started for about a week now and hadn't been able to bring myself to finish it.  Then a couple of awesome doctors here had a celebration with lots of music, theater, art, tons of talent, and that poem just came out.  It had been a long two weeks. I was on call last weekend so I worked 12 days straight.  At the end of the party, I found myself dancing in the middle of a group of people of all backgrounds.  A local hip hop artist trying to teach us some steps, a painter looking just as nerdy as I was trying to bust a move, doctors throwing up their hands with reckless abandon.  It was exactly what I needed.

I've been frustrated.  Before all of the election drama, I was already getting frustrated with the politics of my department and of the medical education system here.  Coming into this position, I knew I wanted to be somewhere that I was doing both clinical work and teaching. But lately I have had the increasing feeling that I am up against a wall here.  I run around trying to staff 30-40 patients per day (unable to actually communicate with them myself) and see the same things over and over.  Babies infected with HIV who are supposed to be screened and followed up but aren't (even though HIV is probably the most well-funded disease here), children dying of TB with a known contact who aren't picked up for exposure, just an endless circle of terrible outcomes and preventable diseases.

So not hard to see why I often leave the hospital completely defeated.  Plus the point of being here and Seed's mission and all that is to strengthen medical education.  And I feel like I don't even have time to think let alone fit in teaching.  I started feeling a bit more optimistic after working with the students last week.  The students here in general are great to work with, but we had a particularly good group on the unit.  After a couple of great days precepting cases with them, I was less cranky.  Then started thinking about the health system here and how there is no money and they are in a hiring freeze so all of these fantastic students we are training will never get jobs here.  They are forced to look for work in South Africa, Swaziland, Lesotho. If they are lucky they might find a job in a private clinic, or with an NGO, or on a foreign-sponsored research project. Despite this, they work incredibly hard.  They are the ones spending the time to explain how to use an inhaler to a family, counseling mothers when their child dies unexpectedly, and chasing down lab results.  So it is not easy knowing that the future for them is very uncertain.  I question almost daily if I should be here, or if it would be more beneficial to just pay one of the many qualified Malawian doctors who would love a job in their home country.

I considered making some comments about the election, but I'm not really sure what to say.  Although I'm still in shock that this man can be president,  I am mostly depressed by the number of intolerant and angry people it has revealed, especially in the aftermath. I think I knew our country still had a lot of this, but maybe wasn't sure of the extent. I at first thought I am sheltered from it, living in California.  But the truth is, I'm really not.  It exists in my own family, on my street, all over my hometown.  And I have made excuses because I know these people will not change their beliefs based on what I say, so I gave up arguing.  But I could have done more to let them know that this is not ok, and I want to start doing that now.  How I am going to have the courage to do this, I'm not sure. Something to think about.


Some less dismal things recently:

my malawi welcome from our gardener


and from my malawi fam


views of blantyre from mt soche


soche!


Malawi hallowatermelons

home

I am sitting in SFO right now waiting for my delayed flight. A flight that starts the long journey back to Malawi.  I thought about writing while I was home, but it was hard. Both hard to fit in and difficult to know what to say.  I didn't realize how much I missed home until I got here. I felt a little guilty about it.

I loved every minute of being home.  Even flying around to 7 cities in 3 weeks and living out of a suitcase.  I saw some of my favorite people (don't worry those of you I couldn't squeeze in, you are still my favorites too) and was overwhelmed with the love and support you gave me for what I am doing. Plus interviewing for something I love to do and meeting others who are just as pumped about it was pretty awesome. It is not easy to leave this and go back to somewhere that I am so far away from all of that.


Examples of support: interview words of wisdom from my mom

I also missed my Malawi family a lot and felt really disconnected from life there.  I was thankful for the texts and pictures from everyone so I still felt a little in the loop.  And the requests for all the goods I am trafficking home :)  It was just starting to feel more like home when I left, so I am hoping it will feel that way when I get back.  It is hard going back knowing that from here I won't be home again for another 9 months. Knowing I'll miss Thanksgiving and Christmas (for the 3rd year in a row) is pretty awful.  But I knew that when I signed up for this and I know the Malawi crew has some fun holiday plans.

