EMMW

Hey everyone, hope you had a good week!

Suz and I wanted to keep you updated about what we have been doing the past week or so. As we mentioned before we made arrangements to get into the maternity ward, Ethel Mutharika (named after the late president’s late wife who died in 2007) here at Kamuzu Central hospital. This by far was what both Suz and I were the most excited about during our time here in Malawi. We finished our maternal/newborn nursing rotation this spring at Rex Healthcare in Raleigh and were really looking forward to seeing how obstetrical care is done globally. Unfortunately, our dreams were somewhat dashed after just a few short days on the ward.

                                                               Suz and I in front of EMMW

I started off on the antenatal and postnatal ward while Suzann was stationed in the labor and delivery ward. We figured we would each spend a few days on a ward and then switch so that we could both experience nursing care before, during, and after birth. While KCH is a government run hospital, we learned that the Ethel Mutharika Maternity Ward (EMMW) is a high risk, tertiary care center that only accepts patients referred from district hospitals or patients who can pay out of pocket for care. This means that the mothers who are at EMMW tend to have diagnoses of high blood pressure, preeclampsia, eclampsia, preterm labor with multiple gestation or other serious ailments. This also means that clinicians are very hesitant to let women labor for very long; therefore, c-sections aka caesars here in Malawi, (not to be confused with the salad dressing) are done quite frequently.  And this all depends on if there are any actual patients…which unfortunately there weren’t.

                                                                   Plaque outside the ward

During Suz’s 4 days in L&D there were approximately 3 patients total. TOTAL!  There were 4 nurses assigned to the unit each and every day, too. After the first day, she questioned the nurses about the lack of patients and they replied that you never know when a woman will go into labor, and so the ward has to stay staffed and doesn’t float down to other units. To pass the time, Suz ventured into the Theatre (aka the OR) to pass the time. There was a little more action going on in their two theatres, and so she got to see a ceasar, a hysterectomy, and a uterine fibroid removal and possible a D&C. While this is not a terrible way to pass the time, this averages out to seeing less than one procedure each day spent at EMMW – not exactly how we wanted to spend our time. 

                                                                 The patient board. EMPTY.

I on the other hand saw a bit more but still felt almost as helpless/unneeded. Each room on the ward holds 6-8 beds with a bathroom/shower at the end of the hall for all to share. Women are grouped based on their condition (or so I thought). There are some women in the antenatal rooms awaiting labor or c-section and then there are those who have already given birth and are staying for a day or so to recover. There is also a room similar to what we would call a PACU (post anesthesia care unit) in the US. This is where women who have had c-sections go to recover. There is a room devoted to women who are in need of more monitoring ie: women who developed a postpartum complication (although during my time on the ward these women were given no more attention than the others and possibly even less) and lastly there are also 2 private rooms which hold only 1 bed each with a bathroom in the middle. These rooms are for those patients who choose to come to EMMW and pay for the services.

During my time on the unit I spent a lot of time observing the nurses and midwives. I usually went on rounds each morning with the doctor, an intern, and a midwife and tried to gather what was going on with each patient so I could try and be helpful later in the day when they needed something, I soon found out this didn’t really happen. I also helped turn and clean patients although not much is done on this front because each patient has a guardian with them, usually their mother, sister, friend or husband who takes care of most of their hygiene needs. This guardian is responsible for providing some of the linen the woman sleeps on, bringing food while on the ward and notifying the nurse if something is wrong. As far as I could tell there was no regularly scheduled times for vitals or general check in. The patient is pretty much left alone until they need to be given medicine or something bad is happening. Then, because there were also a lot of first year nursing students on the ward as well, they were left to handle most situations, most of the time alone.

For example, a patient needed to given an IM shot. The nursing student asked me to come with her while she did it. Once in the room she turned to me and asked where and how she should give the shot and then informed me she had never given one before. I was a little blown away. At home, we practice for months giving meds to mannequins and going over each step of the process.  We are then are watched like hawks by our clinical instructors when we get the opportunity to actually give real patients meds. After realizing this was not the case I told the student we should ask the midwife exactly where the shot should be given and double check the dose as well. After doing so, the patient ended asking me to give her the shot, I think she was a little nervous about being a guinea pig for someone’s first attempt at an IM shot. This is just one of the differences I saw between how nursing students in Malawi and in the US work. More often than not they are left to their own devices to start IVs, give meds, and put in catheters with little to no supervision.