Some highlights from my U.S. tour:

residency buddies and skyline views in philly





















Walls of pez in our Air bnb in portland



being cool at portland shows and catching up with an old friend






BFF, beer, and amazing views in portland




























hiking and matching cargo shorts in reno.  Plus tons of dogs including murphy and her fave vodka-themed toy :)





beach views, old and new friends in SD

Plus many many more awesome people and friends and stuff and things that I couldn't capture.  I am eternally grateful to those of you who opened up your homes, offered advice, met up with me to catch up on such short notice. It meant so much to me that I'm traveling back to Malawi with a full heart.  Overflowing.  I know Malawi is where I need to be right now, despite how hard it is to say goodbye again.  I'll miss you all and there is an open room for any of you waiting in Blantyre if you ever want to visit.  

coping

Things have been a little less dismal since my last post.  I have continued in the special care ward.  It seems Wednesdays are the worst. I assume because people finally make it to the small Gateway health centers by Monday, then get referred to us, and finally make it two days later when they are not in good condition.   We were short a resident this week so it was pretty busy. I am trying to get used to 5 hours of standing rounding and pre-rounding to see the 40-plus patients we are responsible for.  

There are some things I am starting to just accept.  Mainly that nothing happens quickly.  Labs constantly need to be followed up to actually get a result.  Trying to get a consultant to see a patient can take days.  Figuring out where to even send certain tests can also take forever.  I was talking to someone from home and getting frustrated for really no reason when I realized underlying all of this was the fact that I had a child this week die because they had a brain tumor (pineal gland diagnosed on outside CT) that was likely operable, but the neurosurgery team took days to see her and then wouldn't take her on their unit because she was starting to seize.  They sent her back with plans to biopsy sometime this week but given she already had signs of increased pressure in her brain and nothing had been done, she died over the weekend. Some cases I am not happy with but figure there probably wasn't much that could be done in the first place, but this one made me more upset.  This was a lot of political drama between peds and neurosurgery (as they are supposed to be trained to manage seizures as it is a NEUROSURGICAL unit and they have their own HDU) and the more senior pediatric consultants were all appropriately angry and went to discuss this with the neurosurgeons.  There have been some problems recently with patients getting transferred for neurosurgery who then are not seen for days, which is really difficult for everyone.  I got the contact info now for pretty much every consultant in the hospital so that I can now go up the chain of command quicker.  I'm not sure if this will help but at least I can feel like I've done as much as I can short of becoming a brain surgeon.


The HDU where I spend a million hours rounding per day.  
There are about 5-7 of these little box beds per side, each with 1-2 patients in them.
There are tiny cockroaches all over the walls (not pictured haha)


The left wall of the HDU where CPAP happens. Usually has 3 babies in that one bed. 

It goes back to the serenity prayer I suppose. God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.  Our first few months here are all about finding that wisdom.  In any health facility there are places for improvement, it is just figuring out what will actually be helpful and create lasting change.



Jacaranda tree on the hospital grounds seen from where we do sign out each morning. They are all blooming now and are sooo beautiful. 

To keep myself sane, I have been trying to accept the inevitable (e.g. if you are a 1 kg baby born here, you probably won't survive no matter what we do) and not think about the hospital too much when I am outside the hospital.  I also routinely vent to the rest of the GHSP peds team, my fellow consultants here, and residency friends back home about difficult cases, probably to an annoying extent, but the support has been tremendous.  It helps to have people corroborate what I'm thinking or suggest things that I wasn't even starting to think about.  My counterpart here is awesome and is always available to look at difficult cases (not just for me but is consulted by everyone which makes me feel a little bit better haha) and then just picks up an xray or looks at the patient and in 2 seconds goes, "This is TB." Or, "This is KS (Kaposi Sarcoma)." Such confidence.  

Besides traveling around the area, I've found some close by activities to keep me sane.  I played basketball this weekend which was crazy but fun. Lots of elbows and more netball style than I am used to, and I am definitely a little rusty, but had a good time.  I tripped and ate it doing my first lay up in warm ups because the hoop has 2 metal poles directly underneath (like right on the baseline) that I for sure was not used to.  So that was an embarrassing start. It is a little scary they aren't padded or anything so I'm hoping that was the worst of the iron pole encounters.

Some dudes ballin' it up in the game before ours (which started 2 hours late unsurprisingly). The bottom of the offending pole can be seen at the far left.  

 I've also continued my grandmotherly activities like yogurt- and bread-making, cooking mass quantities of food, shopping for fabric... My next goals are jam making/canning (seriously), cross stitch (not as seriously), and mass consumption of cottage cheese with canned peaches.  I am also honing my skills as a cockroach assassin and in-air mosquito killer (currently working on the one-handed mid-air grab, the cockroach technique is just gallons of Raid which is already pretty advanced I think). 