One of the most memorable moments for me while on the ward was with a young woman named Emily. I first came in contact with her when helping the students turn her. She was in the PACU room and was surrounded by other women who had recently given birth and were recovering. The difference was Emily did not have a baby with her. At first I didn’t think much of it, plenty of babies have to go to the nursery after birth and I just assumed because she was being treated like everyone else her baby must have been there too. I couldn’t have been more wrong. I discovered later when I went in to help remove an infiltrated IV line that Emily had in fact had a stillborn the previous night. She was the woman the doctors had talked about in morning report who was put on a fetal heart monitor in the L&D unit. She was monitored for a few minutes and it was discovered her baby had a few decelerations (a very bad indicator of a baby’s oxygen levels). Usually the baby’s heart rate is monitored for 10 or 15 minutes to see if there is a pattern to the decelerations. In this case, because the monitor ran out of paper, the baby’s heart rate was not monitored after the initial 2-3 minutes. She then was not checked on for over an hour, why I have no idea. By the time the problem was discovered, she was rushed to the theater for a c-section, this was approximately an hour and a half after the strip indicated there was a problem. To put this in perspective, in the US if there is a pathological fetal heart rate strip, women are rushed to the OR as soon as possible, usually within 10 minutes of reading the strip. Needless to say, the doctors delivered what they call a “fresh SB” or stillborn.

When Emily looked up at me and told me she lost her baby I did what they tell you not to do in nursing school. I cried. I sat with her, told her I was sorry, held her hand, and cried. I did the only thing I really knew how to do, and that was to be with her. I knew we really couldn’t communicate as she knew little English and I have very limited Chichewa and more than that I knew nothing I could say would make up for her insensible loss. I sat with her for about 30 minutes, holding her hand while she lay in the bed staring in to space while infants cried around her. It was the first of many emotional moments I was to have while here in Lilongwe.

Needless to say, my time at EMMW was a learning experience. While I didn’t put too many of my nursing skills to use, I did learn a lot. I learned about the nursing students and midwives and how they are educated and taught to care for patients.  I learned there are great deficits in care and resources and that often patients do not get the care they deserve or need due to many different circumstances. I also learned Malawi has the highest rates of preterm birth in the world (check out http://www.who.int/pmnch/media/news/2012/preterm_birth_report/en/index1.html for the full report) and that many of these preterm births would be preventable in other parts of the world. While it saddens me, I also am glad I have had these experiences in Malawi and continue to learn from all situations I am presented with.

-Jen

Did we happen to mention we went on a safari?

Hey y'all!

Thought you might enjoy some pictures from our safari in South Luangwa National Park, Zambia this past weekend. We had a blast and saw more than we could have ever imagined! Most of the pictures are courtesy of our friend Alex because she obviously has a much better camera and eye than Suz and I do...hope you enjoy!

                                                             Entrance to the park

                                                          Our lovely accommodations

 

Baobab:Tree of Life

      Wild dogs. Apparently they are rarely seen so we lucked out when we saw a pack of about 4 or 5!

1 of the 2 leopards we saw during our night safari

                                                       Baby baboon and his mother

                                                                Herd of Elephants

 

                                                                  Big hippo yawn

                                                                  Croc hiding out

                                                          Tiny birds hitching a ride

                                              Elephant scratching an itch at a nearby camp

 Suz and I enjoying a magnificent, incredibly beautiful, stunning, once in a life time view of the African sunset. (it was pretty great, can you tell?)

                                                                     Truly amazing

                                 

Working in the STI Clinic

Hi friends!
Sorry we've abandoned the blog for a bit - get ready for a rush of posts this final week!

We are right in the middle of our time here in Africa and have started to spend our days in Ethel
Muthalika maternity ward. We’ll have a whole post or two devoted to the maternity ward at a later
date, but for now we’d like to fill you in on the final UNC Project we assisted with two weeks ago.

Here in Malawi, sexually transmitted infections are treated in their own outpatient unit at the hospital.
Unlike in the US, where STIs may be treated at a gynecology office, Planned Parenthood, or a local
health department, both male and female patients report to clinic 7C at KCH (Kamuzu Central Hospital) daily to receive treatment. UNC also conducts ACTG (AIDS Clinical Trials Group) and various CHAVI (Center for HIV/AIDS Vaccine Immunology) research studies out of this same clinic. Throughout the day, nurses treat STI patients and conduct study patient visits. Jenny and I were fortunate enough to be able to observe both types of visits during the 3 days we spent at 7C.

 The sign directing patients to clinic 7C

A major difference between how STIs are treated here and how they’re treated in the US is what’s
called “syndrome management.” If a patient reports with a genital ulcer of any kind, they’re given treatment by a nurse for Syphilis, Herpes, and Genital Warts. The nurses do not attempt to differentiate between these vastly different infections. I know this may seem weird to y’all, and it did to us too at first. But then, if you think about it, in order to decide exactly what the pathology of their ulcer may be, the nurse would have to take any combination of blood work and swab the infected area. Then, the samples would have to be sent to a lab and analyzed. After this, the patient would have to be contacted to return to the office to be told what infection they have and given a prescription. And finally, the patient would have to have their prescription filled. This whole process is simply not feasible here, both for lack of healthcare personnel and lack of hospital and patient resources. Instead, when a patient shows up, the nurses diagnose the patient with a
particular “syndrome” and then treat according, for example Genital Ulcer Disease or Lower Abdominal Pain. Also, if a patient shows up with a partner, even if the partner is asymptomatic, both of them receive the same treatment.

Signs on the clinic room doors.

I’ve debated about how to describe what I saw in the STI clinic. Jenny and I both saw some
infections that could make anyone vomit as they looked as if they were the worst case scenario from our nursing textbooks, so I won’t go into details. No need to make everyone queasy! You can easily google "genital warts" and see images if you'd like. We both questioned nurses as to why the STIs seem to be so extreme and they said that it takes a long time for people to make their way to KCH, and that they may have tried alternative treatments first before deciding to seek treatment.

 Exam room. Female patients bring their on chitenges to put on the exam table - no linens are provided.

One patient that had the most profound effect on me was a 3.5 year old possible rape victim. The
mother of the patient had left her daughter in the custody of her 18 year old nephew (the girl's cousin) while she ran some errands. When the mother returned, the child was crying, saying her pubic area hurt, and was screaming the boy’s name. Holy Crap! This is not something Jenny and I were taught how to handle in nursing school. I helped the nurse obtain a high vaginal swab while the little girl screamed and cried and kicked. She was given every single medication the nurse had – Penicillin, Gentamycin, Acyclovir, Doxycycline, etc. She also had a rapid HIV test. Her swab was sent to the lab to determine if sperm were present.

After finishing with this patient, my nurse and I had a major debrief session to talk about everything. I
asked her how common this was, and she said maybe a few times a week (FYI – Jenny saw a 9 year old with a similar situation the next day). The nurse also tried to tell me that children are not raped in the US, to which I had to respond that they are, but that it’s just not publicized and certainly not something that nursing students are presented with. Having this chat with my nurse helped me to realize that while this was a terrible situation for the child and her mother, it is always better to see the “real world” instead of living in a bubble.

Also during the week, we spent one day at the Tidzewe center where UNC project is housed helping with a Kaposi Sarcoma/HIV research study. Jenny, because of her work in infectious disease before nursing school, had much more knowledge about KS whereas I was just asking really dumb questions.
The patient we saw was a 24 year old female who was HIV positive and had recently been diagnosed with Kaposi Sarcoma. This cancer is often seen in people with very weak immune systems and is an indicator of AIDS. The patient was at the clinic all day because of some inaccurate information in her chart, mainly whether or not she had a uterus - another whole story by itself. At around 4pm she finally started her enrollment study visit, which consisted of us, an MD and a clinical officer marking the regions containing her KS lesions on her legs. We then identified and photographed 5 KS marker lesions that would be followed at each study visit to assess their progression throughout treatment. Her entire body was photographed so that the clinicians could have a baseline in which to compare how she responded to the ART and chemotherapy she would receive as a part of the study. Last, but not least, one of the lesions on her legs was biopsied using a skin punch biopsy procedure which was extremely painful for the patient. Jenny and I did a lot of assisting the clinical officer with the pictures and the crazy amount of paperwork he had to complete for the study visit.