Last weekend we didn't take any shortcuts and went Lilongwe (ahahaha gets me every time) to see the rest of our crew and pick up my passport.  There were 4 volunteers who just came last week (who had other commitments at home so couldn't start when we did). So we welcomed them and then reunited with the some of the other girls from our crew.  Lilongwe is definitely an experience in how the other half lives.  There are tons of rich ex-pats there because of all the government officials and embassies around. Everything is soooo spread out and suburbic (I just made up that word) and I have no idea how people know where stuff is.  We went to a lovely outdoor garden restaurant called "Brunch" that is next door to a salon that does pedicures, so enough said.  We had a great time, did some hard core chitenje shopping, ate tons of good (but expensive food), and talked about non-hospital things (plus some hospital things like comparing numbers/sizes of things like beds, nursing staff and cockroaches in our units).  

Lilongwe chitenje market finds. A couple will prob be used for house decor (like the little people one) but the rest I need to figure out what article of clothing they should be made into...

My new fave! Found this one at the fabric store here. Was on a mission to find it after I saw a lady at the hospital with it.  I am not sure what the random little clocks are but I love the bikes. I think it's going to be a dress in the near future.  

Otherwise, mostly have been thrilled to have pretty consistent electricity for the past few days (right when I started fighting for Peace Corps to buy us gas stoves). Probably thanks to this:Malawi: Minister Msaka announces new electricity company.  

High fives for this week:
- Asking for help on a malnutrition lecture to a visiting expert and having him offer happily to just give a lecture he already has prepared on the topic (which, for the students is a huge win given I am prob the least qualified for this topic).

- Letting this chronically ill kid that we can't figure out what is going wrong with him use my phone to take selfies.  He was smiling ear to ear (I'd post it but I didn't ask permission).  We also discussed him in rounds and basically no one knows what is going on with him but at least he got to take some happy selfies using my stethoscope.

- Going to the 1 grocery store that has amazing, amazing things like curry paste, sesame oil, cheap coconut oil, and (gasp!) chocolate chips. 

- Buying keys to the peds department so I don't get locked out again (no one told me we needed to get a key and doors lock at 5:30 pm)

- Meeting pretty much every ex-pat in Blantyre at the Fri night hang out spot this weekend and staying up past midnight (I know, I know, goes against my grandmotherly aspirations).

- Electricity!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 

This week is going to be busy with some ultrasound training, a lecture (that I actually have to give and couldn't find someone to pawn it off on hahaha), and then the visit by the Peace Corps director, ahhhhhhhhh! Then I fly back to the states next Sunday! So exciting.  I might try and post something when I'm home but it probably won't be as exciting (if you consider roach killing and yogurt-making exciting, then my blog is pretty thrilling).   

Thanks for reading!!

No mother

This week was long and tiring.  I was in the HDU (high dependency unit) all week. Picture an ICU but then take out all the monitors and equipment and that is our HDU.  So often we know that there will not be much we can do for a patient.  Even with that expectation, it is still really hard to see a child die.  Even when you know it is coming.  One of the Malawian pediatricians said it best I think when she was referring to TB and saying, "We get used to it. We think it is normal for children to die. It is not normal. These are treatable diseases. We cannot accept that children are dying."

It made me think and this was the best I could do to put it into words. A somewhat rambling poem I think.  

No mother should ever have to see her child die
No mother should ever have to wonder if this fever will be the last
If she has enough money to get to the hospital
If she will make it in time walking with a baby on her back
No mother should question whether she should even go
Because she has heard that the hospital is where children go to die
No mother should have to see her child getting CPR
Then wrap its body in a colorful cloth
Wailing as they are wheeled outside surrounded by women who feel her pain 
Because they too have lost sons, daughters, nieces, neighbors
No mother should have to call her family and speak through sobs over a bad connection
Then carry what was once her baby on her back
Now a husk where there used to be soul
As she waits for a mini bus back to a village
That will mourn its own
No mother should call a name into the silence
Where there once were shrieks of laughter
First words
And tiny steps into outstretched arms
No mother should have to place flowers 
Over newly turned earth
And say goodbye
Because no mother's child
Should die

It is difficult because I think we are all aware of the diseases that kill children in these environments. Malaria, TB, HIV, diarrhea, pneumonia, etc. etc.  And we pour money into this.  And it helps. But it is still happening.  So I am trying not to become complacent while I am here. Trying not to get to where I accept this.  And trying to figure out where we can make changes. Because the reality is providing care in the hospital is the easy part. It is the awareness in the community, the getting to the hospital, the using a bed net, the knowing when a child is too sick to stay home, when they are too sick to use traditional medicine... all of those things that make a huge difference.  And that I don't know how to fix.  Despite this being depressing, I am hopeful.  There are still things we can do, information we can learn, problems we can fix. I just am impatient, but I am trying.

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...