Definitely a good week!!

M&Ms

This small, personal-sized bag of M&Ms was initially a perfect purchase. After eating a few, we both thought that they were a bit off, but not terrible. After eating all of them, we checked out the expiration date. Whoops.

A week of work in Malawi

Hey y'all!

I apologize for the delay on the new post, I was almost done with it when blogger crashed, losing about half of what I had written...but all is good and we are back!

Since most of our posts have been more about the social scene here in Lilongwe we wanted to post a little about the work we have been doing as well. Suz and I visited a couple of UNC research studies taking place at various sites around town.

We started off visiting Bwaila hospital where UNC is running the PROMISE study (Promoting Mother and Infant Survival Everywhere). The purpose of the study is to examine effective methods of preventing the transmission of HIV from mother to child during pregnancy, labor and delivery, and breastfeeding by starting women on one of three antiretroviral regimens. Suz and I mostly observed during our time with PROMISE as most everything is done in Chichewa with many of the women speaking little to no English. We watched study visits with pregnant women and new mothers and assisted with scheduling follow up appointments. We also got a chance to see how PROMISE recruits study participants. A few nurses from UNC Project head up to the maternity unit at Bwaila just a short walk up the road. Here they assist with what is essentially the first prenatal visit where pregnant women anywhere from about 8 to 24+ weeks come. The women receive basic prenatal care including routine vaccinations, vitamins, weight and blood pressure screenings, palpation to determine gestational age as well as pre and post test counseling and HIV testing. 

                   Bwaila Maternity Ward, 1 of the newest buildings we have seen, built in 2010

Suz and I both agreed the system was amazing. Flocks of close to 100 women arrive early in the morning to line up and start their long day at the hospital. Women wait patiently moving from an outdoor shelter area into one room after another where they wait on long benches for their turn to have their blood pressure taken, have their weight measured and growing bellies felt, as well as receive numbers for the HIV testing that will take place later in the morning. After this the women are split into two groups for a pretest counseling and HIV information session, one of which happens outside under a UNICEF tent with all the women crowded in and sitting on a tarp on the ground. This session includes information on what HIV and AIDS are, the difference between the two, how HIV is contracted and how one can prevent it. Information is also provided on how the testing works and what it means if the test comes back positive. Lastly the women are told about the choices of a antiretrovirals they will receive if they do in fact come back positive. Here is where they are also given details about the PROMISE study.

                  Our testing area. Each blue/red/green card has 10 individual rapid HIV tests on it. 

One after another, women sit for a finger prick, the nurse places a few drops a blood on the test, adds buffer and watches it run. 1 line = negative, 2 = positive. The whole process takes less than a minute for each woman, with the tests being read after about 15 minutes. Of the 84 women tested the morning I was there, 12 came back positive, with 8 of those being new positives. These women would then be told of their status and counseled as to what the next steps would be. Women who do not go on PROMISE are immediately put on HAART (highly active antiretroviral therapy) and will remain on them for the remainder or their pregnancy and life. If they do choose to join the study, they will have various tests run such as viral load, CBC, CD4 count, and chemistries. They will then be put on one of three ARV regimens and followed throughout their pregnancy and up to two years after the birth of their child. Women benefit from being on PROMISE by receiving routine prenatal care as well as various lab tests throughout their pregnancy and HIV testing for their baby until their final status is determined, usually about 18 months.

One of the aspects of this study that was very interesting to me was that the nurses do not tell the participants about the possible benefits of joining PROMISE until the screening visit for eligibility. When I asked about this, one of the nurses told me it would be coercive to tell the patients about the benefits they may receive. This is very different from all the research I have been involved in as we let people know almost immediately about what they will get in return for participating. It makes me wonder how many people would actually participate in research in the U.S. if they weren't informed about benefits and/or payment for their time.

                                     Suz and I with some of the UNC PROMISE study nurses 

We also spent some time at the Malaria Vaccine Clinic in Area 18, about a 10 minute drive from the hospital. Lilongwe is split up into areas much like districts but as far as I can tell are there is no logical ordering to the areas, ie: Area 18 is next to Area 31 which borders Area 42...you get the picture. 

UNC Project runs a GlaxoSmithKline sponsored phase III clinical trial that is looking at the efficacy of a Malaria vaccine in 2 groups of children, ages 6-12 weeks and 5-17 months.  The trial started in 2009 and has enrolled over 1600 children. Right now the trial involves giving booster shots and seeing kids for sick visits and drawing blood in order to diagnose and track the rates of malaria. Families benefit from the trial as their children receive the vaccine and boosters as well as free medical care when the enrolled child is sick. On average, children in Malawi get malaria 2-3 times each year so the clinic is a welcome addition to the area.

Suz and I spent about 3 days at MAVAC and helped by running charts between clinic rooms, taking vital signs, and trying to distract small children during blood draws (mostly unsuccessfully). We were also given the opportunity to draw blood. After watching one of the nurses work her magic on a screaming infant and effortlessly collecting a tube of blood, she then informed me it was my turn. As some of you may know, I have only drawn blood ONCE IN MY LIFE. And that was on Suzann, whose skin is as translucent as rice paper. Last fall. Needless to say, I was more than a little nervous. 

As I rigged my tourniquet (aka a rubber glove) on the little boy’s arm he immediately knew that I was coming for him with a needle. The screaming and crying commenced, Suz tried distraction, his mother held his feet in between her legs to stop him from kicking, and tried her best to keep his little arm straight and all I could say was "pepani,"a failure at an apology in Chichewa which clearly meant nothing to this 2 year old boy. After attempting to feel for a good vein and taking a deep breath, I dove in. Miraculously, it worked! The blood flowed despite all the odds. As you can probably tell, I’m pretty proud of myself...

 

                       Some of the clients awaiting medicine in the nurses station at MAVAC.

Other than our crash course in phlebotomy on 2 year olds we also had quite a few other highlights from the MAVAC clinic. Some of these include: checking out malaria parasites under the microscope, observing IV insertions, and watching various venders parade into the nurses station selling their wares-corn meal, green peas, okra, turnip greens, peanuts, as well as non-perishables like wigs, bibles, nursing uniforms, and slips. Here in Lilongwe it is completely acceptable to stop what you are doing, whether its checking in a patient or administering medication, check out the goods being sold and bargain for a better price. Suz and I also got to spend time trying to entertain kids while they waited to be seen for their visits. We soon realized that smiley face stickers made from medical tape were the way to go when trying to get a smile. Who needs language in common when there are stickers?

 

One of the other great things about the clinic was getting to know some of the nurses and being invited to eat their traditional lunch of nsima, stewed tomatoes and greens with the occasional bit of meat or boiled egg. You eat this by rolling the nsima (Much like grits. Read more here: http://en.wikipedia.org/wiki/Nshima) into a small patty in your hand and picking up the other food with it.  Everyone gives a bit of money at the beginning of the week and then the clinic aides buy food from the local market and spend time each morning cooking out back behind the clinic. Each day at noon, the majority of the staff gather upstairs in the break room and join in on the communal lunch. While I was a little leery of the ingredients and cooking methods, I joined in with a smile on my face and my water bottle near by. 

                     Me trying out our tasty meal. Thanks Suz for your expert photography skills!

Suz and I enjoyed our time at the MAVAC clinic and really appreciated the warm welcome the clinic staff gave us. We even became facebook friends with a few! We are fortunate to be rotating through various UNC Project’s sites and like seeing all the different research UNC has a hand in.

Hope everyone has a wonderful week and we promise to post again soon! Happy Father's Day Dad!

-Jen 

A Driving Lesson

Hi there friends and fam!

We've been a little MIA the past few days from the interwebs - sorry about that. A pipe burst in the Tidzewe Center where UNC Project is housed, so there was minor flooding over the weekend sometime late Saturday night or early Sunday morning. This resulted in the loss of our internet at the guest houses for the day, but not a big deal because we're all back up and running now!

The past few days have been pretty great. This past weekend, all of the roommates on our side of the guest house thought that Saturday would be the ideal time to truly venture out and explore a bit. We also all wanted to visit the cheaper grocery store that our fellow house-mates had told us about, Shoprite, and refill our empty water jugs. The dilemma is that in order to venture out to do some true grocery shopping, one of us had to step up to the challenge of driving the communal car.... on the left side of the road! Thank goodness the car is automatic or we'd be left to exploring by foot and via 2 wheels, which can be awesome in its own right, but difficult when carrying home groceries, cases of beer, and huge jugs of water. We quickly realized that in order to get the best prices on household stuff, you've got to visit a few different places - 7eleven for water, Shoprite for granola, Spar for meat and cheese, the vegetable market for vegetables and fruit, etc. So, what started out as a quick, run around town turned into a 4 hour adventure in how to manage a left-sided car around roundabouts. Operating the care was truly a community effort of helping each other watch out for pedestrians and other drivers.

This was taken after Jenny did a hail Mary, and proceeded to laugh at my lackluster driving ability.

Brian, from next door, offered to let us share in his Shake Shake carton. For those not aware of the amazing power of the Shake Shake, it’s a Malawian “beer” consisting of fermented corn and sorghum. Before partaking in the Shake Shake, another fellow roommate described it as if you poured a bowl of cornflakes, added milk, and let the mixture sit for days until it fermented. It looks like horchata, my favorite Mexican agua fresca, so I was down to try it. It could not have been more disgusting. It was thin with a pungent aroma and had some corn husk grit that clung to your throat even after you swallowed. Pretty gross, but a requirement for any Mzungu (white person) passing through the area.

The initial reaction to Shake Shake.

Also this past weekend, Jenny and I took a little walk around the block that makes up the Kamuzu Central Hospital compound and the nature conservancy that we border. It was great to see the other side of the wall that’s behind our house.

We're trying to get lots of pictures of the area around where we live, because it's completely different than home. It seems like the sky goes on forever.

Also - we've yet to talk about this amazing thing called the AfriCAN cafe that's on the campus of KCH (Kamuzu Central Hospital) and Bwaila Hospital. Jenny and I both agree that this place would KILL IT in Carrboro. Yes, that is a shipping container that has been transformed into an outdoor cafe. You can buy sodas and small baked goods inside for a little afternoon snack. If this whole nursing thing doesn't work out, we're bringing this to the states!!


Hope you are doing well - we've heard that the weather in the triangle has been gorgeous and unseasonably cool these past few days :)  Enjoy it now! We all know the oppressive heat of summer is coming!


Suzann

Sunday Night Check-in

A lot has happened in the past few days! We are slowly getting settled in and are feeling a bit more comfortable with our surroundings.

Wednesday afternoon after showering up and shaking off the jet lag we set off to volleyball with the rest of the UNC Project Crew. Volleyball happens each Wednesday night at the Shack, a bar with outdoor sand volleyballl courts. The play is pretty competitive and while Suz was brave enough to play with the big dogs I sat out and enjoyed a beer while watching the action unfold. Don’t be fooled Suz also enjoyed a cold one. We met a few expats from various NGOs who explained that the bar was a regular hangout each Wednesday and got more ‘club-like’ as the night went on. After a few hours the jet lag started to set in and we made our way back to the compound for a much needed nights rest in a real bed.

Thursday after handing some administrative stuff at UNC Project we made our way to town where we bought some groceries and exchanged some cash. UNC Project employs several drivers and they are available for us to use during the week as long as it’s convenient for them. The drivers will also pick up patients for their research appointments and return them home if they’re not finished until after dark. Like at UNC in Chapel Hill, everyone tries to make it as convenient for patients as possible so that their participation in the research activities can continue.

While at the grocery store, we learned the Kwacha is in transition and the exchange rate changes daily…on average about 265 per 1 dollar. As expected, the Euro exchange rate is much better than the dollar at over 350:1, so thanks Mom for those Euros.

After talking with some people at UNC project we quickly realized having a cell phone was a necessity. After shopping and the bank we were approached by a Malawian selling minutes for cell phones. After Suz’s quick phone hand gesture, aka the international sign for "I need a phone not just minutes” our friend took off running for the next corner. Upon his return, he presented us with a brand new phone, in the box mind you for 3500 kwacha . We wheeled and dealed and settled on 7000 Kwacha ($26.50) for the phone, sim card, and a bunch of minutes. Quite a steal if I do say so myself!

                                                      The hottest cell phone technology

As many of you know from our previous post, Friday was when we were to visit the Nurse’s and Midwives Council to figure out if we were in fact going to be allowed to work while in Malawi. Turns out, much was accomplished. After about 3 hours of walking from office to office, waiting on a bench and smiling politely, Gertrude, the administrative assistant from UNC Project and our new favorite person, secured a meeting with the head of registration and education. As we walked in to the huge office, we spotted a small but stern woman sitting behind a gigantic desk. After a little Chichewa from Gertrude we were instructed to sit. “What do you want to do in Malawi?” she asked. Suz and I looked at each other and I attempted to choke out a semi-coherent answer. I expressed our interest to help in any way we could, but that we were particularly interested in helping in the maternity wards as well as with HIV care. “Will you be returning to Malawi to work after your education?” We made sure she knew we would be back just as soon as we graduated (you never know…). With that she seemed pleased and after barely glancing at the extensive application forms we were required to fill out, we moved on to lighter subjects. She asked what we thought of the weather and Malawi’s people. I remarked how nice everyone was and she said, “Of course! You are in the Warm…” And then I blurted out “Heart of Africa!!” With that, we ended our interview with a high five and a smile. At the end of a long morning, we left with official letters in hand allowing us to work at Kamuzu Central Hosptial. Fingers crossed we will be working some time this upcoming week.

                               Suz & I holding our official letter in front of the UNC Project house

We then returned to the compound to have lazy afternoon reading and getting to know our fellow house-mates from the house adjacent to ours. From the picture above, you can see that we have a huge front yard, so I thought it would be a fantastic idea to get a towel and lay in the sun to enjoy some light Glamour reading. It turned out to be a terrible idea when I found approximately 100 little black ants crawling all over my body, including in my hair. Note to self: not a good idea to lay in the grass, no matter how appealing it may look.

After brushing all of the ants off my body, Suz and I regrouped in the house to begin our gameplan for dinner. Brian, a med student from Vanderbilt who is doing some research at Kamuzu Hospital, stopped by the house to see if we wanted to go over to the burn unit with him. We both quickly changed clothes and walked over, not quite ready for what we would soon be seeing. During the walk, Brian explained that his research was looking at depression in burn patients, particularly amongst their care givers. Most of the burn patients at KCH are children who have had kitchen accidents right behind their mothers’ back, and so their mother feels incredibly guilty for their children’s burns.  With Brian and a Malawian counselor, we walked through the unit and heard the story of each patient and their burn. It was difficult to see – there were flies buzzing around the rooms and a smell that was unfamiliar to both of us.  Patients in the hospital rely on their family to help care for them, bring additional food and blankets for the cool nights. It was definitely the beginning of what is sure to be an eye-opening experience here in Malawi, and we were so thankful to Brian for his help.

We then returned to the house and started to cook up some dinner for our side of the house.  The day before at Spar (the expensive grocery store) they only carried lasagna noodles and no other pasta. So our spaghetti idea was quickly adjusted into a lasagna night – we like to keep it flexible. Everyone was a little leery of lasagna in a foreign country with an oven in Celsius, cheese we weren’t so sure about, and bag sauce. However, with a few “borrowed” vegetables from the communal fridge and some South African red wine (thanks roommate Amy), the sauce wasn’t half bad. And really, is the combination of starch, cheese, tomatoes and garlic ever that bad? After impressing our roommates with dinner, we all made our way over to Harry’s, an expat bar a few km a way.  Below you’ll see a picture we took with our suite-mate Alex, a med school student also from UNC.  We made it an early night – our parents will be proud to hear that we were home before our high school curfews of midnight (Hi Mom & Dad). 

                                                             Lasagna Lilongwe style

                             Me, Suz, & our super cool med student friend Alex at Harry's Bar

That's all for now! We will make sure to post again soon. Thanks again to everyone for reading!